Studies in the classification of affective disorders. The relationship between anxiety states and depressive illnesses. II

This is the second of two papers dealing with the classification of affective disorders in which the relationship between anxiety states and depressive illnesses is examined. The question at issue is whether a line of demarcation may be drawn between the two disorders or whether they are more appropriately regarded as merging insensibly along a continuum of affective disturbance.

Borderlands between neurology and psychiatry: observations in a neurological hospital

This article describes psychiatric liaison, in its clinical and teaching aspects, at the Montreal Neurological Institute. Referral patterns are illustrated by data on 200 neurological and neurosurgical patients referred for psychiatric consultation. Our total patient material of nearly 1000 such patients seen in consultation and a joint weekly teaching session provide the basis for comprehensive discussion of the borderlands between neurology and psychiatry. It is concluded that close collaboration between these two disciplines is advantageous to both, in terms of improved clinical training of residents, identification of promising areas for interdisciplinary research, and better overall patient care. These gains justify the development of such liaison in other centers.

Some contributions to the measurement of psychopathology

This paper presents some of the more important results of a factor analysis of the mental state ratings made as part of the United States–United Kingdom Diagnostic Project's cross-national study. The project was organized in order to help account for the large differences between the two countries in the admission rates for schizophrenia and for the affective disorders (see Kramer, 1969, and Zubin, 1969). The major results of the study have been reported by Cooper, Kendell et al. (1969), Gurland et al. (1969), Cooper (1970), and Cooper, Kendell, Gurland et al. (1972).

The Maudsley Personality Inventory as a prognostic instrument

In an article published in 1961 entitled “MPI results in cases of endogenous depression before and after treatment” (7, in Swedish), the authors (Wretmark, Åström and Ölander) showed inter alia that the Lie scale in the Maudsley Personality Inventory (3, 8) has a certain value when it comes to predicting the ability of patients with endogenous depression to regain social function. In view of the restricted material, the authors are careful in their conclusions, but it appears from the article that “high values on the Lie scale can be seen as an unfavourable prognostic factor with reference to the patient's ability to re-adapt to working life after treatment for endogenous depression”.

A six year follow-up study of sixty-five adolescent patients: predictive value of presenting clinical picture

Diagnosis of adolescent psychiatric patients is complicated by the absence of history of function in an adult role and by the assumed presence of psychological turmoil, thought to be normal at this age. Information about prognosis, always a useful part of clinical management, is especially important in counselling adolescent patients and their families about the prospects for education, vocation, and marriage.

†Patients came from both rural and urban areas of several neighbouring states. Parents or guardians of approximately one-third were teachers, salesmen, or shopkeepers and of another third, skilled labourers or farmers. The remainder were approximately equally divided between the well-to-do at one extreme and unskilled labourers at the other. That this sample provided a wider distribution among social strata than most private hospitals or most public hospitals is borne out by the fact that some patients who were subsequently hospitalized again were treated in private hospitals while others were admitted to public facilities (state hospitals).

Hysteria: an evaluation of specific diagnostic criteria by the study of randomly selected psychiatric clinic patients

In 1962, Perley and Guze introduced specific criteria for the diagnosis of hysteria based on clinical observations made in 1951 by Purtell, Robins and Cohen. A number of reports have been published since 1962 evaluating the limits and usefulness of these criteria. A recent paper by Guze (1967) summarizes a large part of this work and explores various problems of definition and methodology. In 1968, two papers appeared in this journal evaluating the criteria for hysteria by applying them to women with chronic medical illnesses (Woodruff) and to normal women (Farley, Woodruff and Guze). The present study is an extension of the method used in those reports.

A short diagnostic self-rating scale in the pre-adult remand setting

The ordinary process of specialist examination of individuals on remand involves among other things the making of judgments of several kinds. Among these judgments are those as to normality, subnormality, abnormality, and types of abnormality. For some, such as the establishment of subnormality, there are technical aids, e.g. standard tests of IQ. For others, available aids are often inadequately standardized, inordinately time-consuming, or subject to other critical objections, e.g. as to their appropriateness. This may leave the specialist clinical observer dependent solely on his clinical acumen over a considerable area. This may not matter as regards the outcome in final judgments made, but may make the process unduly burdensome and lengthy.

Forearm blood flow and phobic anxiety

The measurement of muscle blood flow using occlusive plethysmography has recently been proposed as an objective index of anxiety (Harper et al., 1965; Kelly, 1966, 1967). Although the method has been used by physiologists for many years, and its sensitivity to psychological stress has often been mentioned as an incidental finding in physiological studies, its application in psychiatric or psychological research has been slow to develop, perhaps because rather cumbersome apparatus is required. However, promising results were reported by Kelly (1966), who differentiated patients suffering from anxiety states from mixed neurotic patients and normal controls, and who showed changes after leucotomy in anxious patients.

The relationship between clinical diagnosis and anxiety, assessed by forearm blood flow and other measurements

Anxiety may be present to a greater or lesser degree in almost every psychiatric syndrome. The ability to quantify the degree of anxiety present in an individual patient has important implications for diagnosis, treatment and prognosis. Accurate clinical assessment of anxiety is by no means an easy task, although many psychiatrists believe it to be. If no other methods are used, there is no way of knowing how often an individual clinician is right or wrong. However, if several independent methods of assessing anxiety are used, more data are available, and a better overall judgment on an individual patient can be made.