C. Brandon Qualls

Pituitary-adrenal disinhibition in depression: Marker of a subtype with characteristic clinical features and response to treatment?

The data from a series of studies in different patient samples are consistent in showing that resistance to dexamethasone suppression is selectively associated with primary major depressive disorder. In addition, nonsuppressors appear to have more depressive episodes, show greater improvement during hospitalization, tend to be older than suppressors, and may have a specific disturbance in cognitive function. Preliminary data suggest that nonsuppressors and suppressors respond preferentially to different antidepressants. These data raise the possibility that pituitary-adrenal disinhibition, as assessed by the dexamethasone suppression test, is associated with a depressive subtype having a distinctive pathophysiology, clinical course, and treatment response.

A comparison of structural patterns of sexual arousal in male and female homosexuals.

Patterns of sexual arousal were examined for eight male and eight female homosexuals. Comparisons were made in terms of physiological and subjective arousal. The results indicate that for each group there exists very distinct arousal responses, with each group showing the greatest response to same-gender homosexual activity. Results are discussed in relationship to establishing normative data for assessment and clinical function.

Diagnostic Heterogeneity and the DST in Consecutive Psychiatric Admissions

There is uncertainty about the clinical usefulness of the dexamethasone suppression test (DST). It is also unclear whether there are advantages to a 1-mg or 2-mg DST. Eighty-three consecutive psychiatric inpatients were randomly given a 1-mg or 2-mg DST within the first week of admission. Sensitivity, specificity, and diagnostic confidence are reported for this group, and also in combination with those for 119 semi-consecutive psychiatric admissions. Although rates of nonsuppression were consistently higher in patients with affective disorders than in patients with other diagnoses, the diagnostic confidence of the DST for major depression in a diverse and unselected patient population was not greater than the prevalence of the disorder. The DST does not appear to be useful for clinical diagnostic decision-making. Nonetheless, the DST may still be an important biological marker in neuroendocrine psychiatric research.

Pituitary-adrenal regulation over multiple depressive episodes

Pituitary-adrenal activity was evaluated with the dexamethasone suppression test in 11 patients over their multiple hospitalizations for major depression. All six patients who were suppressors during their index admission had one subsequent admission over the period of study during which they were again suppressors. Of five patients who were nonsuppressors during their index admission, three had one subsequent admission and two had three subsequent admissions. Four of these patients were again nonsuppressors during a subsequent admission. For patients who were nonsuppressors during some but not all admissions for depression, pituitary-adrenal activity appeared related to the persistence of the depressive episodes.

The Prevention of Sexual Disorders

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Predicting pharmacotherapy outcome by subjective response

Subjective response to the initial 24-hour dosage of psychoactive medication was evaluated as a predictor of clinical outcome in 33 drug-free patients with DSM-III diagnoses of functional psychoses. Pretreatment evaluation included measures of symptom severity, role functioning and attitude towards treatment. Clinical improvement after 8-21 days was significantly correlated with subjective response. The author suggests that inquiry regarding a patients early subjective response to prescribe chemotherapy can help to identify ultimate drug refusal and clinical unresponsiveness.

The Prevention of Sexual Disorders: An Overview

While human sexuality has long been the subject of intense interest, particularly in its prescriptive and prescriptive aspects, only in the past 100 years has it become an area of legitimate scientific inquiry. Prior to that time, interest in sexuality centered on sexual instincts and sexual deviations (Ellenberger, 1970), but the work of von Krafft-Ebing, Ellis, and Freud, the three major figures who dominated the study of sexuality at the turn of the century, set the stage for the systematic study of this most controversial area of human behavior and experience. Their pioneering example has continued to the present, and in the past 25 years there has been a rapid expansion in our knowledge and understanding of human sexual behavior, so much so that no single researcher can encompass the entire field. Major contributions to this progress have come from a variety of different sources and fields, each lending its own perspective to the vast range of sexual experience and its attendant disorders. This period has witnessed the investigation of the range of sexual behavior in our own culture (Kinsey, Pomeroy, & Martin, 1948; Kinsey, Pomeroy, Martin, & Gebhard, 1953) and of widely variant cultures (Ford & Beach, 1951; Marshall & Suggs, 1971), of the physiology of the human sexual response (Masters & Johnson, 1966), of new measures of sexual arousal (Zuckerman, 1971; Barlow, 1977; Hoon, Wincze, & Hoon, 1976), of biological contributions to gender identity (Money & Ehrhardt, 1972), and of gender identity formation (Money & Ehrhardt, 1972; Green & Money, 1969; Green, 1974), to name but a few of the most recent developments.