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Biomedical subjects

S B Guze

Publications and source records attributed to S B Guze.

At least 37 records · Page 2Linked to original sources

A prospective follow-up and family study of somatization in men and women.

The authors evaluated alternative criteria for somatization disorder in 277 female and 129 male psychiatric outpatients. In women, the diagnosis of somatization disorder based on DSM-III criteria was highly concordant with the diagnosis of Briquet's syndrome based on Guze's original criteria. There was familial aggregation for Briquet's syndrome in women but none among individuals of either sex who had somatization disorder without the full Briquet's syndrome. In men, the diagnosis of somatization disorder was rarer and less stable than in women. The findings show that somatization usually has a different clinical picture and different familial antecedents in men than in women.

Ambulatory Care↗

A follow-up and family study of Briquet's syndrome.

The study began with the systematic clinical evaluation of a cross-section of 500 of the clinic's patients. This was followed by a 'blind' follow-up of the index subjects and a 'blind' study of first-degree relatives. The present report deals with the diagnosis of Briquet's syndrome (hysteria, somatisation disorder) at index, at follow-up, and among first-degree relatives. The data indicate that the criteria used for the diagnosis of Briquet's syndrome select patients who show a high degree of diagnostic consistency over many years, although not all patients who meet these criteria at follow-up receive the diagnosis of Briquet's syndrome initially. Most importantly, the diagnostic criteria select cases associated with a strong familial increase in the risk of Briquet's syndrome and in the risk of antisocial personality. Both are increased among first-degree female relatives, while only antisocial personality is increased among first-degree male relatives.

Antisocial Personality Disorder↗

Diagnosis and prognosis in schizophrenia.

We showed that schizophrenia was a discrete disorder by using a quantitative clinical scale that discriminated schizophrenics from other subjects in a prospective follow-up and family study of 500 psychiatric outpatients. Four symptoms tended to occur together as a stable syndrome throughout the six- to 12-year follow-up: persecutory delusions, delusions of control, firmly fixed mood-incongruent delusions, and auditory hallucinations. Scale scores were computed as the number of these four symptoms that was present less one if there was a history of spending sprees with marked elation. More than 68% of the schizophrenics and fewer than 2% of nonschizophrenics had scores of +2 or greater. The distribution of scores was bimodal: persons with scores of +1 were relatively rare. Also, there was familial resemblance for the presence or absence of schizophrenia, but no additional resemblance for the number of schizophrenic symptoms. Despite this relative discreteness, scale scores were valuable for quantifying the certainty of diagnosis and predicting outcome.

Adult↗

Mortality in a follow-up of 500 psychiatric outpatients. I. Total mortality.

Total or all-cause mortality data were determined from a prospective study of 500 randomly selected psychiatric outpatients during a mean follow-up period of seven years. With the use of age-, sex-, and race-adjusted methods, a mortality nearly twice that expected from reference population rates was observed. Mortality was excessive among younger, but not older, patients; and among white men and women and black men, but not among black women. Certain psychiatric diagnoses (based on structured personal interviews performed at index and using explicit criteria) were associated with excess mortality: alcoholism, antisocial personality, drug addiction, homosexuality, organic brain syndrome, and schizophrenia. Excess mortality was not observed among patients with primary affective disorders, ie, disorders not antedated by nonaffective psychiatric illness.

Adolescent↗

Mortality in a follow-up of 500 psychiatric outpatients. II. Cause-specific mortality.

In a six- to 12-year follow-up study of 500 psychiatric outpatients, death from natural causes occurred 11/2 times the expected rate, although the excess was not significant. Death from unnatural causes occurred 31/2 times the expected rate, a significant elevation. Suicide and homicide rates were particularly excessive. Unnatural mortality was excessive among younger, but not older, patients, and among all sex-race groups except black women, none of whom died unnaturally. Initial psychiatric diagnoses highly predictive of unnatural death included alcoholism, antisocial personality, drug addiction, and homosexuality. Secondary affective disorder was predictive of excess unnatural mortality, but in all cases of such death one of the four disorders associated with excess mortality antedated the affective disturbance. No patient with an index diagnosis of primary affective disorder died of an unnatural cause. Despite a frequent history of suicide attempts, hysteria was not associated with excess unnatural mortality.

Adolescent↗

Alcohol misuse and depression in women criminals.

