Amos Welner

PSYCHOPATHOLOGY IN CHILDREN OF INPATIENTS WITH DEPRESSION: A CONTROLLED STUDY

One quarter of 29 parents hospitalized for depression had children with episodes of depression (eight out of a total of 75 children). None of the children in 41 families with well parents had episodes of depression (a total of 152 children). The differences were significant at the .01 level. It is suggested that symptoms “equivalent” to depression such as hyperactivity, deviant behavior, and learning difficulties are not required in establishing clinical depression in childhood. The methodological shortcomings in this study were discussed.

A CONTROLLED STUDY OF SIBLINGS OF HYPERACTIVE CHILDREN

A controlled study of siblings of hyperactive boys resulted in the following findings. The hyperactive child syndrome is more common among brothers of hyperactive children than among brothers of controls (26 per cent vs. 9 per cent). Both probands and their brothers presented with more symptoms of depression-anxiety than controls. The probands, but not their sibs, presented with more antisocial symptoms than controls. Although differences in intelligence and achievement scores were found between probands, their sibs, and controls, both intelligence level and academic achievement were within normal limits in all groups.

Obsessive-compulsive neurosis: Record, follow-up, and family studies. I. Inpatient record study

Abstract This study consisted of 150 inpatients in whom obsessions and compulsions were major or predominant symptoms. Twenty-one per cent of the patients were included in subgroup I. The clinical picture and course of illness in this subgroup consisted only of obsessions and compulsions, and the cause for hospitalization was incapacitation by these symptoms. Patients in this subgroup were distinguished from all other patients by the absence of decline in their occupational status. Subgroup II, the largest in the study, consisted of 38% of the patients in whom depression followed many years of severe obsessions and compulsions. Depression is recognized as “probably the most common complication of obsessional neurosis,”16 and it would appear that it is the largest single cause of hospitalization for patients with obsessive-compulsive neurosis. Eleven per cent of the patients had primary depressive illness with obsessions and compulsions and were included in subgroup IV which, despite its small size, was readily distinguishable from the previously mentioned subgroup II. The important question of the association between obsessive-compulsive illness and schizophrenia was raised by the 14 patients (9%) in subgroup V who are presented in detail in Table 5. The effective, paranoid, and sometimes remitting types of psychosis that appear to be associated with some cases of obsessive-compulsive illness do not meet the diagnostic criteria for schizophrenia that we have used, and the divergence of opinions in the literature may reflect the impressionistic, rather than systematic, way that the diagnosis of schizophrenia is made. A blind personal follow-up of the patients and the study of psychopathology in their families will provide us with more data that are essential to answer some of the questions and confirm (or reject) findings presented in this study.

The Group of Schizoaffective and Related Psychoses: A Follow-up Study

Abstract A follow-up of 114 patients diagnosed as having schizoaffective and related psychoses demonstrated the following: 71% of the patients had a chronic course of illness, 10% an episodic course and 19% were asymptomatic on medication with phenothiazines; 81% of the patients with a chronic course manifested deterioration; none of the patients with an episodic course manifested deterioration, 39% of the patients who were asymptomatic on medication manifested deterioration; the presence or absence of affective symptoms had no predictive value on course of illness or extent of deterioration; our results indicated, therefore, judging by the chronic course and marked deterioration, that the group of schizoaffective and related psychoses appears to resemble schizophrenia rather than affective disorder.

Bipolar manic-depressive disorder: A reassessment of course and outcome

Abstract A review of follow-up studies of patients with bipolar manic-depressive disorder shows that this illness has a less favorable outcome than is generally considered, both from the standpoint of clinical course and that of social functioning.

Psychiatric symptoms in white and black inpatients. II. Follow-up study.

