Lifetime comorbidity, lifetime history of psychosis and suicide attempts, and current symptoms of patients with deteriorated affective disorder.

This study extends our prior research by examining the lifetime comorbidity, history of psychosis and suicide attempts, and current symptoms of an unusual group of patients with major affective disorders who have not only been symptomatic for prolonged periods but have also been so functionally impaired that they required years of care in psychiatric facilities or by family members. Twenty-seven of these deteriorated affective patients and 29 patients with deteriorated schizophrenia were recruited from a large state hospital; 27 patients with non-deteriorated affective disorder were recruited from an affiliated outpatient facility. Patients with deteriorated affective disorder, as compared to those with non-deteriorated affective disorder, were far more likely to have a history of psychotic symptoms with suicidal themes and a history of life-threatening suicide attempts and completed suicide. Deteriorated affective patients were also more likely to meet criteria for melancholia and to have attentional deficits, thought disorder and negative symptoms. The deteriorated and non-deteriorated affective groups had similar lifetime rates of psychotic symptoms (bizarre and non-bizarre) and lifetime psychiatric comorbidity. Functional deterioration in schizophrenia, as compared to functional deterioration in affective disorders, was distinguished by a virtual absence of psychotic symptoms with suicidal themes, lower lifetime rates of life-threatening suicide attempts, greater variety and severity of psychotic symptoms, and greater severity of current affective flattening, anhedonia-asociality and disorientation to time. The results of this study extend our previous research by demonstrating that patients with major mood disorders who have experienced extreme functional deterioration evidence a distinct constellation of symptoms that differentiates them from their better outcome peers with mood disorders, and from similarly functionally deteriorated patients with schizophrenia.

Demographics, family history, premorbid functioning, developmental characteristics, and course of patients with deteriorated affective disorder.

OBJECTIVE: This exploratory study examined the characteristics of a group of unusual and previously undescribed patients with major affective disorder who not only had been continuously symptomatic for prolonged periods of time but were also so functionally impaired that they required years of continuous care in psychiatric facilities or by family members. METHOD: Twenty-seven inpatients with major mood disorders and 29 inpatients with schizophrenia were recruited from a large state hospital; 27 outpatients with major mood disorders were recruited from an affiliated outpatient facility. The research battery included the Structured Clinical Interview for DSM-III-R--Patient Version, the Premorbid Adjustment Scale, and a semistructured interview designed to assess demographic, family history, developmental, and course information. RESULTS: Inpatients with deteriorated affective disorder differed from outpatients with nondeteriorated affective disorder along several important dimensions, including family history of mental illness, birth-related problems, physical disorders in infancy, premorbid functioning, presence of mixed episodes and rapid cycling, and medication non-compliance between hospitalizations. Inpatients with deteriorated affective disorder differed from inpatients with schizophrenia on the Premorbid Adjustment Scale. Patients with bipolar affective disorder differed from those with unipolar disorder on many of the variables associated with deterioration of functioning. CONCLUSIONS: Birth-related problems, physical disorders in infancy, and poor premorbid adjustment in childhood and adolescence appear to play an important role in deterioration of functioning among patients with unipolar depression. Disruption in treatment because of medication noncompliance and the appearance of mixed episodes and rapid cycling are associated with functional decline in bipolar affective disorder. Several characteristics previously considered specific to deterioration of functioning in schizophrenia, such as a high rate of birth complications and poor premorbid adjustment, appear to be associated with functional deterioration among patients with major depression as well.