Frank Engelsmann

Double-blind comparative study of clomipramine and amitriptyline in obsessive neurosis

Abstract 1. 1. The efficacy of clomipramine hydrochloride in severe obsessive compulsive neurosis (OCN) was compared with that of amitriptyline in a four week randomized double-blind trial. 2. 2. Clomipramine but not amitriptyline produced statistically significant improvement in the obsessive symptoms, depression and anxiety. 3. 3. The lack of significant effect of amitriptyline on anxiety and depression may be due to its inability to improve the primary obsessive symptoms. 4. 4. No serious adverse effects were encountered in either drug group.

The psychotropic effects of inhibitors of steroid biosynthesis in depressed patients refractory to treatment

Twenty patients, diagnosed as suffering from treatment-resistant major depression, were treated with one or more drugs that decrease corticosteroid biosynthesis. Nine were psychotic, 11 nonpsychotic. Seventeen completed the treatment (8 psychotic, 9 nonpsychotic); 13 responded (5 psychotic, 8 nonpsychotic; 11 responded completely (i.e., a drop in the Hamilton Depression Scale of at least 50%, to < or = 15), and 2 responded partially. The mean age of the responders (45.2 +/- 12.6 years) did not differ significantly from that of the nonresponders (48.7 +/- 12/3). Data were analyzed in the following categories; (1) the presence or absence of psychosis, (2) response or nonresponse to treatment, and (3) the drug(s) used (aminoglutethimide, ketoconazole, or a combination of either of these with metyrapone). The patients improved over time on the Hamilton Depression Scale independent of the medication used. Responders demonstrated improvement in mood, insomnia, anxiety, diurnal variation, paranoia and obsessive compulsiveness. Nonpsychotics responded better than psychotics.

Grief Reactions to Perinatal Death — a Follow-Up Study*

Thirty mothers who experienced a perinatal death were offered crisis intervention aimed at facilitating their grief process at a few days, 3 weeks and 3 months after the loss. Evaluaticn of maternal grief reactions and their general psychological adjustment took place at these 3 early contacts and 1 to 2 years later. This last assessment included a semi-structured clinical interview and a number of self-rating scales (Life Events Schedule, Beck Depression Inventory (BDI) and a Mourning Scale). Six of the 30 mothers showed inappropriate grief reactions at the 3 week and 3 month assessment. By the long term follow up only 1 of these 6 displayed depression or other psychiatric disorder. Three other women not identified as high risk candidates by the 3 month evaluation developed high BDI scores and clinical depressions at the 1 to 2 year assessment. Variables associated with abnormal grief and depression such as social support systems, communication between the parents, maternal dreams, and hospital practices were examined and discussed indicating possibilities for future research.

Folic acid deficiency and depression

Abstract To explore the association between folic acid deficiency and depression, the authors selected 48 patients and divided them into three groups–depressed patients, psychiatrically ill (but nondepressed) patients, and medically ill patients. All patients were hospitalized for one week and received standard diets with no drugs or vitamins. At the end of this time, depressed patients had significantly lower serum folic acid levels (P

Contribution to the validation of the SCL‐90‐R in French‐speaking women

This study is a contribution to the French validation of the Derogatis (1977) Symptom Check-List SCL-90-R. Norms reflecting the mental health status of a representative sample of French-speaking women from Montreal, Canada, are provided. Results indicated that the women in our sample generally obtained higher raw scores than those reported by Derogatis for the nonpatient group for the nine symptom scales and the three global scores. The reliability of the French version yielded a satisfactory Cronbach alpha of .91. High and significant positive correlations were found on the test-retest as well as on the Spearman-Brown split-half test. Validity was assessed using the principal component analysis on six factors accounting for 88% of the variance. The correlations between the symptom scales ranged from .32 to .74, indicating the relative independence of the dimensions of the French version of the SCL-90-R. The usefulness of the method will be enhanced by further cross-validation and concurrent validity studies including patient populations.

