Comparison of TCAs and SSRIs in the treatment of major depression in hospitalized geriatric patients.

This study compares a cohort of hospitalized geriatric patients with major depression, treated with tricyclic anti-depressants (TCAs), with a cohort of patients treated with selective serotonin reuptake inhibitors (SSRIs). The groups were compared on demographic, treatment, and outcome variables. Demographically, the groups were similar and did not differ on measures of outcome or risk for side effects. We conclude that SSRIs are equal to TCAs in the treatment of major depression in hospitalized geriatric patients.

Protracted alcohol withdrawal delirium.

Protracted alcohol withdrawal delirium is infrequent, but when it occurs significant morbidity can be anticipated. In this report, a case of protracted alcohol withdrawal delirium is presented. The patient's course was complicated by intracerebral and subdural hemorrhages, sedative-hypnotic drug synergism resulting in respiratory compromise, the failure of benzodiazepines to prevent delirium or shorten its duration, and the onset of Wernicke's encephalopathy.

Substance abuse in borderline personality disorder.

The impact of substance abuse on patients with borderline personality disorder was investigated. Substance abuse was common. Female patients preferred alcohol and sedatives. Male patients preferred stimulants. Substance abuse was associated with poor school performance, unemployment, and promiscuity. Depersonalization-derealization was common in nonsubstance using and alcohol-sedative using patients, but was rarely found in stimulant users. Substance abuse appears to be a devastating complication in the patient with borderline personality disorder.

Psychotic symptoms in patients with borderline personality disorder and concurrent axis I disorder.

OBJECTIVE: Whether psychotic symptoms are part of the fundamental psychopathology of borderline personality disorder remains in dispute. The goal of the study was to examine the incidence and nature of psychotic symptoms in a sample of patients with the disorder. METHODS: The inpatient psychiatric records of 92 patients with a discharge diagnosis of borderline personality disorder, some of whom had comorbid affective disorder or substance abuse disorder, were examined to obtain data on the presence of psychotic symptoms (narrowly defined as delusions and auditory and visual hallucinations), the duration of psychotic episodes, and the clinical characteristics of the patients. RESULTS: Twenty-seven percent of the patients had psychotic episodes, typically lasting many weeks. Comorbid affective or substance abuse disorders did not predict psychotic symptoms. CONCLUSIONS: Psychotic episodes are common but not universal among patients with borderline personality disorder, regardless of whether a concurrent axis I disorder is present. Those episodes are not necessarily brief or transient, and borderline patients who experience psychotic episodes are likely to have repeated hospitalizations.

A comparison of two adjunctive treatment strategies in acute mania.

A benzodiazepine-neuroleptic adjunctive treatment strategy in a cohort of acutely manic patients was compared with standard neuroleptic adjunctive treatment in a matched sample treated in the same hospital. Thirty newly hospitalized manic patients receiving low-dose neuroleptic (310 mg/day chlorpromazine equivalents) and benzodiazepines (1.6 mg/day lorazepam equivalents) were compared, retrospectively, with 30 statistically similar patients receiving standard dose neuroleptic adjunctive treatment (590 mg/day chlorpromazine equivalents; 0.09 mg/day lorazepam equivalents). The benzodiazepine-neuroleptic-treated group demonstrated significantly fewer seclusion and restraint episodes (p less than .05) and were comparable on other parameters. Treatment with the benzodiazepine-neuroleptic combination may lead to fewer inpatient complications than standard neuroleptic treatment alone.

Drug abuse in schizophrenia and bipolar disorder.

The incidence and type of drug abuse for 50 male schizophrenic patients and 60 male and female bipolar, manic patients were determined. Fifty percent of schizophrenic patients and 25% of bipolar patients abused one or more drugs. Alcohol, cannabis, and cocaine accounted for 82% of the drug abuse.

Suicide attempts correlate with delusional content in major depression.

A retrospective analysis of all medically serious suicide attempts made by 45 patients hospitalized consecutively at the Payne Whitney Clinic with the Diagnostic and Statistical Manual III discharge diagnosis of unipolar major depression recurrent with psychotic features was undertaken. Patients with delusions of persecution in combination with delusions of guilt were significantly more likely to make medically serious suicide attempts than patients with single categories of delusions or combinations other than guilt and persecution.

Informed consent as a source of bias in clinical research.

