Evidence for a general neurotic syndrome

Article Abstract:

The concept of neurosis has been construed, over the last century, as either a single disorder with a multiplicity of clinical manifestations, or as a class of entirely separate syndromes requiring unique criteria for diagnosis. In one study of a group of neurotic patients who were followed over two years, there was little variability in phobic symptoms, and the responses of the group to a variety of treatments were independent of diagnosis, supporting the notion of a general neurotic syndrome. At the same time, it is often clinically useful to conceive of individual neurotic syndromes, such as depression, obsessive-compulsive disorder, and panic disorder/agoraphobia, each with its own cause, course, and mode of treatment. A study was designed to examine the co-occurrence of diagnoses of neurotic syndromes among a large (892) group of twins between 18 and 65 years of age, and a group of patients (8 men, 157 women) diagnosed with panic disorder. It was reasoned that if disparate processes are responsible for different disorders, then the patterns of predisposing factors would be unique for each disorder. In the twin group, of 243 subjects who reported symptoms consistent with a diagnosis of at least one neurotic syndrome, 17 percent met the criteria for one diagnosis, 6 percent (54 subjects) met the criteria for two, 2 percent (16) for three, and 2 percent for four. Six subjects met the criteria for five diagnoses, and one person was apparently suffering from panic disorder, social phobia, anxiety disorder, obsessive-compulsive disorder, major depression, and dysthymic disorder. Statistical analysis of these findings revealed there was a pattern of association between a diagnosis and locus of control, that is, the subject's sense of control over his own behavior. In the sample of patients with panic disorder, it was found that although they were diagnosed with a single phobic illness, their experience of neurosis was generalized. It is concluded that even though patients with anxiety disorders seem to be clinically different, there are more common features among the diverse classes of patients than differences, and that all neurotic disorders have in common the fact that they tend to affect people who are vulnerable to adversity. The authors call for a re-evaluation of the concept of a general neurotic syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Identification and classification, Anxiety, Neuroses

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Diagnosis, personality and the long-term outcome of depression

Article Abstract:

There are two conflicting views about the nature of depression, one holding that endogenous (or having an organic cause) and neurotic depression are two distinct disorders, the other claiming that depression is a continuum of emotional disorders. Earlier research relied upon responses to various antidepressant drugs to distinguish between endogenous and neurotic depression. A 15-year follow-up study of patients diagnosed with either form of depression was conducted to determine whether significant enough differences existed to support maintaining the distinction between endogenous and neurotic depression. One hundred ninety-three patients diagnosed with endogenous depression (ED; 66 patients), neurotic depression (ND; 67 patients), or other neurosis with depressive symptoms (ON; 60 patients) participated in the study. Patient information that was examined included global outcome (the extent of any and all psychiatric disorders); time in hospital; time psychiatrically ill; and inability to work. It was found that patients with ED were in the hospital longer and were readmitted significantly more often (63 percent) than ND and ON patients. It seemed that the illness characterizing ED patients was more episodic, while that of ND patients was more insidious. The stability of diagnosis for the endogenous group was higher than for the others. It was also noted that the outcome for patients in both groups was a function of personality. The primary evidence supporting the distinction between endogenous and neurotic depression is that the neurotic depressive has an identifiable personality that is vulnerable to stress. The relationship between vulnerability and depression is not evident in those with endogenous depression. In the treatment of the patients with ND, cognitive behavior therapy can be used to reduce the personality factors that make a person vulnerable to neurosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Analysis, Emotions, Personality and emotions, Personality (Psychology)

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Polycythaemia rubra vera, cerebral ischaemia and depression

Article Abstract:

Polycythemia rubra vera, also known as erythremia, is characterized by an increase in blood volume as well as in the number of red cells, redness of the skin, and enlargement of the spleen, and it can lead to blockage of the blood supply to the brain (cerebral ischemia). The lack of oxygen to the brain that ensues may lead to stroke or even death, but it can also lead to psychiatric affective disorder, such as depression. While polycythemia rubra vera may thus occasionally be expected to cause psychiatric symptoms, there have been no reports in the literature of psychiatric disorder attributed to polycythemia rubra vera. A case is presented of a 72-year-old man with no previous personal or family history of psychiatric disorder. He was diagnosed as having polycythemia rubra vera at age 61 and was treated. Following six weeks of depression he was admitted to a psychiatric ward where he exhibited psychotic (hallucinatory and delusional) and aggressive behavior. Given his low risk for psychiatric illness, investigation revealed brain atrophy that could have been related to polycythemia rubra vera, occurring in an area where such damage is known to be related to affective disorder. This is therefore the first case reported of polycythemia rubra vera associated with psychiatric illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Complications and side effects, Cerebral ischemia, Polycythemia vera, Polycythemia

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