Outcome of neurotic disorders in African patients

Among 130 patients who attended the neurotic diseases clinic in Benin 1963–1965, it was possible to follow-up 60 patients 8–9 years later. Thirty-four patients were diagnosed as anxiety cases and of these 21 had recovered and a further five were considerably improved. Nineteen patients were considered cases of neurotic depression and of these only three had recovered whereas 14 had residual symptoms, although five showed considerable improvement. Two of the depressive patients had died, one during the civil war, the other presumably committed suicide. Of five patients with hysteria, one had recovered and one had become worse, one patient with hypochondriasis had also recovered whereas one patient with obsessional neurosis did not recover. The results are in line with similar European and American follow-up studies of neurotic disorder except that the depressive patients showed a less satisfactory outcome.     

Psychiatric disorders in patients with blepharospasm - a reactive pattern?

Objective: The purpose of this study was to assess the life-time prevalence of all major psychiatric disorders in patients suffering from blepharospasm.Method: A total of 31 consecutive patients with blepharospasm attending the Department of Neurology were interviewed at the Department of Psychiatry at the University of Vienna. Patients had been submitted to standard neurological diagnostic procedures, psychiatric diagnoses were made with the help of the SCID, functional impairment was assessed by the General Assessment of Functioning Scale (GAF).Results: A current or life-time psychiatric diagnosis was made for 22 patients (71%). The most frequent disorders were depressive disorders, mainly major depression (five patients, 16.1%), secondary dysthymia (six patients, 19.3%), and recurrent major depression (five patients, 16.1%). A diagnosis of simple phobia was made for seven patients (22.5%), for obsessive–compulsive disorder in three patients (9.6%). The mean GAF score of our sample was 63.1%.Conclusion: In contrast to previously published results, we did not find a high rate of a single specific disorder or patterns in our study sample, though by the inclusion of life-time diagnostic criteria, the majority of patients fulfilled criteria for at least one diagnosis. This might indicate the considerable negative impact of blepharospasm on the patients' lives.     

Psychiatric diagnoses made by the agecat system in residents of local authority homes for the elderly: Outcome and diagnostic stability after four years

Eighty-six residents of 12 local authority homes for the elderly were interviewed with the Geriatric Mental State (GMS) in 1985/6 after having been classed as depressed by a screening interview. The data so gathered were analysed by the computerized diagnostic program AGECAT in order to derive psychiatric diagnoses for these residents. All were traced after four years; 61 were dead. The 25 survivors were reinterviewed and given a second AGECAT diagnosis. In 1985/6 70 of the 86 examined were ‘diagnostic cases’ of psychiatric disorder. After four years 22 of the 25 survivors were classed as diagnostic cases. AGECAT diagnoses of organic psychosis were stable over four years within this population though the majority of subjects so diagnosed died within four years. Cases of depression had a more varied prognosis, with death, continunce as cases of depression or progression to organic psychosis being the most common outcomes. Recovery from any class of AGECAT disorder was an uncommon event.     

Psychalgic depressive disorder: a descriptive and comparative study

In this study 35 consecutive patients diagnosed as having psychalgic depressive disorder (PDD) who lacked sadness but presented with chronic pain have been described. The patients were mainly female, middle-aged and from an urban background. Pain, usually at multiple sites, was reported to be severe by most patients. Predominant depressive symptoms were lack of interest in surroundings (97%), although this was not directly reported, early morning awakening (91%), loss of appetite (100%), and suicidal ideas (66%). None had marked sadness or weeping spells. Lack of reactivity of mood was present in only 2 cases. These psychalgic depression cases were compared with a group of 30 patients diagnosed as having psychogenic pain disorder. PDD cases were significantly more often female, married, less educated, and from an urban background. Pain was significantly more intense and at multiple sites, as compared with the psychogenic pain disorder cases. Clinical outcome was better for PDD cases.     

Diagnosing major depressive disorder IV: relationship between number of symptoms and the diagnosis of disorder

