Ekkehard Othmer

Subtyping Alcoholics by Coexisting Psychiatric Syndromes: Course, Family History, Outcome

This chapter will describe two studies designed to examine the clinical validity of a relatively new method of classifying alcoholics that was derived from a descriptive, syndromatic approach to psychiatric diagnosis. The rationale for the validation studies was based upon an old model of clinical research that has been successfully used in the past to evaluate the diagnostic significance of major syndromes in both medicine and psychiatry. It is suggested that the proposed approach to subtyping alcoholics may be potentially useful to both the practitioner desirous of finding more effective methods of treatment as well as the clinical researcher interested in exploring etiological factors associated with alcoholism.

BRAIN FUNCTIONS AND PSYCHIATRIC DISORDERS: A Clinical View

Psychiatric disorders are viewed as brain disorders affecting five circuits of the brain: the brainstem, the hypothalamus, the motor striatum, the limbic system (ventral striatum), and the neocortex. This five-circuit model combines neuroscientific, psychopharmacologic, evolutionary, introspective, and behavioral data. The article presents a broad speculative overview of some brain functions and dysfunctions relevant for clinicians.

Development of scales to screen for eight common psychiatric disorders.

The present study was designed to create a group of scales from the items on the Symptom Checklist 90 (SCL-90) to identify common psychiatric diagnoses. Subjects were 1457 adult psychiatric outpatients who completed the Symptom Checklist-90 and a structured diagnostic interview at the time of their initial evaluation. A combination of rational and empirical test construction methods was used to create the SCL-90 Diagnostic Scales, item sets that identify eight common psychiatric conditions: major depression, bipolar disorder, schizophrenia, antisocial personality disorder, somatization disorder, obsessive-compulsive disorder, panic disorder, and agoraphobia. These specially constructed scales were found to possess good internal reliability. These scales were also shown to differentiate patients positive for each of the eight psychiatric disorders from other psychiatric patients who did not have that disorder. Sensitivities and specificities are reported for each item set. In addition to their utility at the time of initial assessment as an aid in identifying diagnosis, the SCL-90 Diagnostic Scales may have other potential uses, such as in monitoring the symptom course of the patients disorder or disorders over time.

Tricyclic-induced electroencephalogram abnormalities and plasma drug concentrations.

In a double-blind study of 34 randomly assigned depressed inpatients, antidepressant-induced electroencephalogram (EEG) abnormalities were compared in amitriptyline-treated versus bupropion-treated patients. Drug-free baseline EEGs plus one or more repeat EEGs under pharmacokinetic steady state conditions were obtained. Of the 34 patients, eight developed EEG abnormalities. Seven were on amitriptyline and one was on bupropion (x2 = 13.77, df = 3, p < 0.01). All but one of the amitriptyline-treated patients with EEG abnormalities had plasma concentrations above its therapeutic range (150 to 250 ng/ml), whereas all with normal EEGs were within or below this range.

Problems in the Treatment of the Chronic Depressive

Antidepressants are effective in the treatment of acute depressive episodes. Their efficacy for more chronic forms of depression however, has not been clearly established. Therefore, the evaluation of the efficacy of established and novel antidepressants for the treatment of chronic depression is of clinical interest.

Development of an automatic sleep EEG analysis and staging system

The application of computers to sleep staging has not replaced manual classification techniques because of the simplifying assumptions employed in the design of most systems. Tltese assumptions result in significant deviations from the results of automated analysis when compared to manual techniques applied to the broad spectrum of sleep electrophysiologic signals that may be observed.