Interrelationship of hypochondriacal, paranoid, depressive, and suicidal symptoms in Chinese psychiatric patients

Data concerning 150 consecutive adult psychiatric patients treated by the authors in a general hospital psychiatric unit were analyzed. All patients with predominant hypochondriacal or paranoid symptoms were selected. The presence of depressed mood and suicidal ideas and their impact on prognosis were investigated. Finally, characteristics of patients with both hypochondriacal and paranoid symptoms were studied. We found that: (a) 79% of the patients with predominant hypochondriacal symptoms were depressed, but only 27% of these had suicidal ideas. These patients usually revealed a poor response to treatment. (b) Only 27% of the patients with paranoid symptoms only were depressed, but their suicidal risk was high. They usually had a good response to treatment. (c) Only 3% of the total sample exhibited both hypochondriacal and paranoid symptoms. They were all thought-disordered schizophrenics but had better prognosis than expected. The psychodynamic background of the results is discussed.     

Distress and attitudes in patients perceived as hypochondriacal by medical staff

The aim of this study was to examine the characteristics of patients perceived by general physicians as hypochondriacal. The authors requested physicians at a general hospital to refer patients for a study of hypochondriasis. In order to measure depression, anxiety, and somatic symptoms, the authors administered several rating and self-rating scales, and to measure hypochondriacal attitudes they administered the Illness Attitude Scales (IAS) and the Illness Behavior Questionnaire (IBQ). The referred patients (N = 29) had more psychiatric disorders, were more depressed and more anxious, and had more severe somatic symptoms than matched medical patients who had not been referred. Self-rated hypochondriacal fears and beliefs did not differ significantly between the groups. Five of the referred patients (17%) whose initial diagnosis was hypochondriasis were subsequently found to have physical diseases that accounted for their symptoms. The implications of these findings for treatment are discussed.     

Hypochondriacal concerns and somatic symptoms in patients with chronic airflow obstruction

In order to explore hypochondriacal concerns in patients with Chronic Airflow Obstruction (CAO) the authors administered the Illness Attitude Scales and the somatization, anxiety, depression and anger-hostility scales of the Hopkins Symptom Checklist to 50 patients with CAO and to matched family practice patients. Somatic symptoms were significantly correlated with fears of disease and hypochondriacal concerns in family practice patients, but were unrelated in CAO. Patients with CAO, although more anxious, depressed and with more severe somatic symptoms than family practice patients, had fewer hypochondriacal concerns. In this respect patients with CAO were unlike any other group previously studied.     

Lobotomy in private practice.

In a follow-up of 43 private psychiatric patients referred for open bimedial prefrontal lobotomies between 1948 and 1970, patients were rated by personal interviews and review of medical records for symptom improvement and organic brain syndromes. Initial diagnoses were obsessive-compulsive neurotic (27), hypochondriacal neurotic (five), manic-deprresive (depressed) (one), and schizophrenic (ten). All had been severely impaired by illness intractable to extensive previous treatment. Thirty-five were found to be virtually free of symptoms that prompted operation, six had some improvement, and two were unimproved. Six had moderate to severe organic brain syndromes; three had seizure disorders necessitating treatment; and 17 incurred substantial weight gains. Best results were for hypochondriacal and obsessive-compulsive neurotic patients with phobic symptoms: poorest results were for paranoid schizophrenic subjects. This study was undertaken to provide some increment of data that could aid ongoing efforts to evaluate the consequences of this treatment.     

Depressed mood and its functional correlates in institutionalized schizophrenia patients

OBJECTIVE: To determine the frequency of depressed mood in institutionalized schizophrenia patients and its association with illness-related and functional variables. METHODS: Out of 657 institutionalized schizophrenia patients, patients with depressed mood were identified and compared to non-depressed patients, matching for potential confounders. RESULTS: Forty-eight (7.3%) patients had moderate to severe depressed mood. They were younger, more educated and had fewer years since their first hospitalization than non-depressed patients. After matching for these variables, depressed patients showed more positive symptoms and exhibited better social and cognitive functioning. When controlling for negative symptoms, the differences in social and cognitive functioning between the depressed and non-depressed patients disappeared, and depressed patients showed more positive symptoms and more impaired impulse control. CONCLUSIONS: Unlike the negative impact of depressed mood in other populations, this study shows that symptoms of depressed mood may identify a subgroup of institutionalized schizophrenia patients who show better functioning across a variety of indicators. Future studies should determine differential treatment responses and long-term outcomes of these patients.     