The symptom inclusion criteria for DSM-IV major depressive disorder (MDD) consist of a list of nine characteristic features of depression, at least five of which must be present. Two of the criteria for MDD, low mood and loss of interest or pleasure, are accorded greater importance than the remaining seven criteria in that one of these two features is required for the diagnosis. The implicit assumption underlying this organization of the criteria is that some individuals might meet five of the nine criteria without experiencing low mood or loss of interest or pleasure and thus be inappropriately diagnosed with major depression. We are not aware of any studies that have examined this assumption. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined how many psychiatric outpatients meet five of the nine DSM-IV criteria for MDD without simultaneously experiencing either low mood or loss of interest or pleasure. If this pattern is rare or does not exist, then the method of counting criteria to diagnose major depression could be simplified to a straightforward five out of nine. Twenty-seven (1.5%) patients reported five or more criteria in the absence of low mood or loss of interest or pleasure. More than half (N = 16) of these 27 patients were diagnosed with MDD or bipolar disorder, depressed type, in partial remission (N = 14), bipolar disorder mixed type (N = 1), or bipolar disorder not otherwise specified (N = 1). Six of the remaining 11 patients were diagnosed with depressive disorder not otherwise specified. Thus, few patients who met five or more of the MDD criteria were not diagnosed with a depressive disorder. This suggests that the diagnostic criteria for MDD can be simplified to a straightforward symptom count without reference to the necessity of low mood or loss of interest or pleasure.     

Prevalence, diagnosis, and treatment of depression and generalized anxiety disorder in a diverse urban community

OBJECTIVE: This study assessed the prevalence, diagnosis, and treatment of major depressive disorder and generalized anxiety disorder among New York City adults. METHODS: As part of the first community-specific Health and Nutrition Examination Survey in the United States, depression and anxiety were assessed in a representative sample of 1,817 noninstitutionalized adults in 2004. RESULTS: A total of 8% had major depressive disorder and 4% had generalized anxiety disorder. Respondents with depression were more likely to be formerly married, publicly insured, younger, and U.S. born. Only 55% of adults with depression were diagnosed, and 38% of those with depression or anxiety were in treatment; individuals with a diagnosis of depression were more likely to receive treatment than those without a diagnosis (61% versus 7%; p<.001). Immigrants with depression were 60% less likely to be diagnosed than their U.S.-born counterparts; immigrants arriving in this country ten or more years ago had slightly more anxiety than immigrants arriving less than ten years ago (3% versus 2%, not significant). Among respondents with anxiety, 23% reported disability compared with 15% of those with depression. Compared with adults with neither diagnosis, adults with depression or anxiety were twice as likely to smoke tobacco (p<.05), adults with depression were twice as likely to have diabetes (p<.01), and those with anxiety were twice as likely to have asthma (p<.01). CONCLUSIONS: Mental disorders are often disabling and inadequately diagnosed and treated. Foreign-born adults experience barriers to diagnosis and treatment despite having less depression; anxiety may increase with time since immigration. Increased awareness of and linkage to mental health services are needed, especially in larger, more diverse urban communities.     

Affective Disorders in Alcoholism

The author examined affeotive disorders and other related symptoms (atypical chronic depressive state, suicide and self-destructive behavior) in 141 male alcoholics to evaluate the relationship between alcoholism and affective disorders. The results were: five cases (3.5%) with primary affective disorder (2 with circular type, 1 with depressed type and 2 with involutional melancholia), nine with atypical chronic depression (4 with depressive neurosis and 5 with depressive paranoid reaction), one with successful suicide and three with prominent self-destructive behavior on excessive drinking. The incidence of primary affective disorder in alcoholism approximates to 2 to 4 percent in Japan, and is a little lower than that of U.S.A or of Europe. A characteristic of the clinic for alcoholism was the frequent presentation of atypical or chronic depression. This was usually diagnosed as depressive neurosis or depressive personality disorder, and some developed to a transient paranoid state with excessive drinking. The rate of suicide in alcoholism seems to be lower in Japan than in Western countries: approximately a few percent in a few years in this country and 7 to 8 percent in Western countries. Those cases with prominent self-destructive behavior were young alcoholics. They had underlying personality disorders and complicated life histories.     

Frequent association of autism spectrum disorder in patients with childhood onset epilepsy

Autism spectrum disorder (ASD) has a close relationship with epilepsy. This study retrospectively examined patients with epilepsy associated with ASD. Among the 519 patients with epilepsy, 79 patients (15.2%) had ASD. Sixty-two patients had idiopathic ASD and 17 had secondary ASD. The epilepsy patients with idiopathic ASD were retrospectively analyzed. There were 47 males and 15 females, ranging from 2 to 43 years of age (median 11 years). The most frequent age at the onset of seizures was 4 years, and 85% occurred before 10. ASD was detected after the onset of epilepsy in 29 cases (46.8%), and eight of them had been overlooked for more than five years. Most of these were high-functioning ASD cases. The most frequent type of seizure was a complex partial seizure (CPS; 68%). Paroxysmal activities on EEG were localized in the frontal area in about half of the cases. Multiple anti-epileptic drugs were used in 33.8% cases (two in 17.7%, three in 16.1%), and 67.3% of the patients were seizure-free for more than two years. An amelioration of the autistic symptoms occurred after epilepsy treatment in five cases (8%).     

