Dr. Modestin Replies

This study sought to determine if rates of childhood sexual, physical, psychological, and multiple abuse (i.e., abuse in more than one form) differed between women with a lifetime history of bulimia nervosa and women with no history of eating disorders. Subjects were 80 women, aged 18-35, with a lifetime history of bulimia nervosa (40 women who had recovered for a year or more and 40 women currently suffering from bulimia nervosa) and 40 women who had never had an eating disorder or related difficulties. The cohort was obtained primarily by newspaper advertisement. Subjects participated in structured diagnostic interviews and completed paper-and-pencil questionnaires related to abusive experiences in childhood. Women in the bulimia nervosa group reported higher levels of childhood physical, psychological, and multiple abuse. Contrary to expectation, rates of sexual abuse did not distinguish the groups, except in combination with other forms of abuse. The higher rates of psychological, physical, and multiple abuse found among women with a lifetime history of bulimia nervosa than among comparison subjects underscore the importance of examining the full range of possible abusive experiences in women with eating disorders, rather than focusing simply on sexual abuse.

Handbook of Neuropsychological Assessment: A Biopsychosocial Perspective

Back to table of contents Previous article Next article ArticleNo AccessDrs. McEvoy and Lohr ReplyJOSEPH P. MCEVOY, and JAMES B. LOHRJOSEPH P. MCEVOYSearch for more papers by this author, and JAMES B. LOHRSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.141.9.1136AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Drs. McEvoy and Lohr Reply." American Journal of Psychiatry, 141(9), p. 1136 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByMedicine, Vol. 96, No. 16Psychiatry and Clinical Neurosciences, Vol. 60, No. 6Psychiatry and Clinical Neurosciences, Vol. 59, No. 1, Vol. 20The Journal of ECT, Vol. 17, No. 3Refusal of ECT by a patient with recurrent depression, psychosis, and catatonia [clinical conference]1 April 2006 | American Journal of Psychiatry, Vol. 154, No. 9Acta Psychiatrica Scandinavica, Vol. 93, No. 2Anticonvulsants combined with nifedipine for epilepsy in adults1 April 2006 | American Journal of Psychiatry, Vol. 148, No. 6Catatonia unexpectedly reversed by midazolam1 April 2006 | American Journal of Psychiatry, Vol. 148, No. 6Effects of administering antidepressants to patients receiving ECT1 April 2006 | American Journal of Psychiatry, Vol. 148, No. 6International Journal of Geriatric Psychiatry, Vol. 6, No. 10Lorazepam for treatment of catatonic symptoms and severe psychomotor retardation1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 9History of phencyclidine use and repeated assaults in newly admitted young schizophrenic men1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 9A case of psychogenic urinary retention1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 9Axis IV of DSM-IIIANDREW E. SKODOL, and PATRICK E. SHROUT1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 8Lorazepam: Therapeutic for Catatonic Schizophrenia?NIRAJ AHUJA1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 8Dr. Salam and Associates ReplySULTANA A. SALAM, AJIT K. PILLAI, and THOMAS BERESFORD1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 8Axis IV of DSM-III23 January 2015 | American Journal of Psychiatry, Vol. 145, No. 8Lorazepam: therapeutic for catatonic schizophrenia?23 January 2015 | American Journal of Psychiatry, Vol. 145, No. 8Psychogenic catatonia treated with lorazepam1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 6Depressive illness with delusions of AIDS1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 6An attempt to commit suicide by contracting AIDS1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 6Carbamazepine in the treatment of catatonia1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 3Treatment of catatonia with low-dose lorazepam1 April 2006 | American Journal of Psychiatry, Vol. 144, No. 9Lorazepam for psychogenic catatonia1 April 2006 | American Journal of Psychiatry, Vol. 144, No. 8Drug Development Research, Vol. 9, No. 1Brainstem and vermis atrophy in catatonia1 April 2006 | American Journal of Psychiatry, Vol. 142, No. 3Clonazepam in the treatment of recurrent symptoms of depression and anxiety in a patient with systemic lupus erythematosus1 April 2006 | American Journal of Psychiatry, Vol. 142, No. 3 Volume 141Issue 9 September 1984Pages 1136-1136 Metrics PDF download History Published online 1 April 2006 Published in print 1 September 1984

