DSM-III personality disorder dimensions

Dimensional scores were computed for the 11 DSM-III personality disorders (PDs) in 797 relatives of psychiatric patients and never ill control subjects interviewed with the Structured Interview for DSM-III Personality Disorders. The distribution of scores for all 11 PD dimensions was skewed to the right. A principal components analysis with varimax rotation produced three factors that closely corresponded to DSM-III's suggested clustering of the PDs into eccentric, dramatic, and anxious types. Men scored significantly higher on the paranoid, schizoid, compulsive, antisocial, and narcissistic dimensions, whereas women had significantly higher histrionic, dependent, and avoidant scores. Age was negatively correlated with most of the PD dimensions, and the correlations were strongest with the four PDs in cluster 2 (histrionic, antisocial, narcissistic, and borderline). Each of the eight axis I disorders examined was associated with increased axis II pathology.

Inhibition of human leukocyte elastase. 2. Inhibition by substituted cephalosporin esters and amides

A variety of 7 alpha-methoxycephalosporin ester and amide sulfones were prepared and tested to determine the structure-activity relations for inhibition of human leukocyte elastase (HLE), a serine protease which has been implicated in several degenerative lung and tissue diseases. The most potent IC50 values were obtained with neutral, lipophilic derivatives, with the esters being more active than the amides. However, the best time-dependent inhibition in this series was observed with the p- and m-carboxybenzyl esters 7b and 7c. These results are discussed in terms of the proposed mechanism of inhibition as well as a molecular modeling study using the recently solved X-ray crystal structure of HLE.

Variability in the application of contemporary diagnostic criteria: endogenous depression as an example

Specified diagnostic criteria have been credited, in part, with improving diagnostic reliability. The authors hypothesize that nonuniform application of these criteria across different research centers has been one factor responsible for the failure to replicate research findings. For example, researchers using a narrow interpretation of the Research Diagnostic Criteria (RDC) have found a highly significant association between endogenous depression and a positive dexamethasone suppression test result, whereas researchers using a broad interpretation have failed to find the predicted relationship. The authors used two interpretations of the RDC and DSM-III endogenous/melancholia criteria to diagnose 60 depressed patients and found significant difference in rates of diagnoses and symptoms.

Diagnosing personality disorders in the community. A comparison of self-report and interview measures

The rapidly expanding empirical study of personality disorders is the result of the publication of operational diagnostic criteria in DSM-III and the development of instruments to assess these criteria. Few researchers have examined the comparability of measures of personality disorders, and to our knowledge there are no studies of the factors associated with discordance between measures. In the present study, 697 relatives of psychiatric patients and healthy controls were interviewed with the Structured Interview for Personality Disorders (SIDP) and completed the Personality Disorders Questionnaire (PDQ). Significantly more individuals had a personality disorder according to the SIDP; however, multiple personality disorders were more frequently diagnosed on the PDQ. Schizotypal, compulsive, dependent, and borderline personality disorders were significantly more frequently diagnosed by the PDQ, whereas the SIDP more frequently diagnosed antisocial and passive-aggressive personality disorder. The corresponding dimensional scores of the two measures were all significantly correlated; however, the concordance for categorical diagnoses was poor. Discrepancies between the PDQ and the SIPD dimensional scores were significantly associated with current level of depressive symptoms and PDQ lie scale scores.

An estimation of dental treatment needs in two groups of refugees in Sweden

The aim of this study was to estimate dental treatment need in groups of Chilean and Polish refugees in Sweden. Of the Nordic countries, Sweden accepts the greatest number of refugees. An average of 5000 refugees arrived annually in 1981-85, increasing to 15,000 during 1986-87. Refugees and their families now comprise 93% of non-Nordic immigration. In 1981-83 a sample of 193 Chilean and 92 Polish refugees in the county of Stockholm was selected for this study. Dental treatment needs were calculated in accordance with CPITN and the working study of Swedish dentistry, which formed the basis for the Swedish scale of dental fees for the National Dental Insurance Scheme. The estimated mean treatment time (+/- SD) in the Chilean sample was 6.9 +/- 2.3 h and in the Polish group 8.4 +/- 3.0; in comparison with estimated treatment needs in a Swedish material, both would be classified as extreme risk groups. There was no correlation between the number of months in Sweden and the estimated treatment needs. The results indicate a cumulative, unmet need for dental care in these groups. Barriers to ensuring adequate health care for immigrants persist; special outreach programmes, conducted by dental health personnel, may be an effective means of introducing immigrants to the Swedish dental care system.