Catatonic features noted in patients with post-partum mental illness

The purpose of the present study was to investigate the prevalence, distribution of psychiatric diagnoses, and treatment responses of patients with post-partum mental illness at an emergency unit at Chang Gung Memorial Hospital at Kaohsiung in Taiwan. During a 1 year period a total of 636 Taiwanese women received psychiatric consultation on their visits to the emergency room. Fifteen of these were noted to have post-partum mental illnesses. All subjects were followed up for a minimum of 3-6 months. The prevalence of patients with post-partum mental illness at an emergency unit at Chang Gung Memorial Hospital at Kaohsiung was 2.4% (15/636). The distribution of psychiatric diagnoses according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria included eight cases of major depressive disorders (53.3%), three cases of bipolar I disorder (20%), three cases of schizophrenia (20%), and one case of psychotic disorder due to a general medical condition (6.7%). Four subjects manifested catatonic features. Of these four, three had complete remission in catatonic symptoms after receiving intramuscular injection of lorazepam. The fourth subject died of multiple medical diseases. The treatment results suggest that most of the clinical presentations in patients with post-partum mental illness could be relieved by antipsychotics, mood stabilizers or antidepressants. In addition, it was found that intramuscular injection of lorazepam was also effective in patients with catatonic features and post-partum depression or psychosis.     

On mental disorder and somatic disease in suicide: A psychological autopsy study of 100 suicides in northern Sweden

Suicide is strongly correlated to mental disorders. In several studies up to more than 90% of the deceased could be given psychiatric diagnoses. The aim of this study is to account for psychiatric and somatic disorders in suicide and to discuss their relation to the suicide and the implications for preventive work. One hundred consecutive cases of suicide in Va¨sterbotten County, 25 women and 75 men, were investigated by means of telephone interviews with close relatives, police reports, psychiatric and other medical records, and data from the forensic investigation. In 96% at least one axis-I diagnosis according to DSM-III-R was found. The most common psychiatric disorders were mood disorders (63%), psychoactive substance use disorders (37%), and personality disorders (22%). Two-thirds of the subjects had one or more somatic disorder of significance for the case. In 50% of the cases two or more psychiatric diagnoses could be given. Schizophrenic subjects died on average 14 years after their first psychiatric contact, at a mean age of 36 years, whereas subjects with major depression died on average 4 years after their first contact, at 55 years. The finding that 96% of the deceased had at least one mental disorder and a high occurrence of somatic disorders is interpreted as a severe increase in the burden of the person, which restricts his/her ability to satisfy vital dependency needs. The issue of specific personality characteristics in suicide should be further investigated.     

Psychiatric adolescent inpatients: eight- to ten-year follow-up.

Seventy-seven adolescent psychiatric inpatients, whose index hospitalization was at a mean age of 16, were followed up for eight to ten years after discharge. The important findings at follow-up were as follows. Twelve patients had bipolar affective disorder and were severely disabled (of these, 11 had a long-term clinical course and three committed suicide). Sixteen patients had unipolar depression: five had one depressive episode and were well throughout the follow-up period, one patient had many episodes with complete remissions, and the remaining ten patients had only partial remissions and their impairment of functioning corresponded to the severity of their symptoms. One of the ten committed suicide. Eighteen (23%) patients were psychiatrically well and functioned adequately throughout the follow-up period. Five had primary depressions, five had undiagnosed psychiatric illness, and eight were diagnosed as not having a psychiatric disorder.     

Anxiety and depression in a primary care clinic. Comparison of Diagnostic Interview Schedule, General Health Questionnaire, and practitioner assessments

Over one half of all persons seen in a primary care clinic were identified as having anxiety or depressive disorder by the primary care provider, the General Health Questionnaire (GHQ), or the Diagnostic Interview Schedule (DIS). In only about 5% of all patients were findings positive on all three assessments concurrently. Both the GHQ and the practitioners identified over 30% of all patients as having a disorder, while about 8% had one or more of five DIS anxiety or depressive disorders (major depression, dysthymia, panic disorder, generalized anxiety disorder, or obsessive-compulsive disorder). Of the patients with DIS disorders 83% had positive GHQ scores, and 73% were identified by the practitioner as having a mental disorder.     

The course of major depression in the offspring of depressed parents. Incidence, recurrence, and recovery.

