Search PubMed⌕ Search

Biomedical subjects

W Coryell

Publications and source records attributed to W Coryell.

At least 109 records · Page 6Linked to original sources
PubMed1988

Family history and five-year suicide risk.

Family history was examined to determine whether suicide in index patients is associated with suicidal behaviour or mental disorder in their first-degree relatives. Twenty-seven suicides occurred within 5 1/2 years among 955 affectively disordered probands. Among 5042 proband relatives aged 18 years and older, 44 had committed suicide prior to proband entry to the study; however, only one was the relative of a proband suicide. Only two of the relatives who committed suicide were themselves related. As to attempted suicide of relatives, neither the number of attempts nor the severity of attempt was predictive of suicide in probands. Comparison of diagnosis between groups of relatives showed more drug abuse among relatives of proband suicides; this appears to be related to drug abuse among the proband suicides themselves. In contrast to the clustering of suicides within biological families found in other research, these data do not support the use of family history as a clinically useful indicator of suicidal potential in affectively disordered probands.

Adolescent↗
PubMed1988

Panic disorder and mortality.

Evidence so far indicates two sources for excess mortality in panic disorder--suicide and cardiovascular morbidity. The risk for eventual suicide may rival that for primary depression, but the predictors and the necessary antecedents probably differ. The lapse between diagnosis and suicide may be larger for panic disorder, and complications such as secondary depression and substance abuse may be necessary. There are few well-established predictors for primary depression despite many relevant studies. The risk for suicide in panic disorder is barely recognized, and established predictors are accordingly remote. One study has demonstrated excess cardiovascular mortality among males with panic disorder, and another from the same center has provided weak support. Only one additional study has provided the necessary detail as to sex and cause, and those findings were quite supportive, although the subjects may have been mixed diagnostically. There are numerous feasible explanations for excess cardiovascular mortality in panic disorder and even some reason to believe that successful treatment might lessen it. To so advise patients would be not only premature at this point but unnecessary and countertherapeutic--unnecessary because these patients are motivated by discomfort to seek treatment and countertherapeutic because cardiovascular morbidity is what many of these patients pathologically fear. Rather, the findings suggest focus for future study. The initial findings of excess cardiovascular morbidity in males badly need replication, as do the more recent findings of Kahn et al. Likewise, animal models may reveal some of the pathophysiologic mechanisms at work. It is hoped that these efforts will converge in the not-too-distant future.

Anxiety Disorders↗
PubMed1987

Familial rates of affective disorder. A report from the National Institute of Mental Health Collaborative Study.

We examined familial rates of affective disorder and related illness in a cohort of 955 probands studied at five centers in the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression: Boston, Chicago, Iowa City, New York, and St. Louis. Six hundred sixteen of these probands were entered into a family study, and 3423 of their first-degree relatives were evaluated. The probands were divided into five diagnostic groups: schizoaffective-bipolar (n = 37), schizoaffective-depressed (n = 18), bipolar I (n = 151), bipolar II (n = 76), and unipolar (n = 330). The relatives of bipolar I probands had a higher rate of bipolar I illness than the relatives of unipolar probands, but the relatives of unipolar probands did not have a higher rate of unipolar illness than the relatives of bipolar I probands. The relatives of probands with schizoaffective disorder, depressed subtype, had a higher rate of schizophrenia than the relatives of schizoaffective-bipolar probands, suggesting that bipolar schizoaffective disorder may be closer to pure affective disorder while schizoaffective depression may be closer to schizophrenia. An increase in bipolar II illness was also observed in the relatives of bipolar II probands. Overall, these data support the widely accepted distinction between bipolar and unipolar affective disorders.

Adult↗
PubMed1987

HPA-axis abnormalities in psychiatrically well controls.

The considerable divergence in the literature describing dexamethasone suppression test (DST) nonsuppression rates among psychiatrically well controls led the authors to explore screening procedures as a possible source of variance. Using what they judged to be a typical screening procedure, the authors eliminated 69 of 128 subjects responding to an advertisement seeking psychiatrically and physically healthy subjects. Structured interviews for Axis I and II disorders then revealed that 36% of the remaining 59 subjects nevertheless had historical evidence of psychiatric illness; the 38 who passed all phases of screening underwent three monthly DSTs, which demonstrated the stability over time of both normal and abnormal results. Moreover, a family study revealed that relatives of nonsuppressors had a significantly higher morbid risk of affective disorder (20.5% vs. 8.8%), particularly mania and hypomania.