Are depressive symptoms nonspecific in patients with acute stroke?

OBJECTIVE: Some investigators have suggested that major depression might be overdiagnosed in stroke patients because of changes in appetite, sleep, or sexual interest caused by their medical illness; others have suggested that depression may be underdiagnosed in stroke patients who deny symptoms of depression because of anosognosia, neglect, or aprosody. The authors' goal was to determine how frequently depressive symptoms occur in acute stroke patients with and without depressed mood to estimate how often diagnostic errors of inclusion or exclusion may be made. METHOD: They examined the rate of autonomic and psychological symptoms of depression in 205 patients who were consecutively hospitalized for acute stroke. Eighty-five (41%) of these patients had depressed mood, and 120 (59%) had no mood disturbance. Forty-six (54%) of the 85 patients with depressed mood (22% of all patients) were assigned the DSM-III diagnosis of major depression. RESULTS: The 120 patients without mood disturbance had a mean of one autonomic symptom, but the 85 patients with depressed mood had a mean of almost four. Tightening the diagnostic criteria to account for one more nonspecific autonomic symptom decreased the number of patients with major depression by only three; adding two more criteria decreased the number by only five. Thus, the rate of DSM-III major depression was 1% higher than the rate with one extra nonspecific autonomic symptom and 2% higher than the rate with two extra criteria. Conversely, loosening diagnostic criteria to account for denial of depressive illness increased the rate of major depression by only 5%. CONCLUSIONS: Both autonomic and psychological depressive symptoms are strongly associated with depressed mood in acute stroke patients.     

The phenomenon of ‘chronic Lyme’; an observational study

Purposes: To chart clinical, laboratory, and psychometric profiles in patients who attribute their complaints to chronic Lyme disease. Methods: We assessed the patients by clinical examination, laboratory tests, and questionnaires measuring fatigue, depression, anxiety, health‐related quality of life, hypochondriasis, and illness perceptions. Results: We found no evidence of ongoing Borrelia burgdorferi (Bb) infection in any of the 29 included patients using current diagnostic guidelines and an extended array of tests. Eight (28%) had other well‐defined illnesses. Twenty‐one (72%) had symptoms of unknown cause, of those six met the suggested criteria for post‐Lyme disease syndrome. Fourteen (48%) had presence of anti‐Bb antibodies. The patients had more fatigue and poorer health‐related quality of life as compared to normative data, but were not more depressed, anxious, or hypochondriacal. Their beliefs about the illness were characterized by negative expectations. Conclusion: Our patients, who all attributed their symptoms to chronic Lyme disease, were heterogeneous. None had evidences of persistent Bb infection, but whether current diagnostic criteria are functional in patients with longstanding complaints is controversial. Other well‐defined illnesses or sequelae from earlier Lyme disease were probable as main explanatory factor in some cases. The patients were not more depressed, anxious, or hypochondriacal than the normal population, but they had poorer health‐related quality of life, more fatigue, and negative expectations about their illness.     

Psychiatric comorbidity in DSM-III-R hypochondriasis.

Forty-two DSM-III-R hypochondriacs from a general medical clinic were compared with a random sample of 76 outpatients from the same setting. Patients completed a research battery that included a structured diagnostic interview (Diagnostic Interview Schedule) and self-report questionnaires to measure personality disorder caseness, functional impairment, and hypochondriacal symptoms. Psychiatric morbidity in the hypochondriacal sample significantly exceeded that of the comparison sample. Hypochondriacs had twice as many lifetime Axis I diagnoses, twice as many Diagnostic Interview Schedule symptoms, and three times the level of personality disorder caseness as the comparison group. Of the hypochondriacal sample, 88% had one or more additional Axis I disorders, the overlap being greatest with depressive and anxiety disorders. One fifth of the hypochondriacs had somatization disorder, but the two conditions appeared to be phenomenologically distinct. Hypochondriacal patients with coexisting anxiety and/or depressive disorder (secondary hypochondriasis) did not differ greatly from hypochondriacal patients without these comorbid conditions (primary hypochondriasis). Because the nature of hypochondriasis remains unclear and requires further study, we suggest that its nosologic status not be altered in DSM-IV.     

