Archives of General Psychiatry

doi: 10.1001/archpsyc.1985.01790320004001pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

doi: 10.1001/archpsyc.1985.01790320010002pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

Spohn, Herbert E.;Coyne, Lolafaye;Lacoursiere, Roy;Mazur, David;Hayes, Kenneth

doi: 10.1001/archpsyc.1985.01790320017003pmid: 2864028

Abstract • Relationships of neuroleptic dosage and tardive dyskinesia with measures of attentional, information-processing, and psychophysiological dysfunctions in medicated chronic schizophrenics were explored by correlational and stepwise multiple-regression analysis. High neuroleptic dosage was found to be associated with increased reaction time, reduced span of apprehension, low basal skin conductance level, and reduced skin conductance reactivity. Severe abnormal involuntary movements were associated with increased eyetracking dysfunction, increased scanning eye-movement rate, increased reaction time, and reduced skin conductance reactivity. These findings led to the hypothesis that neuroleptic dosage and tardive dyskinesia may be sources of error variance in the measurement of attentional, information-processing, and psychophysiological functions in schizophrenics. References 1. Chapman LJ, Chapman JP: Disordered Thought in Schizophrenia . New York, Appleton-Century-Crofts, 1973. 2. Chapman LJ: The problem of selecting drug-free schizophrenics for research . J Consult Psychol 1963;27:540-542.Crossref 3. Spohn HE: The case for reporting the drug status of patient subjects in experimental studies of schizophrenic psychopathology . J Abnorm Psychol 1973;82:102-106.Crossref 4. Orzack MH, Kornetsky C, Freeman H: The effects of daily administration of carpenazine on attention in the schizophrenic patient . Psychopharmacologia 1967;11:31-38.Crossref 5. Tecce JJ, Cole JO: Psychophysiological responses of schizophrenics to drugs . Psychopharmacologia 1972;24:159-200.Crossref 6. Spohn HE, Lacoursiere RB, Thompson K, Coyne L: Phenothiazine effects on psychological and psychophysiological dysfunction in chronic schizophrenics . Arch Gen Psychiatry 1977;34:633-644.Crossref 7. Spohn HE, Fitzpatrick T: Informed consent and bias in a sample of schizophrenic subjects at risk for drug withdrawal . J Abnorm Psychol 1980;89:79-92.Crossref 8. Spohn HE: The informed consent requirement biases sampling. Read before the American Psychiatric Association, Toronto, 1982. 9. Overall JE, Gorham DR: The Brief Psychiatric Rating Scale . Psychol Rep 1962;10:799-812.Crossref 10. Cole JO: Psychopharmacology update antipsychotic drugs: Is more better? J McLean Hosp 1982;7:61-87. 11. Wolf ME, Ryan JJ, Mosnaim AD: Cognitive functions in tardive dyskinesia . Psychol Med 1983;13:671-674.Crossref 12. Shagass C, Ornitz EM, Sutton S, Tueting P: Event related potentials and psychopathology , in Callaway E, Tueting P, Koslow SH (eds): Event Related Potentials in Man . New York, Academic Press Inc, 1978, pp 443-509. 13. Holzman PS, Solomon CM, Levin S, Waternaux CS: Pursuit eye movement dysfunctions in schizophrenia . Arch Gen Psychiatry 1984;41:136-139.Crossref 14. DeAmicis LA, Cromwell RL: Reaction time crossover in process schizophrenics, their relatives and control subjects . J Nerv Ment Dis 1979;167:593-600.Crossref 15. Asarnow RF, MacCrimmon DJ: Residual performance deficit in clinically remitted schizophrenics: A marker of schizophrenia? J Abnorm Psychol 1978;87:597-608.Crossref 16. Spohn HE: Attention, Thought Disorder and Drug Action in Schizophrenia . Progress Report, National Institute of Mental Health grant MH32220-05, June 10, 1983. 17. Abnormal Involuntary Movement Scale. US Public Health Service, Alcohol, Drug Abuse Mental Health Administration, National Institute of Mental Health, 1974. 18. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria . New York, Biometrics Research Division, New York State Psychiatric Institute, 1978. 19. Holzman PS, Levy DL, Proctor LR: Smooth pursuit eye movements, attention, and schizophrenia . Arch Gen Psychiatry 1976;33:1415-1420.Crossref 20. Shagass C, Roemer RA, Amadeo M: Eye tracking performance and engagement of attention . Arch Gen Psychiatry 1976;33:121-126.Crossref 21. Lindsey DT, Holzman PS, Haberman S, Yasillo NJ: Smooth pursuit eye movements: A comparison of two measurement techniques for studying schizophrenia . J Abnorm Psychol 1978;87:491-496.Crossref 22. Gardner RW, Long RI: Control, defense and centration effect: A study of scanning behavior . Br J Psychol 1962;53:129-140.Crossref 23. Steffy RA, Galbraith K: A comparison of segmental set and inhibitory deficit explanations of the crossover pattern in process schizophrenic reaction time . J Abnorm Psychol 1974;83:227-233.Crossref 24. Rodnick EH, Shakow D: Set in the schizophrenic as measured by a composite reaction time index . Am J Psychiatry 1940;97:214-225. 25. Gruzelier JH, Venables PH: Skin conductance responses to tones with and without attentional significance in schizophrenic and nonschizophrenic psychiatric patients . Neuropsychologia 1973;11:221-230.Crossref 26. Lowry R: Active circuits for direct linear measurement of skin resistance and conductance . Psychophysiology 1977;14:329-331.Crossref 27. King HE: Psychomotor Aspects of Mental Disease . Cambridge, Mass, Harvard University Press, 1954. 28. Jeste DV, Wyatt RJ: Changing epidemiology of tardive dyskinesia: An overview . Am J Psychiatry 1981;138:297-309.Crossref 29. Schooler NR, Kane JM: Research diagnosis for tardive dyskinesia . Am J Psychiatry 1982;39:486-487. 30. Phillips L: Case history data and prognosis in schizophrenia . J Nerv Ment Dis 1953;117:515-525.Crossref 31. Davis JM: Dose equivalents of antipsychotic drugs . J Psychiatr Res 1974;11:65-69.Crossref 32. Mialet JP, Pichot P: Eye tracking patterns in schizophrenia: An analysis based on the incidence of saccades . Arch Gen Psychiatry 1981;38:183-186.Crossref

Wegner, James T.;Catalano, Frank;Gibralter, Jonathan;Kane, John M.

