Amelia Nasrallah

Hallucinations and Delusions in 1,715 Patients with Unipolar and Bipolar Affective Disorders

The prevalence of hallucinations and delusions was studied in 1,715 patients with unipolar or bipolar affective disorders hospitalized at a tertiary care facility. The authors found that the presence of psychotic features was significantly associated with diagnostic subtype. Bipolar manics were more likely than primary depressives, secondary depressives, and bipolar depressives to have hallucinations and/or delusions; primary depressives were significantly more likely than secondary depressives to have psychotic features. Among psychotic patients, bipolar manics were more likely than the other diagnostic groups to have delusions only and less likely to have hallucinations only. Possible explanations for these findings are discussed.

Predictors of immediate response in the treatment of mania: The importance of comorbidity

Four hundred thirty-eight bipolar manics were admitted to an acute care psychiatric inpatient ward over a 12-year period. Eighty percent had good and 20% poor immediate outcome. Good outcome patients were characterized by short episode duration, older age of onset, a longer hospitalization, fewer suicide thoughts, and less psychiatric and medical comorbidity than the poor outcome group. Patients were divided into four treatment groups based on primary mode of therapy during index hospitalization: electroconvulsive therapy (ECT), adequate lithium, inadequate lithium, and neither treatment. Patients experiencing good outcome were more likely to be in the adequate lithium group and less likely to receive neither treatment. Regression analysis identified the absence of comorbidity, duration of lithium treatment more than 2 weeks, and duration of episode of less than 1 month as predictors of good outcome at hospital discharge.

Is death from natural causes still excessive in psychiatric patients? A follow-up of 1593 patients with major affective disorder

A follow-up of 1593 Iowans with major affective disorder showed excessive mortality from unnatural causes in primary and secondary depression, and bipolar depression, but not mania, compared with age- and sex-matched controls from the general population. Excessive death from natural causes was found in women with secondary unipolar depression and bipolar depression and in manics (men and women combined) who had concurrent organic mental disorders or serious medical illnesses. Natural death was not excessive in the absence of these conditions. We conclude that excessive natural death reported in psychiatric patients is due to complicating physical disorders and not to the primary psychiatric disorder per se, whereas excessive unnatural death is due to the psychiatric disorder. Also, psychiatrically ill persons are probably referred for hospitalization more frequently when complicating physical disorders are present. Finally, we conclude that mortality patterns were similar in patients with primary and secondary unipolar depression, but bipolar patients were at lower risk for unnatural death than were unipolar patients.

The treatment of depression: Electroconvulsive therapy ν antidepressants: A naturalistic evaluation of 1,495 patients

Abstract Electroconvulsive therapy (ECT), adequate antidepressant, inadequate antidepressant, and neither treatment were compared by reviewing charts of 1,495 patients admitted to our hospital over a 12-year period because of depression. A significantly greater percent of patients receiving ECT had “marked improvement” (70%) than those receiving either adequate or inadequate antidepressant (48% and 50%, respectively) or those receiving neither treatment (45%). Eighty-five percent of those with a schizoaffective disorder, depressed type receiving ECT showed “marked improvement.” More than 73% of those failing to improve with antidepressants had “marked improvement” to ECT. Unilateral and bilateral ECTs were equally effective. Mood incongruent delusions predicted good treatment response. ECT is demonstrated to be a potent treatment for depression.

DST nonsuppressor status: Relationship to specific aspects of the depressive syndrome

Using a conservative definition of suppressor status in hospitalized depressives, we found a relationship between abnormal endocrine function and certain kinds of depressive symptoms, i.e., melancholic symptoms, delusions, and memory deficit. Normal suppressor status is related to an early age of onset, absence of delusions, absence of memory deficit, absence of melancholia symptoms, and a presence of a diagnosis of secondary depression or a family history of alcoholism in depressives. The data suggest the distinction between neurotic-reactive depression and endogenous depression. It is equally important to note that these specific symptoms and characteristics possibly are associated with suppressor status independently of each other.

Does Treatment Influence Mortality in Depressives?: A Follow-up of 1076 Patients with Major Affective Disorders

AbstractThis article reports mortality risk among 1076 Iowans with major affective disorders (705 primary unipolar, 219 secondary unipolar, and 152 bipolar depressives) compared to that of the general population. Patients were divided into four treatment groups depending on primary mode of therapy during the index admission; the groups included electroconvulsive therapy (ECT), adequate antidepressants, inadequate antidepressants, and neither treatment. All patients in the sample had an increased risk for an early death. A high risk for suicide was found for patients within each individual treatment group during the follow-up, especially the first 2 years when 69.4% (n = 25) of total suicides occurred. There were no significant differences in the risk for suicides, or deaths from all causes combined, among patients in the four treatment groups. Furthermore, mortality did not differ between patients having a lifetime history of ECT and patients never having had ECT. We conclude from a short-term follow-up o...

Mortality in Patients with Primary Unipolar Depression, Secondary Unipolar Depression, and Bipolar Affective Disorder: A Comparison with General Population Mortality

Mortality data are presented from a two to fourteen year follow-up of 705 primary unipolar depressives, 302 secondary unipolar depressives, and 586 patients with bipolar affective disorder (BAD) hospitalized at a tertiary care facility. Death ascertainment was made through a record-linkage process. Using sex- and age-standardized mortality ratios (SMRs), the mortality experience of the study population was compared with that of Iowa, the geographical area served by the admitting medical facility for this study group. Results show that risk for all-cause mortality was most pronounced during the first two years following hospital discharge, although secondary unipolar depressives continued to show a significant excess of deaths throughout the entire follow-up period. Deaths occurring from natural causes were significantly excessive only during the initial portion of the follow-up. Deaths from unnatural causes were significantly excessive throughout follow-up except for patients with bipolar affective disorder.

The prediction of recovery using a multivariate model in 1471 depressed inpatients

SummaryStepwise multiple logistic regression was used in an attempt to develop a statistical model which would predict “recovery” in a group of 1471 depressives admitted to a tertiary care hospital. Six variables identified by this approach included: Electroconvulsive therapy, personality disorder, chronicity, anxiety disorder, organic mental disorder, and dysthymia. The meaning and significance of the findings are discussed.

The effect of somatic treatment and comorbidity on immediate outcome in manic patients

Logistic regression was used to determine the association between clinical variables and outcome at discharge in a sample of 438 manics hospitalized at a tertiary care facility. In the total sample, and for males, treatment with electroconvulsive therapy (ECT) and lithium carbonate were positively associated with good outcome. Among females, ECT was positively associated and comorbidity negatively associated with good outcome. Comorbidity appears to be a potentially useful variable in predicting immediate response to treatment.

The Schizoaffective Continuum: Non-Psychotic, Mood Congruent, and Mood Incongruent

The evolutionary line in the development of the schizoaffective diagnosis is not easily traced. This is because we can estimate 24 or 25 different definitions of schizoaffective disorder. Several definitions are operational and well described (Marneros and Tsuang 1986; Levinston and Levitt 1987), while some encompass illnesses that share a lot in common with operational definitions of schizoaffective disorder such as benign stupors, reactive psychoses, good premorbid schizophrenia, cycloid psychoses, schizophreniform illnesses, remitting schizophrenia, and acute schizophrenia (Winokur 1984). Certainly, 24 or 25 definitions are a rough estimate; we made no systematic effort to obtain all of the possible definitions and related diagnoses. Assuming 24 possible definitions and criteria sets, it would be possible to study any patient group and come up with 48 to 50 different studies (assuming a separation of schizoaffective mania and schizoaffective depression).