The interaction of alcohol misuse and major depressive syndromes was examined in 66 convicted women felons. At an initial (index) evaluation and during a 6-yr follow-up, alcohol misuse and depression, although both highly prevalent, were not significantly related. Alcohol misusing and nonmisusing depressives had similar rates of treatment for depression. Follow-up alcohol misuse, occurring in one-quarter of those reinterviewed, was not predicted by an index history of depression even among index alcohol misusers. Nonsignificant trends did suggest some association between the two symptom groups. Depressive subjects with a history of alcohol misuse had a greater rate of depression during follow-up than nonmisusing index depressives. Follow-up misusers had a greater rate of follow-up depression than nonmisusers. Alcohol-related depression could not be discounted simply as a consequence of alcohol misuse. Depression in the context of alcohol misuse was highly predictive of future depression and suicide attempts. The relative independence of alcohol misuse and depression in this group underscores the complexity of their interaction, especially in a population with multiple disorders such as women criminals. The contention that phenomenologically defined major depressive disorders are heterogeneous is supported.

Adult↗

Frequency and differential diagnosis of depressive syndromes in schizophrenia.

The frequency, differential diagnosis, and implications of depression occurring in the course of schizophrenia are considered in light of recently reported findings from a follow-up and family study of 500 psychiatric outpatients (the St. Louis 500 Study). Problems in diagnosis are illustrated in an interview of a schizophrenic patient with a history of depression. Nearly 60% of the schizophrenics studied had suffered a depressive syndrome during the course of their schizophrenic illness, supporting the observations of others. The majority of patients with a history of depression who were otherwise diagnosable as schizophrenic had a course of illness consistent with schizophrenia during follow-up. The pattern of illness among first-degree relatives suggested that intercurrent depression did not represent a biologic unity with primary affective disorder. Intercurrent depression should not be overinterpreted in excluding a diagnosis of schizophrenia.

Adult↗

A follow-up and family study of schizophrenia.

The Washington University Psychiatry Clinic, St Louis, study began with the systematic clinical evaluation of a cross section of 500 of the clinic's patients. This was followed by a "blind" follow-up of the index subjects and a blind study of first-degree relatives. This report deals with the diagnosis of schizophrenia at index, at follow-up, and among the first-degree relatives. The results indicate that the criteria used for the diagnosis of schizophrenia select patients who show a high degree of diagnostic consistency over many years, although not all patients who meet these criteria after follow-up receive the diagnosis of schizophrenia initially. Most important, the diagnostic criteria select cases associated with a strong familial increase in the risk of schizophrenia (nearly fivefold). The follow-up results indicate also that Feighner-positive schizophrenics often experience intercurrent depressions, but that the presence of such depressions does not affect the familial incidence of either schizophrenia or primary affective disorders.

Depressive Disorder↗

Studies in hysteria.

This paper describes how the idea of substituting "Briquet Syndrome" for "Hysteria" developed. It emphasizes the need to base the diagnosis firmly on clinical features and also the value of differentiating "polysymptomatic" forms (Briquet Syndrome) from "conversion" symptoms (unexplained neurological symptoms). Other studies have shown that there is a preponderance of Briquet's Syndrome in women, and that female relatives of patients have an increased prevalence of Briquet's Syndrome, while male relatives have an increased prevalence of antisocial personality and of alcoholism. Conversely, a study of female relatives of a male prison population reveals a high prevalence of Briquet's Syndrome amongst them. It is suggested that the association between Briquet's Syndrome and antisocial personality may explain many clinical and epidemiologic observations.

Alcoholism↗

Alcoholism and female criminality.

Among 66 female felons unselected for psychiatric referral, 31 (47%) were diagnosed alcoholic. This rate is similar to that found in male criminals, whereas in most groups men alcoholics far outnumber women alcoholics. Alcoholism was associated with antisocial personality and homosexuality in this sample, but not with affective disorder. On follow-up 6 years later, 52% of the alcoholic women were in remission. Alcohol abuse was associated with medical problems, with the alcoholic subjects accounting for most deaths, serious medical illness, and psychiatric hospitalization. Criminal recidivism was not significantly related to alcoholism. The remitted alcoholics did not turn to drugs, and, with one exception, remitted drug-dependent women did not turn to alcohol.

Alcoholism↗