Hans G. Stampfer

“Negative Symptoms” : A Cu Mu Latlve Trauma Stress Disorder?

A theory is proposed that “negative symptoms”, which are usually associated with schizophrenia, are manifestations of a traumatic stress disorder that is fundamentally similar in terms of the clinical phenomena and pathophysiological disturbance to chronic post-traumatic stress disorder (PTSD) as defined in DSM-Ill-R. Wider theoretical implications are explored briefly.

Inverse Filter Computation of the Neural Impulse Giving Rise to the Auditory Evoked Potential

SummaryAn impulse response hypothesis for evoked potentials is tested. The auditory evoked potential (AEP) is shown to be the consequence of an impulse (the arrival of sensory signals in cortex) giving rise to an impulse response (the resonation of electrocortical activity in the form of group linear waves). To demonstrate this, pre- and post-stimulus EEG activity was recorded from subjects engaged in performance of an auditory odd-ball experiment. For each stimulus, the impulse required to account for the single auditory evoked potential (AEP) as a linear impulse response, was computed by use of the inverse of a filter obtained by autoregression analysis of the pre-stimulus EEG epoch. Single estimations of the impulse were then averaged. The average impulse exhibits a time course and topology consistent with the arrival of neural volleys in the cortex. The physical validity of the hypothesis is supported by a high lag correlation of the following values of the AEP to the average impulse. A further test calculation supports the linear additivity assumptions of the hypothesis.

The relationship between psychiatric illness and the circadian pattern of heart rate

Objective: The aim of this study was to investigate the relationship between psychiatric status and the circadian pattern of heart rate. Method: Serial 24–hour recordings of minute average heart rate were obtained from 30 normal volunteers and 200 patients representing a range of DSM-III-R diagnoses. Records were compared in terms of their circadian “morphology” and grouped into different pattern types. The distribution of patterns in different diagnoses was analysed statistically. Results: It was found that states such as generalised anxiety and depression are strongly associated with a distinctive circadian pattern, whereas others such as somatoform disorder show more variation in this regard. Serial recordings show that the relationship between psychiatric status and circadian pattern is state-dependent; a change in clinical status leads to a change in the circadian pattern. Conclusions: The presented findings together suggest that there is a systematic relationship between psychiatric status and heart rate in which core physiological differences between certain states are reflected in distinctively different circadian patterns of activity. The state-dependent nature of this relationship suggests obvious practical applications, and examples are given of how these adjunct data can provide objective indices of clinical status and change. At a theoretical level, the physiological dimension revealed by these data may help to define more reliable syndromal distinctions between various clinical manifestations and hence contribute to a more robust nosology.

Does Depressive Illness in the Elderly Have a Poor Prognosis

The few available longitudinal studies of depressive illness in the elderly indicate a poor prognosis. Various risk factors are discussed. Both severe and chronic physical illness, and severity of the depressive disorder are the two most important prognostic factors. The possibility of interactional effects between these risk factors should be studied. Most studies to date have been of severely depressed patients and this may give an unduly pessimistic picture. A case is made for the desirability of well-designed prognostic longitudinal studies with subjects being drawn from a wide spectrum of severity of illness.

Reliability of circadian heart pattern analysis in psychiatry

The assessment of circadian heart patterns represents a new methodology for documenting physiological dysregulation associated with psychiatric illness. Previous research has demonstrated abnormal heart rate patterns, especially during the bedtime interval, that are associated with depression, generalized anxiety disorder, panic disorder, and schizophrenia. These patterns are derived from heart rate data obtained while wearing an unobtrusive, two-lead heart rate monitor over a 24-hour period. To establish basic reliability, the second author blindly rated heart-monitored data from 50 subjects on two occasions, separated by an average of 6.6 weeks (range = 2.9–15.7 weeks). Subjects were classified as “definitely psychiatric,” “probably psychiatric,” “borderline,” “broadly normal,” and “signature normal.” The exact category agreement rate was 78%. If a one-category difference is permitted (e.g., “definitely psychiatric” and “probably psychiatric” counted as an agreement), the agreement rate was 92%. Circadian heart pattern analysis is a promising new technology in psychiatric research and warrants further investigation.

