Thomas A. Aronson

Failure to differentiate bipolar disorder from schizophrenia on measures of neuropsychological function

30 inpatients diagnosed with schizophrenia were compared to 35 inpatients with bipolar affective disorder, manic type, on a large group of neuropsychological measures. Separate factor analyses were performed on measures of verbal, spatial, and speed variables in order to generate summary scales. Controlling for the effects of age, education, sex, duration of illness, number of previous hospitalizations, and medications at time of testing, there were no significant differences between diagnostic groups on the three factors or on individual test variables. Patients on medication performed more poorly on speed variables than those off medication. These findings call into question the notion of differential patterns of cognitive deficit among psychotic diagnoses.

On the longitudinal course of panic disorder: developmental history and predictors of phobic complications

Abstract The longitudinal course and childhood histories of 46 patients with panic disorder or agoraphobia were systematically assessed. DSM-III-R criteria were employed in assessing predictors of phobic complications. It was found that the female sex and any childhood anxiety or depressive disorder were associated with the development of phobic avoidances. Overanxious disorder was reported twice as often as separation anxiety disorder. Most patients could identify a clear-cut precipitant of their disorder, and most developed phobic complications after their first panic attacks. Unemployment, high interpersonal sensitivity, and secondary depression were associated with premature termination.

Relapse in delusional depression : A retrospective study of the course of treatment

Abstract This study naturalistically followed the clinical course of 52 patients with delusional depression for an average of 32 months. Over 80% of the patients relapsed an average of two times during this period. The majority of relapses occurred while patients were either medication free or on tapering doses of neuroleptics during combination treatment with antidepressants or lithium carbonate. Bipolar and unipolar delusional depressives followed different clinical courses. The results suggest that clinicians should be more conservative about tapering patients off medications during the first year post-hospital, and point to a need for controlled prospective studies.

Life events and relapse in bipolar disorder: the impact of a catastrophic event.

ABSTRACT— The literature on life events and the precipitation of bipolar disorder is reviewed. The authors describe an unexpected increase in bipolar relapses in a Lithium Clinic following a catastrophic life event, a hurricane, and contrast the patients who relapsed with an age and sex matched control of bipolars who did not. Though retrospective, the study avoids the question of the independence of life events. The results suggest that certain bipolar patients, especially those recently unstable, may be more vulnerable to the impact of life events.

Biological Correlates of Lactate Sensitivity in Panic Disorder

In this pilot study, 9/9 patients with panic disorder experienced a lactate-induced panic attack as compared with 0/9 controls. Baseline measurements were significant for higher anxiety self-ratings, higher heart and respiratory rates, elevated potassium, and lower lymphocyte 3H-dihydroalprenolol (DHA) binding in the patient group. Spielberger State anxiety scores correlated with baseline mean heart rate, and Spielberger Trait anxiety scores with lymphocyte DHA binding. The lactate infusion was not found to differentially affect any physiological or biochemical measures in the two groups, though heart rate surges occurred in most patients. Intravenous propranolol reduced the panic to a negligible degree, whereas intravenous diazepam was quite effective. Neurobiological implications are discussed, and the contradictory biological findings in the lactate literature are reviewed.

Proposed delusional depression subtypes: preliminary evidence from a retrospective study of phenomenology and treatment course

An analysis of the phenomenology and treatment course of 52 subjects with delusional depression suggests that there may be various subtypes: bipolar, early-onset unipolar and possibly a late-onset unipolar. The bipolar subgroup tended to relapse in different but always psychotic directions, and was resistant to lithium carbonate treatment alone. Treatment refractoriness, delusional depressive recurrences, and a dementia-like presentation were associated with a small late-onset subgroup. A high rate of delusionally depressive relapses also characterized the early-onset unipolar group, however, patients with single episodes were found only in this subgroup.

Mania with associated organic factors.

Thirty‐nine patients with bipolar illness preceded by organic factors were compared to age and sex matched bipolar controls. The patients with pre‐existing organic factors were older at onset of their bipolar illness, had fewer depressive episodes, less family history of affective disorder, and were symptomatically different in a number of respects. The nosology of such disorders is discussed and the literature reviewed.

Cognitive function in manics with associated neurologic factors

Researchers studying cognition in mania have assumed that mania is a homogeneous entity. Recent preliminary evidence indicates that some manic syndromes may be preceded by medical, pharmacological, and neurologic antecedents. While DSM-III suggests that mild cognitive impairment may be associated with these manic syndromes, studies to date have not documented this assertion. We compared bipolar patients with antecedent neurologic factors (neurologic manics, NM) to bipolar patients without such histories (primary manics, PM) on standard neuropsychological measures and clinical parameters to ascertain whether cognitive testing could be used as an adjunctive diagnostic tool in defining this subgroup of patients. Results indicated that the NM group was more dysfunctional in intellectual functioning and course of psychiatric illness than the PM group.

Persistent drug-induced parkinsonism.

Not all drug-induced parkinsonism may be benign or reversible. Parkinsonian symptoms, along with coexistent dyskinesias and akathisias, have been reported to persist following the withdrawal of large doses of long-term phenothiazines (Schmid and Jarcho 1966; Schwab and England 1968). This is reminiscent of the miscellaneous known causes of Parkinsons disease (neurosyphilis, manganese intoxication, etc.) that actually cause a multitude of neurological symptoms only some of which include parkinsonian symptoms (Schwab and England 1968). There are also two reports describing pure parkinsonism persisting after neuroleptic withdrawal. One reported that 16 of 26 patients on long-term phenothiazines developed worsening of their parkinsonian symptoms for up to 5 weeks following the discontinuation of the neuroleptic (Demars 1966). The other report described the occurrence of parkinsonism following a single exposure of the dissociative anesthetic Innovar (a combination of fentanyl and droperidol) to a 16-year-old girl. The first day postoperatively she began experiencing bradykinesia, cogwheel ridigity, pill rolling tremor, and mask-like facies that subsided 6 weeks later after a course of carbidopa-levodopa (Rivera et al. 1975). The following case report is unique in reporting the occurrence of persistent, pure, drug-induced parkinsonism following a single oral dose of haloperidol that has lasted over a year. The patients family history of titubation may constitute a new risk factor accounting for individual susceptibility.

Treatment-emergent depression with antidepressants in panic disorder

Two patients with panic disorder received therapeutic doses of antidepressants. They developed endogenomorphic symptoms of major depression according to DSM-III-R criteria despite remission of their panic attacks. Treatment-emergent depression in panic disorder has been previously associated with high potency benzodiazepines. Whether antidepressant medications may unmask a depressive diathesis or are coincidentally associated with depression is discussed in this report.