Abstract This study is a follow-up of 109 initially undiagnosed psychiatric inpatients; 37 patients were black and 72 patients were white and the mean follow-up period was 39 months. The rate of follow-up was 95% of the designed group for the study. This study confirmed the finding of a previous chart review study that black patients have a significantly higher rate of delusions and hallucinations and this difference cannot be accounted for by a difference in diagnosis. The diagnoses in both studies were established by using a structured interview from which symptoms were extracted to meet rigorous criteria for psychiatric diagnoses. These findings of the follow-up study in addition to those of the chart review study further support the suggestion that the difference in symptomatology is characteristic more of the group rather than the psychiatric disorder. The concordance between the established diagnoses at the time of the follow-up as compared to the diagnoses of the chart review is high in the two groups. However, when an attempt was made to arrive at a diagnosis by a non-systematic clinical impression there was a significantly higher rate of error for black patients as compared to white patients. This finding suggests that a structured interview is of particular importance as a diagnostic tool for black patients.

Psychiatric symptoms in white and black inpatients. I: Record study

Abstract The frequency of symptoms of 256 patients who were discharged from an inpatient service as undiagnosed were compared by race, sex, and age. The symptoms that were significantly more frequent in the black patients were dull affect, delusions of grandeur, delusions of body change (females only), delusions of passivity, fighting, auditory and visual hallucinations, concrete proverb interpretation (males only), psychomotor retardation (females only), decreased need for sleep (males only), increased speech (males only), and vague history (males only). Other variables more frequent in the black patients were age of first psychiatric and first Renard admissions less than 30, and treatment with major tranquilizers during first hospitalization. The only symptom recorded more frequently in the white patients was depressed affect. Sixty-eight percent of the patients met the rigorous criteria for a diagnosis and no significant difference in frequency of diagnosis (includes patients who remained undiagnosed) was found between white and black patients. Greater association was found between symptoms and diagnosis in the white population than in the black population. Because the differences in symptoms between black and white patients could not be explained by a difference in frequency of psychiatric disorders, because selection factors prompting hospitalization and quality of symptoms were not different for the groups, and because the association of symptoms with specific psychiatric diagnoses was greater in the white population than in the black, further support for the possibility that psychiatric symptoms are associated with a certain group of patients is required.

The group of schizoaffective and related psychoses: IV. A family study

Abstract There is increasing evidence that numerous affective symptoms are present during every stage of schizophrenia, often persisting throughout the patients schizophrenic life. This study has shown that sick first-degree relatives have manifested a very similar clinical picture, course and outcome as the probands. Since the course of illness in both probands and relatives was chronic psychotic and deteriorating, it was characteristic of schizophrenia and not of affective disorder. Neither the presence of numerous affective symptoms, nor the family study indicated the presence of schizoaffective psychosis as a diagnostic entity. We suggest, therefore, that the term “undiagnosed” rather than schizoaffective psychosis be used when encountering acute cases of psychotic and affective symptoms. The methodological shortcomings of this study were discussed.

Childbirth-related psychiatric illness

Abstract The term childbirth-related psychiatric illness might have meant: (1) a group of disorders essentially no different from nonchildbirth-related disorders; (2) a group of distinct diagnostic entities peculiar to childbearing; or (3) any specified combination of group (1) and (2). Evidence has been presented that patients with “childbirth-related psychiatric illness” have not been studied as homogeneous cohorts (or at least were not reported as such). A relationship between the illness and the childbearing period was present only in some patients; these patients were not studied separately. In others, any such relationship was either absent, uncertain, or unspecified (for reasons explained in the text). It may be that the unusual descriptions of diagnoses, the controversy over the nature of postpartum delirium, the unexpectedly low mortality rate from all causes, and other unusual characteristics found reflected, in part, the presence of inadequately identified populations in the reviewed studies. For this reason, it was believed unnecessary to include additional data in this review. In conclusion, it is believed that the contribution of this review is to suggest both the lack of and reasons for the inadequate information on childbirth-related psychiatric disorders.

Child abuse: A case for a different approach

Abstract A review of the literature on the subject of child abuse reveals a negligible amount of systematic data in contrast to a generous offering of untested hypotheses and speculations presented as evidence. We believe that the requirement of “nonaccident” as part of the definition and study of child abuse is doing the study a disservice in view of the evidence that “accidental injury” and “nonaccidental injury” are not mutually exclusive; in fact they commonly occur together resulting in a situation where they cannot be measured reliably. We suggest therefore that elimination of the variables “nonaccidental” or “accidental” would be a useful approach for studies on child abuse.