Search PubMed⌕ Search

Biomedical subjects

S Zisook

Publications and source records attributed to S Zisook.

At least 55 records · Page 3Linked to original sources
PubMed1994

The spectrum of depressive phenomena after spousal bereavement.

BACKGROUND: Major depressive syndromes have been found to be prevalent, disabling, and often persistent during the stress of bereavement. To add to the burden of mood changes associated with bereavement, a substantial number of bereaved individuals may suffer from depressive symptoms that do not quite equal the requisite number to meet criteria for a major depressive episode, but which also may be quite disabling, if not be actual forerunners of major depression. This study evaluates the frequency, morbidity, and stability of subsyndromal symptomatic depressions. METHOD: 350 widows and widowers were evaluated for depressive symptoms and syndromes at 2, 13, and 25 months after the death of their spouse. An additional 126 demographically similar men and women also were evaluated. In addition to the presence of a number of depressive symptoms, a number of outcome measures were obtained: use of antidepressant medication, self-perceived physical health, satisfaction with work performance, number of days of social activity per month, self-rated adjustment to widow-hood, satisfaction with ongoing interpersonal relationships, and development of a new relationship. RESULTS: Both symptomatic major depression (SMD) syndromes and subsyndromal symptomatic depression (SSD) were prevalent throughout the first 2 years of widowhood. More than one third of subjects with SSD 2 months after their spouse's death either continue to have SSD after the first full year of bereavement (28%) or worsen (9%) during that time. On most outcome measures, subjects with SSD stand between subjects with no depression and those with SMD and are significantly more likely than euthymic subjects to complain of poor physical health, be dissatisfied with their work performance, and refrain from social activity; they show a statistical trend for more disturbed ongoing relationships with friends and to be less likely to be involved in a new romantic relationship. CONCLUSION: Although heretofore relatively unrecognized, SSDs are prevalent, often persist, and are associated with substantial morbidity in widows and widowers during the first 2 years of bereavement.

Aged↗
PubMed1993

Uncomplicated bereavement.

BACKGROUND: This paper evaluates the validity of the distinction between the depressive syndrome associated with uncomplicated bereavement and major depression by following the course, associated symptoms, and impairment associated with depressive episodes occurring in bereaved widows and widowers. METHODS: Two hundred fifty-nine widows/widowers were interviewed and completed the San Diego Widowhood Questionnaire at 2, 13, and 25 months after the deaths of their spouses. Subjects were diagnosed as depressed or not depressed on the basis of DSM-III-R criteria. RESULTS: Fifty-nine (23%) of subjects met symptomatic criteria for a major depressive syndrome at 2 months. Because of the close proximity to the death, the symptoms in these 59 subjects were considered to represent "uncomplicated bereavement" rather than major depression. Compared with widows/widowers who did not manifest an early depressive syndrome, the "depressed" group was more likely to have past or family histories of major depression, present treatment with antidepressant medication, feelings of worthlessness and suicidal ideation, poor health and job satisfaction, and major depression 1 and 2 years later. CONCLUSION: When a full depressive syndrome is present soon after the death of a spouse, the symptoms may often be prolonged and associated with substantial morbidity. We recommend that future conceptualizations of uncomplicated bereavement exclude persons with major depressive episodes.

Adult↗
PubMed1992

Negative symptomatology in schizophrenic outpatients.

This study examines the prevalence of negative symptoms, and assesses the convergence of negative and depressive symptoms in 60 chronically ill schizophrenic outpatients. Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms and the negative symptom cluster of the Brief Psychiatric Rating Scale (BPRS). Depressive symptoms were assessed with the depression subscale of the Brief Symptom Inventory and the depressive symptom cluster of the BPRS. A majority of patients in this group of relatively stable, schizophrenic outpatients demonstrated mild to moderate degrees of both negative and depressive symptoms. Correlations were not significant between negative symptom and depressive symptom measures, which suggests that the symptom constructs are relatively independent. Comparisons between a subgroup with prominent negative symptoms (N = 18) and a subgroup with minimal negative symptoms (N = 32) also revealed no significant group differences in variables that characterize clinical course (i.e., age of onset and frequency and duration of hospitalization) or in the severity of depressive symptoms. This lack of any significant differences on the clinical course variables may be partially explained by the heterogeneity of negative symptoms. The constellation of negative symptoms may differ not only in etiology but also in their temporal relationships to other aspects of the patient's clinical course. Longitudinal studies will be needed to track the long-term outcome of negative and depressive symptoms.

Adolescent↗
PubMed1992

Past substance abuse and clinical course of schizophrenia.

To evaluate the effects of previous alcohol and drug use on the course and symptoms of schizophrenia, the authors compared 34 patients with schizophrenia who had histories of substance abuse with 17 patients with schizophrenia who were lifelong abstainers. Surprisingly, they did not find that individuals with past histories of abuse were more impaired or had more symptoms.

Adult↗
PubMed1991

Magnetic resonance imaging abnormalities in lenticular nuclei and cerebral cortex in schizophrenia.