Executive functioning and depressed mood before and after unilateral frontal lobe resection for intractable epilepsy

Executive dysfunction occurs in a variety of patients who have sustained damage to the frontal lobes. In individuals with frontal lobe epilepsy (FLE) or after unilateral frontal lobe resection (FLR), a unique neuropsychological profile linking executive functions (EF) with the frontal lobe has been elusive, with conflicting findings in the literature. Some studies show greater risk of executive impairment with left-sided FLE or FLR, while others report greater risk for right-sided patients. Some studies report no relationship between FLE and EF impairment, while others show EF impairment regardless of side of seizure foci or surgery. In patients with temporal lobe epilepsy, executive dysfunction is associated with depressed mood possibly reflecting disruption of cortical-limbic pathways and/or frontal–striatal circuitry. Although not previously examined, depression level may affect executive functioning in those with FLE or FLR. We hypothesized that FLE patients with poor mood state would show greater executive dysfunction than FLE patients without poor mood state. The relationship among EF, side of surgery and depressed mood before and 8 months after unilateral FLR was evaluated in 64 patients using validated measures of EF and mood state (Beck Depression Inventory-II). Results indicated that individuals with depressed mood before surgery had greater difficulty on a task of mental flexibility compared to patients without preoperative depressed mood. Further, individuals with depressed mood before surgery had significant increases in perseverative responding and completed fewer categories on a card-sorting task after surgery compared to patients without preoperative depressed mood. Regression analyses showed that among side of surgery, seizure freedom status after surgery and depression status, only pre-surgical depression status explained a significant amount of variance in executive functioning performance after surgery. Results suggest that clinically elevated depressive symptoms before surgery are a risk factor for moderate declines in EF after surgery. Results may be attributable to reduced cognitive reserve in patients with depressive symptoms, or may reflect a common cause attributable to damage to unilateral dorsal and ventral lateral frontal lobe.     

Association between lifestyle activity and depressed mood among home-dwelling older people: a community-based study in Japan

In the community-based cross-sectional study, we investigated patterns of lifestyle activities among older people and examined the association between specific types of lifestyle activity and depressed mood status. The participants were 656 men and women aged 65 or older in 2004 who lived in a rural town in Japan, neither institutionalized nor hospitalized and who did not have symptoms of dementia. We found that less interaction with neighbors, society and friends was highly associated with depressed mood for men. Additionally, although they were physically active in gardening/farming, it did not necessarily mean that they were mentally healthy if they did not have close ties with friends, family and children/grandchildren. For women, it seemed important to engage in several types of activities relating to society, leisure and children/grandchildren to be in less depressed mood. Even if they were socially inactive, if they had frequent contact with family and children/grandchildren or going out for pleasure they were less likely to be depressed. Distinguishing gender differences in lifestyle activity patterns and the association of activities with depressed mood will help to guide the development of depression intervention programs.     

Correlates of lifetime suicide attempts among individuals with affective disorders in a Chinese rural community.

The aim of this study was to compare the demographic and clinical characteristics of individuals with affective disorders who had attempted suicide at some time in their lives and those who had not made a suicide attempt. In a Chinese rural community, individuals with suicide attempt (N = 30) and those without suicide attempt (N = 166) were assessed with Present State Examination (PSE). Attempters had a significantly higher level of family economic status, higher rate of lifetime depressed mood and hopelessness, and delusions than nonattempters. The logistic regression models also indicated that depressed mood and hopelessness were the most important predictors of suicide attempts. No significant difference in treatment condition was found between attempters and non-attempters. Early identification and interventions focusing on reducing depressed mood, hopelessness, and controlling psychotic symptoms may be helpful in reducing the risk of suicide attempts among individuals with affective disorders residing in the community.     

The role of the mother-child relationship in the route from child ADHD to adolescent symptoms of depressed mood

We attempt to explain the co-variation between ADHD and symptoms of depressed mood, focusing on the family context and testing whether the mother-child relationship mediates or moderates the link between child ADHD and youth depressed mood symptoms. In a longitudinal study, we used mother and youth reports for 596 Swedish youth, 50% boys, from a community sample at 10, 15, and 18 years of age. The results did not support the mediation hypothesis. Only one moderation effect was found. Mother-child conflicts in mid-adolescence, as rated by mothers, increased symptoms of depressed mood symptoms in late adolescent only for youth with high levels of hyperactivity symptoms. However, depressed mood symptoms at age 18 were predicted by low mother-child involvement in mid-adolescence, over and above the effects of inattention symptoms. This latter finding was consistent across mother and youth ratings of the relationship. Implications of these results are discussed.     