The 2-year course, first onset (incidence), recurrence, and recovery of major depression in 174 offspring at high and low risk for major depression were studied. A variety of predictors of course were examined, including parental diagnosis, demographic and clinical characteristics of the family and offspring, comorbidity and social functioning in offspring, and family risk factors. The 2-year incidence rate was 8.5%. All of the incident cases of major depression occurred in offspring of depressed parents. Additional predictors of incidence were a preceding diagnosis of conduct disorder and subclinical symptoms of depression. The recurrence rate results are tentative because of the small sample. The 2-year recurrence rate was 16.1%. Predictors of recurrence were a previous comorbid diagnosis of dysthymia or problems in social functioning. By the end of 2 years, the majority of offspring (87%) had recovered. The mean number of weeks to recovery was 54 in the offspring of depressed parents and 23 in the offspring of nondepressed parents. Offspring with an onset of major depression at age 13 years or younger, who were exposed to divorce in the family or who had been exposed to more than one parental depressive episode, had significantly more protracted times to recovery. We conclude that there are different predictors of incidence of major depression, its recurrence, and time to recovery in offspring, and that parental depression has an impact on the course in offspring.     

Neuropathology and prognosis of foetal brain tumours

A survey of brain tumours that had been diagnosed prenatally by foetal sonography yielded 89 cases. The most commonly found tumour entities were teratomas (53.9%), glioblastomas (14.6%), lipomas (9.0%), plexus papillomas (7.9%) and craniopharyngiomas (5.6%). The mean gestational age at ultrasound diagnosis was 30.0 weeks, ranging between 25.4 weeks in craniopharyngiomas and 35.3 weeks in lipomas. Girls were more frequently affected (57.4%; P < 0.05). The average maximum tumour size at diagnosis was 6.5 cm, ranging between 1.6 cm in lipomas and 8.2 cm in teratomas. Tumours diagnosed between 1979– 1988 accounted for 29.2% of all cases and were larger when identified than the ones reported between 1989– 1998 (5.9 vs 8.4 cm; P = 0.08). Of all patients, only 18.8% were alive after the first week and 10.5% after the 1st year of life. Prognosis was particularly poor among foetuses with brain tumours detected before 30 weeks’ gestation of which 96.9% died. Significantly longer survival was found for lipomas (12.0 vs 3.8 months), tumour detection after gestational age of 30 weeks (6.3 vs 1.2 months) and in cases reported after 1988 (5.3 vs 2.9 months, all P < 0.05). Cytogenetic data was given for eight teratomas of which three showed a pathological and five cases a normal karyotype for both foetus and tumour. In conclusion, foetal brain tumours are rare neoplasms of whose cytogenetics little is known. They are mainly detected at the beginning of the third trimester of pregnancy with teratomas being the most common entity. Foetal brain tumours have a mainly unfavourable clinical outcome. However, their prognosis has improved in the last decade. Received: 16 June 1999 / Revised, accepted: 3 August 1999     

DSM-III diagnoses in chronic pain. Confusion or clarity?

The assessment of patients with chronic pain is receiving increasing attention by psychiatrists. Recent publications have put forward the concept of the "pain-prone disorder" as a variant of depressive illness. This study describes a series of 50 consecutive patients with chronic pain in terms of the five axes of the DSM-III nosology. Diagnoses were made after a 90- to 120-minute psychiatric interview, and a check on diagnostic reliability was made on a small subsample. Psychological factors affecting physical condition were diagnosed in 34% and dysthymic disorder was diagnosed in 28%, while major depression, psychogenic pain disorder, somatization disorder, and anxiety disorders were each respectively diagnosed in 8%. Only 6% had no diagnosis on axis I and 4% had no diagnosis on axis III. Personality disorder was diagnosed in 40%, and traits of dependence, compulsiveness, and anxiety were common. Overall, the patients had experienced a high degree of psychosocial stress with fair to poor adaptive functioning. The notion of chronic pain as a variant of depressive disease is questioned on the basis of these findings. The author suggests that although pain-proneness is a useful psychodynamic concept, the case for its establishment as a new psychobiological disorder is not proven. Furthermore, the concepts of pain-proneness, depression, and psychogenic pain have become confused. The author argues that the current classification is adequate to deal with the varieties of depression associated with chronic pain and that psychogenic pain disorder should be remerged with conversion disorder for the sake of clarity.     

