Life Events and Primary Affective Disorders

BackgroundUnipolar and bipolar patients with a chronic illness pattern were investigated to determine whether they experienced a higher number of life events prior to the onset of recurrent affective episodes.MethodThe study participants consisted of 27 recovered bipolar patients, 24 recovered unipolar patients and 26 healthy control subjects. Life events and psychiatric status were assessed by bimonthly interviews over the period of one year using the Inventory for Recent Life Events and the Research Diagnostic Criteria.ResultsIn both unipolar and bipolar patients, analyses revealed no significant differences in the number of life events experienced, irrespective of whether the patients had presented with a depressive episode of at least minor intensity during the study (all P > 0.1). Specifically, an increase in marital problems was observed in bipolar patients prior to the onset of recurrent hypomanic and manic episodes (P=0.06).ConclusionThe causal association between life events and the onset of depression, shown to be relevant in non-chronically depressed subjects, does not apply in chronic affective disorders. In addition, our results suggest that marital events have an impact on the onset of recurrent hypomanic and manic episodes.

Prediction of ECT Response: Validation of a Refined Sign-Based (CORE) System for Defining Melancholia

BackgroundThe clinical validity of melancholia has been argued on the basis of its capacity to predict response to electroconvulsive therapy (ECT). We have argued that a sign-based (CORE) rating system of psychomotor disturbance can identify patients with melancholia. Therefore, the clinical validity of the CORE system was tested here in terms of its capacity to predict response to ECT.MethodThe response of 81 patients with primary affective disorders to an individualised course of ECT was investigated. CORE scores and other clinical predictors were evaluated in terms of their capacity to predict effect size changes in symptoms and disability.ResultsCORE scores predicted ECT response, as did the presence of psychotic features. The combination of marked psychomotor change (high CORE scores) and psychotic features predicted the best response to ECT.ConclusionThis study supports the clinical validity of the CORE system for diagnosing melancholia.

Personality Assessment Inventory (PAI) Profiles of Adult Female Abuse Survivors

Personality Assessment Inventory (PAI) profiles of 91 adult female, Caucasian subjects were examined to determine if there were significant differences between those subjects who reported a history of broadly-defined childhood/adolescent abuse and those subjects who did not report a history of abuse. PAI profiles of 44 self-reported survivors of abuse were compared with those of 47 subjects diagnosed with primary affective disorders, but without a reported history of abuse. Since there were significant age differences between the two groups, with the nonabused subjects being older, PAI scores were compared using age of subject as covariate in an Analysis of Covariance design. Significant differences between the groups were obtained on several PAI scales and subscales. In addition, the profiles of abuse survivors closely resembled Morey's PAI Cluster 2, which is associated with a diagnosis of post-traumatic stress disorder (PTSD). The PAI scale scores of the abuse survivors were believed to reflect the “acting-out” and “acting-in” tendencies reported in prior PTSD literature. The implications for evaluation of abuse survivors are discussed.

A Hormonal Component to Postnatal Depression

Disorders of the thyroid gland are associated with disorders of mood (Thomas et al, 1970; Van Uitert & Russakoff, 1979; Folks, 1984; Young, 1984; Jadresic, 1990). Both hypothyroid and hyperthyroid states can be associated with depression, which is sometimes accompanied by psychotic features such as delusions and hallucinations (Wilson & Jefferson, 1986). Similarly, primary affective disorders can be accompanied by changes in thyroid function, with low thyroid-stimulating hormone (TSH) levels and elevated thyroxine (T4) (Kirkegaard & Faber, 1980), and in major depressive illness there is often a blunted TSH response to thyrotrophin releasing hormone (TRH) (Prange et al, 1972; Loosen, 1987).