Assessing the acceptability of NORPLANT implants in four countries: findings from focus group research

In 1986-87, a qualitative research project was conducted in the Dominican Republic, Egypt, Indonesia, and Thailand to expand understanding of the acceptability of NORPLANT contraceptive implants beyond inferences made on the basis of continuation rates. In each of the four study sites, focus group discussions or in-depth interviews were held with potential acceptors, current NORPLANT users, discontinuers, husbands of women in these three groups, and service providers. Nonclinical participants generally had little formal education and lived primarily in urban or semi-urban areas where NORPLANT has been available for at least five years. The study focused on attitudes, perceptions, and experiences of each group regarding NORPLANT implants. Results suggest that factors having an impact on the acceptability of NORPLANT implants fall into three general categories: medical/technical, cultural/religious, and informational/educational. This article discusses each of these categories, including programmatic implications of the findings, and puts forward recommendations for enhancing NORPLANT introduction efforts on the basis of these findings.

[Hepatotoxicity of oriental hornet venom]

Reports of hepatic damage following multiple stings by hornets led to this study of the effects of venom sac extract (VSE) from the oriental hornet. We used in-vivo models (serum of cats following a single exposure, and of rats following repeated exposures), in-situ models (perfusion of intact livers) and in-vitro models (monolayers of fetal rat liver tissue culture). Enzyme activities were measured in serum, in perfusates, and in media of cultures, as well as in liver fractions obtained by ultracentrifugation. In cats, levels of albumin, total proteins, electrolytes, urea, cholesterol, bilirubin and blood gases were determined. Bile acids were determined in bile secreted from perfused rat livers. Histologic, histochemical and electron-microscopic studies were also performed. It is concluded that VSE is the first animal product known to possess hepatotoxic properties. The venom mainly damages hepatic cellular membranes, and mitochondria are the organelles most severely injured; cholestasis also results. The damage is partially reversible, and occurs in mammals, including man.

Fluorouracil and recombinant alfa-2a-interferon: an active regimen against advanced colorectal carcinoma

Based on in vitro studies that have demonstrated synergy between recombinant alfa-2a-interferon (rIFN alpha-2a) and the fluoropyrimidine, fluorouracil (5FU), against two human colon cancer cell lines, a pilot clinical trial was initiated to determine the effects of the combination of 5FU and rIFN alpha-2a in patients with advanced, unresectable colorectal carcinoma. A total of 30 patients were enrolled; all were evaluable. 5FU was administered as a loading course, 750 mg/m2 daily for 5 days by continuous infusion followed by weekly bolus therapy, rIFN alpha-2a, 9 MU, was administered subcutaneously three times per week. Of 17 previously untreated patients evaluable for response, 13 achieved a response. Three patients had disease progression. No previously treated patients had a major response. There was one death clearly related to therapy, an event preceded by watery diarrhea and neutropenic sepsis. Other toxicities were reversible and responded to dose reduction. With a median follow-up of 16+ months, median survival has not been reached among the previously untreated patient cohort. We conclude that the combination of 5FU and rIFN alpha-2a is an active regimen against disseminated colorectal cancer in previously untreated patients.

Urban helminthiasis in two socioeconomically distinct Costa Rican communities

A survey on the prevalence of Ascaris lumbricoides, Trichuris trichiura and Hymenolepis nana was conducted in two adjacent, but socioeconomically distinct, urban Costa Rican communities: a squatter settlement and a community with access to modern sewage facilities. The prevalence of these infections was significantly higher in the former. Although squatter children (1-14 years old) were more heavily infected with A. lumbricoides and H. nana than squatter adults, the same pattern was not observed for T. trichiura. The results suggest that local community-based helminthic parasite surveys may more accurately portray the actual health status of socioeconomically diverse urban populations.

