An American validation study of the Newcastle scale. III. Course during index hospitalization and six-month prospective follow-up

One hundred and fifty-two depressed inpatients were classified endogenous or neurotic according to the Newcastle Diagnostic Scale. Endogenous depressives were significantly more likely than neurotic depressives to be treated with electroconvulsive therapy (ECT). Newcastle subtyping was not associated with response to ECT; however, neurotic depressives not treated with ECT were more symptomatic at hospital discharge than endogenous depressives not treated with ECT. A prospective 6 month follow-up interview was completed with 85% of the patients. There was no association between Newcastle subtyping and follow-up outcome.     

The validity of four definitions of endogenous depression. II. Clinical, demographic, familial, and psychosocial correlates

Based on a survey of the classic literature and studies examining the correlates of a clinical diagnosis of endogenous or nonendogenous depression, we found 14 variables that should discriminate endogenous and nonendogenous depressives. We applied four definitions of endogenous depression (Feinberg and Carroll, DSM-III, Research Diagnostic Criteria, and Newcastle) to a consecutive series of 152 unipolar major depressive inpatients. We examined the concordance between the definitions and the relationship between each definition and clinical, demographic, family history, and psychosocial factors. The DSM-III and Newcastle definitions were less inclusive than the other two definitions. We found some support for the validity of each of the four definitions. The validity of the Newcastle scale was the most frequently supported, with the endogenous depressives having a lower rate of personality disorder, marital separations and divorces, familial alcoholism, life events, and nonserious suicide attempts.     

The prognostic significance of HPA-axis disturbance in panic disorder: a three-year follow-up

Seventy-seven patients with DSM-III panic disorder underwent a baseline dexamethasone suppression test (DST), participated in an 8-week controlled treatment trial, and provided follow-up interviews 2-4 years later. The 20 patients who had exhibited DST nonsuppression at baseline had more symptoms of anxiety, more work and social disability, and a greater likelihood of ongoing major depression than did patients who had had normal DST results. DST nonsuppression in panic disorder apparently indicates a more persistent and chronically disabling condition.     

DSM-III personality disorder dimensions

Dimensional scores were computed for the 11 DSM-III personality disorders (PDs) in 797 relatives of psychiatric patients and never ill control subjects interviewed with the Structured Interview for DSM-III Personality Disorders. The distribution of scores for all 11 PD dimensions was skewed to the right. A principal components analysis with varimax rotation produced three factors that closely corresponded to DSM-III's suggested clustering of the PDs into eccentric, dramatic, and anxious types. Men scored significantly higher on the paranoid, schizoid, compulsive, antisocial, and narcissistic dimensions, whereas women had significantly higher histrionic, dependent, and avoidant scores. Age was negatively correlated with most of the PD dimensions, and the correlations were strongest with the four PDs in cluster 2 (histrionic, antisocial, narcissistic, and borderline). Each of the eight axis I disorders examined was associated with increased axis II pathology.     

Increased excretion of histidyl-L-proline diketopiperazine by infants receiving Pregestimil and Nutramigen formulas

Histidyl-L-proline diketopiperazine is excreted in increased amounts by infants receiving Nutramigen or Pregestimil. When these formulas are discontinued, its excretion becomes undetectable. The compound was isolated from Nutramigen and Pregestimil, as well as from the urine of the infants receiving these formulas, and was identified by comparison with authentic histidyl-L-proline diketopiperazine standard in various chromatographic and electrophoretic systems. A neuropeptide widely distributed in the brain and gut and having a variety of biological functions, histidyl-L-proline diketopiperazine may have as-yet-undetermined effects on infants who are receiving these formulas.     

Clinical predictors of suicide in primary major depressive disorder

OBJECTIVE: Follow-up studies of patients with depressive disorders have identified only a few replicable predictors of suicide and have not explored possible interactions between them. The following analysis takes advantage of a large cohort of depressed patients given detailed, structured interviews 2 decades ago. METHOD: The data set on which this analysis is based was collected between 1976 and 1990. Research personnel administered the Schedule for Affective Disorders and Schizophrenia to 785 adults who had major depressive disorder (Research Diagnostic Criteria) but who lacked other Axis I disorders. The current analysis used the National Death Index to determine mortality status as of 2003. RESULTS: One in 4 of the 134 deaths were by suicide for an overall suicide rate of 4.2%. In comparison to the remaining 752 patients, the 33 who died by suicide were more likely to have been inpatients and to have had a history of suicide attempts at the time of baseline assessment. They had also expressed more hopelessness and had higher ratings of suicidal tendency. The last of these variables was the most robust by far and, when tested with other predictors in regression analyses, was the only one to retain significance (p < .0001). No interactions between predictors emerged. As in an earlier, similar study, the suicidal tendency rating was predictive of suicides that occurred after the first year of follow-up, which suggests that suicidal tendencies comprise a trait that persists across episodes. CONCLUSION: A global rating of suicidality appears to be the single most important predictor of eventual suicide in patients with major depressive disorder.