Correlates of Lifetime Suicide Attempts Among Individuals with Affective Disorders in a Chinese Rural Community

The aim of this study was to compare the demographic and clinical characteristics of individuals with affective disorders who had attempted suicide at some time in their lives and those who had not made a suicide attempt. In a Chinese rural community, individuals with suicide attempt (N = 30) and those without suicide attempt (N = 166) were assessed with Present State Examination (PSE). Attempters had a significantly higher level of family economic status, higher rate of lifetime depressed mood and hopelessness, and delusions than nonattempters. The logistic regression models also indicated that depressed mood and hopelessness were the most important predictors of suicide attempts. No significant difference in treatment condition was found between attempters and non-attempters. Early identification and interventions focusing on reducing depressed mood, hopelessness, and controlling psychotic symptoms may be helpful in reducing the risk of suicide attempts among individuals with affective disorders residing in the community.     

The prognosis of depression in old age

A prospective follow-up of depressed elderly patients is described. The subjects, 91 men and 173 women aged 60 years or over, were diagnosed as depressed in an epidemiological study using the DSM-III criteria. One hundred ninety-nine patients suffered from dysthymic disorder. The mean duration of the follow-up was 14.9 +/- 4.3 months. Outcome was not associated with sex and was good in 41% of the cases. In men, poor outcome was associated with low social participation, low frequency of visiting contacts, and poor insight into the depressive disorder. In women, poor outcome was associated with multiple depressive symptoms, depression diagnosed previous to this study, not living alone, low social participation, low self-perceived health, diurnal variation of symptoms, and the occurrence of initial insomnia, loss of libido, and hypochondriacal and compulsive symptoms. Many similarities were found in factors associated with outcome between all depressed patients and the patients whose depression was diagnosed during our epidemiological study.     

Illness beliefs of depressed Chinese American patients in primary care

This study investigated the illness beliefs of 40 depressed Chinese Americans in a primary care setting using the Exploratory Model Interview Catalogue (EMIC). Twenty-two depressed Chinese Americans (76%) complained of somatic symptoms; 4 (14%) reported psychological symptoms including irritability, rumination, and poor memory. No patients reported depressed mood spontaneously. Yet, 93% endorsed depressed mood when they filled out the CBDI. Twenty-one patients (72%) did not know the name of their illness or did not consider it a diagnosable medical illness, and five patients (17%) attributed their symptoms to pre-existing medical problems. Only three patients (10%) labeled their illness as psychiatric conditions. The patients generally sought help from general hospital (69%), lay help (62%), and alternative treatment (55%) but rarely from mental health professionals (3.5%) for their depressive symptoms. The results suggest that many Chinese Americans do not consider depressed mood a symptom to report to their physicians, and many are unfamiliar with depression as a treatable psychiatric disorder.     

Propagation of major depressive disorder: relationship between first episode symptoms and recurrence

Major depressive disorder is a highly recurrent disorder, with long-term estimates of recurrence ranging as high as 80%. The impact of first episode depressive symptoms on later recurrence has not been previously examined. The present study sought to identify risk factors for recurrent major depressive episodes by investigating first episode symptoms. It was predicted that the presence of depressed mood and sleep disturbance in the first episode would increase the likelihood of recurrence. Four hundred eighty-seven randomly selected community participants who met DSM-III-R criteria for at least one major depressive episode were assessed twice during adolescence and once in young adulthood. We examined the association between first major depressive episode symptoms and the presence of a recurrent episode. Recurrence was significant predicted by the presence of depressed mood and increased appetite at episode 1. A nonsignificant trend suggested that female gender may also be associated with recurrence. First episode depressed mood, increased appetite, and female gender may serve as specific risk factors for recurrence. The centrality of depressed mood to major depressive disorder is highlighted.     

