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Prediction of Treatment Response in Mania

Prediction of Treatment Response in Mania Abstract • We evaluated the relation of responsivity to somatic treatment and heterogeneity in a sample of 111 manics (diagnosed by Feighner criteria) by assessing demographic, clinical, and family illness variables—historical variables potentially related to abnormal brain function and cortical function as measured by neuropsychological and EEG techniques. Except for a positive, perhaps unimportant, relationship between an abnormal EEG and improvement, we could find little evidence for biological differences between responders and nonresponders to treatment. However, 30% of the nonresponders and only 4% of the responders prematurely terminated treatment, suggesting a strong nonbiological mechanism underlying treatment failure. We conclude that there are as yet no adequate predictors of short-term treatment response in mania and that evidence for heterogeneity in mania must be sought elsewhere. References 1. Taylor MA, Gaztanaga P, Abrams R: Manic-depressive illness and acute schizophrenia: A clinical family history and treatment response study . Am J Psychiatry 1974;131:678-682. 2. Abrams R, Taylor MA, Gaztanaga P: Manic-depressive illness and paranoid schizophrenia: A phenomenologic, family history, and treatmentresponse study . Arch Gen Psychiatry 1974;31:640-642.Crossref 3. Abrams R, Taylor MA: Catatonia: A prospective clinical study . Arch Gen Psychiatry 1976;33:579-581.Crossref 4. Taylor MA, Abrams R: The prevalence of schizophrenia: A reassessment using modern diagnostic criteria . Am J Psychiatry 1978;135:945-948. 5. Flemming K: The Expectation of Mental Infirmity in a Sample of the Danish Population , No. 7. Occasional Papers of Eugenics, London, Cassell & Co Ltd, 1951. 6. Helgason T: Epidemiology of mental disorders in Iceland: A psychiatric and demographic investigation of 5395 Icelanders . Acta Psychiatr Scand 1964;40( (suppl 173) ). 7. Strömgren E: Contributions to Psychiatric Epidemiology and Genetics , No. 16. Acta Jutlandica Medical Series, Copenhagen, Ejnar Munksgaard, vol 11, 1968. 8. Nielsen J, Nielsen JA: A census study of mental illness in Samso . Psychol Med 1977;7:491-503.Crossref 9. Weissman MM, Myers JK, Harding PA: Psychiatric disorders in a US urban community 1975-1976 . Am J Psychiatry 1978;135:459-462. 10. Taylor MA, Abrams R, Hayman MA: The classification of affective disorders—A reassessment of the bipolar-unipolar dichotomy: A clinical, laboratory and family study . J Affect Disord 1980;2:95-109.Crossref 11. Smeraldi E, Negri F, Melica AM: A genetic study of affective disorders . Acta Psychiatr Scand 1977;56:382-398.Crossref 12. Tsuang MT: Familial subtyping of schizophrenia and affective disorder , in Spitzer RL, Klein DF (eds): Critical Issues in Psychiatric Diagnosis . New York, Raven Press, 1978, pp 203-211. 13. Winokur G, Morrison J, Clancy J, et al: The Iowa 500: II. A blind family history comparison of mania, depression, and schizophrenia . Arch Gen Psychiatry 1972;27:462-464.Crossref 14. Karlsson JL: An Icelandic family study of schizophrenia . Br J Psychiatry 1973;123:549-554.Crossref 15. Tsuang MT: Heterogenity in schizophrenia . Biol Psychiatry 1975; 10:465-474. 16. Brockington IF, Leff JP: Schizo-affective psychosis: Definitions and incidence . Psychol Med 1979;9:91-99.Crossref 17. Abrams R, Taylor MA: The importance of schizophrenic symptoms in the diagnosis of mania . Am J. Psychiatry . to be published. 18. Schlesser MA, Winokur G, Sherman BM: Genetic subtypes of unipolar primary depressive illness distinguished by hypothalamic-pituitary-adrenal axis activity . Lancet 1979;2:739-741.Crossref 19. Dalen P: Family history, the electroencephalogram and perinatal factors in manic conditions . Acta Psychiatr Scand 1965;41:527-563.Crossref 20. Schou M: Lithium in psychiatric therapy . Psychopharmacologia 1959;1:65-78.Crossref 21. Taylor MA, Abrams R: Acute mania: Clinical and genetic study of responders and nonresponders to treatments . Arch Gen Psychiatry 1975;32:863-865.Crossref 22. Abrams R, Taylor MA: Catatonia: Prediction of response to somatic treatments . Am J Psychiatry 1977;134:78-80. 23. Krishna NR, Taylor MA, Abrams R: Response to lithium carbonate . Biol Psychiatry 1978;13:601-606. 24. Feighner JP, Robins E, Guze SB, et al: Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 1972;26:57-63.Crossref 25. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders , ed 2. New York, Biometrics Research Division, New York State Psychiatric Institute, 1975. 26. American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980, pp 208-210. 27. Gibbs FA, Gibbs EL: Medical Electroencephalography . Reading, Mass, Addison-Wesley Publishing Co Inc, 1967. 28. Abrams R, Taylor MA: Differential EEG patterns in affective disorder and schizophrenia . Arch Gen Psychiatry 1979;36:1355-1358.Crossref 29. Wheeler L, Reitan RM: Presence and laterality of brain damage predicted from responses to a short aphasia screening test . Percept Mot Skills 1962;15:783-799.Crossref 30. Heimburger RF, Reitan RM: Early administered written test for lateralizing brain lesions . J Neurosurg 1961;18:301-302.Crossref 31. Reitan RM: Psychological deficits resulting from cerebral lesions in man , in Warren J, Albert K (eds): The Frontal Granular Cortex and Behavior . New York, McGraw-Hill Book Co, 1964, pp 295-312. 32. Luria AR: The Working Brain: An Introduction to Neuropsychology , New York, Basic Books Inc Publishers, 1973. 33. Taylor MA, Greenspan B, Abrams R: Lateralized neuropsychological dysfunction in affective disorder and schizophrenia . Am J Psychiatry 1979;136:1031-1034. 34. Murphy DL, Beigel A: Depression, elation, and lithium carbonate responses in manic patient subgroups . Arch Gen Psychiatry 1974;31:643-648.Crossref 35. Dunner DL, Fieve RR: Clinical factors in lithium carbonate prophylaxis failure . Arch Gen Psychiatry 1974;30:229-233.Crossref 36. Dunner DL, Stallone F, Fieve RR: Lithium carbonate and affective disorders: V. A double-blind study of prophylaxis of depression in bipolar illness . Arch Gen Psychiatry 1976;33:117-120.Crossref 37. Stokes PE, Stoll PM, Shamoian CA, et al: Efficacy of lithium as acute treatment of manic-depressive illness . Lancet 1971;1:1319-1325.Crossref 38. Cade JFJ: Lithium salts in the treatment of psychotic excitement . Med J Aust 1949;2:349-352. 39. Taylor MA, Abrams R: The phenomenology of mania: A new look at some old patients . Arch Gen Psychiatry 1973;29:520-522.Crossref 40. Biederman J, Lerner Y, Belmaker RH: Combination of lithium carbonate and haloperidol in schizo-affective disorder . Arch Gen Psychiatry 1979;36:327-333.Crossref 41. Folstein M, Folstein S, McHugh PR: Clinical predictors of improvement after electroconvulsive therapy of patients with schizophrenia, neurotic reactions and affective disorders . Biol Psychiatry 1973;7:147-152. 42. Prien RF, Caffey EM Jr, Klett CJ: Factors associated with treatment success in lithium carbonate prophylaxis: Report of the Veterans Administration and National Institute of Mental Health Collaborative Study Group . Arch Gen Psychiatry 1974;31:189-192.Crossref 43. Davis JM: Overview: Maintenance therapy in psychiatry: II. Affective disorders . Am J Psychiatry 1976;133:1-13. 44. Mendlewicz J, Fieve RR, Stallone F: Relationship between the effectiveness of lithium therapy and family illness . Am J Psychiatry 1973;130:1011-1013. 45. Mendlewicz J: Prediction of treatment outcome: Family and twin studies in lithium prophylaxis and the question of lithium red blood cell/plasma ratios , in Cooper TB, Gershon S, Kline NS, et al (eds): Lithium Controversies and Unresolved Issues . Amsterdam, Excerpta Medica, to be published. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Prediction of Treatment Response in Mania