The excitation of cutaneous nerve endings in a neuroma by capsaicin

Spontaneous electrophysiological activity and excitation by capsaicin of regenerating sensory fibers has been studied using 1 to 20-week-old neuromas induced in rats by ligating and transecting the saphenous nerve. Overall, spontaneous activity occurred in 12% of fibers, and capsaicin at concentrations up to 1.0 microM excited 3.8% of all the A delta-plus C-fibers examined. There was a slight increase in the incidence of spontaneous activity, but not excitation by capsaicin, with increasing age of the neuromas. The responses to capsaicin were similar to those seen with normal saphenous nerve endings, including bursting discharges and desensitization with repeated applications. The results are considered in the context of the requirements for reexpression of normal sensory capacities on regenerating sensory nerve endings.

DSM-III personality disorder diagnoses in a nonpatient sample. Demographic correlates and comorbidity

Seven hundred ninety-seven first-degree relatives of normal controls and patients with a variety of psychiatric disorders were interviewed with the Diagnostic Interview Schedule and the Structured Interview for DSM-III Personality Disorders. Slightly more than one sixth of the sample received a personality disorder (PD) diagnosis, and of those with a PD, almost one fourth had more than one. The most prevalent diagnoses were mixed, passive-aggressive, antisocial, histrionic, and schizotypal PD. The demographic correlates and frequency of Axis I disorders in individuals with each specific PD were examined, and all but histrionic and passive-aggressive PDs had distinctive profiles.

Personality disorder in the families of depressed, schizophrenic, and never-ill probands

In a blind family study of 176 probands with nonpsychotic major depression, psychotic major depression, schizophrenia, or no history of DSM-III disorders, only the relatives of depressed probands with mood-incongruent psychotic features had a risk for personality disorders higher than that for the relatives of never-ill probands. The authors did not find a high rate of borderline personality in relatives of depressed probands or of schizotypal personality disorder in relatives of probands with schizophrenia or any psychosis. However, depressed probands with normal dexamethasone test results had a significantly higher familial loading for the DSM-III cluster of histrionic, antisocial, borderline, and narcissistic personality disorders.

HPA axis hyperactivity and recovery from functional psychoses

Some patients with functional psychoses follow a chronic, deteriorating course and others recover; at present clinicians have essentially no established factors beyond diagnosis and chronicity to predict which course a psychotic patient might follow. Because data on diagnostic specificity suggested that the dexamethasone suppression test might provide another, much needed prognostic factor, the authors administered these tests to 98 consecutively admitted patients with nonmanic psychoses. High postdexamethasone cortisol levels (6 micrograms/dl or higher) at baseline predicted recovery from psychosis at 1 year, independent of episode chronicity and diagnosis. Diagnosis did not correspond well to test results but was itself an important predictor.

Diagnostic criteria for melancholia. The comparative validity of DSM-III and DSM-III-R

The psychometric properties and validity of the DSM-III and DSM-III-R definitions of melancholia were examined in 60 depressed inpatients. The prevalence of melancholia was significantly higher according to the DSM-III-R criteria, and the kappa-coefficient of agreement between the two definitions was .40. For both criteria sets, the internal consistencies and item-scale correlations were low. Both definitions were associated with overall symptom severity and the melancholia symptom subscale; however, only DSM-III melancholics scored higher on the nonmelancholia symptom subscale. The DSM-III-R criteria were associated with more of the predicted correlates of endogenous subtyping. According to both definitions, melancholics were characterized by less stress, greater symptom severity, and less frequent nonserious suicide attempts prior to admission. The DSM-III-R melancholic subtyping was additionally associated with a family history of antisocial personality and substance abuse, presence of a premorbid personality disorder, age, and a tendency to blame others for the depression.

Melancholia: from DSM-III to DSM-III-R

On July 26, 1985, an ad hoc committee appointed by the APA Work Group to Revise DSM-III met and reviewed the research on the validity of the DSM-III criteria for melancholia. In this paper the proceedings of the meeting are related. After reviewing studies of the validity of the DSM-III melancholia criteria, the authors describe the committee's discussion of alternative proposals for DSM-III-R and the process of developing the new DSM-III-R criteria.