doi: 10.1001/archpsyc.1985.01790320028004pmid: 2864029

Abstract • We investigated the role neurologic soft signs, premorbid asociality, psychometric tests, and family history of psychiatric illness may play in the identification of patients at risk for tardive dyskinesia (TD) development. Thirty-two TD and 32 non-TD schizophrenics served as subjects. The results indicated that patients with TD have more soft signs, are more frequently rated as poor premorbid asocials, perform more poorly on psychometric testing, and have a familial loading for affective disorders in first-degree relatives higher than control patients. A discriminant function analysis correctly classified 84.4% of the patients into their respective groups. Subtle yet quantifiable differences exist between TD and non-TD patients and these deficits may render the individual more vulnerable to TD development. References 1. Baldessarini RJ, Cole JO, Davis JM, Gardos G, Preskorn SH, Simpson GM, Tarsy D: Task Force Report of the American Psychiatric Association on Late Neurological Effects of Antipsychotic Drugs . Washington, DC, American Psychiatric Association, 1980. 2. Kane JM, Smith JM: Tardive dyskinesia: Prevalence and risk factors . Arch Gen Psychiatry 1982;39:473-481.Crossref 3. Kane JM, Woerner M, Weinhold P, Wegner J, Kinon B, Borenstein M: Incidence of tardive dyskinesia: Five-year data from a prospective study . Psychopharmacol Bull 1984;20:39-40. 4. Uhrbrand L, Faurbye A: Reversible and irreversible dyskinesia after treatment with perphenazine, chlorpromazine, reserpine, and electroconvulsive therapy . Psychopharmacologia 1960;1:498-510.Crossref 5. Druckman R, Seelinger D, Thulin B: Chronic involuntary movements induced by phenothiazine . J Nerv Ment Dis 1962;135:69-76.Crossref 6. Edwards H: The significance of brain damage in persistent oral dyskinesia . Br J Psychiatry 1970;116:271-275.Crossref 7. Faurbye A, Rasch PJ, Petersen PB, Brandborg G, Pakkenberg H: Neurological symptoms in pharmacotherapy of psychoses . Acta Psychiatr Scand 1964;40:10-27.Crossref 8. Hunter R, Earl CJ, Thornicroft S: An apparently irreversible syndrome of abnormal movements following phenothiazine medication . Proc R Soc Med 1964;57:758-762. 9. Kline NS: On the rarity of 'irreversible' oral dyskinesias following phenothiazines . Am J Psychiatry 1968;124( (suppl) ):48-54. 10. Brandon S, McClelland HA, Protheroe C: A study of facial dyskinesia in a mental hospital population . Br J Psychiatry 1971;118:171-184.Crossref 11. Fann WE, Davis JM, Janowsky DS: The prevalence of tardive dyskinesia in mental hospital patients . Dis Nerv Syst 1974;35:324-326. 12. Jus A, Pineau R, Lachance R, Pelchat G, Jus K, Pires P, Villeneuve R: Epidemiology of tardive dyskinesia . Dis Nerv Syst 1976;37:210-214. 13. Hunter R, Blackwood W, Smith MC, Cumings JN: Neuropathological findings in three cases of persistent dyskinesias following phenothiazine medication . J Neurol Sci 1968;7:763-773.Crossref 14. Gross H, Kaltenbäch E: Neuropathological findings in persistent hyperkinesia after neuroleptic long-term therapy , in Cerletti A, Bové FJ (eds): The Present Status of Psychotropic Drugs . Amsterdam, Excerpta Medica, 1969, pp 474-476. 15. Christensen E, Møller JE, Faurbye A: Neuropathological investigation of 28 brains from patients with dyskinesia . Acta Psychiatr Scand 1970;46:14-23.Crossref 16. Gelenberg AJ: Computerized tomography in patients with tardive dyskinesia . Am J Psychiatry 1976;133:578-579. 17. Jeste DV, Wagner RL, Weinberger DR, Rieth KG, Wyatt RJ: Evaluation of CT scans in tardive dyskinesia . Am J Psychiatry 1980;137:247-248. 18. Jeste DV, Weinberger DR, Zalcman S, Wyatt RJ: Computed tomography in tardive dyskinesia . Br J Psychiatry 1980;136:606-607.Crossref 19. Famuyiwa OO, Eccleston D, Donaldson AA, Garside RF: Tardive dyskinesia and dementia . Br J Psychiatry 1979;135:500-504.Crossref 20. Paulson GW: An evaluation of the permanence of the 'tardive dyskinesias.' Dis Nerv Syst 1968;24:692-694. 21. Gardos G, Cole JO, LaBrie RA: Drug variables in the etiology of tardive dyskinesia: Application of discriminant function analysis . Progr Neuropsychopharmacol 1977;1:147-154.Crossref 22. Mallya A, Jose C, Baig M, Williams R, Cho D, Mehta D, Volavka J: Antiparkinsonics, neuroleptics, and tardive dyskinesia . Biol Psychiatry 1979;14:645-649. 23. Wegner JT, Struve FA, Kane JM: The B-Mitten EEG pattern and tardive dyskinesia: A possible association . Am J Psychiatry 1977;134:1143-1145. 24. Wegner JT, Struve FA, Kantor JS, Kane JM: Relationship between the B-Mitten EEG pattern and tardive dyskinesia . Arch Gen Psychiatry 1979;36:599-603.Crossref 25. Pincus JR, Tucker GJ: Behavioral Neurology . New York, Oxford University Press, 1974. 26. Kennard MA: Value of equivocal signs in neurological diagnosis . Neurology 1960;10:753-764.Crossref 27. Torrey EF: Neurological abnormalities in schizophrenic patients . Biol Psychiatry 1980;15:381-388. 28. Quitkin F, Rifkin A, Klein DF: Neurologic soft signs in schizophrenia and character disorders . Arch Gen Psychiatry 1976;33:845-853.Crossref 29. Rochford JM, Detre T, Tucker GJ, Harrow M: Neuropsychological impairment in functional psychiatric diseases . Arch Gen Psychiatry 1970; 22:114-119.Crossref 30. Mosher LR, Pollin W, Stabenau JR: Identical twins discordant for schizophrenia: Neurologic findings . Arch Gen Psychiatry 1971;24:422-430.Crossref 31. Tucker GJ, Campion EW, Silberfarb PM: Sensorimotor functions and cognitive disturbance in psychiatric patients . Am J Psychiatry 1975;132:17-21. 32. Cox SM, Ludwig AM: Neurological soft signs and psychopathology: I. Findings in schizophrenia . J Nerv Ment Dis 1979;167:161-165.Crossref 33. Handford HA: Brain hypoxia, minimal brain dysfunction, and schizophrenia . Am J Psychiatry 1975;132:192-194. 34. Bellak L: Schizophrenic syndrome related to minimal brain dysfunction: A possible neurologic subgroup . Schizophr Bull 1979;5:480-489.Crossref 35. Strauss JS, Kokes RF, Klorman R, Sacksteder JL: Premorbid adjustment in schizophrenia: Concepts, measures, and implications: I. The concept of premorbid adjustment . Schizophr Bull 1977;3;182-185. 