ABSTRACT
Tardive dyskinesia (TD) is a movement disorder that can be expressed at various body effector points, including the face, neck, arms, fingers, legs, and torso. In this prospective longitudinal study researchers examined whether the effector pattern of TD changed during the course of neuroleptic medication withdrawal in adults with mental retardation. Results indicated that the effector pattern of TD changed over the course of neuroleptic withdrawal. Peak dyskinesia was associated with the involvement of more body areas relative to baseline. Although dyskinesia decreased at follow-up and fewer body areas showed signs of dyskinesia, there were still differences in the effector pattern of dyskinesia relative to baseline at periods of 1 to 2 years following neuroleptic withdrawal. These findings suggest that TD is a dynamic disorder associated with changes in both severity and effector pattern over time.
Subject(s)
Antipsychotic Agents/adverse effects , Dyskinesia, Drug-Induced/psychology , Substance Withdrawal Syndrome/psychology , Adolescent , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Psychomotor Performance/physiologyABSTRACT
The lip movements associated with dyskinesia in adults with mental retardation were investigated through a dynamic analysis at medication baseline, at the points of the highest level of withdrawal dyskinesia as indexed by the DISCUS rating scale, and at the lowest level of dyskinesia following complete withdrawal of the medication. Results showed that the changes in the amount of lip oscillations following medication reduction and eventual withdrawal were strongly linked to changes in the structural complexity of the dynamics of lip motions. These findings provide evidence that neuroleptic medication reduces the df of the dynamics of the movement output and that this change is inversely related to the level of tardive dyskinetic motion observed in the clinical setting.
Subject(s)
Antipsychotic Agents/adverse effects , Dyskinesia, Drug-Induced/diagnosis , Intellectual Disability/drug therapy , Lip Diseases/chemically induced , Substance Withdrawal Syndrome/diagnosis , Adolescent , Adult , Antipsychotic Agents/administration & dosage , Female , Humans , Lip Diseases/diagnosis , Male , Middle Aged , Neurologic Examination/drug effectsABSTRACT
OBJECTIVE: This study evaluated the relation between baseline clinical phenomena and response to amitriptyline in patients with posttraumatic stress disorder (PTSD). METHOD: Data were obtained from an 8-week placebo-controlled, double-blind study of combat veterans. Bivariate and multivariate statistics were used to evaluate the relations between the following variables and outcome: age, depression, anxiety, severity of PTSD symptoms, personality, psychiatric comorbidity, level of exposure to trauma, and individual symptoms of depression, anxiety, and traumatic stress. Outcome measures were scores on the Clinical Global Impression scale, Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety, and Impact of Event Scale. RESULTS: Drug response was related to lower baseline levels of depression, neuroticism, combat intensity, anxious mood, impaired concentration, somatic symptoms, feelings of guilt, and one intrusion and four avoidance symptoms of PTSD. CONCLUSIONS: The results demonstrate that response to amitriptyline is related to measures of depression, anxiety, PTSD, personality, and intensity of combat trauma. Similar relationships were not observed in the placebo group, suggesting a specific relationship to the drug.
Subject(s)
Amitriptyline/therapeutic use , Stress Disorders, Post-Traumatic/drug therapy , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Comorbidity , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Double-Blind Method , Humans , Life Change Events , Male , Middle Aged , Placebos , Probability , Psychiatric Status Rating Scales , Severity of Illness Index , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Treatment OutcomeABSTRACT
Amitriptyline hydrochloride was compared with placebo in 46 veterans with chronic posttraumatic stress disorder. Treatment continued up to 8 weeks, and efficacy was measured by five observer and two self-rated scales. Percent recovery rates were higher for amitriptyline than placebo on two measures. In patients who completed 4 weeks (n = 40), better outcome with amitriptyline was noted on the Hamilton depression scale only. In the group completing 8 weeks of treatment (n = 33), the drug was superior to placebo on Hamilton depression, Hamilton anxiety, Clinical Global Impression severity, and Impact of Event scales. There was no evidence for drug effects on the structured interview for posttraumatic stress disorder. Drug-placebo differences were greater in the presence of comorbidity in general, although recovery rates were uniformly low in the presence of major depression, panic disorder, and alcoholism. At the end of treatment, 64% of the amitriptyline and 72% of the placebo samples still met diagnostic criteria for posttraumatic stress disorder.
Subject(s)
Amitriptyline/therapeutic use , Stress Disorders, Post-Traumatic/drug therapy , Ambulatory Care , Analysis of Variance , Anxiety Disorders/diagnosis , Clinical Trials as Topic , Comorbidity , Double-Blind Method , Hospitalization , Humans , Mental Disorders/complications , Mental Disorders/diagnosis , Outcome and Process Assessment, Health Care , Panic , Placebos , Psychiatric Status Rating Scales , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , WarfareABSTRACT
Delusions presented by patients with psychiatric disorders are often a combination of psychopathology and current events. The authors present three cases that document the delusion of having acquired immune deficiency syndrome (AIDS) in patients who were not members of high-risk groups but had psychiatric disorders. This clinical phenomenon raises psychodynamic issues as well as adds a new dimension to the controversy over AIDS testing.
Subject(s)
Acquired Immunodeficiency Syndrome , Delusions/psychology , Depressive Disorder/psychology , Acquired Immunodeficiency Syndrome/diagnosis , Adult , Bipolar Disorder/diagnosis , Bipolar Disorder/psychology , Delusions/diagnosis , Depressive Disorder/diagnosis , Humans , Male , Middle Aged , Risk FactorsABSTRACT
A questionnaire was constructed and used to assess the perception of symptoms of a depressive disorder by nonpsychiatric physicians in patient evaluations. Results showed that respondents consistently perceived depression as resulting from psychological rather than biological factors. It is suggested that such perception on the part of physicians may hinder consolidation of a patient's symptom complex with the degree of certainty necessary for a diagnostic consideration of depressive disorder.
Subject(s)
Attitude of Health Personnel , Depressive Disorder/diagnosis , Physicians , Depressive Disorder/etiology , Depressive Disorder/psychology , Family Practice , Humans , Internal Medicine , Surveys and QuestionnairesABSTRACT
Classification of depressive disorders can be performed following the Linnaean binomial nomenclature model by defining depression as a genus and the subtypes as species. A medical classification of depressive disorders would need to be jointly inclusive and mutually exclusive between subtypes, and to provide time of onset, severity of illness, pathological process, prognosis, and treatment indications. Etiologic, phenomenologic (clinical, descriptive), statistical, and biological approaches have been used to classify depression. A convergence of these various systems in different combinations has evolved, and a consensus approach using the multiaxial system, such as DSM-III, has advanced psychiatric nomenclature to provide clinical relevance and heuristic possibilities.