Relationship between country of birth and psychiatric admissions in Western Australia

The rates of admissions in 1976–78 to all hospitals in Western Australia, both psychiatric and non‐psychiatric, of patients with a primary psychiatric diagnosis were analysed specifically for country of birth and whether they lived in Perth or in country areas. Eastern European migrants had the highest hospitalization rates, and Southern European migrants the lowest. Rates for schizophrenia were high in the Eastern Europeans, and for alcoholism low in Southern European and Asian females and high in Northern European males. The United Kingdom migrants were most like the Australian born in regards to admission rates, diagnostic composition, and in the distribution of hospitalization patterns between psychiatrists and non‐psychiatrists. Women, especially Southern European, in the country areas are at special risk to be admitted for neurosis/personality disorder.

The relationship between distance from inpatient facilities and the rate of psychiatric admissions in Western Australia

Western Australia is the largest and most sparsely populated state in Australia with all its specialised psychiatric inpatient facilities in Perth, the capital city. This study tested a number of hypotheses concerning the effect of distance from Perth, firstly, on total hospitalisation rates for psychiatric illness of the rural population and secondly, on the proportion who were hospitalized in Perth. High rates of alcoholism in males and of neuroses in females, together with local conditions in various rural centres, rather than distance from Perth, were major determining factors affecting both total hospitalisation and th proportion sent to Perth. The major exception was that the proportion of male alcoholics admitted to Perth hospitals decreased the further the patient lived from Perth. These findings were contrary to those reported in the literature. However the distances from Perth were much greater than those usually reported elsewhere. It was concluded that beyond a certain distance from psychiatric facilities, distance per se was not a major factor governing admissions to these facilities.

Comparison of Psychiatric Admissions between City and Country Residents in Western Australia

Data are presented of all patients with a primary psychiatric diagnosis who were admitted to all psychiatric and non-psychiatric hospitals, in Western Australia during 1976–78. Patients resident in the country were compared with those resident in Perth, the capital city of Western Australia. A high proportion of both Perth and country residents were admitted under non-psychiatrists. Age standardised admission rates were highest for female country residents, the excess rate being mainly due to their very high rates of neurosis/personality disorder. The higher male admission rates for Perth compared with country residents were mainly due to higher Perth rates for alcoholism. The implications of these findings are discussed.

Statin Dose Based on Limited Evidence

The review by Smith and Grundy [(1)][1] of the American College of Cardiology/American Heart Association Cholesterol Treatment Guideline is helpful, but recommendations for statin dosing are not supported by robust evidence. Simvastatin is routinely available in a 16-fold range of strengths (5 to 80

Variations in circadian heart rate in psychiatric disorders: theoretical and practical implications

Correspondence: Hans G Stampfer School of Psychiatry and Clinical Neurosciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia Tel +618 9346 2140 Email hans.stampfer@uwa.edu.au: Background: Data are presented to demonstrate dimensions of variation in circadian heart rate in patients under treatment for a psychiatric disorder and to comment on their clinical relevance. Method: Serial recordings of 24-hour heart rates were obtained from individuals under treatment for a psychiatric disorder and from healthy volunteers. Results: The mean 24-hour heart rate can vary independently of the circadian rate pattern or “rate architecture.” Sleep and waking heart rate can vary independently. Variations in circadian heart rate are state-dependent: broadly different clinical states are associated with distinctly different patterns of circadian heart rate, particularly during sleep. Conclusion: Different regulatory mechanisms or pathways are involved in mediating different aspects of circadian heart rate. An analysis of circadian heart rate can contribute useful physiological adjunct information to psychiatric assessment and the monitoring of patient response to treatment.