Depressive Disorder↗
PubMed1987

The dexamethasone suppression test in healthy controls.

We have summarized the results of 53 studies which examined the dexamethasone suppression test in normal controls. Only 3.6% of 687 0800 hr postdexamethasone cortisol levels were above 5 micrograms/dl. Corresponding figures for 1600 hr and 2300 hr cortisol levels were 7.4% (85/1144) and 6.3% (28/434), respectively. Neither the type of assay (competitive protein binding or radioimmunoassay) nor mean/median age of the subjects was associated with non-suppression rates.

Adult↗
PubMed1987

The importance of psychotic features to major depression: course and outcome during a 2-year follow-up.

Despite substantially greater levels of impairment during the five years preceding intake to this study, patients with nonbipolar psychotic depression (n = 55) were as likely to recover as were patients with nonpsychotic depression (n = 451) during a 2-year follow-up. Though patients with psychotic depression were more psychosocially impaired at 6 months, these differences resolved during the ensuing 18 months. In replication of an earlier study, early outcome was more predictive of later outcome in psychotic patients than it was in nonpsychotic patients.

Adolescent↗
PubMed1987

The inventory to diagnose depression, lifetime version.

The lifetime version of the Inventory to Diagnose Depression (IDDL) is a 22-item self-report scale designed to diagnose a lifetime history of DSM-III major depressive disorder (MDD). One hundred and sixty-four first-degree relatives of healthy control probands completed the IDDL and were interviewed with the Diagnostic Interview Schedule (DIS). The IDDL had good internal consistency (Cronbach's alpha = 0.92), split-half reliability (Spearman-Brown coefficient = 0.90), and all of the item total correlations were significant. The lifetime prevalence of MDD was nonsignificantly higher in the IDDL than the DIS (14.8% vs. 11.7%). Using the DIS as the criterion measure, the sensitivity of the IDDL was 74% and its specificity was 93% and the chance corrected agreement between the two measures was kappa = 0.60.

Adult↗
PubMed1987

The prognostic validity of DSM-III axis IV in depressed inpatients.

DSM-III suggests that axis IV should have prognostic value--that patients with higher scores will have a better outcome than patients with low ratings. The authors used axis IV to assign scores to 130 depressed inpatients and examined these scores in association with the patients' course during the index hospitalization and at 6-month prospective follow-up. Higher axis IV scores were associated with more depressive symptoms on hospital discharge, but they did not predict follow-up outcome. These results are consistent with other studies of the prognostic value of ratings of psychosocial stress and indicate that, at least for depression, there is little empirical support for DSM-III's suggestion that stress is a favorable prognostic sign.

Adolescent↗
PubMed1987

Clinical predictors of suicide in patients with major affective disorders: a controlled prospective study.

The authors report prospective uniform clinical data differentiating 25 patients who committed suicide from 929 patients who did not in a group of 954 patients with major affective disorder followed for an average of 4 years in the Collaborative Program on the Psychobiology of Depression. Eight (32%) of the suicides occurred within 6 months and 13 (52%) within 1 year of entry into the study. Hopelessness, loss of pleasure or interest, and mood cycling during the index episode differentiated the suicide group. Diagnostic subcategories, suicidal ideation at entry to the study, suicide attempts during current or past episodes, and medical severity of prior attempts did not differentiate the suicide group.

Adult↗
PubMed1987

Progress in the classification of functional psychoses.

The three most widely used diagnostic systems in American psychiatry--the Feighner criteria, the Research Diagnostic Criteria, and DSM-III--appeared sequentially at 4-year intervals. The fact that the latter two systems each incorporated changes in essentially all diagnostic categories implied progress toward greater validity; however, this assumption has rarely been tested directly. To do this, the authors applied each of these three systems to 98 consecutively admitted patients with nonmanic psychoses. Although family history and 6-month follow-up data strongly supported the validity of diagnostic distinctions made in each of the three systems, they did not show increments in validity with successively developed criteria sets.

Diagnosis, Differential↗
PubMed1987

State and personality in depressed and panic patients.

The authors examined 36 patients with panic disorder, 66 patients with major depression, and 124 control subjects to determine personality differences between them in the ill and the recovered states. The panic and depressed groups did not differ from each other in either state. Both recovered groups had less emotional strength and greater interpersonal dependency than the control subjects. The effect of state on personality measures appears to be similar for anxious and depressed patients. No personality measures that clearly differentiated the recovered panic and depressed patients were found.