Clinical observation suggested that schizophrenic patients more often refused to participate in experiments. In two studies psychiatric patient volunteers and nonvolunteers were compared on discharge diagnoses (psychiatric and medical), medication given, demographic measures, and hospitalization characteristics. In each study, patients with paranoid schizophrenia were more likely to refuse participation. Also, in each study, volunteers received more benzodiazepines and more nonpsychiatric medication. The latter difference could not be explained on the bases of rated severity of or probability of drug use in diagnosed medical illnesses, or number of medical illnesses. Characteristics of schizophrenic patients such as suspiciousness, negativism, and ambivalence were suggested as possible sources of their refusal to participate. Nonvolunteers were suggested to be less agreeable and compliant in general, and perhaps less likable, possibly explaining their receiving fewer benzodiazepines and nonpsychiatric medications. Attempts to characterize and correct the volunteer bias should be made, including offering tangible reward.

Prevalence of self-reported depressive symptoms in young adolescents.

To investigate the significance and measurement of depressive symptoms in young adolescents, 624 junior high school students were asked to complete the Center for Epidemiologic Studies Depression Scale (CES-D) during home interviews. In 384 usable symptom scales, item-scale correlations (most were above .50), inter-item correlations, coefficient alpha (.85), and patterns of reported symptoms were reasonable. Persistent symptoms were reported more often by Blacks, especially Black males. Prevalence of persistent symptoms in Whites was quite close to reported figures for adults, ranging from 1 per cent to 15 per cent in adolescent males and 2 per cent to 13 per cent in adolescent females. Adolescents reported persistent vegetative symptoms less often and psychosocial symptoms more often. Reports of symptoms without regard to duration were much more frequent in the adolescents, ranging from 18 per cent to 76 per cent in White males, 34 per cent to 76 per cent in White and Black females, and 41 per cent to 85 per cent in Black males. The results support the feasibility of using a self-report symptom scale to measure depressive symptoms in young adolescents. Transient symptoms reported by adolescents probably reflect their stage of development, but persistent symptoms are likely to have social psychiatric importance.

Serum creatine phosphokinase levels in patients meeting the St. Louis research diagnostic criteria for schizophrenia.

In this study 18 patients with a research diagnostic criteria diagnosis of schizophrenia had a mean initial serum creatine phosphokinase level significantly higher than that of 36 control subjects with other RDC diagnoses. There were no corresponding elevations in the serum levels of nondrinking alcoholics or patients with primary or secondary affective disorders. The authors suggest that increased creatine phosphokinase levels in schizophrenic patients may be due to a sudden increase in the substance in the dopaminergic or limbic system due to increased muscle membrane permeability or to sympathetic nervous system or adrenergic dominance.

Mental health center versus community perceptions of mental health services.

A list of 53 mental health programs and services was presented to community samples of county commissioners and mental health board members, mental health program administrators, mental health clinicians, mental health clerical staff, clients, general public, staff of agencies related to mental health, and staff of community agencies not so related with a request to (a) indicate which programs and services were being offered by the mental health agencies of the catchment area, (b) indicate the relative importance of each offered service, and (c) indicate the relative importance for future program development of those not currently offered. Accuracy of program identification is noted and intergroup perceptions of mental health programs and services are compared.

Lithium carbonate in the treatment of schizophrenia and schizo-affective disorder: review and hypothesis.

The success of lithium carbonate in the treatment of manic-depressive illness has led to its use in many other psychiatric disorders. Within this group, schizophrenia and schizo-affective disorder have come under the closest scrutiny. The literature, however, is difficult to reconcile. Conclusions are often contradictory, methodologies confusing, and well-designed studies few in number. In this paper, the authors have attempted to extract common denominators that may prove of value in delineating those symptoms which predict therapeutic response to lithium carbonate.

Trends in community mental health programming.

One hundred-seventy-three mental health centers responded to a survey inquiring about allocation of staff time for mental health services and about the availability of an array of services at present, 3 years previous, and 3 years hence. The data reflect an emphasis upon reactive services as opposed to those considered proactive, and on services directed to individuals as opposed to other groups. However, this emphasis seems to be changing. Future projections call for a de-emphasis on individual reactive programs and increased emphasis on programs directed toward families and small groups, and toward proactive programs directed to the communities-at-large. Data about specific programs and services further suggest de-emphasis of services that involve the mental health professional and the client in direct interaction, and continued growth in services that can be delivered by less formally trained mental health workers or volunteers.

Problem-solving strategies in consultation.

Techniques for overcoming common stumbling blocks in consultation are outlined, and the advantages to consultants of viewing consultation as a mutual problem-solving process are discussed. It is suggested that the consultant-in-training can achieve confidence in this approach only through experiencing the relationship from the other side by gaining first-hand understanding of the situation of the consultee. Strategies towards this end are offered.