Morphologic changes in the renal glomerulus and the juxtaglomerular apparatus in human preeclampsia

The renal biopsies of ten women with preeclampsia without other underlying renal disease were examined in detail using light and electron microscopy and immunofluorescence. Characteristic preeclamptic glomerular lesions with endocapillary cell swelling, subendothelial and mesangial deposits, and mesangial interposition were detected in each patient. Juxtaglomerular regions were not prominent and were poorly granulated on light microscopy; ultrastructurally, they showed myoepithelioid cells with sparse renin granulation and considerable heterogeneity of granule size and density in association with relatively meagre granular endoplasmic reticulum and Golgi profiles. These morphologic findings suggest that, in patients with clinical and renal biopsy evidence of preeclampsia, there is no significant stimulation of the renin-angiotensin system.

Tendon cell outgrowth rates and morphology associated with kevlar-49

A rat tendon cell model was used to evaluate the in vitro biocompatibility of kevlar-49. The cell response to kevlar was compared to carbon AS-4 and nylon sutures. Three trials were run and cell growth rates were statistically similar for all the materials tested. A separate experiment was conducted in which the same fiber materials were placed in the same Petri dish. Again, the rates were similar for each material. Finally, the cells were observed with a scanning electron microscope, and the three classic cell morphologies associated with this tendon cell model were observed. Also, cellular attachment to the fiber and cellular encapsulation of the fiber were identical for the three materials tested. Kevlar-49 proved to be comparable to carbon AS4 and nylon sutures in terms of cellular response and cell outgrowth rates.

Diagnosing personality disorder in depressed patients. A comparison of patient and informant interviews

Personality disorder (PD) diagnosis were made in 66 depressed patients based on independent interviews of the patient and a close informant. The patients and informants markedly differed in their descriptions of the patients' normal personality. The kappa coefficient of agreement for the diagnosis of any PD was .13, and all kappa values for the individual PD diagnoses were below .35. Informants reported more pathologic conditions than the patients, such that PDs were diagnosed in 57.6% (38/66) of the patients, based on the informant interview, and in 36.4% (24/66), based on the patient interview. We also examined dimensional scores. In general, we found only modest correlations between the patient and informant dimensional scores and that the ratings based on the informant interviews were higher. These results varied by specific PD diagnoses. Consensus ratings, which were based on both sources of information, were sometimes more strongly associated with patient information and sometimes with informant information, and this, too, varied among the different PDs.

The validity of a self-report questionnaire for diagnosing major depressive disorder

Six hundred thirteen first-degree relatives of schizophrenics, depressives, and normal controls were interviewed with the Diagnostic Interview Schedule (DIS) and completed the Inventory to Diagnose Depression (IDD), a self-report scale to diagnose major depressive disorder (MDD). The current point prevalence of MDD was nearly identical according to the two measures (DIS, 2.8%; IDD, 2.6%). Diagnostic concordance varied according to the Interval between the evaluations. When the two measures were completed within two days of each other the agreement was as high as can be expected between two instruments with less than perfect reliability. We used a family study approach to examine validity and found that both the DIS and IDD cases of depression were two to three times more frequent in the relatives of depressed patients than the relatives of schizophrenics and controls.

Diagnosis and outcome in schizo-affective depression: a replication

Forty-three inpatients with RDC schizo-affective depression were given structured interviews and then followed to 1 year using a design closely resembling that of another recent follow-up of schizo-affective patients. In replication of the earlier study, patients with either 'chronic' or 'mainly schizophrenic' schizo-affective disorder had significantly worse outcomes than did patients with nonchronic or 'mainly affective' schizo-affective depression and bipolar patients were significantly more likely to develop manic syndromes. The preceding duration of schizophrenia-like symptoms and a history of schizophrenia-like prodromes appeared to be the most important components of these two distinctions. In both studies, diagnostic subtype was the most robust of various potential outcome predictors. Also in both studies, 'mainly affective' and 'nonchronic' schizo-affective patients had outcomes no different from patients with psychotic depression.

Past loss as a symptom formation factor in depression

We examined the relationship between past loss and endogenous subtyping of depressed patients. In a sample of 124 female depressed inpatients there was no association between past loss and RDC endogenous or DSM-III melancholic subtyping. We thus failed to replicate Brown and colleagues' finding that past loss is a symptom formation factor.

