Characterological depressions. Clinical and sleep EEG findings separating 'subaffective dysthymias' from 'character spectrum disorders'.

Early-onset characterological depressions are distinguished from late-onset chronic depressions that complicate the long-term course of unipolar and nonaffective illnesses. In turn, characterological depressions are divisible into at least two subtypes: (1) "Subaffective dysthymias" have even sex distribution, are often complicated by superimposed depressive episodes, rapid eye movement latency is shortened, and they tend to respond to tricyclics of lithium carbonate. In brief, they share many features of primary affective illness. (2) "Character spectrum disorders," by contrast, represent a heterogeneous mixture of personality disorders with inconstant depressive features, are more common in women, are often complicated by alcohol and drug abuse, and outcome tends to be unfavorable.

Differentiation of primary affective illness from situational, symptomatic, and secondary depressions.

Analysis of family history and antidepressant drug response variables of 100 "neurotic" depressives followed up prospectively over three to four years disclosed that primary depressions (unipolar and bipolar) could be distinguished from nonprimary cases by (1) the early occurrence of "pharmacological-hypomania;" (2) family history of bipolar illness; (3) family history for affective disorder in two or three consecutive generations, especially when "loaded." Although each of these variables alone occurred in only one fifth to one third of the primary group, they individually displayed better than 95% specificity for it. Thus, the confidence with which the diagnosis of primary affective illness could be made in the presence of any of these variables ranged from 88% to 100%. These findings argue for considering such nonsymptomatological variables for their potential in strengthening the phenomenologic diagnostic criteria for depressive illness.

The nosological status of neurotic depression: a prospective three- to four-year follow-up examination in light of the primary-secondary and unipolar-bipolar dichotomies.

One hundred patients with "mild" depressive states, variously referred to as "situational," "reactive," or "neurotic," were studied. During a three- to four-year prospective follow-up, 4% had developed bipolar I, 14% bipolar II, and 22% unipolar disorders with predominantly favorable social outcome. Most of the remainder were suffering from nonaffective disorders; in this group, intermittent depressive symptomatology followed a protacted course (paralleling the underlying disorder) with generally unfavorable outcome. Irrespective of diagnostic subtype, a "characterological" component occurring in 24% of the total sample appeared to predict unfavorable prognosis, including three suicides. The diagnostic usage of the concept of neurotic depression may no longer be clinically meaningful, since it lacks sufficient phenomenological characterization and refers to a heterogeneous group of disorders. The data suggest the merits of a biaxial approach to the nosology of depressive disorders whereby phenomenologically based affective diagnoses are qualified as to the presence or absence of character disorder.

Effects of doxepin on withdrawal symptoms in smoking cessation.

In a double-blind study, 15 cigarette smokers self-monitored 10 withdrawal symptoms. For the first 21 days (baseline), subjects received doxepin hydrochloride, up to 150 mg/day, or inert medication while continuing to smoke. On day 22, they were instructed to stop smoking; medication was continued. Withdrawal symptoms on the first 28 days of treatment (baseline and 7 days of attempted cessation) were analyzed. During cessation, subjects taking doxepin reported significantly less craving for cigarettes. Results from this study and others suggest that antidepressants may attenuate the severity of symptoms during withdrawal from addictive substances.

Doxepin as an adjunct to smoking cessation: a double-blind pilot study.

In a double-blind study, 19 adults received bedtime doses of either 150 mg of doxepin hydrochloride (N = 9) or placebo (N = 10). After 3 weeks the subjects were instructed to stop smoking and continue taking medication for 4 additional weeks. Cessation was reported by all nine doxepin subjects 1 week after cessation and by seven doxepin subjects 9 weeks after cessation. One placebo subject reported cessation. Cotinine assays generally confirmed cessation but were subject to interpretation. Doxepin assays suggested that the precessation level was associated with cessation. Further studies with larger samples and extended follow-up are needed to determine the reliability of these results.

Increased plasma tricyclic antidepressant concentrations in two patients concurrently treated with fluoxetine.