The relationship between academic performance and severity of depressed mood during medical school

We employ a structural equation model to examine the relationship between academic performance and depressed mood over 4 years for a single medical school class. Academic performance measures included undergraduate gradepoint average, first- and second-year medical school gradepoint average, full Medical College Admissions Test (MCAT) and total National Boards Part I (NB) scores. Severity of depressed mood was assessed by administering the Beck Depression Inventory two times per year during the first 2 years, and once per year during the last 2 years. Overall there is little reason to think that depressive mood states compromise academic performance during the first 2 years of medical school for the class as a whole. Medical school grades had no direct impact on depressed mood, and mood had no direct impact on grades. There was a non-significant tendency for mood in the months preceding National Boards Part I to influence Board scores, which in turn influenced mood. Students with higher college gradepoint averages consistently reported fewer depressive symptoms throughout medical school. The latter result directs attention to a subgroup of medical students less susceptible to depression, or less prone to admit distress or symptoms. The non-susceptible and/or minimizing qualities of this subgroup merit further investigation.     

Relationship between hypochondriacal concerns and personality dimensions and traits in a military population

Our aim was to examine the relationship between personality dimensions and hypochondriacal concerns and somatic symptoms in a military population. The Schedule of Nonadaptive and Adaptive Personality along with measures of hypochondriacal concerns and somatic symptoms were administered to 602 military veterans who had been on active duty during the 1991 Gulf War. Factor analyses identified six separable dimensions-two of hypochondriacal concerns, two of somatic symptoms, and two of possible mechanisms of symptom generation-for study. Multiple regression models determined the proportion of variation in these measures of somatic distress explained by personality scales. Personality measures explained between 26% and 38% of the variance in hypochondriacal concerns and somatic symptoms, and Negative Temperament accounted for most of this. Moderately strong positive correlations were observed between trait scales Mistrust, Low Self-Esteem, and Eccentric Perceptions and the various measures of somatic distress. Thus, when Negative Temperament was taken into account, few significant correlations between personality measures and hypochondriacal concerns or somatic symptoms remained. Negative temperament or neuroticism is strongly associated with hypochondriacal concerns. Important features of hypochondriasis and somatic distress appear to lie within the domain of personality. It remains for future research to show whether negative temperament is a vulnerability factor for hypochondriasis or hypochondriasis is itself a personality disorder.     

The specificity of depressive symptoms in patients with Alzheimer's disease

OBJECTIVE: This study assessed the specificity of depressive symptoms in patients with Alzheimer's disease and examined the discrepancies between patient and caregiver symptom reports. METHOD: The study group was composed of a series of 233 patients with Alzheimer's disease, 47 patients with depression but without dementia, and 20 healthy comparison subjects; the latter two groups were comparable in age with the patients with Alzheimer's disease. The patients and comparison subjects received a comprehensive psychiatric evaluation, which included administration of the Hamilton Depression Rating Scale and the Structured Clinical Interview for DSM-IV. RESULTS: Patients with Alzheimer's disease with a score of 2 or higher on the "depressed mood" item of the Hamilton depression scale, as scored by their respective caregivers, comprised a group with depressed mood (N=92), whereas patients who scored 0 on this item comprised a group without depressed mood (N=62). A statistical comparison of the scores on the remaining Hamilton depression scale items (2-16) between the Alzheimer's disease patients with and without depressed mood revealed significant differences on all items, except "loss of appetite." However, there were no significant differences on any single Hamilton depression scale item between the Alzheimer's disease patients without depressed mood and the age-comparable healthy comparison subjects. CONCLUSIONS: Depressive symptoms are not widespread among patients with Alzheimer's disease but are significantly related to an underlying depressed mood. Patients with Alzheimer's disease may not be fully aware of the extent of their depressive symptoms.     

The cognitive-behavioral model of hypochondriasis: misinformation and triggers.

According to the cognitive-behavioral model, hypochondriacal individuals hold dysfunctional assumptions about illness, which may be triggered by critical incidents. In this study 1,158 participants completed measures of hypochondriacal concerns and self-esteem, and estimated the likelihood of various symptoms indicating catastrophic and minor illnesses. Participants who were more hypochondriacal believed that catastrophic outcomes were more likely than did the less hypochondriacal participants, but they did not differ in their estimates for minor illnesses. Estimates of the likelihood of catastrophic illness and self-esteem independently contributed to the prediction of hypochondriacal concerns. In this study 2,177 participants completed a measure of hypochondriacal concerns, performed a scrambled-sentences task that included either illness terms or neutral terms, and completed a state anxiety inventory. The illness terms did not trigger higher levels of anxiety in the more hypochondriacal participants; instead, these terms appeared to make the less hypochondriacal participants as anxious as their hypochondriacal counterparts.