Allen Raskin

Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives.

In a prior study, we identified factors of psychopathology in the interview, ward behavior and self-report ratings of 124 depressed patients from 9 hospitals. The present study attempts to replicate these findings in a sample of 648 depressed patients from 10 hospitals. The criteria for patient selection and the factor analytic methods employed were identical in both studies. The major factors of psychopathology identified in the first study were replicated in the second study. Further, the loadings of the key items on these factors were highly similar in both studies. However, the factors in the second study encompassed a narrower range of psychopathology than those in the first. As a consequence, more factors were extracted for the same evaluation instruments in the second study. The 12 major categories of psychopathology discernible from these analyses were: 1) depressive mood, 2) feelings of guilt and worthlessness, 3) hostility, 4) anxiety-tension, 5) cognitive loss and subjective uncertainty, 6) interest and involvement in activities, 7) somatic complaints, 8) sleep disturbance, 9) retardation in speech and behavior, 10) bizarre thoughts and behavior, 11) excitement and 12) denial of illness. The break-up of some of the larger, global factors from the first study into smaller and more narrowly defined factors in the second study was a distinct asset in later efforts to discern the differential effects of various antidepressant drugs. The results from both studies also highlighted the advantages of using different rating instruments and sources of information about the patient. First, within a particular category of psycho-pathology, such as hostility, nuances of behavior across rating instruments would have been missed had we sampled only one aspect of patient behavior. Second, some categories of psychopathology, such as depressed mood, emerged as strong factors on certain rating instruments and were either poorly represented or absent on others.

Parent-child relationships and adult depression.

Reports of early parental behavior provided by 714 hospitalized depressed patients were compared with those provided by 387 normal adults. The 2 groups were also compared on ratings of parental behavior along the acceptance-rejection and autonomy-control dimensions, based on reports of other informants. Differences between the groups suggest that depression in adult life may be related to parental rejection and control through techniques such as derision, negative evaluation, and withdrawal of affection during childhood. Maternal rejection was found more closely associated with depression in female than in male children, and the effect was essentially the same among black and white subjects. Paternal rejection, on the other hand, appeared more closely associated with depression in males than females among blacks, while among whites paternal rejection was related to depression in females rather than males. It is suggested that the thoughts of personal worthlessness and inferiority seen in depression and theorized by Beck to be of principal etiologic significance in the disorder may have their origin in the early parent-child relationships.

The endogenous--neurotic distinction as a predictor of response to antidepressant drugs.

An inverse factor analysis of 880 depressed inpatients on 33 endogenous-neurotic variables yielded four patient types. Type 3 resembled the endogenous depressions and Type 2 the neurotic depressions. Type 3 patients responded well to both imipramine and chlorpromazine and did poorly on a placebo. Type 2 patients showed the greatest overall improvement at three weeks irrespective of treatment received, including a placebo.

Age-sex differences in response to antidepressant drugs.

Age-sex differences were examined in two multihospital collaborative studies of drug treatment in depression. The 325 patients in study 1 and 555 patients in study 2 were subdivided into four age-sex groups: females under 40; females 40 and over; males under 40; and males 40 and over. The major focus of the statistical analyses was on differential treatment effects in the four age-sex groups. The treatments in study 1 were chlorpromazine (600 mg/day), imipramine (300 mg/day), or a placebo. Study 2 patients received diazepam (30 mg/day), phenelzine (45 mg/day), or a placebo. Results after 3 weeks of treatment were as follows: 1. Older males in both studies generally responded better to one of the active treatments than to a placebo. 2. Older females were more selective and only did well on imipramine. 3. Young females in study 1 did well on placebo and poorly on imipramine. Imipramines negative effects for these women were discernible primarily on the hostility variables and seemed related to its mild euphoriant and activating properties. 4. Young males showed a marked negative response to a placebo in study 1 and a positive placebo response in study 2. This finding highlighted the need to evaluate placebo response in the context of the active comparison drugs. Hostility was a serious problem for many of these patients and chlorpromazine provided relief from symptoms in this area. This was not true of either of the active drugs in study 2. These results indicated that an analysis of sex differences alone could prove misleading, since there were as many differences in drug response between younger and older women and between younger and older men as there were between the sexes. These findings could be “explained” in terms of relationships among factors such as presenting symptoms, initial severity of illness, sensitivity to side effects, pharmacological action of the study drugs, and placebo response.

Psychosocial factors associated with urban adolescent female suicide attempts.

