Biomedical subjects

W Coryell

Publications and source records attributed to W Coryell.

205 records · Page 12Linked to original sources

PubMedDate not supplied

Validity of an operational definition for neurotic unipolar major depression.

After we reviewed the literature to identify the clinical and phenomenologic correlates of neurotic depression, we constructed a 6-item operational definition to distinguish neurotic unipolar major depressive disorder from non-neurotic major depression. The neurotic depressives were characterized by a low rate of abnormal dexamethasone suppression test (DST) results and a strong family history of alcoholism. Neurotic depressives improved less than non-neurotic depressives during the index hospitalization, and were more frequently rehospitalized during a 6-month prospective follow-up. Neurotic subtyping was significantly negatively associated with DSM-III melancholia. Neurotic classification remained significantly associated with the above validating variables after melancholic status was held constant, whereas melancholic subtyping did not predict DST results, familial alcoholism rates, or outcome when neurotic status was controlled.

Depressive Disorder↗

PubMedDate not supplied

Outcome in RDC schizo-affective depression: the importance of diagnostic subtyping.

A 2-year semiannual follow-up of 40 patients with RDC schizo-affective disorder, depressed type revealed poorer outcomes among those who were subtyped as chronic or mainly schizophrenic patients than among their counterparts with nonchronic or mainly affective schizo-affective depression. Outcomes for these latter groups, in turn, were no worse than those for patients with psychotic major depression. Among a variety of predictors entered into step-wise regression analyses, diagnosis was most important in predicting recovery overall and outcome at 6 months, while demographic variables, particularly sex, predicted outcome at 2 years.

Adult↗

PubMedDate not supplied

Diagnosis and outcome in schizo-affective depression: a replication.

Forty-three inpatients with RDC schizo-affective depression were given structured interviews and then followed to 1 year using a design closely resembling that of another recent follow-up of schizo-affective patients. In replication of the earlier study, patients with either 'chronic' or 'mainly schizophrenic' schizo-affective disorder had significantly worse outcomes than did patients with nonchronic or 'mainly affective' schizo-affective depression and bipolar patients were significantly more likely to develop manic syndromes. The preceding duration of schizophrenia-like symptoms and a history of schizophrenia-like prodromes appeared to be the most important components of these two distinctions. In both studies, diagnostic subtype was the most robust of various potential outcome predictors. Also in both studies, 'mainly affective' and 'nonchronic' schizo-affective patients had outcomes no different from patients with psychotic depression.

Adult↗

PubMedDate not supplied

Past loss as a symptom formation factor in depression.

We examined the relationship between past loss and endogenous subtyping of depressed patients. In a sample of 124 female depressed inpatients there was no association between past loss and RDC endogenous or DSM-III melancholic subtyping. We thus failed to replicate Brown and colleagues' finding that past loss is a symptom formation factor.

Depressive Disorder↗

PubMedDate not supplied

Schizophrenia and affective disorder--distinct entities or continuum?: an analysis based on a prospective 6-year follow-up.

The purpose of this study was to determine whether the preponderance of data support a continuum hypothesis of the psychoses or a concept of separate, autonomous illnesses. Patients (N = 70) were hospitalized for nonmanic psychoses, given structured interviews and a dexamethasone suppression test (DST), and diagnosed according to the Research Diagnostic Criteria (RDC). Patients were then evaluated at 1 year and 6 years with a structured interview. Diagnoses were made at three points of time: intake, 1 year, and 6 years. The patients were divided into groups that had a consistent (over the three points) set of affective disorder diagnoses (affective disorder or schizoaffective disorder, mainly affective [AD group]) and those that had a consistent set of schizophrenic diagnoses (schizophrenic or schizoaffective disorder, mainly schizophrenic [S group]). A third group (inconsistently diagnosed) consisted of subjects who at one point were diagnosed in the AD group and at another in the S group. A series of discriminant function analyses suggested that the AD group differs widely from the S group; and the inconsistently diagnosed group most closely resembled the AD group. The family background of the inconsistent group was similar to that of the AD group. The DST and outcome showed that the inconsistent group was more like the AD group than the S group. Using the characteristics of the medical model-clinical picture, outcome, laboratory tests, and family history-the group that was inconsistent with regard to diagnosis over time appeared similar to the AD group. Taking the follow-up evaluation into account, the data favor the possibility that patients who have a variable clinical diagnosis over time do not suffer from schizophrenia.

Adult↗

PubMedDate not supplied

Course and outcome of conversion and somatization disorders. A four-year follow-up.

Although the two disease concepts have very different histories, many previous studies have mixed conversion disorder and somatization disorder and none has made direct comparison between them. The authors applied DSM-III criteria to inpatient and outpatient medical records and attempted to follow 98 patients who met criteria for somatization disorder or conversion disorder. Five of these patients died 4 years later and, of those who survived, 70 (75.3%) were given follow-up interviews by a rater blind to baseline diagnosis. The 32 patients with a baseline diagnosis of conversion disorder were significantly less likely than the 38 patients with somatization disorder to be given the same diagnosis at follow-up. Six of the conversion disorder patients were given follow-up diagnoses of somatization disorder and, in four other cases, subsequent developments revealed medical explanations for the presenting complaint. Of the two baseline diagnoses, somatization disorder predicted substantially more impairment in a variety of domains.

Adult↗

PubMedDate not supplied

Persistence of depressive symptoms and cardiovascular death among patients with affective disorder.

OBJECTIVE: Studies of both community and clinical samples have associated depressive symptoms with risks for subsequent cardiovascular morbidity and mortality. Because the physiological mechanisms thought to underlie this link would be cumulative in their effects, the following analyses tested the prediction that risks for cardiovascular death would increase in proportion to the persistence of depressive symptoms in a long-term follow-up. METHODS: Baseline assessment was performed as patients sought treatment for major depressive disorder, mania, or schizo-affective disorder. Follow-up evaluations occurred semiannually for the next 5 years and annually thereafter. The 903 patients described, observed for a mean of 11.0 years (SD = 5.2 years), were divided into thirds according to the proportion of follow-up weeks in episodes of major depressive disorder, schizoaffective disorder, or intermittent depressive disorder. The resulting groups were then compared by cumulative risks of cardiovascular death. RESULTS: Patients whose depressive symptoms were the most persistent were no more likely to die of cardiovascular causes than were those with the fewest weeks ill. A regression analysis showed that older age and the presence of cardiovascular disease at baseline, but not the subsequent chronicity of depressive symptoms, predicted cardiovascular death. CONCLUSIONS: The physiological concomitants of depressive illness apparently do not promote cardiovascular mortality in a cumulative manner. Efforts should be directed toward identification of risk factors common to both lifetime depressive symptoms and cardiovascular morbidity.

Adult↗