36. Bromet E, Harrow M, Kosl S: Premorbid functioning and outcome in schizophrenics and nonschizophrenics . Arch Gen Psychiatry 1974;30:203-207.Crossref 37. Houlihan JP: Heterogeneity among schizophrenic patients: Selective review of recent findings (1970-75) . Schizophr Bull 1977;3:246-257.Crossref 38. Zigler E, Phillips L: Social competence and the process-reactive distinction in psychopathology . J Abnorm Soc Psychol 1962;65:215-222.Crossref 39. Herron WG: The process-reactive classification of schizophrenia . Psychol Bull 1962;59:329-343.Crossref 40. Tutko TA, Spence JT: The performance of process and reactive schizophrenics and brain injured subjects on a conceptual task . J Abnorm Soc Psychol 1962;65:387-394.Crossref 41. Davis WE, DeWolfe AS, Gustafson RC: Intellectual deficit in process and reactive schizophrenia and brain injury . J Consult Clin Psychol 1972;38:146.Crossref 42. Brackbill G, Fine H: Schizophrenia and central nervous system pathology . J Abnorm Soc Psychol 1956;52:310-313.Crossref 43. Herron WG: Abstract ability in the process-reactive classification of schizophrenia . J Gen Psychol 1962;67:147-154.Crossref 44. Watson CG: Abstract thinking deficit and autism in process and reactive schizophrenics . J Abnorm Psychol 1973;82:399-403.Crossref 45. Belmon I, Birch HG, Klein DF, Pollack M: Perceptual evidence of CNS dysfunction in schizophrenia . Arch Gen Psychiatry 1964;10:395-408.Crossref 46. Weinberger DR, Cannon-Spoor E, Potkin SG, Wyatt RJ: Poor premorbid adjustment and CT scan abnormality in chronic schizophrenia . Am J Psychiatry 1980;137:1410-1413. 47. Quitkin F, Rifkin A, Tsuang MT, Kane JM, Klein DF: Can schizophrenia with premorbid asociality be genetically distinguished from the other forms of schizophrenia? Psychiatry Res 1980;2:99-105.Crossref 48. Smith JM, Baldessarini RJ: Changes in prevalence, severity, and recovery in tardive dyskinesia with age . Arch Gen Psychiatry 1980;37:1368-1373.Crossref 49. Spitzer RL, Endicott J, Robin E: Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders , ed 2. New York, New York State Psychiatric Institute, Biometrics Research, 1975. 50. Simpson GM, Lee JH, Zoubek B, Gardos G: A rating scale for tardive dyskinesia . Psychopharmacology 1979;64:171-179.Crossref 51. Cohen J: A coefficient of agreement for nominal scales . Educ Psychol Meas 1960;20:37-46.Crossref 52. Kendler KS, Gruenberg AM, Tsuang MY: Outcome of schizophrenic subtypes defined by four diagnostic systems . Arch Gen Psychiatry 1984;41:149-154.Crossref 53. Gittelman-Klein R, Klein DF: Premorbid asocial adjustment and prognosis in schizophrenia . J Psychiatry Res 1969;7:35-54.Crossref 54. Harris JG: An abbreviated form of the Phillips rating scale of premorbid adjustment of schizophrenia . J Abnorm Psychol 1975;84:129-137.Crossref 55. Kokes RF, Strauss JS, Klorman R: Premorbid adjustment in schizophrenia: II. Measuring premorbid adjustment: The instruments and their development . Schizophr Bull 1977;3:186-212.Crossref 56. Willner AE: Conceptual Level Analogy Test . New York, Cognitive Testing Service, 1971. 57. Lezak MD: Neuropsychological Assessment . New York, Oxford University Press, 1976. 58. Reitan RM: The relation of the trail making test to organic brain damage . J Consult Psychol 1955;19:393-394.Crossref 59. Reitan RM: Validity of the trail making test as an indicator of organic brain damage . Percept Mot Skills 1958;8:271-276.Crossref 60. Willner AE: Different types of impaired abstraction among schizophrenic and nonschizophrenic hospitalized patients . Proc Am Psychol Assoc 1970;7:335-336. 61. Mattarazzo JD: Wechsler's Measurement and Appraisal of Adult Intelligence , ed 5. New York, Oxford University Press, 1972. 62. Endicott J, Andreasen NC, Spitzer RL: Family History Research Diagnostic Criteria . New York, New York State Psychiatric Institute, Biometrics Research, 1975. 63. Light RJ: Measure of response agreement for qualitative data: Some generalizations and alternatives . Psychol Bull 1971;76:365-377.Crossref 64. Andreasen NC, Endicott J, Spitzer RL, Winokur G: The family history method using diagnostic criteria: Reliability and validity . Arch Gen Psychiatry 1977;34:1229-1235.Crossref 65. Cochran WG: Some methods for strengthening the common ϰ2 tests . Biometrics 1954;10:417-451.Crossref 66. Maxwell S, Massengill R, Nashold B: Tardive dyskinesia . J Speech Hear Disord 1970;35:33-36. 67. Portnoy RA: Hyperkinetic dysarthria as an early indicator of impending tardive dyskinesia . J Speech Hear Disord 1979;44:214-219. 68. Cohen J, Cohen P: Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences . Hillsdale, NJ, Lawrence Erlbaum Assoc, 1975. 69. Tsuang MT, Winokur G, Crowe RR: Morbidity risks of schizophrenia and affective disorders among first degree relatives of patients with schizophrenia, mania, depression, and surgical conditions . Br J Psychiatry 1980;137:497-504.Crossref 70. Johnstone EC, Cunningham Owens DG, Gold A, Crow TJ, MacMillan JF: Institutionalization and the defects of schizophrenia . Br J Psychiatry 1981;139:195-203.Crossref 71. Rosenthal D: Genetic Theory and Abnormal Behavior . New York, McGraw-Hill Book Co, 1970. 72. Pope HG, Jonas JM, Cohen BM, Lipinski JF: Failure to find evidence of schizophrenia in first degree relatives of schizophrenic probands . Am J Psychiatry 1982;139:826-828. 73. Abrams R, Taylor MA: The genetics of schizophrenia: A reassessment using modern criteria . Am J Psychiatry 1983;140:171-175. 74. Kendler KS: Heritability of schizophrenia . Am J Psychiatry 1983; 140:131. 75. Weissman MM, Merikangas KR, Pauls DL, Leckman JF, Gammon GD: Heritability of schizophrenia . Am J Psychiatry 1983;140:131-132. 76. Kendler KS, Masterson CC, Ungaro R, Davis KL: A family history study of schizophrenia-related personality disorders . Am J Psychiatry 1984;141:424-427. 77. Gershon ES, Hamovit J, Guroff JJ, Dibble E, Leckman JF, Sceery W, Targum SD, Nurnberger JI, Goldin LR, Bunney WE: A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands . Arch Gen Psychiatry 1982;39:1157-1167.Crossref 78. Kane JM, Struve FA, Weinhold P, Woerner M: Strategy for the study of patients at high risk for tardive dyskinesia . Am J Psychiatry 1980;137:1265-1267. 79. Davis KL, Berger PA, Hollister LE: Tardive dyskinesia and depressive illness . Psychopharmacol Commun 1976;2:125-130. 80. Galdi J, Rieder RO, Silber D, Bonato RB: Genetic factors in the response to neuroleptics in schizophrenia: A psychopharmacogenetic study . Psychol Med 1981;11:713-728.Crossref