Two patients taking stable doses of standard tricyclic antidepressants were additionally treated with fluoxetine as the first step in a transition to that drug. After fluoxetine was added, both patients' plasma tricyclic antidepressant levels increased substantially. Adverse side effects occurred in one patient. Fluoxetine may increase the plasma levels of standard tricyclic antidepressants and the likelihood of tricyclic antidepressant toxicity.

Familial and developmental factors in characterological depressions.

Patients with chronic low-grade depressions (screened to exclude primary affective illness and those secondary to rigorously defined nonaffective disorders) were divided into subaffective dysthymic versus character-spectrum groups and compared to 40 primary unipolar controls. A prior report found the 30 character-spectrums different from the 20 dysthymics (and usually from the unipolars) on pharmacological, phenomenological, REM sleep, social and outcome criteria. The present study parsed family history and developmental differences: The character-spectrum group had significantly lower incidence of familial depressions, but higher frequencies of loss of a parent in childhood, familial alcoholism, and parental assortative mating than both other groups--which did not differ. Just 10% of our 90 patients had bipolar family histories; 7 were dysthymics and 6 of these had earlier shown brief, tricyclic-induced hypomania. The results support, at the subsyndromal level, Winokur's separation of disorders with +FH for alcoholism from those with +FH for affective illness. Furthermore, data suggest the DSM-III concept of 'dysthymia' is too broad and needs further distinctions among several subaffective and nonaffective chronic depressions.

Chronic depressions. Part 1. Clinical and familial characteristics in 137 probands.

Factors associated with chronicity in 137 probands with 2 or more years of low-grade intermittent depression were evaluated in a naturalistic setting. Four groups were tentatively identified and chronicity related to: (1) early onset (less than 25 years) intermittent subsyndromal or dysthymic depressions with positive family history for both unipolar and bipolar illness; (2) a spectrum of 'unstable' characterologic disorders with history for childhood object loss; (3) pre-existing non-affective psychiatric or incapacitating medical disorders, especially in combination; (4) incomplete remission from late-onset primary unipolar episode(s) with strong familial background for affective illness, multiple object losses, alcohol and sedative hypnotic dependence, superimposed incapacitating medical disorders, use of depressant antihypertensive agents, disabled spouses, and 'marital deadlock'. Beneficial effects of thymoleptic drugs and practical psychotherapy occurred in 45% of the total sample and were largely limited to groups 1 and 4. These findings argue against a common clinical stereotype that equates all chronic depressions with character disorder.

Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors.

Twenty percent of a cohort of 206 outpatient depressives with no past bipolar history switched during prospective observation. These 41 probands developed manic periods on the average of 6.4 years (median 4, range 1-25) after their first depressive episode. The change in polarity occurred throughout the life span, but was most common in adolescence and early adulthood. The following variables were found useful in predicting this outcome: onset less than or equal to 25 years, bipolar family history, loaded pedigrees, precipitation by childbirth, hypersomnic-retarded phenomenology, and pharmacologically-mobilized hypomania. Although the respective sensitivities of these findings were relatively low (32-71%), their specificities ranged from 69% to 100% for bipolar outcome; the diagnostic specificity of any 3 of these variables when combined was 98%. When compared with nonbipolar depression, bipolar disorder was seldom chronologically secondary to nonaffective psychiatric disorders. These findings suggest that many young depressives with lethargy and oversleeping are not manifesting a "neurotic" disorder, but rather a precursor of primary bipolar affective disorder. Finally, a psychotically depressed adolescent or young adult with positive bipolar family history should be observed for eventual bipolar outcome, especially when the clinical presentation is that of stupor.

To soothe the savage breast.