Acute Disease↗
PubMed1987

Prognostic validity of the dexamethasone suppression test: results of a six-month prospective follow-up.

In a 6-month prospective follow-up study, the authors located and interviewed 165 (88.2%) of 187 primary unipolar depressed inpatients to whom a 1-mg dexamethasone suppression test (DST) had been given during their first week of hospitalization. Longitudinal ratings of symptoms over the follow-up period and 6-month cross-sectional ratings on the Hamilton Rating Scale for Depression, the Beck Depression Inventory, and the Global Assessment Scale were obtained for each patient. The authors also collected information on rehospitalization after discharge from the index episode. Baseline DST results were not associated with any of the outcome variables.

Adult↗
PubMed1987

The significance of past mania or hypomania in the course and outcome of major depression.

Patients with primary major depression (N = 372) were followed for 2 years to determine the prognostic importance of past manic or hypomanic episodes. While bipolar I and bipolar II patients were more likely to relapse and bipolar I patients were more likely to attempt suicide, these patients resembled nonbipolar depressed patients in likelihood of recovery and psychosocial impairment in various areas. Compared to nonbipolar patients, those with bipolar I depression were much more likely to develop mania, while bipolar II patients were more likely to develop hypomania. Cycling during the index episode predicted a relatively low likelihood of recovery for bipolar I patients but had no apparent prognostic significance for patients with bipolar II illness.

Adult↗
PubMed1987

Shifts in attitudes among psychiatric residents: serial measures over 10 years.

Psychiatric residents completing their training in 1976, 1978, 1980, and 1986 were sent surveys on their attitudes toward treatment and training among a "dynamic-organic continuum." Their responses indicated decreasing antagonism toward the medical model and increasing endorsement of medical education, experience in neurology, and the internship as essential aspects of psychiatric education. The rankings of various treatment modalities for each of four disorders were remarkably stable across surveys. Except for megavitamin therapy, residents in 1986 were at least somewhat more likely to consider essential each of six therapies for each of the four disorders, indicating a general increase in therapeutic optimism.

Attitude of Health Personnel↗
PubMed1987

An American validation study of the Newcastle Diagnostic Scale. II. Relationship with clinical, demographic, familial and psychosocial features.

We completed the Newcastle Diagnostic Scale on 152 unipolar depressed in-patients: its validity was supported by the findings that endogenous depressives were, in contrast to neurotic depressives, older, more severely depressed, with better social support, fewer life events, less personality disorder, and a lower morbid risk of alcoholism and antisocial personality in their first-degree relatives. The relationship between Newcastle scores and the morbid risk for alcoholism was non-linear, such that a cut-off score of 4, rather than 5, maximised the difference between the endogenous and neurotic groups with respect to familial alcoholism rates as well as other validating variables.

Cognition Disorders↗
PubMed1987

Desipramine plasma levels and clinical response: evidence for a curvilinear relationship.

Twenty-six outpatients with major depression completed a 6-week, fixed dose trial of desipramine and provided plasma samples. Recovery after 6 weeks, defined in either of two ways, corresponded to lower desipramine levels, while clinical status at 4 weeks bore no apparent relationship to plasma levels. Upper limits of 140 or 155 ng/ml emerged depending on the outcome measure used. Patients with endogenous depression, those with primary depression, and those with abnormal dexamethasone suppression test results yielded similar therapeutic thresholds, while the sharpest blood level/response relationship emerged in the subgroup with an abnormal escape from dexamethasone.

Adolescent↗
PubMed1987

Prognostic validity of self-report and interview measures of personality disorder in depressed inpatients.

Presence of personality disorders was assessed with the Structured Interview for the DSM-III Personality Disorders (SIDP) in a series of 78 nonpsychotic inpatients with major depression. Measures of severity of depression were administered at admission, at discharge, and 6 months after admission. Outcome for the depression was especially poor in patients meeting criteria for multiple personality disorders from multiple DSM-III clusters. A subgroup of 38 patients received both the SIDP interview and a self-report measure of personality disorder, the Personality Diagnostic Questionnaire. Depressed inpatients who met more than the median number of personality disorder criteria by either measure were approximately half as likely to show improvement at discharge and at 6-month follow-up than were patients with less than the median number of criteria.

Adult↗