Munetz, Mark R.;Roth, Loren H.

doi: 10.1001/archpsyc.1985.01790320034005pmid: 2864030

Abstract • The effects of a formal (written) approach v an informal (oral) approach to obtaining informed consent for neuroleptic treatment were compared in 25 schizophrenic outpatients with tardive dyskinesia. Both groups had significant Increases in knowledge, but only the informal/oral presentation group retained significant new knowledge at two-month follow-up. Overall, patients did not learn the information deemed most relevant for rational decision making about neuroleptic treatment. Younger patients started out with more knowledge and retained significant new knowledge at follow-up. All study patients remained in treatment and all but one remained on neuroleptic regimens. There was no increase in relapse or treatment noncompliance in the study population compared with a comparison group. While information about tardive dyskinesia can be safely disclosed to schizophrenic outpatients, such disclosure is evidently most meaningful when repeated informally in the context of a therapeutic relationship. References 1. Munetz MR, Roth LH, Cornes CL: Tardive dyskinesia and informed consent: Myths and realities . Bull Am Acad Psychiatr Law 1982;10:77-88. 2. Davis JM: Overview: Maintenance therapy in psychiatry: I. Schizophrenia . Am J Psychiatry 1975;132:1237-1245. 3. Baldessarini RJ, Cole JO, Davis JM, Gardos G, Preskorn SH, Simpson G, Tarsy D: Report of the American Psychiatric Association Task Force on Late Neurological Effects of Antipsychotic Drugs . Washington, DC, American Psychiatric Association, 1979, p 18. 4. Jeste DV, Wyatt RJ: Understanding and Treating Tardive Dyskinesia . New York, Guilford Press, 1982. 5. Gardos G, Cole JO: Overview: Public health issues in tardive dyskinesia . Am J Psychiatry 1980;137:776-781. 6. Ayd FJ: Ethical and legal dilemmas posed by tardive dyskinesia . Int Drug Ther Newslett 1977;12:29-34. 7. Sovner R, DiMascio A, Berkowitz D, Randolph P: Tardive dyskinesia and informed consent . Psychosomatics 1978;19:172-177.Crossref 8. DeVeaugh-Geiss J: Informed consent for neuroleptic therapy . Am J Psychiatry 1979;136:959-962. 9. Grossman JD, Summers F: A study of the capacity of schizophrenia patients to give informed consent . Hosp Community Psychiatry 1980;31:205-206. 10. Alexopoulos GS: Lack of complaints in schizophrenics with tardive dyskinesia . J Nerv Ment Dis 1979;167:125-127.Crossref 11. Kobayashi JS, Albala BJ: The phenomenon of tardive dyskinesia. Read before the annual meeting of the American Psychiatric Association, Toronto, May 20, 1982. 12. Vaccarino JM: Consent, informed consent and the consent form . N Engl J Med 1978;298:455.Crossref 13. Slovenko R: On the legal aspects of tardive dyskinesia . J Psychiatr Law 1979;7:295-331. 14. Cassileth BR, Zupkis RV, Sutton-Smith K, March V: Informed consent: Why are its goals imperfectly realized? N Engl J Med 1980;302:896-900.Crossref 15. Grunder TM: On the readability of surgical consent forms . N Engl J Med 1980;302:900-902.Crossref 16. Calif Admin Code title 9, subchapter 4, article 5.5, § 851, 1980. 17. Rennie v Klein, 476 F Supp, 1294, 1309-1310 (D. NJ 1979). 18. Jaffe R: Informed consent: Recall about tardive dyskinesia . Compr Psychiatry 1981;22:434-437.Crossref 19. Corby JC, Bernal P, Leiderman PH: Informed consent for psychoactive medication. Read before the annual meeting of the American Psychiatric Association, New York, May 3, 1983. 20. Meisel A, Roth LH: Toward an informed discussion of informed consent: A review and critique of the empirical studies . Ariz Law Rev 1983;25:265-346. 21. Lidz CW, Meisel A, Zerubavel E, Carter M, Sestak RM, Roth LH: Informed Consent: A Study of Psychiatric Decisionmaking . New York, Guilford Press, 1983. 22. Guy W: ECDEU Assessment Manual for Psychopharmacology . Washington, DC, US Dept of Health, Education, and Welfare, 1976. 23. Smith JM, Oswald WT, Kucharski LT, Waterman LJ: Tardive dyskinesia: Age and sex differences in hospitalized schizophrenics . Psychopharmacology 1978;58:207-211.Crossref 24. Clites v Iowa (Iowa D Ct for Pottawattamie Cty, Law No. 46274, 1980) 25. also cited in Pittsburgh Press, Aug 10, 1980, p A-11. 26. Alfidi RJ: Informed consent: A study of patient reaction . JAMA 1971;216:1325-1329.Crossref 27. Tarsy D, Granacher R, Bralower M: Tardive dyskinesia in young adults . Am J Psychiatry 1977;134:1032-1034. 28. Coles GS, Roth L, Pollack LW: Literacy skills of long-term hospitalized mental patients . Hosp Community Psychiatry 1978;29:512-516. 29. Berg A, Hammitt KB: Assessing the psychiatric patient's ability to meet the literacy demands of hospitalization . Hosp Community Psychiatry 1980;31:266-268. 30. Roth LH: Question the experts . J Clin Psychopharmacol 1983;3:207-208.Crossref 31. Miller R, Willner HS: The two-part consent form . N Engl J Med 1974;290:964-966.Crossref

Barnes, Thomas R. E.;Braude, Walter M.