The authors' goal was to determine the levels of trauma and psychiatric symptoms in a randomly selected group of Cambodian refugees and to determine the relationship between the amount of trauma experienced and subsequent psychiatric symptoms. Data on traumatic experiences and symptoms of posttraumatic stress, dissociation, depression, and anxiety were collected on 50 randomly selected Cambodian refugees who had resettled in the United States. Subjects experienced multiple and severe traumas and showed high levels of all symptoms measured. Forty-three (86%) of the subjects met DSM-III-R criteria for posttraumatic stress disorder, 48 (96%) had high dissociation scores, and 40 (80%) could be classified as suffering from clinical depression. Correlations between trauma scores and symptom scores and among symptom scores were moderate to large. These results indicate that a high proportion of Cambodian refugees who are not psychiatric patients suffer from severe psychiatric symptoms and that there is a relationship between the amount of trauma they experienced and the severity of these symptoms.

Dr. Volkow and Associates Reply

The purpose of this study was to quantify the proportion of patients who show no response to a fixed dose of fluoxetine after 2, 4, and 6 weeks of treatment and then respond by week 8. In an open trial, 143 outpatients who met DSM-III-R criteria for major depressive disorder were treated with a regimen of fluoxetine, 20 mg/day. The authors analyzed the proportion of patients who had less than a 20% decrease from baseline in their scores on the Hamilton Rating Scale for Depression after 2, 4, and 6 weeks and who went on to have a 50% or greater reduction by week 8. A last-observation-carried-forward strategy was used to calculate conditional probabilities of 8-week response. Kaplan-Meier survival analysis was used to estimate probabilities of response at week 8 given degrees of response at week 2. Eighty-two subjects (57.3%) who started the trial responded by week 8. Of those subjects who showed no improvement at weeks 2, 4, and 6, the proportions of responders at week 8 were 36.4%, 18.9%, and 6.5%, respectively. The Kaplan-Meier estimate of 8-week response given nonresponse at week 2 was 0.45. The proportion of patients with no response to antidepressant treatment by 4 or 6 weeks who responded by week 8 was substantially less than that for subjects who had at least a partial response. Nonresponse as early as week 2 predicted 8-week outcome.

Of 437 adolescent girls admitted to a psychiatric hospital for emotional problems, 61 reported an incestuous involvement. Their mean age at the time of their first experience was 11.9 years. The liaisons occurred as often with fathers as with stepfathers; other, less frequent perpetrators of incest included brothers, brothers-in-law, uncles, a grandfather, an adoptive father, and a half-brother. The authors note that the victim of incest is almost always a preadolescent and that the occurrence of incest is probably not accurately reported nationally.

