Marijan Herjanic

The natural history of affective disorders—I. Symptoms of 72 patients at the time of index hospital admission

Abstract Fifty-four patients hospitalized with primary affective disorder (depression) were compared with eighteen patients hospitalized with secondary affective disorder (depression). Primary affective disorder was defined as an affective illness occurring in a patient who had no previous psychiatric history other than that compatible with affective illness. Secondary affective disorder was defined as a depression occurring in a patient with a pre-existing, non-affective, psychiatric illness. The distribution and prevalence of affective symptoms in the current episode of illness was found to be the same among the two groups. This investigation indicates that the cross-sectional picture does not serve to distinguish primary from secondary affective disorders among hospitalized patients.

Mourning and Depression: Their Similarities and Differences*:

Previous studies have shown that bereaved people respond to their loss with a set of psychological symptoms which are in many instances indistinguishable from depressive illness, but accepted by them and their environment as normal (1,3,5). On the other hand, patients with primary affective disorder experience their condition as a “change”, “not usual self” (7), which leads them to seek help, and in this way they define themselves as patients. A comparison of frequencies of psychiatric symptoms between depressed 34, and bereaved 34, subjects matched for sex and age shows that hospitalized depressed subjects have more symptoms — 15 — than bereaved subjects (7). However, there is enough overlap that, on the basis of symptoms, the two groups cannot be differentiated satisfactorily for research purposes. In psychiatry, most diagnostic criteria are arbitrary. If they are set narrow some patients with a mild form of illness are excluded, while if broad criteria are employed persons with other conditions or no illness at all are included. For research purposes if the symptoms of depression occur only after the death of a near relative the subjects should not be included in the group diagnosed as suffering from primary affective disorder.

Children of Heroin Addicts

Fourteen Black male, opiate addicts, their wives, and their children were studied intensively using psychiatric interviews and psychological tests. Their 32 children were compared to 37 pediatric clinic children. The children raised in a home where father is an opiate addict function cognitively less well than their father, and the teenagers show earlier and stronger antisocial trends than pediatric clinic peers. On the other hand, there is a surprising absence of other psychopathology that one might expect, taking into consideration the deviant environment from which they come.

WHO ARE THE “COMMITTED”?

A record review of patients who were committed by the court during the course of a hospitalization at an acute urban facility was carried out. Court-committed patients represented 4% of total patients admitted during a 2-year period. Black patients and patients over the age of 70 were more likely to reach the stage of a court hearing and be committed. Schizophrenia was the most frequent diagnosis, being present in well over one half of court-committed patients. Approximately one third of the patients had a hospital stay exceeding 3 months, and transfer to a long term inpatient program occurred significantly more often among court-committed patients as compared to the rest of the hospitalized population. The majority of court-committed patients were eventually returned to the community; about one fifth were placed in intermediate facilities such as boarding or nursing homes. When legal status of previous and subsequent hospitalizations of this sample of court-committed patients was examined, a clear predominance of uncomplicated voluntary hospitalization became apparent.

Forensic psychiatry: anatomy of a service.

Abstract An examination of an urban forensic service over a 22 year period was undertaken by reviewing the records of 1195 defendants admitted. This revealed an increasing referral of violent and youthful defendants. Referral rates were highest for homicide. The prominent diagnosis seen was antisocial personality (27%), while schizophrenia (16%) was the next most common diagnosis. The reports to the court indicate an increasing tendency toward a finding of competency to stand trial as a result of increasing pretrial treatment. These data are compared to reports for other English-speaking forensic services and a correlation between admissions of schizophrenic defendants and a tendency toward relatively minor criminal offenses is seen.

Forensic psychiatry: diagnosis and criminal responsibility

An examination of the primary and secondary diagnoses of 1195 defendants admitted to an urban forensic service was carried out. This indicated that personality disorders dominated the referral patterns from the court. Of those conditions which could produce thought disorders, schizophrenia dominated. An analysis of the prevalence of schizophrenia among defendants charged with homicide in St. Louis revealed a rate of schizophrenia similar to that found in the general population. Organic brain syndromes resulted in a large proportion of assaultive behavior, and these cases also involved a large number of secondary diagnoses. Alcohol and drug abuse were the most common secondary diagnoses. In general, no correlation between psychiatric diagnosis and types of criminal activity was found.