doi: 10.1001/archpsyc.1985.01790320042006pmid: 2864031

Abstract • Eighty-two schizophrenic outpatients receiving maintenance antipsychotic medication were assessed for akathisia and tardive dyskinesia. Thirty-nine (48%) manifested patterns of nondyskinetic, restless movement characteristic of akathisia. On the basis of their clinical features, these patients were divided into three groups: "acute" akathisia (recent onset, related to an increase in antipsychotic drug dose); "pseudoakathisia" (motor signs but no subjective symptoms); and "chronic" akathisia (a mixed category including persistent acute akathisia and "tardive" akathisia with the pharmacologic characteristics of tardive dyskinesia). Coarse, jerky foot tremor was observed as an invariable accompaniment of acute akathisia. A significant association was found between choreoathetoid limb dyskinesias, orofacial dyskinesias, and the presence of chronic akathisia. Also, the findings suggested a possible relationship between pseudoakathisia, orofacial and limb dyskinesia, and the severity of negative schizophrenic symptoms. References 1. Haškovec L: Akathisie . Arch Bohemes Med Clin 1902;3:193-200. 2. Haškovec L: Nouvelles remarques sur l'akathisia . Nouv Iconogr Salpetriere Clin Maladies Systeme Nerv 1903;16:287-293. 3. Steck H: Le syndrome extrapyramidal et diencephalique au cours des traitments au largactil et au serpasil . Ann Med Psych 1954;112:737-743. 4. Ayd FJ: A survey of drug-induced extrapyramidal reactions . JAMA 1961;175:1054-1060.Crossref 5. Marsden CD, Tarsy D, Baldessarini RJ: Spontaneous and druginduced movement disorders in psychotic patients , in Benson DF, Blumer D (eds): Psychiatric Aspects of Neurological Disease . New York, Grune & Stratton Inc, 1975, pp 219-265. 6. Braude WM, Barnes TRE, Gore SM: Clinical characteristics of akathisia: A systematic investigation of acute psychiatric inpatient admissions . Br J Psychiatry 1983;143:139-150.Crossref 7. Freyhan FA: Occurrence and management of extrapyramidal syndromes in psychiatric treatment with trifluoperazine , in Brill H (ed): Trifluoperazine, Clinical and Pharmacological Aspects . Philadelphia, Lea & Febiger, 1958. 8. Van Putten T: The many faces of akathisia . Comp Psychiatry 1975;16:43-47.Crossref 9. Yagi G, Ogita K, Ohtsuka N, Itoh H, Miura S: Persistent dyskinesia after long-term neuroleptics in Japan: Its present status and clinical problems . Keio J Med 1976;25:27-35.Crossref 10. Kalinowsky LB: Appraisal of the 'tranquilizers' and their influence on other somatic treatments in psychiatry . Am J Psychiatry 1958;115:294-298. 11. Raskin D: Akathisia: A side effect to be remembered . Am J Psychiatry 1972;129:345-347. 12. Van Putten T: Why do schizophrenics refuse to take thier drugs? Arch Gen Psychiatry 1974;31:67-72.Crossref 13. Van Putten T: Drug refusal in schizophrenia: Causes and prescribing hints . Hosp Community Psychiatry 1978;29:110-112. 14. Delay J, Deniker P: Drug-induced extrapyramidal syndromes , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology . Amsterdam, North Holland Publishing Co, 1968, vol 6, pp 248-266. 15. Crane GE, Naranjo ER, Chase C: Motor disorders induced by neuroleptics: A proposed new classification . Arch Gen Psychiatry 1971;23:179-184.Crossref 16. Sovner R, DiMascio A: Extrapyramidal syndromes and other neurological side-effects of psychotropic drugs , in Lipton MA, DiMascio A, Killam KF (eds): Psychopharmacology: A Generation of Progress . New York, Raven Press, 1978, pp 1021-1032. 17. Kekich WA: Neuroleptics: Violence as a manifestation of akathisia . JAMA 1978;240:2185.Crossref 18. Kumar BB: An unusual case of akathisia . Am J Psychiatry 1979;136:1088. 19. Friis T, Behnke K, Rosted Kristensen T, Gerlach J: Sodium valproate (a GABA agonist) and biperiden (an anticholinergic drug) in akathisia, abstract F143. Abstracts of the III World Congress of Biological Psychiatry, Stockholm, June 28-July 3, 1981. 20. Jenner P, Marsden CD: Antiparkinsonian and antidyskinetic drugs , in Tyrer PG (ed): Drugs in Psychiatric Practice . London, Butterworth, 1982, pp 82-125. 21. Faurbye A, Rasch PJ, Peterson PB, Brandborg G, Pakkenberg H: Neurological symptoms in phamacotherapy of psychoses . Acta Psychiatr Scand 1964;40:10-27.Crossref 22. Brandon S, McClelland MA, Prothroe C: A study of facial dyskinesia in a mental hospital population . Br J Psychiatry 1971;118:171-184.Crossref 23. Kennedy PF, Hershon HI, McGuire RJ: Extrapyramidal disorders after prolonged phenothiazine therapy . Br J Psychiatry 1971;118:509-518.Crossref 24. Wojcik JD, Gelenberg AJ, La Brie RA, Mieske M: Prevalence of tardive dyskinesia in an outpatient population . Comp Psychiatry 1980;21:370-380.Crossref 25. Chouinard G, Annable L, Ross-Chouinard A: Fluphenazine enanthate and fluphenazine decanoate in the treatment of schizophrenic outpatients: Extrapyramidal symptoms and therapeutic effect . Am J Psychiatry 1982;139:312-318. 26. Mukherjee S, Rosen AM, Cardenas C, Varia V, Olarte S: Tardive dyskinesia in psychiatric outpatients . Arch Gen Psychiatry 1982;39:466-469.Crossref 27. Barnes TRE, Kidger T, Gore SM: Tardive dyskinesia: A three-year, follow-up study . Psychol Med 1983;13:71-81.Crossref 28. Mackay AVP: Clinical controversies in tardive dyskinesia , in Marsden CD, Fahn S (eds): Neurology . London, Butterworth, 1982, vol 2: Movement Disorders, pp 249-262. 29. Kidger T, Barnes TRE, Trauer T, Taylor PJ: Sub-syndromes of tardive dyskinesia . Psychol Med 1980;10:513-520.Crossref 30. Granacher RP: Differential diagnosis of tardive dyskinesia: An overview . Am J Psychiatry 1981;138:1288-1297. 31. Bobruff A, Gardos G, Tarsy D, Rapkin RM, Cole JO, Moore P: Clonazepam and phenobarbital in tardive dyskinesia . Am J Psychiatry 1981;138:189-193. 32. Barnes TRE, Rossor M, Trauer T: A comparison of purposeless movements in psychiatric patients treated with antipsychotic drugs, and normal individuals . J Neurol Neurosurg Psychiatry 1983;46:540-546.Crossref 33. American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 34. Krawiecka M, Goldberg D, Vaughan M: A standardized psychiatric assessment scale for rating chronic psychotic patients . Acta Psychiatr Scand 1977;55:299-308.Crossref 35. Johnstone EC, Owens DGC, Gold A, Crow TJ, Macmillan JF: Institutionalization and the defects of schizophrenia . Br J Psychiatry 1981;139:195-203.Crossref 36. Simpson GM, Angus JWS: A rating scale for extrapyramidal sideeffects . Acta Psychiatr Scand 1970;212( (suppl 44) ):11-19.Crossref 37. Barnes TRE, Trauer T: Reliability and validity of a tardive dyskinesia videotape rating technique . Br J Psychiatry 1982;140:508-515.Crossref 38. Research Group on Extrapyramidal Disorders of the World Federation of Neurology: Classification of extrapyramidal disorders: Proposal for an international classification and glossary of terms . J Neurol Sci 1981;51:311-327.Crossref 39. Ekbom KA: Asthenia crurum parasthetica (irritable legs) . Acta Med Scand 1944;118:197.Crossref 40. Ekbom KA: Restless legs syndrome . Neurology 1960;10:868-873.Crossref 41. Hodge JR: Akathisia, the syndrome of motor restlessness . Am J Psychiatry 1959;116:337-338. 42. Braude WM, Charles IP, Barnes TRE: Coarse, jerky foot tremor: Tremographic investigation of an objective sign of akathisia . Psychopharmacology 1984;82:95-101.Crossref 43. Wiles DH: Tardive dyskinesia and depot fluphenazine . Br J Psychiatry 1979;135:382-383.Crossref 44. Wiles DH, Gelder MG: Plasma fluphenazine levels by radioimmunoassay in schizophrenic patients treated with depot injections of fluphenazine decanoate . Br J Clin Pharmacol 1979;8:565-570.Crossref 45. Jørgensen A: Pharmacokinetic studies in volunteers of intravenous and oral cis-(z) flupentixol and intramuscular cis-(z) flupentixol decanoate in viscoleo . Eur J Clin Pharmacol 1980;18:355-360.Crossref 46. Jørgensen A, Overø KF: Clopenthixol and flupenthixol depot preparations in outpatient schizophrenics: III. Serum levels . Acta Psychiatr Scand Suppl 1980;279:41-54. 47. Simpson GM: Neurotoxicity of major transquilizers , in Roizin L, Shiraki H, Grčević N (eds): Neurotoxicity . New York, Raven Press, 1977, vol 1, pp 1-7. 48. Munetz MR, Cornes CL: Akathisia, pseudoakathisia and tardive dyskinesia: Clinical examples . Comp Psychiatry 1982;23:345-352.Crossref 49. De Veaugh-Geiss J: Prediction and prevention of tardive dyskinesia , in De Veaugh-Geiss (ed): Tardive Dyskinesia and Related Involuntary Movement Disorders . Boston, John Wright & Sons, 1982, pp 161-166. 50. Jeste DV, Wyatt RJ: Understanding and Treating Tardive Dyskinesia . New York, Guildford Press, 1982, p 64. 51. Braude WM, Barnes TRE: Late-onset akathisia: An indicant of covert dyskinesia: Two case reports . Am J Psychiatry 1983;140:611-612. 52. Andreasen NC: Negative symptoms in schizophrenia . Arch Gen Psychiatry 1982;39:784-788.Crossref 53. Wing JK: The social context of schizophrenia . Am J Psychiatry 1978; 135:1333-1339. 54. Crow TJ: Positive and negative schizophrenic symptoms and the role of dopamine . Br J Psychiatry 1980;137:383-386. 55. Bing R: Textbook of Nervous Diseases , ed 5, Haymaker W (trans). London, Henry Kimpton, 1939, pp 169, 758-759.

