Predictive value of thought disorder in new-onset psychosis.

OBJECTIVE: This research addresses the relationship of formal thought disorder in the early stages of psychotic illness to the long-term outcome of mental health many years later. The specific topic of concern was to evaluate the prognostic significance of thought disorder on the severity of psychosis over time. METHODS: Subjects with new-onset psychosis were evaluated on a variety of measures including education, physical health, Brief Psychiatric Rating Scale scores. They were also given the Thought, Language, and Communication Scale to evaluate thought disorder. Subjects were interviewed again at 10 and 20 years to evaluate variations in outcome. Appropriate statistical methods were used to evaluate changes in the level of functioning over time. RESULTS: Thought disorder was not unique to schizophrenia. Bipolar patients presented with significant positive thought disorder at the onset of psychosis. Overtime positive thought disorder gradually improved in most patients. Negative thought disorder was more persistent, especially in subjects with schizophrenia. Initial psychosis with thought disorder characterized by poverty of content seemed to be associated with poor long-term outcome. CONCLUSION: Formal thought disorder can predict outcome in some cases of psychosis. Not all types of thought disorder have the same prognostic implication. Positive forms of thought disorder (pressured speech, tangentiality) had no significant predictive value. Negative thought disorder (particularly poverty of speech and poverty of content) tend to predict a chronic, more unrelenting course of illness.

The relationship between DST results and suicidal behavior.

The authors assessed the relationship between dexamethasone suppression test (DST) results and suicidal ideations and behavior. Four-hundred-twenty-three mood disorder patients admitted to a tertiary care medical center were administered the DST from 1978 to 1981. The patients were subsequently followed up to determine death status using a record-linkage method. More than 44% had abnormal cortisol suppression (nonsuppressors) at the index admission. Suppressors and nonsuppressors did not differ significantly with respect to frequency of suicidal ideations or completed suicides. Suppressors were significantly more likely than nonsuppressors to have a history of suicide attempts or to have a suicide attempt following hospital discharge. Using logistic regression, and controlling for several important variables including diagnosis, maximum postdexamethasone cortisol was not significantly associated with suicide, suicidal ideation, or suicide attempts. We conclude that an abnormal DST is not useful as a predictor of suicidal behavior.

A Multivariate Analysis of the Experience of 423 Depressed Inpatients Treated with Electroconvulsive Therapy.

Stepwise multiple logistic regression was used in an attempt to identify variables associated with "recovery" in a group of 423 depressed inpatients who received electroconvulsive therapy (ECT). Patients who had recovered were older at index admission than the nonrecovered, and had received fewer ECT sessions. They were less likely to have a secondary depression, to have Winokur's depression spectrum disease, to receive lithium, or to have a chronic course. The significance of the findings is discussed.

Illness Duration and Acute Response in Major Depression.

The authors looked at the association of illness duration and acute treatment response in 1,087 patients with unipolar major depression. Three treatment groups were compared, including a group that received electroconvulsive therapy (ECT), a group that received antidepressants, and a group receiving neither ECT nor antidepressants. Up to an illness duration of 2 years, treatment was significantly associated with recovery; ECT produced significantly better results than other treatments. However, when the illness had lasted >2 years, the ECT-treated group showed a significant decline in recovery, and ECT was no longer superior to other treatments. We conclude that duration of illness at index hospitalization has an important influence on treatment response rates and the likelihood of recovery by hospital discharge.

Convulsive Therapy and the Course of Bipolar Illness, 1940-1949.

A total of 93 bipolar patients admitted in the 1940s were divided into those who received convulsive therapy and those who did not. Clinically, the two groups were similar. Those who received convulsive therapy were discharged back home more frequently, indicating the efficacy of the treatment. Those who received convulsive therapy showed more episodes, both manias and depressions, in the course of their illnesses. The reason for this difference in course of illness is not known, but deserves further exploration. The explanation may involve either biological factors or social circumstances related to a successful treatment outcome.

ECT in Unipolar and Bipolar Disorders: A Naturalistic Evaluation of 460 Patients.

We compared the efficacy of electroconvulsive therapy (ECT) and numbers of ECTs received by unipolar depressive (n = 368), bipolar depressive (n = 55), and manic patients (n = 37) in a review of records of patients treated in a 12-year period in a university hospital medical center. Both unipolar and bipolar depressive patients received nine treatments, one half more on average than the number of treatments received by manic patients, but the difference was not significant. ECT was equally effective in unipolar and bipolar depression (69.8 and 69.1%, respectively, rated as "markedly improved"), whereas 78.4% of patients with mania had "marked improvement." Both unilateral and bilateral ECTs were equally effective for the three groups. Bipolar depressive and manic patients receiving mixed courses (some unilateral, some bilateral) received more treatments than did those receiving unilateral or bilateral treatments exclusively and tended not to respond as well. We conclude that ECT is an effective treatment for mania, unipolar, and bipolar depression, that unilateral and bilateral treatments are equally effective, and that no significant difference exists in the number of ECTs used to treat these disorders.