Does personality predict long-term outcome in depression?

Article Abstract:

Different types of depression have distinct outcomes, as the disorder itself is heterogeneous. While personality disorders are often found among those diagnosed with depression, it is unclear what effect they may have upon outcome of depression. A study of 89 psychiatric inpatients diagnosed with depression was conducted to answer questions about the ability of personality measures to predict outcome of depression; the relationship between such variables and a patient's location on the neurotic-psychotic continuum; and the process by which such measures can predict outcome. In 1965 and 1966, 27 men and 62 women, with an average age of 39 years, were selected for the study. Each was accorded a place on the neurotic-psychotic scale in accord with a calculated diagnostic index (DI). In addition, other variables, such as degrees of extroversion (E) and neuroticism (N), were measured. Obsessional interference (I) and other obsessional traits were also calculated. It was found that patients with a high DI score (who were thus more psychotic) were more likely to have a poor outcome. Previous studies identifying neuroticism as the personality factor that predicted a poor outcome of depression are confirmed by these results, even when discounting the severity of mood disturbance at the time the patient was initially diagnosed. In addition, obsessiveness, especially obsessive interference upon recovery from depression, did not bode well for a favorable long-term outcome. Although depression remains a complex disorder with no clear-cut determinant of long-term outcome, the authors claim that observed links between DI score and bipolarity (manic depression), obsessive interference and social adjustment, and neuroticism and the development of chronic depression, represent a good starting point for developing reliable indicators of outcome of depression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Prognosis, Depression, Mental, Depression (Mood disorder), Identification and classification, Obsessive-compulsive disorder, Obsessive compulsive disorder, Neuroses

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Neuroleptic-induced priapism, hepatotoxicity and subsequent impotence in a patient with depressive psychosis

Article Abstract:

Reports of neuroleptic (antipsychotic) drug-related priapism - a rare but serious side effect in male psychiatric patients - are becoming more frequent. Priapism involves persistent penile erection in the absence of sexual arousal, accompanied by pain and tenderness. Its underlying causes are unknown. Even with treatment, priapism often results in impotence. The case is reported of a 59-year-old man admitted to the hospital with agitated psychotic depression. Upon admission, he was given chlorpromazine (a phenothiazine antipsychotic drug). Onset of priapism was five days later, and medication was terminated. He underwent an emergency decompression and a shunt operation. On the 28th day of hospitalization, his liver functions, which had been normal at admission, became grossly abnormal, but gradually stabilized over the next three weeks. Treatment with lithium led to the restoration of his mental state, although recovery was complicated by impotence and his inability to recall the priapism or the subsequent operation. It has been generally accepted that chlorpromazine-induced hepatotoxicity (liver damage) involves a hypersensitivity reaction, and is likely to be detected two to four weeks after the initial dose of medication. Hypersensitivity is suspected if there is a latent period between exposure and reaction; a reaction is elicited by relatively small doses; and there is an association with other known hypersensitivity phenomena. Since there was an association of priapism and hepatotoxicity in this case, it was suggested that hypersensitivity may be involved in some cases of neuroleptic-induced priapism. Further exploration of this problem is required to spare patients a traumatic disability following psychiatric disturbance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Antipsychotic drugs, Antipsychotic agents, Priapism

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The genetics of schizophrenia is the genetics of neurodevelopment

Article Abstract:

New noninvasive diagnostic techniques such as computerized tomography and magnetic resonance imaging have demonstrated that there are structural brain abnormalities involved in schizophrenia. The majority of schizophrenic patients appear to have enlarged cerebral ventricles (cavities) and reductions in temporal lobe structures, in particular, the hippocampus. Damage to or shrinkage of the hippocampus is thought to result in mood alterations as well as memory and learning deficits. Discordant identical twin pairs (in which only one twin is schizophrenic) have been studied to evaluate the importance of both genetic and environmental factors in the causation of brain abnormalities. Schizophrenics have been shown to have larger ventricles than their nonschizophrenic twins, indicating that brain abnormalities cannot be explained by genes alone and that environmental factors are likely to be involved in the disease process. For instance, obstetric complications are more frequent among mothers of schizophrenics than among mothers of other psychiatric patients or normal comparison subjects. It is posited that a clearer understanding of brain development is necessary for understanding how biological and environmental factors interact in the schizophrenic process, and that the search for a specific gene which codes directly for schizophrenic symptoms may prove to be unfruitful. By analyzing developmental brain changes, it may be possible to discover a defect which predisposes an individual to the later development of schizophrenia. By understanding the molecular rules which foster and govern neurodevelopment, the genetic and environmental factors which lead to schizophrenia may become clearer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Environmental aspects, Genetic aspects, Brain, Schizophrenia, Brain abnormalities

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