George E. Murphy

The Process of Change in Cognitive Therapy and Pharmacotherapy for Depression

\s=b\ Twenty-eight moderately depressed outpatients were randomly assigned to 12 weeks of cognitive therapy (N =14) or pharmacotherapy (N =14). Significant changes in mood, cognitive processes, and content were similar to those found in previous studies demonstrating effectiveness of cognitive therapy. Patients treated with medication, however, demonstrated nearly identical change on all measures, including cognitive measures, despite the absence of direct focus on cognitive activity. Further analyses disclosed that cognitive change may be an important feature of overall clinical improvement, as patients whose conditions did not improve (regardless of treatment modality) showed significantly less change on cognitive measures. These findings suggest that cognitive change may be more accurately seen as a part of improvement rather than the primary cause of improvement. This suggests a more complex conceptualization of the role of cognitions in the change secured by cognitive therapy. (Arch Gen Psychiatry 1984;41:45-51)

Family history of suicidal behavior among suicide attempters.

Efforts to predict suicide and attempted suicide are hampered by their relative rarity on the one hand and the inadequate specificity of clinical characteristics and relevant antecedent events on the other; that is, these features are found widely among the nonsuicidal as well. In an effort to further understand these phenomena, the authors studied family history of suicidal behaviors (suicide, attempted suicide, and suicide threats) in 127 patients hospitalized following a suicide attempt. Patients with personality disorders (antisocial personality disorder, alcoholism, somatization disorder, and narcotic addiction), comprising 45 per cent of the sample, frequently reported a family history of these behaviors, most notably attempted suicide. Patients with primary affective disorder reported a family history of suicidal behaviors somewhat less often. The diagnoses grouped here as personality disorders (excepting alcoholism) contribute little to the suicide rate, while primary affective disorder contributes substantially. Although further data are needed, it is suggested that a family history of suicidal behavior in primary affective disorder should alert the clinician to heightened suicide risk, while a similar history in nonalcoholics with other psychiatric diagnoses is not particularly significant.

The Development of the Feighner Criteria: A Historical Perspective

This essay outlines the historical context in which the Feighner criteria emerged; reconstructs, as far as possible, the process by which the criteria were developed; and traces the influence the criteria had on subsequent developments in American psychiatry. In the 1950s, when American psychiatry under psychoanalytic dominance had little interest in psychiatric diagnosis, Edwin Gildea recruited to the Department of Psychiatry at Washington University faculty who advocated a medical model for psychiatry in which diagnosis had a central role. In 1967, at the urging of the then-resident John Feighner, a discussion group led by Eli Robins and including Sam Guze, George Winokur, Robert Woodruff, and Rod Muñoz began meeting with the initial goal of writing a review of prior key contributions to psychiatric diagnosis. In their meetings over the next year, the task soon shifted to the development of a set of new diagnostic criteria. For three diagnoses, major depression, antisocial personality disorder, and alcoholism, the authors could identify the original criteria from which this group worked and the rationale for many of the changes they introduced. Published in 1972, the Feighner criteria were soon widely cited and used in research, and they formed the basis for the development of the Research Diagnostic Criteria, which in turn were central to the development of DSM-III. The team that developed the Feighner criteria made three key contributions to psychiatry: the systematic use of operationalized diagnostic criteria; the reintroduction of an emphasis on illness course and outcome; and an emphasis on the need, whenever possible, to base diagnostic criteria on empirical evidence.

Suicide and Attempted Suicide

Studies have shown that the majority of suicides consult physicians within weeks or even hours before their deaths. The author spells out the questions that can identify well-defined prodromal symptoms and details the differences between truly suicidal persons and those who are primarily suicide “attempters.” Guidelines are given for dealing with drug overdose, the method used by four out of five attempters, mainly young women.