O. J. Rafaelsen

The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale

In a study of 18 patients with manic symptomatology and 31 patients with melancholic symptomatology the Bech‐Rafaelsen Mania Scale (BRMS) and the Hamilton Depression Scale (HDS) have been compared. The results showed that the inter‐observer reliability of the BRMS was adequate compared with the HDS. Both scales are constructed for assessing the severity of manic or melancholic states, and no difference was found in the total BRMS or HDS score between the various diagnostic groups, when the patients were classified by an index of the course and symptomatology of their disorder, using the Multi‐axial Classification System for Affective Disorders (MULTI‐CLAD). The homogeneity of the BRMS seemed more adequate than that of the HDS, when each item was correlated to the corresponding total score. Although the homogeneity of the BRMS needs to be evaluated by other statistical models than correlation analysis, our results seem to indicate that the improvement in assessing manic‐melancholic states quantitatively is a matter of redefining items or incorporating new items in the melancholic rather than the manic part of these rating scales.

The permeability of the blood—brain barrier during electrically induced seizures in man

Abstract. The blood‐brain barrier (BBB) in man was studied during various conditions using the indicator dilution method of Crone [8]. Using 113mIn‐DTPA as reference substance the extraction, E, of the small test substances 24Na+, 36Cl‐, 14C‐urea and 14C‐thiourea was estimated from the areas under the venous outflow curves following intracarotid slug injection of tracers. Interlaminar diffusion and red cell carriage were taken into consideration when calculating E. Cerebral blood flow (CBF) was measured using the intra‐arterial 133Xe‐injection method. Twenty‐two patients receiving electro‐convulsive therapy (ECT) were studied before and during seizures and during hypercapnia. Before seizures the extraction values in % were as follows: ENa+ 1.6, ECl‐ 1.9, Eurea 3.9 and Ethiourea 7.8; the corresponding values for the permeability‐surface area products (PS) in ml/100 gX min were 0.5, 0.3, 0.7, 4.1, respectively. During seizure a decrease of Ethiourea and an increase of PSurea were significant. During hypercapnia PSNa and PSthiourea rose significantly.

Nocturnal temperature in affective disorder

The temperature rhythms of 9 drug-free patients with primary affective disorder were measured during depression and after recovery and compared with those of 12 normal controls. The patients had higher nocturnal temperatures and decreased 24-hour amplitudes when depressed than when they had recovered and compared to the controls. There was no evidence that the temperature minimum occurred earlier in the night in depression compared to controls. However, in 4 of 7 patients the temperature minimum occurred earlier in the night during depression compared to recovery.

The WHO Depression Scale RELATIONSHIP TO THE NEWCASTLE SCALES

The WHO (World Health Organization) Depression Scale is a new rating scale developed to evaluate the complete clinical history and description of depression. Items of the WHO scale were transformed to cover the items of the two Newcastle scales that are designed to differentiate between endogenous and non‐endogenous depressions. In 98 depressed inpatients examined prior to antidepressive therapy only moderate agreement between scores transformed to the two Newcastle scales was found. Also the distribution patterns of the scores on the two scales were different. In patients classified as endogenous on one or both scales a significant relationship between plasma levels of imipramine or clomipramine and antidepressive effect was found. In patients classified on both scales as doubtful – or non‐endogenous depressions – no such correlation could be identified. The initial severity of depression, as defined by the Hamilton Depression Scale, was the same in endogenous, doubtful and non‐endogenous depression according to the scores transformed to the two Newcastle scales.

The Hamilton Anxiety Scale: Evaluation of homogeneity and inter-observer reliability in patients with depressive disorders

In the present study the Hamilton Anxiety Scale (HAS), originally constructed for patients with neurotic anxiety, has been applied to patients with diagnosis of depressive disorders. The inter-rater reliability and homogeneity are evaluated and total scale score has been correlated to the Bech-Rafaelsen Melancholia Scale (BRMES). Twenty-two patients entered the study, 13 with endogenous depressions, and 9 with non-endogenous depressions when classified according to the ICD-8. For both scales the inter-rater reliability was found statistically significant. Concerning the homogeneity of the HAS, statistical significance was obtained for 7 items reflecting psychic anxiety, whereas in the BRMES statistical significance was found in all items apart from 2. Total scale score on HAS correlated positively with total score on BRMES for all 2 patients. However, when the patients were classified according to the ICD-8 this correlation seemed to be due to the endogenously depressed group as no significant correlation was seen for the group of non-endogenous depression. On the other hand, when the patients were classified according to the MULTI-CLAD system no significant intercorrelation of the HAS and BRMES scores was found within the subtypes of depression.

LITHIUM EFFECTS ON DIURNAL RHYTHM OF CALCIUM, MAGNESIUM, AND PHOSPHATE METABOLISM IN MANIC‐MELANCHOLIC DISORDER

The diurnal rhythm of plasma phosphate, calcium, and magnesium was studied in 34 lithium treated patients, in 42 other psychiatric patients, and in 47 healthy persons. Seventeen blood samples were drawn from each person during the 24‐hour period.

Personality in unipolar and bipolar manic-melancholic patients

By use of standardized case‐recording criteria (MULTI‐CLAD) manic‐melancholic patients were classified as unipolar (n= 13) and bipolar (n= 23). Personality patterns were evaluated when patients were in a neutral mood (defined by low symptom rating scale scores).

Delirium tremens and related clinical states: AETIOLOGY, PATHOPHYSIOLOGY AND TREATMENT

Definitions of Delirium Tremens (DT) and related clinical states are discussed together with the concepts of aetiology and pathogenesis in relation to psychiatric disease.

Long-term lithium treatment and psychological functions

A group of 50 long‐term lithium‐treated outpatients were investigated with psychological examinations in order to study cognitive and emotional functions (memory, attention, speed, loss of effort, level of processing, productivity, and reactivity).

The Diagnostic Melancholia Scale (DMS) : dimensions of endogenous and reactive depression with relationship to the Newcastle Scales

The two diagnostic Newcastle Scales for depression have been evaluated in a drug trial with antidepressants. By use of latent structure analysis (Rasch models) it was found that two dimensions are necessary for describing the diagnosis of depression, one for endogenous features and one for reactive features. Of the depressed patients 50% had a pure endogenous depression, 14% had a pure reactive depression, 32% had mixed endogenous and reactive depression, and 4% had uncertain diagnosis. In the pure endogenous depression group 77% had a monotonically non-decreasing improvement curve during treatment whereas in the other diagnostic categories around 50% had such an improvement.