Depression among cocaine abusers in treatment: relation to cocaine and alcohol use and treatment outcome.

OBJECTIVE: The authors investigated the theoretical and clinical role of depression among cocaine abusers in treatment. METHOD: Eighty-nine cocaine-abusing patients underwent 2 weeks of substance abuse treatment. Posttreatment major depressive disorder, depressive symptoms before and after substance abuse treatment, and alcohol diagnoses were assessed and their relation to pretreatment substance use, cravings in high-risk situations, and 3-month follow-up status was examined. RESULTS: High rates of major depressive disorder were found but were unrelated to pretreatment substance use. The decrease in depressive symptoms during treatment was independent of major depressive disorder or alcohol diagnoses and predicted treatment attrition. Higher levels of depressive symptoms during treatment were associated with greater urge to use cocaine, alcohol, and other drugs in high-risk situations. Concurrent major depressive disorder and depressive symptoms did not predict cocaine use at follow-up. However, patients who had an alcohol relapse episode experienced more depressive symptoms during treatment than did those who abstained. CONCLUSIONS: The results highlight the relationship of depression to alcohol use among cocaine abusers and suggest a need for further studies of the association between depression and substance use disorders.

Hospitalized children of substance-abusing parents and physically and sexually abused children: a comparison.

The symptoms and diagnoses of 58 psychiatrically hospitalized children aged 12 or under who were children of substance abusing parents (COSAPs) were compared with a matched group of 51 children who were not COSAPs. These two groups were further subdivided according to history or lack of history of physical and/or sexual abuse. Symptoms and diagnoses of COSAPs and physically and/or sexually abused (P/SAs) children differed significantly from the hospitalized group who were neither COSAPs nor P/SAs. Being a COSAP and/or P/SA are strong correlates of psychiatric hospitalization for the children studied. Both high-risk groups should be awarded special diagnostic and treatment consideration that would include their systematic identification and focused treatment.

Characteristics of adolescent psychiatric patients who engage in problematic behavior while intoxicated.

Although many adolescent psychiatric patients drink and use drugs, not all engage in problematic behaviors or experience social difficulties while intoxicated. The goal of this study was to identify characteristics of adolescent psychiatric patients for whom intoxication leads to behavioral, social, and medical problems. Alcohol-involved adolescent psychiatric inpatients were divided into high and low problem severity groups and compared on a number of measures. The groups did not differ in alcohol or drug consumption or psychiatric diagnoses. High problem severity was primarily associated with drinking in response to unpleasant affect and the belief that alcohol enhances social behavior. Explanations for the results are discussed, along with clinical implications.

Incarcerated adolescents' attributions for drug and alcohol use.

Incarcerated adolescents' attributions for drug use were investigated. A new 50-item questionnaire, the Inventory of Drug Taking Situations (IDTS), was used to assess reasons for use. The IDTS yields eight subscales corresponding to risky situations identified by Marlatt and others. On the IDTS, subjects indicate how frequently they used their drug of choice when confronted with each risky situation. The IDTS scales had good internal consistency and higher scores were significantly associated with self-reports of drug use frequency. Furthermore, IDTS scores were most valid for the type of drug the measure was filled out about. Adolescents reported that they tended to use more frequently in response to positive and/or interpersonal experiences, as opposed to negative and/or internal ones. Positive, negative, interpersonal, and internal reasons for use were all equally correlated with frequency of use. In the most heavily drug-involved adolescents, however, negative reasons were more highly correlated with frequency of use than positive reasons. Treatment implications are discussed.

Family dysfunction and alcohol and drug use in adolescent psychiatric inpatients.

This report examines the relationship between family functioning and substance abuse in adolescent psychiatric inpatients. The adolescents, who had been hospitalized after acute psychiatric crises, provided reports of drug and alcohol use, intoxication-related problems, and family functioning during the 4 months preceding hospitalization. Greater degrees of family dysfunction in the areas of affective responsiveness and role functioning were associated with higher levels of substance abuse. When age, sex, and diagnosis were controlled for, family dysfunction in these areas was still significantly associated with alcohol consumption but not with drug use or intoxication-related problems. Implications for treatment are discussed.

MMPI profiles in anorexia nervosa patients with and without major depression.

Anorexia nervosa patients with (AN-RDC+) and without (AN-RDC-) a current episode of nonbipolar major depression (MDD) differed with respect to their Minnesota Multiphasic Personality Inventory (MMPI) profiles. Mean MMPI scores in AN-RDC+ significantly differed from AN-RDC-patients in all but two MMPI scales. AN-RDC+ patients had a significantly higher number of abnormal (T greater than 70) MMPI scales per subject and significantly more subjects with greater than or equal to 3 abnormal scales compared with AN-RDC-patients. These MMPI data suggest that the presence or absence of MDD in anorectic patients may distinguish meaningful subtypes and provide further support for the validity of the stratification of anorectic patients into those with and without nonbipolar MDD.

Depressive disorders in relatives of anorexia nervosa patients with and without a current episode of nonbipolar major depression.