Neuropathologic and brain imaging studies have produced evidence of brain abnormalities in schizophrenic patients, often within the cerebrum's limbic lobe, and, less frequently, within basal ganglia. In the present study we used magnetic resonance imaging morphometric techniques to estimate volumes of specific cerebral structures in schizophrenic patients and age- and sex-matched normal controls. Estimates of the volume of mesial temporal lobe structures were reduced and estimates of the volume of the lenticular nucleus were increased in the schizophrenic patients. There was also evidence of reduced cranial volume in some schizophrenics. The magnitude of the lenticular abnormality, but not the temporal lobe abnormality, was associated with age at first psychiatric contact; earlier onset was associated with larger lenticular nuclei. The possible relevance of these results to neurodevelopmental hypotheses about the pathogenesis of schizophrenia is discussed.

Adolescent↗
PubMed1991

The generalized pattern of neuropsychological deficits in outpatients with chronic schizophrenia with heterogeneous Wisconsin Card Sorting Test results.

Forty schizophrenic outpatients and 40 normal subjects were assessed using extensive clinical (eg, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms) and neuropsychological (extended Halstead-Reitan Battery) measures. The schizophrenic patients had multiple neuropsychological deficits on tests of complex conceptual reasoning, psychomotor speed, new learning and incidental memory, and both motor and sensory-perceptual abilities. Neuropsychological impairment correlated more strongly with negative than positive symptoms. Overall, the schizophrenic outpatients showed relatively modest increases in the number of perseverative responses on the Wisconsin Card Sorting Test of abstraction flexibility. A subgroup of these schizophrenic patients seemed to be particularly impaired on the Wisconsin Card Sorting Test. This pattern of results, in conjunction with previous studies, supports the idea that, while some schizophrenic patients may have fixed, frontally based dysfunctions, these dysfunctions may be most prominent, and even fixed, in deteriorated, kraepelinian patients. These data provide evidence for diffuse and far-reaching deficits in a majority of outpatients with chronic schizophrenia.

Adult↗
PubMed1991

Predictors of response to monoamine oxidase inhibitors: do they exist?

Multiple regression analysis was conducted on potential response predictors in a double-blind study of monoamine oxidase inhibitors (MAOI) and placebo treatment in 130 depressed outpatients. Positive main effects were found for sex (female), lack of prior hospitalization, presence of precipitating events. A negative main effect was found for concurrent physical illness. Treatment x predictor effects were found for distinct quality and non-reactivity. Non-reactivity was associated with positive outcome in the active drug group, but with negative outcome in the placebo group [corrected]. Distinct quality demonstrated a more complex effect, its presence being associated with decreased improvement in the treatment group and greater improvement in the control group. No atypical depressive symptoms predicted MAOI response, and we were unable to characterize a specifically responsive MAOI syndrome.

Adult↗
PubMed1991

Early psychological reaction to the stress of widowhood.

As part of an ongoing panel study, we evaluated 350 widows and widowers at 2 and 7 months following the loss of their spouses. In general, no consistent progression of grief resolution was noted. At 7 months, grief-specific feeling states remain remarkably similar to what they were at 2 months. Anxiety levels remain high and change little from 2 to 7 months. When changes do occur, they are not unidirectional. For example, subjects are about as likely to increase as to decrease their drinking or smoking. Furthermore, depression scores at month 2 correlate well with depression and anxiety scores at month 7. Over 50% of the subjects were depressed at some time during the study period, but the depression could initially manifest itself at any time during this period. Despite the presence of psychological distress in a significant minority, most bereaved individuals report good health, satisfactory work performance and good adjustment to widowhood.

Adaptation, Psychological↗
PubMed1991

Depression through the first year after the death of a spouse.

OBJECTIVE: This study assesses the frequency of depressive syndromes during the first 13 months after the death of a spouse. METHOD: Men and women whose spouses had recently died were identified through death certificate records. These subjects completed a multidimensional questionnaire and were interviewed 7-8 weeks (2 months) after the death. Follow-up questionnaires were completed 7 and 13 months after the death. The questionnaires contained specific items corresponding to DSM-III-R criteria for depressive episodes as well as other widely used measures of depressive symptoms such as the Zung Depression Scale and the Hopkins Symptom Checklist. RESULTS: Eighty-four (24%) of 350 widows and widowers met criteria for depressive episodes at 2 months, 72 (23%) of 308 did so at 7 months, and 46 (16%) of 286 did so at 13 months. At each time period, the prevalence was substantially higher than the 4% rate of depressive episodes observed in a comparison group of 126 subjects whose spouses were still living. Widows and widowers most likely to meet criteria for depressive episodes 13 months after the bereavement were younger, had past histories of major depression, were still grieving 2 months after the loss, and met DSM-III-R criteria for depressive episodes 2 and/or 7 months after the death. CONCLUSIONS: Depressive episodes are common after the death of a spouse. Clinicians should maintain a high index of suspicion for the possibility of depression, particularly in young widows and widowers who have a past history of depression or who experience a full depressive syndrome soon after the loss.

Depressive Disorder↗
PubMed1990

Anxiety and bereavement.

