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W Coryell

Publications and source records attributed to W Coryell.

At least 181 records · Page 10Linked to original sources
PubMed1983

The dexamethasone suppression test and ECT outcome: a six-month follow-up.

In an earlier report, the dexamethasone suppression test (DST) predicted globally rated outcome at discharge in 42 patients treated with ECT. To determine the predictive value of the DST following discharge we reevaluated these patients 6 months after admission. Suppressors and nonsuppressors did not differ in any of the follow-up measures; DST results added very little to the variance accounted for by diagnosis, age, and episode duration. Surprisingly, patients whose DST had converted at discharge from abnormal to normal were less likely to have sustained remission during follow-up than were patients whose DST had remained abnormal.

Depressive Disorder↗
PubMed1982

Treatment received by depressed patients.

We report on the treatment received by 217 patients in the community with a diagnosis of major depressive disorder of at least one month's duration. Only a low proportion of subjects received intensive treatment with antidepressant medication or electroconvulsive therapy, as judged by research standards and current clinical teaching. Specific associations emerge between treatment and several clinical, sociodemographic, and diagnostic variables; however, taken together these variables account for only a small fraction of the variance in treatment received. Even among patient subgroups based on severity and long duration of illness, high proportions did not receive adequate therapeutic trials. Substantial differences are found in treatment across community centers that are not attributable to variation in the clinical characteristics of patients. We conclude that more research is needed to determine how patients and practitioners contribute to this phenomenon of low intensity of somatic treatment.

Adult↗
PubMed1982

DSM-III schizophreniform disorder. Comparisons with schizophrenia and affective disorder.

We compared blind ratings of outcome and familial psychopathology across four diagnostic groups to test the validity of DSM-III schizophreniform disorder. Outcome ratings for schizophreniform disorder fell between those for affective disorder and those for schizophrenia. Outcome differences between schizophreniform and schizophrenic groups were no longer significant when patients who received somatic therapy during their index admission were excluded. Furthermore, schizophreniform probands had patterns of familial psychopathology that resembled those for schizophrenic probands more than those for affective disorder probands. In the combined group of schizophrenic and schizophreniform patients, longer illness durations at index admission predicted lower recovery rates. Our data suggests that a shorter specified duration may be appropriate in the definition of schizophreniform disorder.

Adult↗
PubMed1982

Excess mortality in panic disorder. A comparison with primary unipolar depression.

We located 113 former inpatients with panic disorder 35 years after index admission. According to age- and sex-specific Iowa population figures, patients with panic disorder had significant excess mortality due to death by unnatural causes. Other studies suggest that secondary depression and alcoholism may have had a role in these deaths. Men with panic disorder also exhibited excess mortality due to circulatory system disease. In an age- and sex-matched patient group with primary unipolar depression, both men and women showed excess mortality. Suicide accounted for 20.0% and 16.2% of deaths in the panic disorder and primary depression groups, respectively. We conclude that panic disorder accounted for much of the excess mortality formerly noted in the "neuroses."

Agoraphobia↗
PubMed1982

Primary unipolar depression and the prognostic importance of delusions.

A consecutive series of inpatients with primary unipolar depression was categorized by the presence or absence of delusions as noted in the charts. The systematically obtained follow-up material contained in these charts showed that delusional patients had a relatively poor short-term outcome regardless of whether they received somatic treatment. Recovery rate increased with longer follow-up periods in both groups. In accord with this, a 40-year follow-up revealed no differences between delusional and nondelusional groups in terms of marital, residential, or occupational status, psychiatric symptoms, a final diagnosis of bipolar disorder, or death by suicide.

Antidepressive Agents↗
PubMed1982

Hypomania.

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Antidepressive Agents, Tricyclic↗
PubMed1982

Psychotic features in major depression. Is mood congruence important?

We studied outcome and family history in 203 patients with psychotic depression. Patients whose psychotic features were mood-incongruent were significantly younger and had a slightly poorer outcome. Morbid risks for affective disorder and schizophrenia among relatives distinguished these mood-incongruent patients from patients with non-psychotic depression but not from patients with schizophrenia. In contrast, depressive probands with mood-congruent psychotic features resembled probands with non-psychotic depression and differed significantly from schizophrenia probands in terms of family history. While depressed patients with mood-congruent psychotic features experienced poorer short-term outcome relative to non-psychotic depressed patients, a 40-year follow-up has shown that these differences disappear over time. Moreover, these two groups are quite similar according to family history data. Both family history and short-term outcome data suggest that major depression with mood-incongruent psychotic features cannot be classified altogether with either affective disorders or schizophrenia. More definite conclusions must await the results of long-term outcome and family studies of these patients presently underway.

Adolescent↗
PubMed1982

Hypothalamic-pituitary-adrenal axis abnormality and ECT response.

Response to electroconvulsive therapy (ECT) was assessed in 42 depressed patients grouped by dexamethasone suppression test (DST) response. Patients with initially abnormal DST results had better outcomes according to global ratings than did patients with initially normal DST results: final Hamilton Rating Scale scores did not distinguish these two groups, however. No group had an outcome that was clearly poor; only three (14.3%) patients with initially normal DST results were rated as unimproved at discharge. The results of this and other studies attempting to predict response to ECT are sensitive to the heterogeneity of patients referred for ECT, the timing and type of outcome assessment, and the differential action of placebo effects.

Adult↗
PubMed1982

Early improvement as a predictor of response to amitriptyline and nortriptyline: a comparison of 2 patient samples.

