George Winokur

Affective disorder *: IV. Mania

Summary In this paper 31 patients with a diagnosis of manic depressive, manic are matched for age, sex and socioeconomic status with 31 patients with a diagnosis of manic depressive, depressed. The study shows that hospitalized manics contain a higher percentage of men than hospitalized depressives and the manics are hospitalized at an earlier age. It is also noted that the first symptoms are seen at an earlier age. There were no significant differences in the family histories of manics and depressives. Turning to the clinical picture of mania, cuphoria, overactivity and push of speech were seen in almost all patients studied. Objective confusion was seen in 18 of the 31 (58 per cent) patients. Eighteen of 24 patients (58 per cent), in whom information about depressive symptoms was recorded, reported a depression immediately preceding the onset of the mania. Special attention was given to those patients who exhibited schizophrenic symptomatology in their index admission. Seven patients with passivity feelings were personally interviewed approximately 2 years after their index admission. It was found that in none had classical schizophrenia with deterioration developed. Their cases histories are presented.

Familial differences in schizophrenia with good and poor prognosis.

Probands with schizophrenia of good and poor prognosis were selected according to defined criteria. Families were investigated blindly. The families with poor prognosis contained significantly more schizophrenia, neurosis, and overall illness, but less affective disorder than the families with good prognosis.

The EEG and reaction to photic stimulation as an index of anxiety-proneness.

Abstract One hundred and ninety one subjects (patients and controls) were utilized in an attempt to develop an EEG measure for selecting anxiety-prone individuals. All were carefully studied by psychological tests and psychiatric interviews and rated for their proneness to develop anxiety under stress. EEGs were taken under resting conditions and during intermittent photic stimulation. An electronic brain wave analyser was used. There was a significant correlation between the criteria of anxiety-proneness and the following: 1. 1. Per cent of fast, slow and low alpha activity in the electronically analysed resting EEG. 2. 2. Pattern of fundamental driving response. 3. 3. Amount of harmonic driving response, particularly in the 20–30 c/sec. range to stimulation with flicker frequencies 1 2 or 1 4 this rate. 4. 4. Amount of subjective dysphoria produced by intermittent photic stimulation. A check list of EEG anxiety indicators derived from the above correlated 0.51 with the validating criterion of anxiety-proneness.

Affective disorder: VI. A family history study of prevalences, sex differences and possible genetic factors ☆

1. 1.|This is a study of the family histories of 748 consecutive admissions to a psychiatric hospital and 250 stratified controls from a general hospital ill population. A sub-group of 366 affectively disordered patients in particular was studied. A systematic interview was used. 2. 2.|Prevalence of affective disorder in parents of a non-psychiatric hospital population was 2 ±0.62 per cent. 3. 3.|Psychiatric patients with a diagnosis other than that of an affective disorder exhibited a higher frequency of parental affective disorder than would have been expected from the data of our control population. 4. 4.|These non-affective disorder patients with a parental history of affective disorder showed a loading toward alcoholism and personality disorder. 5. 5.|Compared to parents of controls who had no psychiatric illness, parents of affectively disordered patients manifested a much higher rate of affective disorder (p <0·01) and showed five times the prevalence of alcoholism. 6. 6.|Affectively disordered patients with a parental history of affective disorder showed a higher percentage of affectively disordered siblings than did a group of similar patients without a parental history. 7. 7.|Affective disorder appears to manifest itself more in females than in males, but both sexes transmit the disorder equally to their children. 8. 8.|Neither a simple dominant gene with complete penetrance hypothesis nor an X borne dominant gene hypothesis is satisfied as a mode of transmission by the data.

Experimental investigation of the specificity of attitude hypothesis in psychosomatic disease.