Spontaneous remission of cerebral palsy

Among 2100 children with a diagnosis of cerebral palsy (CP) twenty carried the diagnosis: Previous CP, now normalized. Seventeen patients could be traced and were reevaluated. Cerebral palsy was diagnosed in these seventeen children (ten boys, seven girls) between the ages of three months and three years (average eleven months). They were found to be normal when reexamined between the ages of one year and five years (average two years two months). Two patients had tetraplegia, three diplegia, nine paraplegia ("paraplegia" were cases of diplegia with minimal affection of the upper limbs - now called "diplegia type I"), and one hemiplegia. One patient had atactic diplegia, and one was athetotic. The records of these seventeen patients were evaluated with respect to aetiology and symptomatology. Upon reexamination seven patients were found to be completely normal. Five patients had no motor symptoms but showed signs of specific neuropsychological difficulties. Two patients were intellectually retarded without motor symptoms. One showed signs of neuropathy, and one had fetal alcohol syndrome. Signs consistent with CP could be demonstrated in one patient only. This study shows that signs of CP may in rare cases disappear altogether.     

Effect of depression on recovery from PTSD

It has been suggested that the treatment strategy needs to be reviewed and changed if depression occurs in patients with posttraumatic stress disorder (PTSD). We analyzed data extracted from the Marmara Epidemiological Survey (MES) which had examined 683 survivors at 3 years after a devastating earthquake. Fifty three cases (40.5%) out of the 131 cases with PTSD had also been diagnosed with MDD. Comorbid PTSD and MDD group has significantly lower rates of recovery from PTSD in comparison to PTSD without MDD (26.4% vs. 47.4% respectively). Rates of past psychiatric disorder and past traumatic experience were significantly more frequent among the comorbid group. Moreover, comorbidity of PTSD and MDD was clearly associated with greater psychological distress, more severe PTSD, and diminished perceived social support. Past psychiatric disorder, General Health Questionnaire (GHQ-12) and Multidimensional Scale of Perceived Social Scale (MSPSS) total scores succeeded in predicting the comorbidity of PTSD and MDD significantly.     

Screening for mental disorders in cardiology outpatients

The objective of the study was to compare the frequency of mental disorders in cardiology outpatients to the number of patients with psychological problems identified by cardiologists. In a cardiology outpatient service, 103 consecutive patients were asked to participate in the study. Of these 86 were included and screened for mental disorder with the Primary Care Evaluation of Mental Disorders (PRIME-MD), Structured Clinical Interview for DSM-IV (SCID) psychosis screening, the Clock Drawing Test, and the WHO-5 Well-being Index. The cardiologists were asked to rate the severity of somatic and mental problems in each patient on visual analogue scales (VAS-som and VAS-men). The current treatments, including psychiatric and psychological treatments, were noted, and the survival was followed for 3 years. Of the 86 patients included, 34 (40%) had a diagnosis of mental disorder. Eleven (12.8%) had major depression, six (7.0%) minor depression, six (7.0%) anxiety disorder, two unspecified somatoform disorder, seven (8.1%) dementia, one alcohol abuse and one psychosis. Three of the patients were in long-term psychopharmacological treatment. Although the cardiologists predicted mental disorder significantly better than chance, none of the patients was in relevant treatment for their mental disorder. At 3-year follow-up, 20 (24%) of the patients had died. Age and severity of heart disease predicted mortality, while the presence of a mental disorder did not. Mental disorders, especially depression, were frequent in cardiology outpatients. Even in cases where the cardiologists identified psychological problems, the diagnosis had no consequence, as none of the patients was offered relevant treatment.     

Testing predictors of bipolar-II disorder with a 2-day minimum duration of hypomania

The study's aim was to find if features often reported to distinguish bipolar and depressive disorders could predict bipolar-II disorder (BP-II). Consecutive major depressive episode (MDE) outpatients, including 284 with BP-II and 196 with major depressive disorder (MDD), were interviewed with the Structured Clinical Interview for DSM-IV, Hypomania Interview Guide, and Family History Screen, in a private practice. The minimum duration of past hypomania was 2 days. Mixed depression was defined as an MDE plus three or more intradepressive, non-euphoric hypomanic symptoms. BP-II predictors were early onset (<20 years), many recurrences (>4 MDEs), bipolar family history, mixed depression, and atypical depressions. Bipolar family history had the highest positive predictive value (PPV) (80.8%) but low sample frequency (32.7%); early onset had high PPV (75.2%) and a sample frequency of 37.0%; many recurrences had the highest frequency (70.4%) but the lowest PPV (66.5%). Combinations of three or more predictors had high PPV (79.0%) and a sample frequency of 46.6%. Predictors and combinations of predictors may correctly identify 75% to 80% of BP-II, reducing the misdiagnosis of BP-II as MDD (by prompting careful probing for hypomania history), and improving treatment of depression (as antidepressants alone may worsen BP-II course). As PPV is related to disease prevalence, findings need to be replicated in different settings.