We review quite a range of procedures--some strange, some familiar--to calm, and spare fantasied harm. Drugs can help a whole bunch, but there is no 'free lunch.' Side-effects from long use, and the risk of abuse, make it wiser to find other means to 'unwind.' (Anxious folks spin a messful of thoughts that are stressful.) Against pressures that fluster, tranquil images muster a sense one is resting--rather than testing how much one achieves (while one's family grieves). Muscle programs to lower tense states, and pace slower, can bring manifold gains easing worry and pains. There are diverse connections among muscle flexions--however those function--that can serve as an unction. Movements practiced each night do more good than the 'right' exercises in theory, left undone by the weary. Thus give choice of routines as well as calm scenes: one might dodge heart attacks if one learns to relax. It will not cheer one's mood to review woes nor brood over future collusions, intrusions, confusions, perfection, rejection and other delusions. Like over-tight shoe points, loosen Puritan viewpoints because standards too stern make adrenaline burn. Teach instead: 'Mellow visions need not earn derisions. People who play more are invited to stay more.' Massages and dancing, gentle fiction entrancing or dulcet harmonics are suitable tonics. For self-damaging actions bring on wholesome distractions. There are so many names for so many games, from social adventures to buying debentures, trip-planning, food-canning and even gold-panning. Thus cease surplus panting but cultivate planting since turmoil may go when one makes flowers grow, or elsewhere embraces Nature's several faces: oceans, rivers, or canyons, mountains, redwoods or banyans, or (thanks to some vets), peaceful contacts with pets.

Students' self-ratings of stress in medical school: a replication across 20 months.

We replicated the essential results of a prior study on the capacity of the BAROMAS scales to reflect stress in medical school as perceived by students. As before, subjective stress was high at the start of medical school, and when facing the exams prerequisite to entry into clinical clerkships. On most measures, stress was lowest when the second year began (i.e. after having passed the first). Once again, most test-retest reliabilities (significant rs ranged from 0.24 to 0.66 for confidence ratings at 12- and 20-months after entry) were moderate.

Leisure interest patterns and subjective stress in college students.

A first study of the Leisure Interests Checklist (LIC) is reported based on a large (N = 670) normative sample of college students. Acceptable reliability was found on the total interest scores, and on both rationally- and factorially-derived LIC subscales. The BAROMAS stress scales were also studied concurrently with the same college students, and normative data are provided from that sample. Interest in very active diversions and Sports on the LIC did correlate with confidence in doing sports on the BAROMAS. Otherwise, the two instruments showed little overlap. Comparisons between ethnic and gender groupings mainly agreed with advance expectations by disclosing culturally conventional differences in response patterns. The LIC appears promising for future use in both applied and research contexts.

Predicting outcome of chronic pain treatment via a modified self-efficacy scale.

This study utilized a modified self-efficacy scale and examined the relationship of perceived self-efficacy to treatment outcome in a chronic, intractable, benign pain population (N = 62). In two separate studies a self-efficacy scale was given to inpatients in a combined cognitive-behavioral and medical treatment program. The scale categories consisted of (1) walking distance, (2) lifting ability, (3) pain coping, (4) working ability, and (5) social and recreational engagement. Self-efficacy beliefs were found to be associated with the level of functioning of these patients and their response to treatment. Patients with higher self-efficacy scores following treatment rated themselves as more improved and demonstrated better overall functioning with greater reductions in chronic illness behavior at followup. These observations support the merits of self-efficacy measures as predictors of treatment outcome in chronic pain patients.

Similarities and differences on five inventories among mood and anxiety disorder patients.

The Eysenck Personality Questionnaire (EPQ), BAROMAS, Leisure Interests Checklist (LIC), Mental Health Inventory (MHI) and a one-page checklist of Body Problems were given to 128 outpatients with serious mood or anxiety disorders. Compared to normative data published on the first four devices, the combined patients were far 'sicker' in nearly all comparisons (P less than or equal to 0.01). However, anxiety and mood patients did not differ on the EPQ, BAROMAS, or LIC. On Body Problems, strong contrasts emerged (P less than 0.04), especially when 'fringe' cases were excluded (e.g. dysthymics from mood, and obsessives from anxiety disorder diagnoses). Small anxiety subtype groups also differed (P less than 0.05). On the MHI, both global and core groups of mood--especially unipolar (depressed)--patients differed from the anxiety disorders (P less than 0.04).

Assessing emotional distress at the internist's office.

