Alberto Dimascio

Deprivation in the childhood of depressed women.

With recent developments in community psychiatric services, concern with prevention has become an urgent social, as well as medical challenge. Comprehensive investigation into causation must therefore be given systematic emphasis. This paper is an effort toward clarification of etiology, specifically of the depressive disorder, in terms of early childhood experiences. The work is based on social and psychiatric history data collected by experienced psychiatric social workers on two groups of subjects from the National Institute of Mental Health (NIMH) Collaborative Depression Studies under the direction of Allen Raskin, Ph.D. of the NIMH Psychology Research Branch, and a third group of subjects from Boston State Hospital. The hypothesis that childhood deprivation, defined as “the lack, loss or absence of an emotionally sustaining relationship prior to adolescence,” has a meaningful association with the occurrence of adult depression was tested in a sample of 347 depressed inpatient women and 114 outpatient women in comparison to 198 normal women used as a control or reference population. The subjects were all Caucasian. Events occurring during childhood that could be considered within the definition of deprivation were documented. Further, subjects were assessed as to depriving childrearing experiences. The findings revealed no association of adult depression with overt childhood loss events, but did provide evidence to support an association of depriving childrearing processes with adult depression. The findings also revealed evidence of a relationship between the degree of the depriving childrearing experience with the severity of the adult illness as measured by hospital status. The results are discussed in relation to findings from other studies of childhood deprivation and psychiatric disorder.

The effects of benzodiazepines on aggression: Reduced or increased?

The effects of various benzodiazepines on animal models of aggression are presented. The differences in response noted after single dose or after chronic drug administrations are stressed. The implications for predicting responses to these drugs in humans are discussed.

Clinical response to amitriptyline among depressed women.

Eighty-five female depressed patients were treated for 4 weeks with amitriptyline in a flexible dose (median, 150 mg daily). Predictive analyses of outcome were carried out, using both typological and regressional models based on the same 29 predictor variables. The typological prediction utilized a previously described four-group typology derived by multivariate cluster analysis and comprising psychotic depressives, anxious depressives, hostile depressives, and young depressives with personality disorder. Patients were assigned to groups by discriminant functions on the basis of scores on the predictor variables. The four groups were found to predict outcome significantly. Psychotic depressives, initially the most severely depressed, improved the most; anxious depressives, a little less severely ill initially, showed the least improvement and the most residual illness at 4 weeks; hostile depressives and young depressives with personality disorders, initially the least severely ill, showed intermediate improvement and were least ill, by a small margin, at 4 weeks. The 29 predictor variables also predicted outcome significantly in linear multiple regression analyses. Five variables showed regression weights significantly different from zero: high initial severity predicted high improvement but more residual illness; initial insomnia, more previous depressions, longer illness, and hypochondriasis all predicted low improvement and more residual illness. Predictions by using typological and regression models were compared, and their interrelationships were examined. The regression prediction accounted for more variance in outcome measures than did the typology, but the statistical significances of the regression and typological predictions were of the same order. Two variables appeared particularly important—high initial severity of illness which characterized the psychotic depresives and increased number of previous depressions which characterized the anxious depressives. Typological prediction was not solely due to these two variables in linear regression model sicne it remained significant when the outcome measure was adjusted for both by analysis of covariance. Both typological and regressional models provide useful approaches to prediction, with only limited overlap. The typological approach, which has been relatively neglected in recent years, warents more frequent application as an alternative to multiple regression.

Rapidity of symptom reduction in depressions treated with amitriptyline.

A group of depressed women treated with amitriptyline was studied with particular attention to the speed of response in different symptoms of depression and in psychotic as compared to neurotic depressives. The findings showed rapid improvement in suicidal feelings, insomnia, and anorexia, but slower and more gradual improvement in impaired work and interests, retardation and pessimism and hopelessness. Psychotic depressives did not show substantial improvement until the third week of treatment whereas neurotic depressives improved markedly within the first week. It is suggested that the psychotic classification may be more useful as a predictor of speed of response than as a predictor of final treatment outcome.

Relationship of patient background characteristics to efficacy of pharmacotherapy in depression.