The results reported here support the observations that anxiety symptoms are prevalent, often severe, and may last through at least the first seven months of bereavement. In addition, many widows and widowers are prescribed, or take on their own, medications geared to attenuate the discomfort of these symptoms. A preliminary profile of persons most likely to suffer substantial and relatively prolonged anxiety after the stress of widowhood includes: someone who is young, female and experiences a loss of income related to the death; someone who lacks social support; and someone who experiences acute grief, a depressive syndrome and anxiety symptoms at the end of two months. We hope to build on this profile over time, so that vulnerable individuals might be identified and offered early intervention.

Adaptation, Psychological↗
PubMed1990

Depression in the context of human immunodeficiency virus infection: implications for treatment.

A chart review of 90 male outpatients was conducted to document the type of depressive symptomatology associated with HIV infection and to review the nature of antidepressant treatment provided in two university-affiliated outpatient settings. Forty-five individuals who tested positive for HIV infection and who were treated with antidepressant medications were compared with a like number of individuals who had no known risk factors as determined by chart review for HIV infection. Although depressive symptoms were generally similar among the two groups, HIV-positive individuals reported greater decreases in sleep and appetite than the HIV-negative comparison group. Overall, imipramine and fluoxetine earned the most favorable efficacy ratings while producing minimal side effect ratings in both HIV-positive and HIV-negative patients. Among the HIV-positive patients, the asymptomatic group had a better response to treatment with antidepressant medications than either the ARC or AIDS patient groups.

AIDS-Related Complex↗
PubMed1989

Classification of depression by grade of membership: a confirmation study.

One hundred and thirty out-patients with depression were studied by grade of membership multivariate (GOM) analysis. Five depressive types were generated. Pure Type I represented a mild form of melancholia in older, stable males, who showed a modest drug response. Pure Type II included obsessive-anxious symptoms in older patients who responded well to an MAOI drug, but poorly to placebo. Pure Type III was a mildly symptomatic form of depression which responded well to placebo. Pure Type IV included features of agitation, mood worsening later in the day, anorexia and depersonalization; it was commonly precipitated by external stress and MAOI treatment was more effective than placebo. In Pure Type V depression, patients were mostly younger females with high levels of symptomatology, atypical vegetative symptoms, unstable life-styles, disadvantaged backgrounds and a poor response to MAOI and placebo. These results resemble in many ways our earlier GOM study of depression, as well as other multivariate studies of depression in the literature.

Adult↗
PubMed1988

An efficacy study of isocarboxazid and placebo in depression, and its relationship to depressive nosology.

Isocarboxazid and placebo were evaluated in 130 anxious depressives. Drug was superior to placebo on depression, anxiety, interpersonal sensitivity, and global measures, and on symptoms of hostility, anxiety, obsessiveness, and psychological-cognitive components of depression. There were no significant differences between treatment effects on psychomotor and typical vegetative symptoms. Isocarboxazid was more effective than placebo in major, but not in minor, depression. It was significantly more effective in depression classified as endogenous depression or melancholia by various diagnostic criteria. Drug was more effective than placebo in atypical depression with vegetative reversal and in Brief Psychiatric Rating Scale (BPRS)-derived profiles of anxious and hostile depression; there were no drug-placebo differences in atypical depression without vegetative reversal, or in BPRS retarded and agitated/excited depression. Interpersonal sensitivity emerged as an important drug-responsive dimension.

Adult↗
PubMed1988

The clinical significance of thought disorder across time in psychiatric patients.

The occurrence and clinical significance of thought disorder, as measured by general abstraction ability and idiosyncratic abstractions, remains a complex and ambiguous area of inquiry. We studied 49 subjects in a longitudinal design in which the effects of general psychopathology and depression on abstraction function were assessed. Results indicate that a) depressive patients have a generalized abstraction dysfunction not limited to specific content areas, b) some depressive patients have a residual abstraction deficit on discharge from the hospital, c) idiosyncratic abstractions are a characteristic but not pathognomonic marker for schizophrenia, and d) across all subjects, abstraction difficulties represent a seemingly state-dependent "final common pathway" that significantly correlates with general psychopathological impairment rather than level of depression.

Depressive Disorder↗
PubMed1988

Antidepressant drug studies in the elderly.

This article reviews the literature on antidepressant drug trials conducted in elderly populations. Only 27 studies of cyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and psychostimulants deal specifically with subjects that were over age 60. Methodologic problems were found in many studies, including lack of diagnostic criteria and inadequate controlling for cognitive impairment, concurrent medical illnesses, and nonpsychotropic medications. Most studies compared second-generation antidepressants against placebo or tricyclic antidepressants (TCAs). Antidepressant drugs are effective treatments for geriatric depression, and limiting side effects are comparable with those seen in younger populations.

Aged↗
PubMed1988

Psychopharmacologic approaches to the borderline patient.

Five case examples are presented to illustrate the role of psychopharmacology in the treatment of patients diagnosed as Borderline Personality Disorders. The cases range from organic through affective and schizophrenic syndromes which are not infrequently at the "border" of personality disorders, and which often respond to specific pharmacologic interventions. The importance of looking for and recognizing drug treatable syndromes within the wide array of patients who satisfy DSM-III criteria for Borderline Disorders is discussed.

Adult↗