Samuel B. Guze

Alcoholism and the hyperactive child syndrome.

Comparisons were made between alcoholics and nonalcoholics in a sample of Danish adoptees (mean age 30) and it was found that the alcoholics, as children, were more often hyperactive, truant, antisocial, shy, aggressive, disobedient, and friendless. The literature suggesting a relationship between the hyperactive child syndrome and subsequent alcoholism is reviewed, as well as a possible relationship between these disorders and antisocial behavior. The adoptive parent of the two groups did not differ with regard to socioeconomic class, psychopathology, or drinking histories. However, 10 of the 14 alcoholics had biological parents who were alcoholic, with no known alcoholism among the biological parents of the nonalcoholics. As adults, the alcoholics differed from the nonalcoholics only with regard to drinking history, use of drugs, and overt expression of anger.

Biological psychiatry: is there any other kind? *

It has been my custom as Head of the Department of Psychiatry at Washington University to interview as many as possible of the medical students applying for positions in our residency training programme. I typically ask the candidates how they decided to apply to us, what they know about our programme, and what they have heard from others about our department. The answers to these questions have been interesting and informative to me and have characteristically provided a good basis for the discussions that followed, designed to help us decide about the applicants and, equally important, to help the applicants decide about us.

Anxiety neurosis among psychiatric outpatients

Abstract Anxiety neurosis, a common disorder, is seen with relative infrequency in psychiatric hospitals and perhaps even in psychiatric clinics. Sixty-two patients given the diagnosis of anxiety neurosis in a psychiatric clinic are described in this report. The data suggest that anxiety neurotics who do come to a psychiatrist are likely to have secondary affective disorder, alcoholism, or severe phobias. Anxiety neurotics with and without secondary affective disorder are compared. In similar fashion, anxiety neurotics with and without alcoholism are compared. This is no evidence that patients with either additional illness should be separated from the larger group of anxiety neurotics.

A Family Study of Hysteria

ONE of us (S.B.G.) has been pursuing a series of studies to clarify the diagnostic features of hysteria and to learn more about its natural history.1 2 3 We use the term hysteria to designate the s...

‘Secondary’ affective disorder: A study of 95 cases

Patients with ‘secondary’ affective disorder differ from those with ‘primary’ affective disorder in that there are additional symptoms of their pre-existing illness among the former. Hysteria, anxiety neurosis, antisocial personality, alcoholism, and drug dependency are the psychiatric conditions most frequently associated with ‘secondary’ affective disorders. There are other differences which may also be related to the presence of pre-existing illness. These differences include the findings that patients with ‘secondary’ affective disorder are younger, more often male, and are rarely manic; they suggest that it is appropriate to distinguish between ‘primary’ and ‘secondary’ affective disorder for research purposes.

The neo-Kraepelinian revolution in psychiatric diagnosis

New revisions of diagnostic categories have produced the most recent classification systems, namely DSM-IV and ICD-10. The diagnostic approaches exemplified by these two nomenclatures are very similar to one another and represent a return to descriptive psychiatry in which careful observation of symptoms, signs, and course of mental diseases become the diagnostic criteria themselves. In many ways, these newest classification schemata can be considered a return to phenomenological psychiatry perhaps best exemplified at the start of this century by Emil Kraepelin. Thus, recent developments in psychiatric diagnosis can be thought of as “neo-Kraepelinian”. Because they represent a relatively radical change from psychodynamic approaches to evaluation and diagnosis, they can also be called “revolutionary.” This paper traces the roots of current diagnostic systems and compares and contrasts these systems to the classification schema described by Kraepelin. Diagnostic criteria for schizophrenia are used as an example of how diagnostic conventions have changed dramatically over the past 50 years. Discussion of the implications of this neo-Kraepelinian revolution in psychiatric diagnosis is included.

Heredity and Alcoholism

Alcoholism is a familial disorder. Studies have repeatedly shown a high prevAlcnce of alcoholism among the relatives of alcoholics. “Familial” however, is not synonymous with “hereditary.” Speaking French may also be familial but presumably not because of genes.

Nature of psychiatric illness: Why psychiatry is a branch of medicine

Abstract Are psychiatric conditions diseases? How is disease defined? Is there a satisfactory definition of disease for nonpsychiatric conditions? Why is there such intensity in the debate? Are there implications of different answers that reach beyond definitions to include more substantive issues? If there are no important issues in the controversy other than which word to use to refer to certain psychologic or behavioral states, is the discussion worth continuing? Compromise, a new nomenclature, or the victory of one side will permit attention to shift to more important matters. But if the argument reflects significant differences about important underlying issues, these differences need to be clarified and resolved through critical analysis and observation.

The evaluation of diagnostic concordance in follow-up studies: I. A general model of causal analysis and a methodological critique☆

Abstract An improved method for the design and evaluation of follow-up studies of psychiatric disorders is presented. Available indices of diagnostic consistency are reviewed and their limitations discussed. A general causal model of diagnostic concordance for reliability and follow-up studies is described. This model describes the relationship of diagnosis to true clinical status, interview procedures, the consistency of the historian, typicality of the clinical features, and temporal influences. Using the method of path analysis, estimates of the influences of these variables are derived under a wide range of experimental conditions. The method has implications for classification systems, strategies of research design, and the integration of reliability and follow-up studies. Its advantages include distinguishing the effects of the multiple causes of concordance and discordance and facilitating quantitative comparisons between different groups and different experimental designs.

Hysteria and parental psychiatric illness

A two-generation study of 46 families of convicted women felons showed that the daughters of sociopathic fathers had a significantly higher prevalence of hysteria than did the daughters of other fathers. The differences were significant both for daughters with hysteria plus sociopathy and for daughters with hysteria without sociopathy. The association was independent of assortative mating between sociopathic men and women with hysteria or sociopathy.