Glick, Ira D.;Clarkin, John F.;Spencer, James H.;Haas, Gretchen L.;Lewis, Alfred B.;Peyser, Joanne;DeMane, Nancy;Good-Ellis, Marcie;Harris, Elizabeth;Lestelle, Veronica

doi: 10.1001/archpsyc.1985.01790320054007pmid:

Falloon, Ian R. H.;Boyd, Jeffery L.;McGill, Christine W.;Williamson, Malcolm;Razani, Javad;Moss, Howard B.;Gilderman, Alexander M.;Simpson, George M.

doi: 10.1001/archpsyc.1985.01790320059008pmid: 2864032

Abstract • Environmental stress may contribute to the clinical morbidity of established cases of schizophrenia treated with optimal neuroleptic drugs. A family-based approach that aimed to enhance the problem-solving capacity of the index patient and his family caregivers was compared with a patientoriented approach of similar intensity over a two-year period. Thirty-six patients who returned to stressful parental households after florid episodes of schizophrenia (CATEGO and DSM-III) were stabilized with optimal neuroleptics before being randomly assigned to family or individual therapy in a comprehensive community management program. After nine months, family-managed patients had fewer exacerbations of schizophrenia, lower ratings of schizophrenic psychopathology, fewer hospital admissions, and a trend toward lower deficit symptoms and reduced neuroleptic dosage. This reduced clinical morbidity was sustained throughout the second year of less intensive follow-up. The relative efficacy of the family approach in this clinical management study did not appear to be due to prognostic factors, rater bias, stressful life events, or the effectiveness of pharmacotherapy. Definitive tests of these findings with respect to efficacy require further well-designed studies. References 1. Brown GW, Birley JLT, Wing JK: Influence of family life on the course of schizophrenic disorders: A replication . Br J Psychiatry 1972;121:241-258.Crossref 2. Vaughn CE, Leff JP: The influence of family and social factors on the course of psychiatric illness: A comparison of schizophrenic and depressed neurotic patients . Br J Psychiatry 1976;129:125-137.Crossref 3. Vaughn CE, Snyder KS, Jones S, Falloon IRH, Liberman RP: Family factors in schizophrenic relapse: A replication . Schizophr Bull 1982;8:425-426.Crossref 4. Brown GW, Birley JLT: Crises and life changes and the onset of schizophrenia . J Health Soc Behav 1968;9:203-214.Crossref 5. Leff J, Vaughn C: The interaction of life events and relatives' expressed emotion in schizophrenia and depressive neurosis . Br J Psychiatry 1980; 136:146-153.Crossref 6. Leff JP, Hirsch SR, Gaind R, Rohde PD, Stevens BC: Life events and maintenance therapy in schizophrenic relapse . Br J Psychiatry 1973;123:659-660.Crossref 7. Birley JLT, Brown GW: Crises and life changes preceding the onset or relapse of acute schizophrenia: Clinical aspects . Br J Psychiatry 1970;116:327-333.Crossref 8. Keith SJ, Mathews SM: Group, family and milieu therapies and psychosocial rehabilitation in the treatment of the schizophrenic disorders , in Grinspoon L (ed): Psychiatry 1982: Annual Review . Washington, DC, American Psychiatric Press, 1982. 9. Grinspoon L, Ewalt JR, Shader RI: Schizophrenia, Pharmacotherapy and Psychotherapy . Baltimore, Williams & Wilkins Co, 1972. 10. May PRA: Treatment of Schizophrenia . New York, Science House, 1968. 11. O'Brien CP, Hamm KB, Ray BA, Pierce JF, Luborsky L, Mintz J: Group vs individual psychotherapy with schizophrenics: A controlled outcome study . Arch Gen Psychiatry 1972;27:474-478.Crossref 12. Hogarty GE, Goldberg SC, Schooler NR, Ulrich RF: Drug and sociotherapy in the aftercare of schizophrenic patients: II. Two-year relapse rates . Arch Gen Psychiatry 1974;31:603-608.Crossref 13. Hogarty GE, Schooler NR, Ulrich RF, Mussare F, Ferro P, Herron E: Fluphenazine and social therapy in the aftercare of schizophrenic patients: Relapse analysis of a two-year controlled trial . Arch Gen Psychiatry 1979;36:1283-1294.Crossref 14. Liberman RP, Wallace CJ, Falloon IRH, Vaughn CE: Interpersonal problem-solving therapy for schizophrenics and their families . Compr Psychiatry 1981;22:627-629.Crossref 15. Laing RD: The Politics of Experience . New York, Pantheon Books Inc, 1967. 16. Jackson DD, Weakland JH: Conjoint family therapy: Some consideration on theory, technique, and results . Psychiatry 1961;24:30-45. 17. Friedman AS, Boszormeny-Nagy I, Jungreis S, Lincoln G, Mitchell H, Sonne J, Speck RL, Spivack G: Psychotherapy for the Whole Family . New York, Springer Publishing Co Inc, 1965. 18. Langsley D, Machotka R, Flomenhaft K: Family crisis therapy: Results and implications . Fam Process 1968;7:145-158.Crossref 19. Goldstein MJ, Rodnick EH, Evans JR, May PR, Steinberg M: Drug and family therapy in the aftercare treatment of acute schizophrenia . Arch Gen Psychiatry 1978;35:1169-1177.Crossref 20. Anderson CM, Hogarty GE, Reiss DJ: Family treatment of adult schizophrenic patients: A psychoeducational approach . Schizophr Bull 1980;6:490-505.Crossref 21. Leff J, Kuipers L, Berkowitz R, Eberlein-Vries R, Sturgeon D: A controlled trial of social intervention in the families of schizophrenic patients . Br J Psychiatry 1982;141:121-134.Crossref 22. Falloon IRH, Liberman RP, Lillie FJ, Vaughn CE: Family therapy for relapsing schizophrenics and their families: A pilot study . Fam Process 1981;20:211-221.Crossref 23. Falloon IRH, Boyd JL, McGill CW, Razani J, Moss HB, Gilderman AM: Family management in the prevention of exacerbations of schizophrenia: A controlled study . N Engl J Med 1982;306:1437-1440.Crossref 24. Wing JK, Cooper JE, Sartorius N: The Measurement and Classification of Psychiatric Symptoms . London, Cambridge University Press, 1974. 25. Vaughn CE, Leff JP: The measurement of expressed emotion in families of psychiatric patients . Br J Soc Clin Psychol 1976;15:157-165.Crossref 26. Falloon IRH, Boyd JL, McGill CW, Strang JS, Moss HB: Family management training in the community care of schizophrenia , in Goldstein MJ (ed): New Developments in Interventions with Families of Schizophrenics . San Francisco, Jossey-Bass, 1981, pp 61-77. 27. Falloon IRH, Boyd JL, McGill CW: Family Care for Schizophrenia: A Problem-Solving Approach to Mental Illness . New York, Guilford Press, 1984. 28. Overall JE, Gorham DR: The brief psychiatric rating scale . Psychol Rep 1962;10:799-812.Crossref 29. Lipman RB, Covi L, Rickels K, Uhlenhuth EH, Lazar BA: Selected measures of change in outpatient drug evaluation , in Psychopharmacology: A Review of Progress , Public Health Service publication 1836, 1968, pp 249-254. 30. Falloon IRH, Marshall GN, Boyd JL, Razani J, Wood-Siverio C: Relapse in schizophrenia: A review of the concept and its definitions . Psychol Med 1983;13:469-477.Crossref 31. Falloon IRH: Family Management of Schizophrenia: A Study of Clinical, Social, Family and Economic Benefits . Baltimore, Johns Hopkins University Press, 1985. 32. Strang JS, Falloon IRH, Moss HB, Razani J, Boyd JL: The effects of family therapy on treatment compliance in schizophrenia . Psychopharmacol Bull 1981;17:87-88. 33. Falloon I, Watt DC, Shepherd M: A comparative controlled trial of pimozide and fluphenazine decanoate in the continuation therapy of schizophrenia . Psychol Med 1978;7:59-70.Crossref 34. Falloon I, Watt DC, Shepherd M: The social outcome of patients in a trial of long-term continuation therapy in schizophrenia: Pimozide vs. fluphenazine . Psychol Med 1978;8:265-274.Crossref