Back to table of contents Previous article Next article ArticleNo AccessSchizoaffective and Mood-Incongruent Psychotic Affective DisordersMARIO MAJMARIO MAJSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.151.3.455AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Schizoaffective and Mood-Incongruent Psychotic Affective Disorders." American Journal of Psychiatry, 151(3), p. 455 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing Psy[email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byBipolar IllnessNordic Journal of Psychiatry, Vol. 69, No. 6Issues in Estimating the Course of Rapid-Cycling Bipolar DisorderRANJAN BHATTACHARYYA, M.D.MALAY KR GHOSHAL, M.D.DEBASISH SANYAL, M.D.PRATHAMA GUHA, M.D., D.N.B.SUDDHENDU CHAKRABORTYD.P.M.,1 March 2009 | American Journal of Psychiatry, Vol. 166, No. 3Dr. Schneck RepliesCHRISTOPHER D. SCHNECKM.D.,1 March 2009 | American Journal of Psychiatry, Vol. 166, No. 3European Archives of Psychiatry and Clinical Neuroscience, Vol. 259, No. 3Cognitive Behavioral Therapy for Rapid-Cycling Bipolar Disorder: A Pilot StudyJournal of Psychiatric Practice, Vol. 13, No. 5Update and long-term clinical management of rapid cyclingInternational Clinical Psychopharmacology, Vol. 22, No. Supplement 1A 20-Month, Double-Blind, Maintenance Trial of Lithium Versus Divalproex in Rapid-Cycling Bipolar DisorderJoseph R. Calabrese, M.D., Melvin D. Shelton, M.D., Ph.D., Daniel J. Rapport, M.D., Eric A. Youngstrom, Ph.D., Kelly Jackson, L.P.C.C., M.A., Sarah Bilali, M.A., Stephen J. Ganocy, Ph.D., and Robert L. Findling, M.D.1 November 2005 | American Journal of Psychiatry, Vol. 162, No. 11Familial Variation in Episode Frequency in Bipolar Affective DisorderMaria E. Fisfalen, M.D., Thomas G. Schulze, M.D., J. Raymond DePauloJr., M.D., Leslie J. DeGroot, M.D., Judith A. Badner, M.D., and Francis J. McMahon, M.D.1 July 2005 | American Journal of Psychiatry, Vol. 162, No. 7Comparison of Rapid-Cycling and Non-Rapid-Cycling Bipolar Disorder Based on Prospective Mood Ratings in 539 OutpatientsRalph W. Kupka, M.D., Ph.D., David A. Luckenbaugh, M.A., Robert M. Post, M.D., Trisha Suppes, M.D., Ph.D., Lori L. Altshuler, M.D., Paul E. KeckJr., M.D., Mark A. Frye, M.D., Kirk D. Denicoff, M.D., Heinz Grunze, M.D., Gabriele S. Leverich, M.S.W., Susan L. McElroy, M.D., Jörg Walden, M.D., Ph.D., and Willem A. Nolen, M.D., Ph.D.1 July 2005 | American Journal of Psychiatry, Vol. 162, No. 7Phenomenology of Rapid-Cycling Bipolar Disorder: Data From the First 500 Participants in the Systematic Treatment Enhancement ProgramChristopher D. Schneck, M.D., David J. Miklowitz, Ph.D., Joseph R. Calabrese, M.D., Michael H. Allen, M.D., Marshall R. Thomas, M.D., Stephen R. Wisniewski, Ph.D., Sachiko Miyahara, M.S., Melvin D. Shelton, M.D., Ph.D., Terence A. Ketter, M.D., Joseph F. Goldberg, M.D., Charles L. Bowden, M.D., and Gary S. Sachs, M.D.22 December 2014 | American Journal of Psychiatry, Vol. 161, No. 10Critical Care, Vol. 8, No. 6Current Opinion in Psychiatry, Vol. 16The Prognostic Significance of “Switching” in Patients With Bipolar Disorder: A 10-Year Prospective Follow-Up StudyMario Maj, M.D., Ph.D., Raffaele Pirozzi, M.D., Lorenza Magliano, M.D., Ph.D., and Luca Bartoli, M.D.1 October 2002 | American Journal of Psychiatry, Vol. 159, No. 10Adjunctive Lamotrigine Treatment for Major DepressionTHOMAS M. MALTESE, M.D., 1 November 1999 | American Journal of Psychiatry, Vol. 156, No. 11Sublingually Administered Fluoxetine for Major Depression in Medically Compromised PatientsMURAT PAKYUREK, M.D., and ELIAS PASOL, M.D., 1 November 1999 | American Journal of Psychiatry, Vol. 156, No. 11Reliability and Validity of Four Alternative Definitions of Rapid-Cycling Bipolar DisorderMario Maj, M.D., Ph.D., Raffaele Pirozzi, M.D., Anna Maria Rosa Formicola, M.D., and Alfonso Tortorella, M.D.1 September 1999 | American Journal of Psychiatry, Vol. 156, No. 9Rapid Cycling in Women and Men With Bipolar Manic-Depressive DisordersLeonardo Tondo, M.D., and Ross J. Baldessarini, M.D.1 October 1998 | American Journal of Psychiatry, Vol. 155, No. 10Long-Term Outcome of Lithium Prophylaxis in Bipolar Disorder: A 5-Year Prospective Study of 402 Patients at a Lithium ClinicMario Maj, M.D., Ph.D., Raffaele Pirozzi, M.D., Lorenza Magliano, M.D., and Luca Bartoli, M.D.1 January 1998 | American Journal of Psychiatry, Vol. 155, No. 1International Journal of Psychiatry in Clinical Practice, Vol. 1, No. sup1Journal of Clinical Psychopharmacology, Vol. 16, No. 1Depression, Vol. 3, No. 4 Volume 151Issue 3 March 1994Pages 455-455 Metrics PDF download History Published online 1 April 2006 Published in print 1 March 1994

The authors investigated the pharmacological treatment of delusional depression by assigning patients on a random double-blind basis to amitriptyline alone, perphenazine alone, or a combination of the two. Fourteen (78%) of the 18 patients assigned to amitriptyline plus perphenazine were responders, compared with seven (41%) of 17 patients treated with amitriptyline alone and three (19%) of the 16 patients treated with perphenazine alone. The combination of amitriptyline and perphenazine was clearly superior (p less than .01).