The heritability of schizophrenia and schizoaffective disorder. A family study

Ninety-one consecutively admitted patients with schizophrenia (n = 21), schizoaffective depression (n = 43), or psychotic depression (n = 27) entered a blind family study along with 36 never-ill controls. Though schizophrenia spectrum disorders clustered within families, they were not significantly more prevalent in the families of schizophrenic probands. In contrast, morbid risks for affective disorder clearly separated the families of psychotically depressed probands from the families of both schizophrenics and controls. Family study data for schizoaffective probands indicated links to both affective disorder and schizophrenia and suggested, as well, that a small number of patients with schizoaffective disorder may carry a genetic liability to both conditions.

The reliability of the family history method for psychiatric diagnoses

We evaluated the test-retest interrater reliability of the Family History Research Diagnostic Criteria (FH-RDC) in 58 depressed patients who described 341 first-degree relatives. Reliability was examined as a function of the threshold to determine caseness. In general, diagnostic reliability was good-excellent for specific FH-RDC disorders, but not for the residual category of other psychiatric disorder. A higher diagnostic threshold was associated with greater reliability, especially for the diagnosis of depression. Patient variance accounted for a greater percentage of the disagreements between the interviewers than did rater variance.

Dental health status in two groups of refugees in Sweden

The aim of this study was to determine dental health status in two separate groups of Chilean and Polish refugees in Sweden. In Scandinavia, Sweden has the largest number of immigrants--1 million out of a population of 8.3 million. Since 1975, most immigrants have been refugees and their families. During 1978-82 Sweden granted residency to 20,000 refugees, the two largest groups being Chileans and Poles. In 1981-83 a sample of 193 Chilean and 92 Polish refugees in the county of Stockholm were selected for this study. The investigation consisted of a questionnaire followed by clinical examination, including roentgenograms. The average age was 34.0 years in the Chilean group and 34.8 years in the Polish group. The Chileans had been in Sweden for 17.3 months on an average and the Poles for 16.0 months. The Chileans had an average of 10.0 carious surfaces, D(s), and the Poles 11.3. Gingivitis was recorded in 87% of the total number of sites examined in the Chilean group. The corresponding figure in the Polish group was 79%. Of the Chileans 36.5% and of the Poles 32.5% had periodontal pockets measuring more than 5 mm. The results indicate that, when compared with Swedish individuals of a corresponding age, the refugee groups have a high prevalence of caries and periodontal disease.

Prognostic validity of the familial subtypes of depression

We examined the prognostic validity of Winokur's familial subtypes of depression in 184 in-patients with primary unipolar major depression. Patients with familial pure depressive disease had a more favorable hospital course and reported less symptoms during a 6-month follow-up evaluation than patients with depressive spectrum disease or sporadic depressive disease. Consistent with previous studies of the validity of the familial subtypes, the use of stringent thresholds to diagnose the patient's relatives increased the validity of classification.

Prognostic validity of self-report and interview measures of personality disorder in depressed inpatients

Presence of personality disorders was assessed with the Structured Interview for the DSM-III Personality Disorders (SIDP) in a series of 78 nonpsychotic inpatients with major depression. Measures of severity of depression were administered at admission, at discharge, and 6 months after admission. Outcome for the depression was especially poor in patients meeting criteria for multiple personality disorders from multiple DSM-III clusters. A subgroup of 38 patients received both the SIDP interview and a self-report measure of personality disorder, the Personality Diagnostic Questionnaire. Depressed inpatients who met more than the median number of personality disorder criteria by either measure were approximately half as likely to show improvement at discharge and at 6-month follow-up than were patients with less than the median number of criteria.

The design and analysis of a laminated partially degradable composite bone plate for fracture fixation