Pfohl, Bruce;Sherman, Barry;Schlechte, Janet;Stone, Rodney

doi: 10.1001/archpsyc.1985.01790320069009pmid: 2994590

Abstract • We studied disturbances in the circadian pattern of plasma corticotropin and cortisol concentrations in 25 depressed patients (eight dexamethasone suppression test [DST] nonsuppressors and 17 suppressors) and 21 normal control subjects. Blood samples were drawn every 20 minutes for 24 hours before the administration of dexamethasone, and for a second 24 hours after the administration of 1 mg of dexamethasone. The corticotropin and cortisol level rhythms were examined using three different statistical methods. Nonsuppressors averaged greater elevations in plasma cortisol and corticotropin levels than did subjects in the other two groups, both before and after administration of the dexamethasone. The cortisol levels of the suppressors were virtually identical to those of the control subjects. However, the suppressors had significant elevations of corticotropin levels compared with normal control subjects, especially on the day before taking dexamethasone. Before taking dexamethasone, the depressed patients reached a daily nadir of cortisol concentration approximately two hours earlier than did the normal control subjects. The DST nonsuppressors also exhibited a blunting in the expected circadian rhythm of the corticotropin level. References 1. Carroll BJ, Mendels J: Neuroendocrine regulation in affective disorders , in Sachar EJ (ed): Hormones, Behavior and Psychopathology . New York, Raven Press, 1976, pp 193-223. 2. Schlesser MA, Winokur G, Sherman BM: Hypothalamic-pituitaryadrenal axis activity in depressive illness . Arch Gen Psychiatry 1980;37:737-743.Crossref 3. Carroll BJ, Feinberg M, Greden JF, Tarika J, Albala A, Haskett R, James N Mc I, Kronfol Z, Lohr N, Steiner M, de Vigne JP, Young E: A specific laboratory test for the diagnosis of melancholia: Standardization, validation, and clinical utility . Arch Gen Psychiatry 1981;38:15-22.Crossref 4. Targum SD: Neuroendocrine challenge studies in clinical psychiatry . Psychiatr Ann 1983;13:385-395.Crossref 5. Fang VS, Tricou BJ, Robertson A, Meltzer HY: Plasma ACTH and cortisol levels in depressed patients: Relation to dexamethasone suppression test . Life Sci 1981;29:931-938.Crossref 6. Reus VI, Joseph MS, Dallman MF: ACTH levels after the dexamethasone suppression test in depression . N Engl J Med 1982;306:283-284. 7. Kalin NH, Weiler SJ, Shelton SE: Plasma ACTH and cortisol concentrations before and after dexamethasone . Psychiatry Res 1982;7:87-92.Crossref 8. Yerevanian BI, Woolf PD: Plasma ACTH levels in primary depression: Relationship to the 24-hour dexamethasone suppression test . Psychiatry Res 1983;9:45-51.Crossref 9. Fullerton DT, Wenzel FJ, Lohrenz FN, Fahs H: Circadian rhythm of adrenal cortical activity in depression . Arch Gen Psychiatry 1968;19:674-680.Crossref 10. Jarrett DB, Coble PA, Kupfer DJ: Reduced cortisol latency in depressive illness . Arch Gen Psychiatry 1983;40:506-511.Crossref 11. American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1983, pp 214-215. 12. SAS Institute: Statistical Analysis System Users Guide. Cary, NC, 1982. 13. Halberg F: Implications of biologic rhythms for clinical practice . Hosp Pract 1977;12:139-149. 14. Edelstein CK, Roy-Bryne P, Fawzy FI, Dornfeld L: Effects of weight loss on dexamethasone suppression test . Am J Psychiatry 1983;140:384-391. 15. Berger M, Pirke KM, Doerr P, Krieg C, von Zerssen D: Influence of weight loss on the dexamethasone suppression test . Arch Gen Psychiatry 1983;40:585-586.Crossref 16. Kline MD, Beeber AR: Weight loss and the dexamethasone suppression test . Arch Gen Psychiatry 1983;40:1034-1035.Crossref 17. Zimmerman M, Pfohl B, Coryell WH: Appetite and weight change and the dexamethasone suppression test . Biological Psychiatry 1984;19:923-928. 18. Coppen A, Harwood J, Wood K: Depression, weight loss and the dexamethasone suppression test . Br J Psychiatry 1984;145:88-90.Crossref 19. Sherman B, Pfohl B, Winokur G: Circadian analysis of plasma cortisol before and after dexamethasone in depressed patients . Arch Gen Psychiatry 1984;41:271-275.Crossref 20. Fehm HL, Voigt KH, Lang RE, Beinert KE, Kummer GW, Pfeiffer EF: Paradoxical ACTH response to glucocorticoids in Cushing's disease . N Engl J Med 1977;297:904-907.Crossref 21. Fehm HL, Voigt KH, Kummer G, Pfeiffer EF: Positive rate-sensitive corticosteroid feedback mechanism of ACTH secretion in Cushing's disease . J Clin Invest 1979;64:102-108.Crossref 22. Carr DB, Wool C, Lydiard B, Fisher J, Gelenberg A, Klerman G: Rate-sensitive inhibition of ACTH release in depression . Clin Res Rep 1984;141:590-592. 23. Dallman MF, Engeland WC, Rose JC, Wilkinson CW, Shinsako J, Siedenburg F: Nycthemeral rhythm in adrenal responsiveness to ACTH . Am J Physiol 1978;235:R210-R218. 24. Engeland WC, Shinsako JS, Winget CM, Vernikos-Danellis J, Dallman MF: Circadian patterns of stress-induced ACTH secretion are modified by corticosterone responses . Endocrinology 1977;100:138-147.Crossref 25. Engeland WC, Byrnes GJ, Gann DS: The pituitary-adrenocortical response to hemorrhage depends on the time of day . Endocrinology 1982;110:1856-1860.Crossref 26. Kaneko M, Kaneko K, Shinsako J, Dallman MF: Adrenal sensivitity to adrenocorticotropin varies diurnally . Endocrinology 1981;109:70-75.Crossref 27. Engeland WC, Byrnes GJ, Presnell K, Gann DS: Adrenocortical sensitivity to adrenocorticotropin (ACTH) in awake dogs changes as a function of the time of observation and after hemorrhage independently of changes in ACTH . Endocrinology 1981;108:2149-2153.Crossref 28. Meier AH: Daily variation in concentration of plasma corticosteroid in hypophysectomized rats . Endocrinology 1976;98:1475-1479.Crossref 29. Ottenweller JE, Meier AH, Ferrell BR, Horseman ND, Proctor A: Extrapituitary regulation of the circadian rhythm of plasma corticosteroid concentration in rats . Endocrinology 1978;103:1875-1879.Crossref 30. Weitzman ED, Zimmerman JC, Czeisler CA, Ronda J: Cortisol secretion is inhibited during sleep in normal man . J Clin Endocrinol Metabol 1983;56:352-358.Crossref