Resident's Guide to Treatment of People With Chronic Mental Illness: Report 136

Although attention deficit hyperactivity disorder is a common disorder of childhood, its status as a disorder in adults is not clear. The authors reasoned that if the adult diagnosis of the disorder is a valid clinical entity, it should be similar to the childhood disorder with regard to patterns of psychiatric and cognitive findings. Eighty-four adults with a clinical diagnosis of childhood-onset attention deficit hyperactivity disorder confirmed by structured interview who were referred for treatment were studied. Findings were compared with those from a preexisting study group of referred children with attention deficit hyperactivity disorder, nonreferred adult relatives of those children who also had attention deficit hyperactivity disorder, and adults without the disorder who were relatives of normal children. Subjects were evaluated with a comprehensive battery of psychiatric, cognitive, and psychosocial assessments. The referred and nonreferred adults with attention deficit hyperactivity disorder were similar to one another but more disturbed and impaired than the comparison subjects without the disorder. The pattern of psychopathology, cognition, and functioning among the adults with attention deficit hyperactivity disorder approximated the findings for children with the disorder. These results show that referred and nonreferred adults with attention deficit hyperactivity disorder have a pattern of demographic, psychosocial, psychiatric, and cognitive features that mirrors well-documented findings among children with the disorder. These findings further support the validity of the diagnosis for adults.

The authors investigated information processing in schizophrenia by studying 30 paranoid schizophrenic patients and 30 depressed inpatients. The basic methodology relied on tachistoscopic presentation of stimuli. First, the critical stimulus duration needed for identification of a target stimulus was determined. Second, when the target stimulus was followed by a masking stimulus, a measure of speed of information processing was obtained. The schizophrenic patients were imparied on input factors and speed of processing. The authors think it is unlikely that the results were due to medication effect or to gross psychopathology. Their discussion centers on how this two-factor deficit in information processing may result in cognitive disruption and how this study relates to other investigations.

Epidemiologic studies have reported an association between prenatal exposure to influenza and adult schizophrenia. The authors studied this association in individual patients with schizophrenia and also investigated the relationship of obstetric complications, another postulated risk factor, to adult schizophrenia. Using a structured interview instrument, the authors assessed infections during pregnancy, obstetric complications, gestational age, and birth weight by interviewing the mothers of 121 patients with DSM-III-R schizophrenia. Significantly more infections were reported in the second trimester of the patients' gestations than in the combined first and third trimesters. Influenza accounted for 70% of second-trimester infections. Patients with schizophrenia whose mothers reported having influenza during the second trimester were almost five times more likely to experience at least one definite obstetric complication than were patients who were not exposed to influenza during the second trimester; the exposed patients weighed a mean of 210 g less at birth than the unexposed patients. Maternal influenza during the second trimester may impair fetal growth and predispose to obstetric complications and lower birth weight in a proportion of individuals destined to develop schizophrenia.

Considerable effort has been directed toward identifying and conceptualizing information-processing deficits in schizophrenia and other psychotic disorders. The impressive gains in this field have made meaningful contributions to our understanding of the etiology and course of these disorders. This article considers whether the time is ripe to move beyond identification of these deficits to remediation of them. This move is far from a simple matter; it requires careful attention to theoretical frameworks and to the criteria for selecting certain cognitive deficits, among many, for remediation. A sparse and somewhat dated literature suggests that certain types of cognitive remediation, at least when defined in a narrow sense, are feasible with schizophrenic patients. This literature can reasonably justify continuing investigations on a modest scale. Specific questions for further studies include the following. 1) Which cognitive models provide a framework to guide cognitive interventions? 2) Which specific functions or levels of information processing should be targeted by cognitive interventions? 3) Are cognitive interventions effective? 4) Does the remediation of basic cognitive deficits generalize? A major strength of this area of investigation is the testability of the questions. Several research designs are tentatively suggested.

To further investigate the hypothesis that hyperactivity of the hypothalamic-pituitary-adrenal axis in patients with depression may be mediated by hypersecretion of corticotropin-releasing factor (CRF), the authors measured CRF-like immunoreactivity in CSF samples from 138 neurological control, 54 depressed, and 27 nondepressed (23 schizophrenic and four manic) subjects. The CSF CRF concentration was markedly higher (almost twofold) in depressed patients than in control subjects and nondepressed psychiatric patients. The concentration of CSF CRF was slightly but significantly higher in schizophrenic patients than in control subjects. These findings provide further support for the hypothesis that CRF hypersecretion occurs in major depression.