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doi: N/Apmid: N/A
A group of depressed women treated with amitriptyline was studied with particular attention to the speed of response in different symptoms of depression and in psychotic as compared to neurotic depressives. The findings showed rapid improvement in suicidal feelings, insomnia, and anorexia, but slower and more gradual improvement in impaired work and interests, retardation and pessimism and hopelessness. Psychotic depressives did not show substantial improvement until the third week of treatment whereas neurotic depressives improved markedly within the first week. It is suggested that the psychotic classification may be more useful as a predictor of speed of response than as a predictor of final treatment outcome.
doi: N/Apmid: N/A
With recent developments in community psychiatric services, concern with prevention has become an urgent social, as well as medical challenge. Comprehensive investigation into causation must therefore be given systematic emphasis. This paper is an effort toward clarification of etiology, specifically of the depressive disorder, in terms of early childhood experiences. The work is based on social and psychiatric history data collected by experienced psychiatric social workers on two groups of subjects from the National Institute of Mental Health (NIMH) Collaborative Depression Studies under the direction of Allen Raskin, Ph.D. of the NIMH Psychology Research Branch, and a third group of subjects from Boston State Hospital. The hypothesis that childhood deprivation, defined as “the lack, loss or absence of an emotionally sustaining relationship prior to adolescence,” has a meaningful association with the occurrence of adult depression was tested in a sample of 347 depressed inpatient women and 114 outpatient women in comparison to 198 normal women used as a control or reference population. The subjects were all Caucasian. Events occurring during childhood that could be considered within the definition of deprivation were documented. Further, subjects were assessed as to depriving childrearing experiences. The findings revealed no association of adult depression with overt childhood loss events, but did provide evidence to support an association of depriving childrearing processes with adult depression. The findings also revealed evidence of a relationship between the degree of the depriving childrearing experience with the severity of the adult illness as measured by hospital status. The results are discussed in relation to findings from other studies of childhood deprivation and psychiatric disorder.
doi: N/Apmid: N/A
The discrepancies between experts' criteria for hospitalization of suicide attempters with actual clinical practice were explored to develop utilization review criteria which reflect current clinical thinking and which could form guidelines for the assessment of clinical care. Experts' criteria predicted that a hospitalized group of suicide attempters did not require hospitalization and that a nonhospitalized group of suicide attempters required hospitalization. Examination of the discrepancies between clinical practice and experts' criteria not only revealed that incorporation of clinical measures of depressive symptomatology could improve the experts' criteria for hospitalization but also showed that clinicians did not hospitalize a group of markedly symptomatic and socially impaired white suicide attempters. Clinician and patient factors that may have contributed to this decision making and the application of these findings for utilization review are discussed.
doi: N/Apmid: N/A
The attendance patterns of 36 predominantly lower class, depressed women receiving outpatient psychotherapy were studied to determine the actual amount and frequency of therapy received in an 8-month period. At the initiation of therapy, the majority of patients expressed either neutral or negative attitudes to therapy. Contrary to the usually held belief that indifferent attitudes to therapy coupled with the patients' low socioeconomic status augured poorly for the patients' continuation in therapy, we found that the sample studied attended regularly and remained in therapy until the end of the prescribed 8-month period. Missed appointments occurred rarely and were usually preceded by cancellations. The majority of therapy sessions were with patients, but provisions were available for the involvement of spouses and other relatives where indicated. It is suggested that the time-limited nature of therapy, the delineation of short term, realistically attainable goals, and the vigorous outreach techniques by the therapists may have contributed to the unexpectedly high therapy attendance.
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