Joy G. Schulterbrandt

Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives.

In a prior study, we identified factors of psychopathology in the interview, ward behavior and self-report ratings of 124 depressed patients from 9 hospitals. The present study attempts to replicate these findings in a sample of 648 depressed patients from 10 hospitals. The criteria for patient selection and the factor analytic methods employed were identical in both studies. The major factors of psychopathology identified in the first study were replicated in the second study. Further, the loadings of the key items on these factors were highly similar in both studies. However, the factors in the second study encompassed a narrower range of psychopathology than those in the first. As a consequence, more factors were extracted for the same evaluation instruments in the second study. The 12 major categories of psychopathology discernible from these analyses were: 1) depressive mood, 2) feelings of guilt and worthlessness, 3) hostility, 4) anxiety-tension, 5) cognitive loss and subjective uncertainty, 6) interest and involvement in activities, 7) somatic complaints, 8) sleep disturbance, 9) retardation in speech and behavior, 10) bizarre thoughts and behavior, 11) excitement and 12) denial of illness. The break-up of some of the larger, global factors from the first study into smaller and more narrowly defined factors in the second study was a distinct asset in later efforts to discern the differential effects of various antidepressant drugs. The results from both studies also highlighted the advantages of using different rating instruments and sources of information about the patient. First, within a particular category of psycho-pathology, such as hostility, nuances of behavior across rating instruments would have been missed had we sampled only one aspect of patient behavior. Second, some categories of psychopathology, such as depressed mood, emerged as strong factors on certain rating instruments and were either poorly represented or absent on others.

Factor Analyses of Normal and Depressed Patients' Memories of Parental Behavior.

An abbreviated 90-item version of the Childrens Reports of Parental Behavior Inventory was administered to two samples of 371 and 177 hospitalized depressed patients and a third sample of 254 normal adults. In each sample there were roughly twice as many females as males. Ss rated mothers and fathers on separate but identical forms. The three major factors which emerged from these six factor analyses closely resembled Schaefers three conceptual dimensions—Acceptance vs Rejection, Psychological Autonomy vs Psychological Control and Firm Control vs Lax Control. Essentially the same items had significant loadings on comparable mother and father factors. Finally, patients rated both parents more negatively on these factors than the normal adults.

Further Replication of Factors of Psychopathology in the Interview, Ward Behavior and Self-Reported Ratings of Hospitalized Depressed Patients

Factors of psychopathology in the interview, ward behavior, and self-reported ratings were initially obtained for 124 depressed patients from nine hospitals and subsequently replicated in an independent sample of 648 depressed patients from these same plus one additional hospital. The present study provided a further test of the generalizability and stability of these factors in a third independent sample of 325 depressed patients from these same hospitals. These factors appeared to be quite stable across the three studies and could be categorized into 10 major areas of psychopathology: Depressed Mood, Hostility, Guilty-Ashamed, Anxiety, Sleep Disturbances, Interest and Involvement in Activities, Paranoid Projections, Cognitive Loss, Apathy-Motor Retardation, and Hypochondriasis.

True and apparent side effects in a controlled trial of chlorpromazine and imipramine in depression

Five hundred and fifty-five acutely depressed patients receiving chlorpromazine and imipramine, were studied to determine the incidence and severity of drug-related side effects. The ability of clinicians to distinguish between drug-related side effects and symptoms considered natural to the depressive illnesses was also investigated. The results indicated that side effects were minimal for both active drug groups and that among the dropouts for serious side effects (31 cases) the majority were receiving chlorpromazine. Skin rash and hypotension were the most frequent reasons cited for side effect terminations from the study.It appeared that clinicians were generally able to distinguish drug-related side effects from symptoms usually associated with depression. There was some indication, however, that they tended to rate as non-medication related, certain symptoms which were actually drug-induced. The latter included muscle rigidity, edema, and dry mouth on chlorpromazine and tremulousness on imipramine.

Initial response to drugs in depressive illness and psychiatric and community adjustment a year later.

Three hundred and sixty depressed in-patients initially treated with imipramine, chlorpromazine or a placebo were re-evaluated a year later. Patients showing the poorest adjustment at one year were those who failed to show a good initial response to treatment and those who responded positively to a placebo.