The first-degree relatives of anorexia nervosa patients with current nonbipolar major depression had a higher rate of depression than the relatives of anorexic patients without current depression, whose rate was similar to that for relatives of normal control subjects.

Amitriptyline in the treatment of anorexia nervosa: a double-blind, placebo-controlled study.

The tricyclic antidepressant drug amitriptyline was evaluated as a short-term treatment of anorexia nervosa patients. In a 5-week double-blind, placebo-controlled study 11 patients were given amitriptyline and 14 received placebo. In addition, 18 patients who refused to participate in the drug trial and received only psychosocial treatment were used as an additional comparison group. Overall, patients in the three groups showed little improvement. No statistically significant differences favoring amitriptyline were found in any of the outcome variables. Plasma levels varied widely among patients receiving similar doses. No association was found between plasma levels and improvement in either psychiatric symptomatology or weight. Amitriptyline patients did not manifest any tendency for a reduction of depressive symptomatology. In addition, amitriptyline treatment was associated with substantial discomfort and adverse affects.

Anorexia nervosa and affective disorders: a controlled family history study.

Analysis of family history information from a prospectively studied group of 40 young female patients with anorexia nervosa and 23 normal control female subjects of similar age showed more depression and substance use disorders in first- and second-degree relatives of anorexia nervosa patients. Further, the pedigrees of the patients differed significantly from those of the control subjects in the higher frequency of depression and substance use disorders in consecutive generations and in the family "loading" of these disorders. These findings, consistent with previous reports, add to the growing evidence of an association between anorexia nervosa and familial risk for affective and related disorders.

Platelet MAO activity in anorexia nervosa patients with and without a major depressive disorder.

Platelet MAO activity was determined in 33 anorexia nervosa patients. A subgroup of 15 patients who met Research Diagnostic Criteria for a concomitant major depressive disorder were found to have, both initially and after 5 weeks of treatment, significantly lower mean platelet monoamine oxidase (MAO) activity than 28 matched normal control subjects. In contrast, mean platelet MAO activity in the patients who did not meet criteria for major depressive disorder was similar to values in control subjects. The authors found that significantly more depressed patients had low MAO activity compared with nondepressed patients and controls. Platelet MAO activity may be useful in discriminating among subtypes of anorexia nervosa patients.

High frequency of HLA-Bw16 in patients with anorexia nervosa.

Anorectic patients (N = 37) had a higher frequency of HLA-Bw16 than normal controls, due to the higher frequency of HLA-Bw38. They also had a higher rate of A26-Bw38. HLA typing may lead to hypotheses about the biology of anorexia nervosa.

Urinary mhpg in anorexia nervosa patients with and without a concomitant major depressive disorder.

Twenty-four hour urinary MHPG excretion was measured in a group of anorexia nervosa patients before and after five weeks of treatment and in matched normal control subjects. A sub-group of anorexia nervosa patients who met research diagnostic criteria (RDC) for a concomitant major depressive disorder (AN-RDC +) was found to have, both initially and after treatment, significantly lower mean urinary MHPG levels than the normal control subjects. In contrast, mean urinary MHPG levels in anorexia nervosa patients who did not meet criteria for major depressive disorder (AN-RDC +) were similar to values in normal controls. Utilizing the median value of all urinary MHPG samples as the cut-off point, it was found that significantly more AN-RDC + patients excreted low MHPG compared with AN-RDC-patients and normal control subjects. The manifestation of a major depressive disorder according to RDC was found to be more important than body size variables in predicting the variance of MHPG. It is suggested that urinary MHPG levels may be useful in discriminating between sub-types of anorexia nervosa patients.

Psychiatric effects of the anticonvulsant regimens.

The necessity for and efficacy of the anticonvulsant regimens are undisputed. However, inasmuch as epileptic patients are prone to psychiatric disorders, neurologists, psychiatrists, and others working with epileptic patients need to be aware of the role that anticonvulsant regimens may play in causing or exacerbating psychiatric disorders. Additionally, some of the anticonvulsants are thought to have potent positive psychotropic effects. The current literature on this important biopsychosocial topic is reviewed with the purpose of suggesting helpful clinical and research approaches to patients treated by such methods.

The Börjeson-Forssman-Lehmann syndrome: a new case.

A new case of the Borjeson-Forssman-Lehmann syndrome is described with details of anthropometry, dermatoglyphs, endocrine function studies and mental state. Comparisons are made with the five previously reported cases. The diagnosis is based on the clinical appearance. Endocrine studies gave normal results and the patient's short stature is not due to growth hormone deficiency. There is no evidence for primary hypogonadism.

Diagnosis and lithium treatment of affective disorder in the retarded: five case studies.

The authors report on five institutionalized retarded patients who had symptoms strongly suggestive of manic-depressive illness and who showed significant symptom reduction in a single-blind placebo-controlled three-year trial of lithium. The number of illness episodes was reduced, and symptoms decreased in all major illness dimensions. These findings indicate that major affective disorder can be both diagnosed and treated in individuals with primary mental retardation.