&NA; A specificity of attitude hypothesis, developed originally from the clinical study of patients with various psychosomatic diseases, was tested experimentally by suggesting attitudes to normal subjects and measuring concomitant changes in skin temperature of the hand. The hypothesis states that each attitude toward a disturbing situation is associated with its own specific disease or set of physiological changes. Subjects were hypnotized as an aid in inducing the desired attitudes and were told to assume the attitudes the original study had found to be associated with hives and with Raynauds disease. Since rise of skin temperature is related to the development of hives and fall in skin temperature is part of Raynauds disease, it was predicted that skin temperature would rise with the hives attitude and fall with the Raynauds attitude. After elimination of experiments in which the subjects skin showed marked cooling before the experiment proper began, there remained for evaluation a total of 22 experimental sessions involving 8 subjects and 41 separate attitude, suggestions. The hives attitude was suggested on 23 occasions. Averaging all responses to these suggestions produced a curve that after a preliminary fall showed a steady rise in temperature. The Raynauds attitude was suggested on 18 occasions. Averaging all responses to these suggestions produced a curve that showed a steady fall in temperature. The difference between the temperature responses to the two suggestions was statistically significant. The temperatures during the attitude periods reached points significantly different from the last control temperature. This occurred sooner with Raynauds than with hives, because of the necessity for overcoming the initial drop in the latter. The evaluation of individual experiments in terms of the change in slope of the temperature curve in the attitude period as compared with the control period (acceleration produced by the hives suggestion, deceleration produced by the Raynauds suggestion) showed a statistically significant difference between the hives and Raynauds suggestions, even when the experiments rejected because of the pre‐experimental skin cooling were included in the analysis. Covariance analysis showed that the effects obtained were independent of the temperatures during the control periods. Correlation with available cardiovascular data suggests that the pre‐experimental skin cooling was part of an “anxiety” response. The results of the experiment are in conformity with the predictions of the “specificity of attitude” hypothesis.

An efficacy study of electroconvulsive therapy and antidepressants in the treatment of primary depression

At discharge, a significantly larger percentage of unipolar patients treated with electroconvulsive therapy (ECT) respond with marked improvement as compared with those receiving antidepressants or other treatment. No treatment appears to be more efficacious in the bipolar group. In studying the covariables related to the length of time between hospitalizations, we found that the type of treatment is not important for the unipolar patient, whereas a combination of ECT and antidepressants lengthens the time to rehospitalization of the bipolar patient. Previous hospitalization is an important predictor variable for all patients.

Two genetic factors in manic-depressive disease

Abstract In the families of 61 manic probands the finding of an increased number of ill maternal relatives over ill paternal relatives suggests that one genetic factor in manic depressive disease is an X-linked dominant one. This finding supports previous clinical and linkage research which has indicated that an X-linked dominant gene is implicated in the transmission of manic depressive disease. Alcoholism is frequently seen in these families but evolves independently of affective disorder. It is posible that alcoholism is one of the ways in which a second genetic factor expresses itself. The X-linked dominant factor may be the disease factor itself. A number of affectively iol family members of manic probands suffer from depression only. The second factor may be responsible for the presence of mania in the other affectively ill family members. Alcoholism may be one way in which such a second factor may manifest itself in the absence of the primary X-linked dominant contribution.

Association of Conditionability with Degree of Reactivity in Psychiatric Patients

A positive relationship exists between the number of times a subject responds with a psychogalvanic response to an orienting or alerting stimulus (tone) and the rate of learning in classical conditioning. This is seen by a correlation (p=.65 and .643 when corrected for ties) between the number of orienting responses and the resistance to extinction of the conditioned psychogalvanic response.

Family history studies. VI. Depressive disease types

Abstract On the basis of genetic studies, previous investigators have proposed the existence of two types of affective disorder: (1) primary affective disorder, manic-depressive disease, and (2) primary affective disorder, depressive type. This is a study of the pattern of inheritance in families of probands with the depressive type disease. Data from five previously published series of patients with affective disorder were analyzed for morbid risk of affective illness in siblings and children of probands who had depressions only and in whose families no mania occurred. Significant sex differences in morbid risk were found in both siblings and children of female probands: low risks for affective disorder in brothers and sons, compared to higher risks for sisters and daughters. Morbid risks for the siblings and children of male probands showed no sex difference in morbid risk for affective disorder. This pattern of risk for depressive illness is not compatible with the genetic model proposed by Reich, Clayton and Winokur of an X-linked dominant inheritance for manic-depressive illness. This finding supports the hypothesis of two types of affective disorder. The pattern of an excess of ill daughters and sisters of female probands is difficult to explain by a simple genetic model, but is compatible with the hypothesis that depressive illness is made up of at least two subgroups: one group in which males and females inherit an equal morbid risk, and a second group in which the illness is sex-limited to females.