The Hillside journal of clinical psychiatry最新文献

Of 88 inpatients admitted for assessment of affective illness, 70 met RDC criteria for major depressive disorder. All patients had a quantitative electroencephalogram (QEEG) after ten days drug-free. Several QEEG variables were examined by multivariate stepwise discriminant analysis of data from patients and controls. Measures of interhemispheric coherence, beta activity, and slow wave excess were potent discriminators. Depressives were discriminated from normals with an accuracy of eighty-six percent. Primary depressives were discriminated from alcoholics, primary dementias and normals with an overall accuracy of 76% (25% expected by chance). Primary and secondary major depressives were correctly classified with 77% accuracy. Unipolar depressives were discriminated from bipolar depressives with 88% accuracy. Differential diagnosis and treatment implications are discussed.

Five case examples are presented to illustrate the role of psychopharmacology in the treatment of patients diagnosed as Borderline Personality Disorders. The cases range from organic through affective and schizophrenic syndromes which are not infrequently at the "border" of personality disorders, and which often respond to specific pharmacologic interventions. The importance of looking for and recognizing drug treatable syndromes within the wide array of patients who satisfy DSM-III criteria for Borderline Disorders is discussed.

We conducted a randomized, double-blind clinical trial of propranolol versus placebo as a single treatment of neuroleptic-induced akathisia in eleven schizophrenic patients. Neither propranolol nor placebo treated patients showed a significant improvement in akathisia. While propranolol may be useful as an adjunct to anticholinergic medication in the treatment of neuroleptic-induced akathisia, propranolol does not appear to be effective within 48 hours as a primary treatment in a select group of schizophrenic patients.

Of 216 symptomatic adult depressives who underwent comprehensive inpatient biomedical assessment of their illness, 111 met Research Diagnostic Criteria for primary unipolar depressive disorder. Seventy of these patients were segregated into two groups having different frequency analysis profiles as determined by quantitative electroencephalography (QEEG). The following variables were assessed and tabulated for each of the seventy patients: age and sex; presence of endogenous, nonendogenous or atypical symptoms, cognitive impairment, anxiety, obsessive-ruminative thinking, panic and/or phobic symptoms; abnormalities of the dexamethasone suppression test (DST) and the thyrotropin releasing hormone stimulation test (TRHST). Frequency of occurrence of each variable was compared between groups. Two variables were significant--age and TRHST abnormalities. The patients in group 1, characterized electrophysiologically by beta deficit with or without slow wave excess, were older and had more TRHST abnormalities than the patients in group 2, who were characterized electrophysiologically by having slow wave excess only. The implications of these preliminary findings for objective diagnostic subtyping of depression are discussed.

A psychiatric inpatient unit with expertise in family treatment has developed an integrated effort to provide a one to three month treatment program for hospitalized borderline patients. Treatment goals are more ambitious than those obtainable by simple crisis intervention. Appreciation of staff splitting is enhanced by an intergenerational family systems approach. Early and sustained focus on splitting is aided by the use of a 15 minute educational tape and a weekly therapy group required for all nonpsychotic patients and recommended for their families. Cases illustrating the family perspective and a group therapy session are presented in detail. The therapy group, run by an interdisciplinary team (the authors) requires active staff initiative and confrontation to avoid responsibility-evading patient coalitions. Diagnostic considerations and impact of the program on patients and on staff are discussed.

Clinical, behavioral, physiological, biochemical and receptor binding parameters are useful as dependent measures in studies into the pathophysiology of affective disorders. Pharmacological perturbation of cholinergic mechanisms and modification of cholinergic-monoaminergic interaction mimics aspects of the neurobiology of affective disorders. The effects of these pharmacological manipulations can be quantitatively assessed by measuring their impact on variables in each of these classes. These deviations are easily and safely produced by several classes of drugs which directly or indirectly modify the function of central muscarinic cholinergic networks. Methods for inducing these changes in cholinergic systems and their application to clinical and basic research in the field of affective disorders are highlighted.

Seventy-six inpatient RDC major depressives (51 primary and 25 secondary), drug free for at least ten days, and 93 normals were examined by quantitative electroencephalography (QEEG). Multivariate analyses of variance were performed on several diagnostic subgroups using QEEG variables identified in an earlier study as discriminators. Decreased interhemispheric coherence in the delta and/or theta frequency bands was present to a statistically significant degree in depressed subjects. Secondary major depressives showed a lesser decrease than did primary major depressives in both anterior and posterior brain regions. Depression secondary to organic brain syndrome was distinguished from other secondary depressions by the presence of significant slow wave excess in the former only. The ability of beta activity to discriminate unipolar from bipolar major depression was confirmed.

With a decrease in recent years in the external impediments which prevent women from realizing their full potential has come a better view of internal factors. The author explores developmental and psychodynamic issues in the paradoxical situation in which women fear to achieve what they have long desired. The author describes clinical manifestations of success phobia, and analyzes symptom origin within a developmental and psychodynamic framework, and illustrates the types of success inhibition arising from family and early social variables, separation-individuation problems, pathological narcissism, and Oedipal conflict.

The paper is concerned with the integration of psychodynamic theory with psychometric theory in order to find meaningful ways to measure psychodynamic variables. Four reasons are suggested for the use of self-report tests in psychotherapy research. These include the need for reliable measuring instruments, cost-efficient methods of data collection, and the progressive refinement of "fuzzy" concepts through the process of test construction. A three-stage approach to outpatient assessment is presented which is called sequential psychodiagnostic evaluation. The first stage refers to the evaluation of crisis issues such as suicidality or psychosis; the second to egodystonic symptom assessment; and the third refers to the assessment of egodystonic states such as personality traits, ego strength and defenses. The construction of a number of these scales is illustrated and their use in a research study of predictors of psychotherapy outcome described.

Failure to begin the hospital treatment of the "borderline" patient with a formulation of the problems requiring hospitalization is an indication of a lack of integration in the staff's view of the patient's pathology. This failure may dovetail with a basic lack of integration in the patient's personality and recapitulate similar confusion and inconsistency within that patient's family. A 15-minute educational tape about "borderline" illness has been used to enhance integration and formulation of problems by staff and patients in a hospital setting in which stay is limited to one or two months. The program is described, and the taped programs included. "Self-regulatory disorder" is preferred to "borderline personality disorder." After one year's experience with the program, the staff has been better able to formulate difficulties in clinical discussions with patients and their families. The staff has noted a clearcut reduction of disruptive impulsive action in this population of hospitalized nonpsychotic patients.