Richard D. Wetzel

Depression among medical students

304 first- and second-year medical students were prospectively assessed for depression with a monthly Beck Depression Inventory (BDI). Students scoring above nine on the BDI and a control group were then interviewed with the NIMH Diagnostic Interview Schedule. The incidence of major depression or probable major depression by DSM-III criteria during the first two years of medical school was 12%. The lifetime prevalence was 15%, three times greater than the rate in the general population. An episode of depression prior to medical school was much more common among the depressed students (69 vs. 8%, P less than 0.001) as was a family history of treated depression (46 vs. 21%, P less than 0.025). The elevated rate of depression during medical school does not appear to be a result of the medical school experience alone. Rather, it suggests a positive bias of unknown nature in the selection of students predisposed to depression.

Predicting response to cognitive therapy of depression: The role of learned resourcefulness

Thirty-five moderately depressed outpatients were randomly assigned to 12 weeks of cognitive therapy (N = 19), or nortriptyline (N = 16). The patients were assessed on a number of measures before the initiation of treatment to explore the potential of pretreatment variables for predicting treatment response. Both groups of patients showed significant improvement by termination. Improvement did not differ as a function of the type of treatment received. However, an interaction between initial levels of learned resourcefulness, as measured by Rosenbaums (1980a) Self Control Schedule (SCS), and type of treatment was found. Specifically, patients entering cognitive therapy with relatively high SCS scores did better than patients with low SCS scores. Patients in the pharmacotherapy group showed the opposite pattern: Patients with initially low scores on the SCS did better with medication than did the high scorers.

Family history of suicidal behavior among suicide attempters.

Efforts to predict suicide and attempted suicide are hampered by their relative rarity on the one hand and the inadequate specificity of clinical characteristics and relevant antecedent events on the other; that is, these features are found widely among the nonsuicidal as well. In an effort to further understand these phenomena, the authors studied family history of suicidal behaviors (suicide, attempted suicide, and suicide threats) in 127 patients hospitalized following a suicide attempt. Patients with personality disorders (antisocial personality disorder, alcoholism, somatization disorder, and narcotic addiction), comprising 45 per cent of the sample, frequently reported a family history of these behaviors, most notably attempted suicide. Patients with primary affective disorder reported a family history of suicidal behaviors somewhat less often. The diagnoses grouped here as personality disorders (excepting alcoholism) contribute little to the suicide rate, while primary affective disorder contributes substantially. Although further data are needed, it is suggested that a family history of suicidal behavior in primary affective disorder should alert the clinician to heightened suicide risk, while a similar history in nonalcoholics with other psychiatric diagnoses is not particularly significant.

Cognitive Behavior Therapy, Relaxation Training, and Tricyclic Antidepressant Medication in the Treatment of Depression:

Outcomes of seven treatment trials comparing cognitive behavioral therapy to treatment with tricyclic antidepressant medication in major depressive disorder have been quite similar to one another. This led us to question whether treatment outcome in time-limited studies reflected a unique effect of cognitive behavioral therapy. To test the uniqueness hypothesis, relaxation training, a nonpharmacologic, noncognitive treatment, was chosen as a comparison for cognitive behavioral therapy as well as drug therapy. Treatment duration was 16 weeks. The sample of 37 patients treated for major depressive disorder was less depressed than those previously studied. For both cognitive behavioral therapy and relaxation training, outcome of depression was superior to that of tricyclic antidepressant medication by endpoint analysis. The posttreatment scores on the Beck Depression Inventory of 82% of the group receiving cognitive behavioral therapy improved to a Beck Depression Inventory score ≤9 which was not significantly greater than that for the group receiving relaxation training.(73%), so a unique effect was not demonstrated for cognitive behavioral therapy. The outcome for tricyclic antidepressant medication (29% improved to criteria) was significantly worse than that for cognitive behavioral therapy. The patients pretreatment initial expectancy was not predictive.

