Outcome in schizoaffective, psychotic, and nonpsychotic depression. Course during a six- to 24-month follow-up.

In the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression, six-month follow-up evaluations are available for 24 patients with schizoaffective disorder (depressed type), 56 with psychotic depression, and 274 with nonpsychotic major depression. Outcome for patients with schizoaffective depression was significantly worse than for patients with nonpsychotic depression. The psychotic depression group held an intermediate position on most outcome measures and on psychosocial measures had outcomes significantly worse than those of the nonpsychotic group. Recovery rates assumed a very similar pattern in another cohort admitted more than 40 years ago and followed up without somatic treatment. Follow-ups of 12, 18, and 24 months are available for proportions of each diagnostic group. Survival curves suggest similar outcomes in psychotic depression and nonpsychotic depression, whereas outcomes in schizoaffective depression remain disparate. These trends together with family history studies suggest that a small proportion of patients with schizoaffective disorder, depressed type, will have a long-term course consistent with schizophrenia. Moreover, these data show that outcome studies of schizoaffective disorder must control for follow-up length and the effects of psychosis per se.

MRI abnormalities in adolescent bipolar affective disorder.

There is increasing evidence for structural differences in the brains of patients with affective disorders. Recent magnetic resonance imaging (MRI) studies have reported focal signal hyperintensities in the deep white matter of bipolar patients. These previous reports had focused on adult patients with prior episodes of illness. In this case report, the authors discuss a young adolescent patient during her first episode of mania and the finding of subcortical focal signal hyperintensities on brain MRI. The etiology, pathophysiology, and clinical correlates of these lesions will be reviewed.

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.

Computerized interviews as a method of assessing psychopathology in children.

A computerized version of the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) has been developed. There are three versions of the interview, one for children aged 6 to 12, one for adolescents aged 13 to 18, and one for parents of children aged 6 to 18. Acceptability and reliability studies of the child and adolescent versions were performed on 93 subjects. The results show that children of all ages enjoyed the computer, and most were able to complete the interview with very little help. Reasonable reliability was found for both age groups despite difficulty with certain diagnostic criteria.