At their first visits to a clinic, 102 outpatients rated the severity of their presenting complaint, of 12 possible body problems including 6 nonspecific symptoms, of a set of adjustment difficulties, and answered the Welsh A and the Beck Depression inventories. Then, an internist 'blind' to the foregoing answers performed a routine history and physical exam, afterward rating the patient for degree of organic and of psychosomatic involvement. Significant correlations were found between clinician judgments of psychosomatic involvement and patients' self-reported complaints on all assessment measures (smallest r = 0.25, P less than 0.01). Substantial intercorrelations were found among the assessment measures, especially between Welsh A (Anxiety) and Beck Depression scores (r = 0.73).

Comparing high school and college students' leisure interests and stress ratings.

We compared a large high school area sample with normative data from prior research with college students on the Leisure Interests Checklist (LIC) factor scales, and on the BAROMAS. Whether combined or separated by sex, the college sample displayed far more interest in the LIC activities than the high school students (all P << 0.001). On the BAROMAS, differences were more complex. The teenagers expressed more confidence about dismissing time pressures, sleeping soundly and finding time to do sports, but college students were more confident about falling asleep and sticking to set priorities. The high school data replicated the previous pattern of LIC x BAROMAS relationships, with most scales significantly inter-correlated within inventories, but mainly the sports scales covarying across the two inventories. Numerous differences between the sexes emerged from the high school student sample.

Redundant clothing: a readily observable marker for schizophrenia in the psychiatric emergency room population.

Most mental health workers have seen bizarrely dressed patients who wear multiple pieces of some item of clothing. Since many of these patients carried a schizophrenic diagnosis, we devised a study to test whether redundant clothing is a reliable indicator of schizophrenia. Of 25 patients who presented at the city psychiatric emergency room wearing redundant clothes, 18 received schizophrenic diagnoses. A Chi square analysis comparing proportions attained significance at the P < .0001 level. Although not a particularly sensitive measure, wearing redundant clothes appears to be a readily observable behavior associated with schizophrenia in the psychiatric emergency room.

Conception failure in swine: importance of the sex ratio of a female's birth litter and tests of other factors.

Failure of gilts and sows to conceive when they are mated is a potentially serious economic cost for swine producers. In Exp. 1, we determined that anogenital distance of newborn gilts is related to the proportion of males in the litter (P < .001). Gilts from litters with more males have larger anogenital distances (mean = 8.0 +/- .2 mm); those from litters with low proportions of males have smaller anogenital distances (mean = 5.7 +/- .1 mm). In Exp. 2, we examined the effect of birth litter sex ratio of sows and gilts on reproductive performance using a 13-yr database of breeding and litter data. Gilts that failed to become pregnant on the first breeding attempt came from litters with significantly higher proportions of males than gilts that successfully conceived on the first breeding attempt. Overall, female swine were significantly more likely to exhibit lower rates of successful breeding during their first four breeding attempts if they had been born in a male-biased litter. These results have implications for swine producers deciding which gilts to keep and which to market. Given the higher probability of reproductive problems for gilts from litters of 12 or more pigs with 67% or more males, these females should likely become market hogs. Sow's age, mode of insemination, and the number of insemination attempts at an estrus period, but not season, can affect successful breeding.

Personality profiles of mothers of sexual abuse victims and their daughters.

Sixty-five mothers of sexual abuse victims and 25 of their daughters were compared with 65 control mothers and 32 control daughters on the Eysenck Personality Questionnaire and the Leisure Interest Checklist. Results showed both study groups to be significantly less impulsive than their control counterparts. Victim mothers also presented themselves as being more constricted than control mothers.

Gender differences dominate sleep disorder patients' body problem complaints.

We studied it age, gender, diagnostic status, and psychiatric features affected 291 consecutive sleep disorder patient's body complaints on a brief checklist. Gender had a strong impact on all four (tested) dependent measures, with women reporting more distress than men. Age produced significant regressions on two measures, with younger patients complaining more than older. Presence of psychiatric features was associated with more complaints on one dependent measure--previously found to reflect internal medicine patients' emotional distress. The results of regression analyses were largely supported by follow-up ANOVAs. However, contrasting insomniac versus hypersomniac versus all other sleep disorder diagnoses did not affect body complaints on any dependent measure. The results caution against combining males and females to compare self-reported distress between sleep disorders.