The Association of Irritable Bowel Syndrome and Somatization Disorder

Background and objective: Irritable bowel syndrome (IBS) and somatization disorder (SD) are defined by nonobjective symptoms that overlap considerably. Psychiatric symptoms associated with IBS may originate from SD in IBS patients. Previous studies of IBS have not considered SD separately from IBS. Methods: This study explored psychiatric symptoms and illness behavior in IBS in relation to SD. A total of 50 outpatients with IBS or ulcerative colitis (UC) were evaluated with the Diagnostic Interview Schedule and Illness Behavior Questionnaire. Results: Definite or probable SD was diagnosed in no UC patients and in 42% of IBS patients (confirmed in 25% and lacking one symptom in another 17%). IBS patients with probable or definite SD, but not those without SD, reported more psychiatric symptoms and abnormal illness behaviors than did UC patients. SD accounted for the association of psychiatric symptoms with IBS. Conclusions: In this university-based office setting, the association of psychiatric features with IBS appears heterogeneous predicated on whether SD is present. Future studies of functional bowel diseases should distinguish between patients with and without SD to clarify its relationship to these disorders. Clinicians should consider whether patients with functional disorders have SD, a diagnosis that indicates specific clinical management strategies.

The Safety of ECT in Geriatric Psychiatry

Electroconvulsive therapy (ECT) is often described as an effective and safe treatment of depression in the elderly. However, we have previously reported that there may be increased morbidity in this population, particularly in the very old. This paper extends this work to a second, larger sample of 136 subjects of whom 40 are over 60 years of age. We have again found that while ECT is efficacious, complications increase with age (r = .26; P ≤ .003), occurring in 35% of the elderly as opposed to 18% of the younger group. This increased rate of complications appears to be accounted for by problems in the very old; six of eight subjects over 75 years of age had some untoward event. Common complications in the elderly included severe confusion, falls, and cardiorespiratory problems. Complications in the whole sample were related to health status (r = .22; P ≤ .008) which in turn correlated with age (r = .50; P ≤ .0001). Those taking a greater total number of medications and a greater number of cardiovascular medications had significantly more complications during ECT. There was no relationship between either complications and outcome or complications and the number or laterality of treatments.

Depression in diabetics: A critical appraisal

Abstract Depression can be encountered concurrently with chronic medical illnesses. The low mood and its associated symptoms may comprise a reaction to a protracted malady, an independent primary affective disorder, a consequence of characterological vulnerabilities highlighted by the medical illness, a side effect of drugs employed to treat other conditions, or perhaps a direct result of the illness process. As one of the most frequent chronic medical conditions, diabetes mellitus can be expected to be associated with depression in a considerable number of instances. Previous efforts to characterize psychological factors, accompanying diabetes have been marred by methodological problems, especially inadequate measuring devices and unreliable psychiatric diagnostic criteria. While the literature is suggestive, firm conclusions cannot be drawn. A systematic description of the relationship between depression and diabetes, detailing incidence and prevalence of depression in diabetics, the effect of depression on blood glucose control, the applicability of standard diagnostic criteria for identifying depression in diabetics, and the fit of theoretical models of depression to such a population, is not available. The authors focus on controlled studies which examine psychological variables relevant to depression in diabetics. The use of clearly delineated diagnostic criteria, instruments, and research subjects is advocated. Suggestions are made for designing studies within the framework of theoretical models of depression.

Personality as a subclinical expression of the affective disorders

Abstract The literature on the relationship between personality traits and the various forms of affective disorder were reviewed. On the basis of this review, it was hypothesized that probands with primary unipolar affective disorder and their relatives would be significantly higher on cyclothymia, as measured by trait A of the 16 PF, and that no other significant correlations between depression and personality traits would be found. Contrary to the hypotheses, depressed probands and their relatives were lower than appropriate controls on cyclothymia. Evidence for the familial transmission of an increased amount of secondary trait Q II (adjustment versus anxiety) was found. It was speculated that the spectrum disorder involving subdepressive behavior (Q II ) and unipolar affective disorder is independently transmitted from the spectrum involving cyclothymia, bipolar I and II, and mania. 21 Designs to test these speculations were discussed.

Ratings of life and death and suicide intent.

154 Ss rated the concepts life and death with the semantic differential. Ratings of life and life minus death significantly discriminated between suicidal and non-suicidal Ss and between more and less suicidal Ss. Changes in evaluation of life were significantly associated with changes in self-rated suicide intent. Evaluation of life was more sensitive than other life factor scores to suicide behavior and suicide intent.

SELF-CONCEPT AND SUICIDE INTENT'

154 Ss rated the concept myself on a semantic differential. Ratings of myself distinguished between suicidal and non-suicidal Ss and between more and less suicidal Ss. Changes in ratings of myself were significantly associated with changes in suicide risk.