During the early stages of fracture healing, rigid internal fixation maintains alignment and promotes primary osseous union. Unfortunately, as healing progresses rigid fixation from bone plating can cause bone in the region of the plate to undergo stress protection atrophy. This can result in significant loss of bone mass and osteoporosis. Refracture of the bone upon device removal is a widely reported complication. In an effort to minimize or eliminate stress protection atrophy, we have designed a partially absorbable, fiber-reinforced bone plate. Ideally, such a plate gradually loses rigidity as the fracture heals, increasingly transferring stress to the bone. Stress protection may be avoided and removal of the device after healing may be unnecessary. Composite theory was used to determine an optimum fiber layup for a composite bone plate. Composite analysis suggested the mechanical superiority of a 0 degree/ +/ -45 degree laminae layup. Given this laminated design, a thermoplastic absorbable polymer (polylactic acid polymer) was reinforced with high-modulus carbon fiber to produce a semiabsorbable composite. Implant evaluation included optimizing fabrication techniques, thorough mechanical device testing, and implantation on canine femurs to determine biocompatibility and efficacy. The composite design proved to have superior static and fatigue properties to laminated or random fiber designs used previously. Two techniques for hole fabrication were tested. The production of screw holes during the molding process rather than machining postmolding, improved the mechanical integrity of the finished plate. Although the 0 degree/ +/- 45 degree carbon/polylactic acid composite possessed superior mechanical properties, it was unsuccessful in the in vivo environment. Water absorption and subsequent delamination made the plate flexible. Hypertrophic nonunions developed. Further development to prevent water intrusion and premature loss of mechanical properties is necessary.

Progress in the classification of functional psychoses

The three most widely used diagnostic systems in American psychiatry--the Feighner criteria, the Research Diagnostic Criteria, and DSM-III--appeared sequentially at 4-year intervals. The fact that the latter two systems each incorporated changes in essentially all diagnostic categories implied progress toward greater validity; however, this assumption has rarely been tested directly. To do this, the authors applied each of these three systems to 98 consecutively admitted patients with nonmanic psychoses. Although family history and 6-month follow-up data strongly supported the validity of diagnostic distinctions made in each of the three systems, they did not show increments in validity with successively developed criteria sets.

The inventory to diagnose depression, lifetime version

The lifetime version of the Inventory to Diagnose Depression (IDDL) is a 22-item self-report scale designed to diagnose a lifetime history of DSM-III major depressive disorder (MDD). One hundred and sixty-four first-degree relatives of healthy control probands completed the IDDL and were interviewed with the Diagnostic Interview Schedule (DIS). The IDDL had good internal consistency (Cronbach's alpha = 0.92), split-half reliability (Spearman-Brown coefficient = 0.90), and all of the item total correlations were significant. The lifetime prevalence of MDD was nonsignificantly higher in the IDDL than the DIS (14.8% vs. 11.7%). Using the DIS as the criterion measure, the sensitivity of the IDDL was 74% and its specificity was 93% and the chance corrected agreement between the two measures was kappa = 0.60.

An American validation study of the Newcastle Diagnostic Scale. II. Relationship with clinical, demographic, familial and psychosocial features

We completed the Newcastle Diagnostic Scale on 152 unipolar depressed in-patients: its validity was supported by the findings that endogenous depressives were, in contrast to neurotic depressives, older, more severely depressed, with better social support, fewer life events, less personality disorder, and a lower morbid risk of alcoholism and antisocial personality in their first-degree relatives. The relationship between Newcastle scores and the morbid risk for alcoholism was non-linear, such that a cut-off score of 4, rather than 5, maximised the difference between the endogenous and neurotic groups with respect to familial alcoholism rates as well as other validating variables.

HPA-axis abnormalities in psychiatrically well controls

The considerable divergence in the literature describing dexamethasone suppression test (DST) nonsuppression rates among psychiatrically well controls led the authors to explore screening procedures as a possible source of variance. Using what they judged to be a typical screening procedure, the authors eliminated 69 of 128 subjects responding to an advertisement seeking psychiatrically and physically healthy subjects. Structured interviews for Axis I and II disorders then revealed that 36% of the remaining 59 subjects nevertheless had historical evidence of psychiatric illness; the 38 who passed all phases of screening underwent three monthly DSTs, which demonstrated the stability over time of both normal and abnormal results. Moreover, a family study revealed that relatives of nonsuppressors had a significantly higher morbid risk of affective disorder (20.5% vs. 8.8%), particularly mania and hypomania.

Prognostic validity of the dexamethasone suppression test: results of a six-month prospective follow-up

In a 6-month prospective follow-up study, the authors located and interviewed 165 (88.2%) of 187 primary unipolar depressed inpatients to whom a 1-mg dexamethasone suppression test (DST) had been given during their first week of hospitalization. Longitudinal ratings of symptoms over the follow-up period and 6-month cross-sectional ratings on the Hamilton Rating Scale for Depression, the Beck Depression Inventory, and the Global Assessment Scale were obtained for each patient. The authors also collected information on rehospitalization after discharge from the index episode. Baseline DST results were not associated with any of the outcome variables.