Halbreich, Uriel;Asnis, Gregory M.;Shindledecker, Richard;Zumoff, Barnett;Nathan, R. Swami

doi: 10.1001/archpsyc.1985.01790320076010pmid: 4037990

Abstract • Plasma levels of cortisol were sampled for 24 hours in 32 endogenously depressed (ED) patients and 72 normal controls who also underwent the dexamethasone suppression test. The ED patients had significantly higher mean 24-hour plasma levels of cortisol (X̄ 24h PC). However, X̄ 24h PC values of subjects in both groups were normally distributed, with a marked overlap between the two. Only seven ED patients had X̄ 24h PC values higher than 2 SDs from the normal mean (>10 μg/dL). An abnormal dexamethasone suppression test result was only partially related to basal cortisol levels. The mean plasma level of cortisol between 1 and 4 pm was found to be highly correlated with the X̄ 24h PC value in ED patients, as has been previously reported in normal subjects and patients with various other diseases (in which it also powerfully discriminated between hypersecretors and normosecretors). This finding supports the use of mean cortisol levels between 1 and 4 pm as a reliable and convenient indication of cortisol secretion. References 1. Gibbons JL, McHugh PR: Plasma cortisol in depressive illness . J Psychiatr Res 1962;1:162-171.Crossref 2. Sachar EJ, Hellman L, Roffwarg HP, Halpern FS, Fukushima DK, Gallagher TF: Disrupted 24-hour patterns of cortisol secretion in psychotic depression . Arch Gen Psychiatry 1973;28:19-24.Crossref 3. Ettigi P, Brown GM: Psychoneuroendocrinology of affective disorders: An overview . Am J Psychiatry 1977;134:493-501. 4. Sachar EJ: Evidence for neuroendocrine abnormalities in the major mental illnesses , in Freedman DX (ed): Biology of the Major Psychoses . New York, Raven Press, 1975, pp 347-358. 5. Carroll BJ, Curtis GC, Mendels J: Neuroendocrine regulation in depression: I. Limbic system-adrenocortical dysfunction . Arch Gen Psychiatry 1976;33:1039-1044.Crossref 6. Stokes PE, Pick GR, Stoll PM, Nunn WD: Pituitary-adrenal function in depressed patients: Resistance to dexamethasone suppression . J Psychiatr Res 1975;12:271-281.Crossref 7. Carroll BJ, Curtis GC, Mendels J: Neuroendocrine regulation in depression: II. Discrimination of depressed from nondepressed patients . Arch Gen Psychiatry 1976;33:1051-1058.Crossref 8. Carroll BJ: The hypothalamic-pituitary-adrenal axis in depression , in Davies B, Carroll BJ, Mowbray R (eds): Depressive Illness: Some Research Studies . Springfield, Ill, Charles C Thomas Publisher, 1972, pp 23-208. 9. Schlesser MA, Winokur G, Sherman BM: Hypothalamic-pituitary-adrenal axis activity in depressive illness: Its relationship to classification . Arch Gen Psychiatry 1980;37:737-743.Crossref 10. Carroll BJ, Feinberg M, Greden JF, Tarika J, Albala AA, Haskett RF, James NM, Kronfol Z, Lohr N, Steiner M, de Vigne JP, Young E: A specific laboratory test for the diagnosis of melancholia: Standardization, validation, and clinical utility . Arch Gen Psychiatry 1981;38:15-22.Crossref 11. Sherman B, Pfohl B, Winokur G: Circadian analysis of plasma cortisol levels before and after dexamethasone administration in depressed patients . Arch Gen Psychiatry 1984;41:271-275.Crossref 12. Stokes PE, Stoll PM, Koslow SH, Maas JW, Davis JM, Swann AC, Robins SE: Pretreatment DST and hypothalamic-pituitary-adrenocortical function in depressed patients and comparison groups: A multicenter study . Arch Gen Psychiatry 1984;41:257-266.Crossref 13. Doig RJ, Mummery RV, Wills MR, Elkes A: Plasma cortisol levels in depression . Br J Psychiatry 1966;112:1263-1267.Crossref 14. Butler PWP, Besser GM: Pituitary-adrenal function in severe depressive illness . Lancet 1968;1:1234-1236.Crossref 15. Carroll BJ, Curtis GC, Mendels J: Cerebrospinal fluid and plasma free cortisol concentrations in depression . Psychol Med 1976;6:235-244.Crossref 16. Traskman L, Tybring G, Asberg M, Bertilsson L, Lantto B, Schalling D: Cortisol in the CSF of depressed and suicidal patients . Arch Gen Psychiatry 1980;37:761-767.Crossref 17. Brown WA, Shuey I: Response to dexamethasone and subtype of depression . Arch Gen Psychiatry 1980;37:747-751.Crossref 18. Krieger DT, Allen W, Rizzo F, Kriger HP: Characterization of the normal temporal pattern of plasma corticosteroid levels . J Clin Endocrinol Metabol 1971;32:266-284.Crossref 19. Weitzman ED, Fukushima D, Nogeire C, Roffwarg H, Gallagher TF, Hellman L: Twenty-four hour pattern of the episodic secretion of cortisol in normal subjects . J Clin Endocrinol Metabol 1971;33:14-22.Crossref 20. Halbreich U, Asnis GM, Shindledecker R, Zumoff B, Nathan RS: Cortisol secretion in endogenous depression: II. Time-related functions . Arch Gen Psychiatry 1985;42:909-914.Crossref 21. Spitzer RL, Endicott J, Robbins E: Research Diagnostic Criteria for a Selected Group of Function Disorders , ed 3. New York, Biometrics Research Division, New York State Psychiatric Institute, 1978. 22. Hamilton M: A rating scale for depression . J Neurol Neurosurg Psychiatry 1960;23:56-62.Crossref 23. Asnis GM, Sachar EJ, Halbreich U, Nathan RS, Halpern FS: Cortisol secretion and dexamethasone response in depression . Am J Psychiatry 1981;138:1218-1221. 24. Asnis GM, Halbreich U, Sachar EJ, Nathan RS, Davis M, Novacenco H, Ostrow L, Endicott J, Puig-Antich J: Relationship of dexamethasone (2 mg) and plasma cortisol hypersecretion in depressive illness: Clinical and neuroendocrine parameters . Psychopharmacol Bull 1982;18:122-126. 25. Halbreich U, Asnis GM, Zumoff B, Nathan RS: The effect of age and sex on cortisol secretion in depressives and normals . Psychiatr Res 1984;13:221-229.Crossref 26. Halbreich U, Zumoff B, Kream J, Fukushima DF: The mean 1-4 pm plasma cortisol concentration as a diagnostic test for hypercortisolism . J Clin Endocrinol Metabol 1982;54:1262-1264.Crossref 27. Asnis GM, Halbreich U, Nathan RS, Ostrow L, Halpern FS, Endicott J, Sachar EJ: The dexamethasone suppression test in depressive illness: Clinical correlates . Psychoneuroendocrinology 1982;7:295-301.Crossref 28. Novacenko H, Halpern F, Sachar EJ: Improved protein-binding radioassay for plasma cortisol . Clin Chem 1980;26:312-313. 29. Halberg F: Physiologic considerations underlying rhythmometry with special reference to emotional illness , in de Ajuriaguerra (ed): Cycles Biologique et Psychiatric . Paris, Mason et Cie, 1968, pp 73-126. 30. Halbreich U, Asnis GM, Goldstein S, Gasparini F: The afternoon cortisol test (ACT): Representation of the mean 24 hour plasma levels of cortisol by a single short continuous blood sample . Clin Neuropharmacol 1984;7( (suppl) ):147-148.Crossref 31. Halbreich U, Goldstein S, Asnis GM, Gasparini F: The afternoon cortisol test (ACT). Program and abstracts of the Annual Meeting of the American College of Neuropsychopharmacology, San Juan, Puerto Rico, Dec 12-16, 1983, p 118. 32. Asnis GM, Halbreich U, Quitkin F, Endicott J, Puig-Antich J, Sachar EJ: Mean 1-4 pm plasma cortisol levels may distinguish various depressive subtypes. Program and abstracts of the Annual Meeting of the American College of Neuropsychopharmacology, San Juan, Puerto Rico, Dec 12-16, 1983, p 119. 33. Brown WA, Keitner G, Qualls B, Haier R: The dexamethasone suppression test and pituitary-adrenocortical function . Arch Gen Psychiatry 1985;42:121-123.Crossref