As a part of a Collaborative Depression Treatment Study pretreatment background characteristics (socioeconomic, demographic, and prior psychiatric status) of 163 depressed women were examined to determine whether they were related to the degree of clinical response to amitriptyline. Further analyses were done to determine whether these characteristics could be of use in identifying those women who completed a 4-week course of pharmacotherapy from those who dropped out. It was found that clinically oriented background data related to present and past emotional illness were more highly associated with the degree of treatment response obtained. Sociodemographic characteristics, on the other hand, were more valuable for discriminating between patients who were willing to complete the 4-week course of antidepressant drug treatment and those who dropped out early.

Tardive dyskinesia and informed consent

Abstract The clinical literature pertaining to tardive dyskinesia (TD) indicates that this drug-induced extra pyramidal syndrome alters the risk/benefit ratio of neuroleptic drug therapy for two distinct groups of patients: those who receive neuroleptic agents continuously for more than one year, and those who already have TD but must nevertheless continue treatment with these agents. Written informed consent for treatment should be obtained from these two groups of patients as a condition for neuroleptic drug therapy to protect both patients and clinicians. Evidence is presented that employing such written consent will not adversely affect patient compliance.

Chlordiazepoxide, expectation and hostility

SummaryAn experiment is described in which chlordiazepoxide or placebo was administered to a group of low anxious normal male volunteers with and without instructions of a set (expectation) that the drugs would decrease their feelings of hostility and anxiety. The data indicated that chlordiazepoxide alone, and expectation alone, each increase hostility scores, but that when combined together, there was no such increase in baseline hostility levels. Introduction of set after hostility levels were increased served to further increase rather than reverse these scores. Drug, placebo, expectation or the combination of drug and expectation had no effect on anxiety scores.

Pharmacokinetics and Clinical Effects of Amantadine in Drug‐Induced Extrapyramidal Symptoms

Plasma amantadine concentrations were assessed in a series of hospitalized schizophrenic patients receiving this drug during a double-blind trial of amantadine and benztropine in the treatment of neuroleptic-induced extrapyramidal symptoms (EPS). Mean (+/- S.E.) plasma amantadine concentrations were 0.54 +/- 0.08 microgram/ml on day 7 and 0.43 +/- 0.08 microgram/ml on day 14. Overall improvement of EPS was not correlated with plasma level, but improvement in the target EPS of rigidity was correlated with plasma amantadine concentration on day 7 (r = 0.75) and day 14 (r = 0.68). There was no evidence that the overall improvement in schizophrenic symptomatology was influenced by plasma amantadine concentrations.

Non-polar urinary metabolites of chlorpromazine in male schizophrenics

Abstract Twenty-four hour urine collections were made on 12 male schizophrenic patients recieving varying doses of chlorpromazine. Gas chromatographic analyses for chlorpromazine and six non-polar metabolites were performed. Two major metabolites, desdimethylchlorpromazine sulfoxide (nor 2 CPSO) and desmethylchlorpromazine sulfoxide (nor 1 CPSO) were found to be excreted in significant amounts, accounting for about 7 per cent of the ingested dose. The variations in excretion of these compounds were found to be independent of urine volume, dose administered, or of the clinical state of the patients. It was concluded that the metabolism of chlorpromazine into the oxidized demethylated forms was a relatively constant phenomenon.

The effects of some phenothiazine derivatives on the discrimination of auditory clicks

SummaryThis study describes the effects of chlorpromazine, promethazine, perphenazine and trifluoperazine at each of four dose levels on the discrimination of the frequency rate or at several different standard auditory pulse rates.Thirty subjects recruited from local colleges participated in the study. Four groups of five subjects each were administered one of the four drugs at each of four dose levels. Discrimination was assessed by use of the three-category Method of Constant Stimuli after each dose of the drug and after the administration of placebo. A control group of ten subjects were subjected to the same discrimination procedures without the administration of drug or placebo.The results suggest that one of the aliphatic derivatives, chlorpromazine, impaired discrimination (as assessed by both the difference limen and standard deviation of judgments) at both high and low standard frequencies. The other aliphatic derivative, promethazine, impaired discrimination only at the higher frequency. Increases in the difference limen under the higher doses of chlorpromazine was related to a systematic increase in the use of equal judgments at these dose levels.The piperazine derivatives, perphenazine and trifluoperazine, were not observed to impair discrimination as measured by either the difference limen or the standard deviation of judgments. However, a “crescent” shaped dose curve for the difference limen was noted under perphenazine which was consistent with similar dose effects which have appeared when other, different, behavioral measures were used.