The prognostic validity of DSM-III axis IV in depressed inpatients

DSM-III suggests that axis IV should have prognostic value--that patients with higher scores will have a better outcome than patients with low ratings. The authors used axis IV to assign scores to 130 depressed inpatients and examined these scores in association with the patients' course during the index hospitalization and at 6-month prospective follow-up. Higher axis IV scores were associated with more depressive symptoms on hospital discharge, but they did not predict follow-up outcome. These results are consistent with other studies of the prognostic value of ratings of psychosocial stress and indicate that, at least for depression, there is little empirical support for DSM-III's suggestion that stress is a favorable prognostic sign.

The dexamethasone suppression test in healthy controls

We have summarized the results of 53 studies which examined the dexamethasone suppression test in normal controls. Only 3.6% of 687 0800 hr postdexamethasone cortisol levels were above 5 micrograms/dl. Corresponding figures for 1600 hr and 2300 hr cortisol levels were 7.4% (85/1144) and 6.3% (28/434), respectively. Neither the type of assay (competitive protein binding or radioimmunoassay) nor mean/median age of the subjects was associated with non-suppression rates.

Validity of an operational definition for neurotic unipolar major depression

After we reviewed the literature to identify the clinical and phenomenologic correlates of neurotic depression, we constructed a 6-item operational definition to distinguish neurotic unipolar major depressive disorder from non-neurotic major depression. The neurotic depressives were characterized by a low rate of abnormal dexamethasone suppression test (DST) results and a strong family history of alcoholism. Neurotic depressives improved less than non-neurotic depressives during the index hospitalization, and were more frequently rehospitalized during a 6-month prospective follow-up. Neurotic subtyping was significantly negatively associated with DSM-III melancholia. Neurotic classification remained significantly associated with the above validating variables after melancholic status was held constant, whereas melancholic subtyping did not predict DST results, familial alcoholism rates, or outcome when neurotic status was controlled.

The effect of nicotine on aortic endothelium. A quantitative ultrastructural study

This study used quantitative electron microscopy to assess ultrastructural features of endothelial injury occurring with exposure to nicotine. Fourteen mice were given nicotine in their drinking water for 5 weeks. The dose (5 mg/kg body wt/day) was equivalent to a human smoking 50-100 cigarettes/day. A control group of mice was unexposed to nicotine over the same period. Stereological analysis of electron micrographs of endothelium from both groups revealed that the nicotine-exposed endothelium showed greater cytoplasmic vacuolation, mitochondrial swelling and subendothelial oedema than the control endothelium. In addition the intercellular cleft morphology was significantly (P less than 0.005) less complex than in the control endothelium. This difference in cleft morphology suggests the nicotine-exposed endothelium is more permeable than the control endothelium. The ultrastructural differences noted in this study are indicative of endothelial damage, and provide structural evidence to support the hypothesis that nicotine contributes to the pathogenesis of arterial disease in smokers.

A self-report scale to diagnose major depressive disorder

The Inventory to Diagnose Depression (IDD) is a self-report scale designed to diagnose DSM-III major depressive disorder (MDD). In our analysis, its test-retest reliability and internal consistency were high. The IDD was significantly associated with other self-report and interviewer rated depression scales and was sensitive to clinical change. Diagnostic agreement between the IDD and clinician's diagnosis of MDD was as high as that found in studies examining the interrater reliability of the diagnosis of MDD. Moreover, our results suggested that the IDD may aid clinicians in detecting secondary depression and distinguishing psychotic depression from nonaffective psychoses. The IDD may be particularly useful in light of the recent evidence that American psychiatrists continue to underdiagnose depression and overdiagnose schizophrenia.

An American validation study of the Newcastle diagnostic scale. I. Relationship with the dexamethasone suppression test

The Newcastle diagnostic index was completed on 159 depressed in-patients, who received the dexamethasone suppression test during their first week in hospital. Patients suffering from endogenous depression had a significantly higher rate of DST non-suppression, were older, were more frequently psychotic, and more frequently lost weight; even after controlling for these variables, DST non-suppression was significantly more frequent in the endogenous group. The relationship between Newcastle scores and the frequency of DST non-suppression was non-linear.