This study compared serial severity ratings from 2 methodologically similar tricyclic antidepressant studies. Though the groups resembled each other in terms of diagnosis and baseline severity, response patterns were surprisingly different. In particular, early change was highly predictive of outcome in one group but not in the other. The results of response predictor studies must, therefore, be generalized with caution. These data, nevertheless, do allow some guidelines for predicting response from early changes and severity.

Age Factors↗
PubMed1982

The organic-dynamic continuum in psychiatry: trends in attitudes among third-year residents.

Identical surveys, designed to assess attitudes toward training and treatment in psychiatry, were distributed to the half of all third-year residents in 1976, 1978, and 1980. The 1976 survey results revealed considerable support for the medically oriented aspects of training and for organic approaches to treating endogenous depression and schizophrenia. Residents rated the treatment modalities for alcoholism differently than they did for schizophrenia and depression. Results from the 1978 and 1980 surveys replicated the 1976 findings, suggesting remarkable stability in attitudes. Changes in attitude over the three survey years may require a greater time span to manifest.

Alcoholism↗
PubMed1982

The dexamethasone suppression test and familial subtypes of depression--a naturalistic replication.

The authors used a naturalistic design to replicate studies which validated the familial subtyping of primary depression. Ninety-three inpatients with unipolar depression had received the DST within 1 week of admission and were free of confounding medical problems. A blind rater assigned diagnoses based on chart material recorded before DST results were known. The results supported the earlier conclusions of Schlesser et al. With 8 AM sampling, 53% of familial pure depressive disease patients and 14% of depression spectrum disease patients were nonsuppressors. Differences, though smaller, remained significant with multiple sampling. Only 1 of 24 patients with secondary depression had an abnormal DST. Patterns of nonsuppression among patients with psychotic features resembled those of the larger group.

Adult↗
PubMed1981

Diagnosis-specific mortality. Primary unipolar depression and Briquet's syndrome (somatization disorder).

A 42-year follow-up of 76 women with Briquet's syndrome revealed no evidence of excess mortality. A carefully matched group of patients with primary unipolar depression had excess mortality in comparison both with the Briquet's syndrome group and with the Iowa population. Although one of the 30 patients with Briquet's syndrome with available death certificates died by suicide, the rate of death due to unnatural causes in the Briquet's syndrome group was not greater than that predicted by relevant population figures. These findings suggest that some psychiatric illnesses involve excess mortality while others do not. Reasons for this excess likewise may vary by diagnosis.

Adolescent↗
PubMed1981

Obsessive-compulsive disorder and primary unipolar depression. Comparisons of background, family history, course, and mortality.

Research criteria were applied to 110 charts with a principle discharge diagnosis of obsessive-compulsive illness. The family history, course, and mortality experience of the resulting 44 patients clearly distinguished them from carefully matched inpatients with primary unipolar depression. Among selected background variables, only IQ distinguished the groups. A 40-year mortality follow-up supported earlier conclusions that obsessive-compulsive disorder patients are at low risk for suicide.

Adolescent↗
PubMed1981

Effect of case definition on affective disorder rates.

In a preliminary analysis by the NIMH-Clinical Research Branch Collaborative Program on the Psychobiology of Depression the lifetime rate of affective illness among 1,090 interviewed relatives of depressed and manic probands was considerably lower in Iowa than in the other four centers. Among various affective disorder diagnoses, only primary unipolar depression was significantly less frequent in Iowa. This rate difference decreased with increasingly restrictive case definitions. Possible determinants of the low depression rate in Iowa will be investigated; the present data illustrate the importance of case definition in the interpretation of future findings.

Bipolar Disorder↗
PubMed1981

Suicide and the dexamethasone suppression test in unipolar depression.

The authors studied 243 inpatients with unipolar depression who had received DSTs. Of 205 patients with primary depression, the 4 who later committed suicide were among 96 with abnormal DST results; 1 patients with secondary depression committed suicide despite a normal DST result. The authors suggest that hypothalamic-pituitary-adrenal dysfunction is associated with a type of primary depressive illness that is more likely to involve suicide than are other types.

Adult↗
PubMed1980

A blind family history study of Briquet's syndrome. Further validation of the diagnosis.

We undertook a blind family history study of Briquet's syndrome to complement earlier follow-up work by Perley and Guze. The same criteria were used in a chart review to select 49 Briquet's syndrome cases. One control group consisted of consecutive "non-Briquet hysteria" admissions and another of matched primary unipolar depressed cases. First-degree relatives of the Briquet's syndrome probands had significantly less affective disorder and more "complicated medical history" then either control group. The "non-Briquet hysteria" group contained more faily histories with instances of schizophrenia than either the Briquet's syndrome or effective disorder groups. These results provide additional validation of the Briquet's syndrome diagnosis.

Humans↗
PubMed1980

Symptoms as predictors of response to amitriptyline and nortriptyline -- the plasma level variable.

Data collected to define therapeutic plasma levels for amitriptyline and nortriptyline were re-analyzed to test endogenous and non-endogenous symptoms as response predictors while controlling for plasma level variable. The selection criteria limited the range of historical predictors. Initial symptom quality was not predictive of outcome for the entire group of 44 patients or for the 27 with therapeutic plasma levels. Delusions were not associated with poor outcome. The authors conclude that historical components of the endogenous--non-endogenous distinction (e.g., premorbid personality, stability of symptoms over time, quality of remissions) may be more important as response predictors.

Amitriptyline↗