This study identified psychosocial factors that differentiated 19 adolescent female suicide attempters from 21 demographically similar nonattempters in a low income, urban area. Adolescents and their parents independently completed questionnaires and participated in structured and semistructured interviews. Attempters expressed significantly higher levels of suicidal ideation and were described by their parents as displaying higher levels of depressed mood and delinquent behavior problems than nonattempters. Attempters also identified fewer support persons, were less likely to be living with their mothers, were less likely to describe confiding relationships with parents/guardians, and had less active and affectionate relationships with mother figures than nonattempters. Finally, attempters reported more undesirable life stresses than nonattempters.

The psychological effects of the war in Afghanistan on young Afghan refugees from different ethnic backgrounds

This study examined the psychological effects of the war in Afghanistan on two groups of young Afghan refugees currently residing in the United States. One group, with Tajik parents showed significantly less evidence of post-traumatic stress disorder (PTSD) and depression than the second group with Pashtun parents. These two groups of young refugees came from very different socio-economic and cultural backgrounds. Some of these differences persist to the present. The Tajik parents are wealthier, more likely to speak English at home and less religious than the Pashtun parents. Their wartime experiences were also different. The Pashtun parents and their children spent more time in Afghanistan during the war, and experienced or witnessed more traumatic events, such as torture or combat, than the Tajik parents and their children. The possible effects of these ethnic differences on current psychopathology are described and discussed.

Factors associated with attempted suicide among hospitalized depressed patients

An attempt was made to identify background, sociodemographic and clinical variables which are associated with attempted suicide in depression. Within a sample of 308 depressed psychiatric inpatients, suicide attempters were younger than non-attempters and were identified by a pattern of chronic interpersonal maladjustment reflected clinically in withdrawal from social contact and the display of hostility or irritability toward others.

Psychiatric Assessment of a Nursing Home Population Using Audiovisual Telecommunication

The purpose of this study was to demonstrate that psychiatric assessment of nursing home residents could be reli ably carried out remotely via telecommunications. Twenty-seven nursing home residents each had two interviews consisting of the following three rating scales: the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Brief Psychiatric Rating Scale (BPRS). The interviews were conducted by three trained psy chiatrists, each of whom interviewed two-thirds of the subjects. Subjects were sequentially assigned to have either two in-person interviews (in-person group) or one in-person and one remote interview via telecommunication (remote group). Inter-rater reliability was calculated separately for each condition (in-person vs remote group) for each of the three rating scales. Intraclass correlations on the MMSE were .95 for the remote group and .83 for the in-person group. On the GDS, they were .82 for the remote group and .86 for the in-person group. Finally, on the BPRS, they were .81 for the remote group and .49 for the in-person group. There were no statistically significant differences in intraclass correlation on any of the three scales for the remote group compared with the in-person group, indicat ing that nursing home residents can be reliably assessed remotely via telecommunication. (J Geriatr Psychiatry Neurol 2001; 14:63-65).

Some Predictors of Psychiatric Consultation in Nursing Home Residents

OBJECTIVE Despite the high rate of psychiatric disorders in nursing homes, research indicates that psychiatric consultation is requested infrequently. The authors sought to determine the rate of psychiatric consultation in a nursing home population and to assess what factors were related to a consultation request. METHODS Subjects were recruited from a stratified random sample of 59 nursing homes across Maryland. All new admissions age 65 years and older from September 1992 through March 1995 were eligible for the study. A total of 2,285 subjects were included in the study. Variables examined were factor scores from the Cornell Scale for Depression in Dementia and the Psychogeriatric Dependency Rating Scale (Behavioral Subscale), nursing home characteristics, and whether the resident had a psychiatric consultation within 90 days of admission. RESULTS Twenty percent of the residents (N=404) had a psychiatric consultation. There was no significant association with demographic variables. Behaviors that triggered a psychiatric consultation included agitation, physical/verbal abuse, wandering, and manic/destructive acts. A psychiatric consultation was also requested when residents displayed anxiety. Surprisingly, depression in retarded and psychotic residents did not trigger a psychiatric consult. CONCLUSION As expected, behavioral problems and agitation are common reasons for a psychiatric consultation. However, the resident who is depressed, particularly the quiet or retarded depressed resident, may be overlooked. In this context, it is important for the nursing staff to recognize that lethargy and social withdrawal may be signs of depression, and a referral to a psychiatrist may be in order.

Competency evaluations in a VA hospital ☆: A 10-year perspective

The authors reviewed all 228 competency evaluations performed at the Baltimore VA Medical Center during a 10-year period. Between 1980 and 1984 and 1985 and 1989, the rate of inpatients who had competency evaluations increased from 0.20% to 0.42%, and the average number of competency evaluations per year doubled from 12 to 24.6. The percentage of all psychiatric consultations which were for competency evaluation nearly doubled from 5% to 9.4%. The rate of competency evaluations was slightly but not significantly higher for patients over age 65 than the rate for younger patients (0.44% vs. 0.33%). However, older patients were significantly more likely to be judged incompetent.