Grief reactions to perinatal death: An exploratory study

Abstract Mothers who lose a baby may show inappropriate grief reaction (IGR) at varying times following the event. The authors describe an interdisciplinary crisis-intervention team aimed at assessing and reducing pathologic grief in such mothers, and report their preliminary findings. Among the factors found associated with increased risk of IGR are the mothers desire for a baby, history of previous psychiatric problems, premature birth, failure to see the baby, and poor communication between the parents.

Children of parents with manic-depressive illness: a follow-up study.

Thirty-seven offspring from 21 families with a manic-depressive parent were studied 3 to 7 years following initial evaluation. The study examined both pedigree information and psychosocial variables including parental, marital and overall adjustment, measures of chronicity and severity of parental illness and family assessment measures in rleationship to offspring functioning. Nine of the 37 offspring (24%) received a positive DSM-III diagnosis, which is a similar percentage of positive diagnosis of children as we found previously. The diagnoses clustered in the affective illness spectrum. When the presence of affective traits was considered, there was evidence for continuity of psychopathology in most cases. Associations between offspring psychopathology and both non-specific and specific parental risk factors are discussed.

Psychopathology in the offspring of parents with bipolar affective disorders.

Thirty-nine children from intact families with a manic-depressive parent were evaluated by a semi-structured clinical interview and a number of rating scales for the presence or absence of psychopathology. This sample represents a larger one than in an earlier study, which showed minimal offspring psychopathology compared with reports of other investigators. The current study also examines the inter-relationships between the presence or absence of offspring psychopathology with both genetic loading and a number of psychosocial variables including measures of parental marital adjustment, severity and chronicity of proband parent illness and early exposure of children to parental illness. Nine of the thirty-nine children, (23%) received a positive DSM-III diagnosis, with depression of the dysthymic type being the most common. There was no significant correlation between genetic loading and offspring psychopathology. However, there were significant associations between children with psychopathology and paternal marital dissatisfaction and the age and chronicity of illness of the proband parent as compared with the children with no psychopathology.

Lithium and memory: a review.

This paper reviews systematic clinical studies suggesting memory and cognitive impairment inpatients suffering from unipolar and bipolar affective disorders treated with lithium. A number of studies failed, however, to demonstrate lithium induced memory deficits. Thus, the results of studies were equivocal. This lack of empirical consensus was in part due to the heterogeneity of samples and a variety of methodological and design problems. The definition of short- and long-term memory was often arbitrary and lacked standard criteria. Some studies revealed a stability of the memory test scores over time and showed that subjective complaints of memory impairment were correlated with depression. The authors also reviewed studies examining the effects of lithium on cognition and memory of healthy control subjects. In animal research it was difficult at times to distinguish between toxic and pharmacologic effects of lithium. There is a need for prospective studies of the effect of lithium in large samples of patients using refined memory tests.

Behavioural changes following gastric surgery for morbid obesity: a prospective, controlled study.

The authors present results of a prospective, controlled longterm follow-up study of patients undergoing a gastric procedure for morbid obesity. Pre-operatively the gastric surgery group (GS) was compared with a group of normal weighted (NC) and obese (OC) individuals participating in self-help weight reduction groups. The GS group was assessed at 3-months, 6-months and one year or more post-operatively. All groups were examined by a structured self-rating schedule reflecting personal characteristics and family history, current attitudes and experiences related to personal weight, and an extensive exploration of eating habits. Moreover, the groups completed the Minnesota Multiphasic Personality Inventory (MMPI), the Katz Adjustment Scale and the Zung Self-rating Depression Scale. The results demonstrated major differences between the GS and the NC and OC groups initially, and at follow-up; the GS demonstrated major weight loss without major psychopathologic reactions. The GS did not show, however, major alterations in eating habits, but clearly showed behavioural change subsequent to weight loss.