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Publisher
American Medical Association
Copyright
Copyright © 1981 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1981.01780320080009
Publisher site
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Abstract

Abstract • We evaluated the relation of responsivity to somatic treatment and heterogeneity in a sample of 111 manics (diagnosed by Feighner criteria) by assessing demographic, clinical, and family illness variables—historical variables potentially related to abnormal brain function and cortical function as measured by neuropsychological and EEG techniques. Except for a positive, perhaps unimportant, relationship between an abnormal EEG and improvement, we could find little evidence for biological differences between responders and nonresponders to treatment. However, 30% of the nonresponders and only 4% of the responders prematurely terminated treatment, suggesting a strong nonbiological mechanism underlying treatment failure. We conclude that there are as yet no adequate predictors of short-term treatment response in mania and that evidence for heterogeneity in mania must be sought elsewhere. References 1. Taylor MA, Gaztanaga P, Abrams R: Manic-depressive illness and acute schizophrenia: A clinical family history and treatment response study . Am J Psychiatry 1974;131:678-682. 2. Abrams R, Taylor MA, Gaztanaga P: Manic-depressive illness and paranoid schizophrenia: A phenomenologic, family history, and treatmentresponse study . Arch Gen Psychiatry 1974;31:640-642.Crossref 3. Abrams R, Taylor MA: Catatonia: A prospective clinical study . Arch Gen Psychiatry 1976;33:579-581.Crossref 4. Taylor MA, Abrams R: The prevalence of schizophrenia: A reassessment using modern diagnostic criteria . Am J Psychiatry 1978;135:945-948. 5. Flemming K: The Expectation of Mental Infirmity in a Sample of the Danish Population , No. 7. Occasional Papers of Eugenics, London, Cassell & Co Ltd, 1951. 6. Helgason T: Epidemiology of mental disorders in Iceland: A psychiatric and demographic investigation of 5395 Icelanders . Acta Psychiatr Scand 1964;40( (suppl 173) ). 7. Strömgren E: Contributions to Psychiatric Epidemiology and Genetics , No. 16. Acta Jutlandica Medical Series, Copenhagen, Ejnar Munksgaard, vol 11, 1968. 8. Nielsen J, Nielsen JA: A census study of mental illness in Samso . Psychol Med 1977;7:491-503.Crossref 9. Weissman MM, Myers JK, Harding PA: Psychiatric disorders in a US urban community 1975-1976 . Am J Psychiatry 1978;135:459-462. 10. Taylor MA, Abrams R, Hayman MA: The classification of affective disorders—A reassessment of the bipolar-unipolar dichotomy: A clinical, laboratory and family study . J Affect Disord 1980;2:95-109.Crossref 11. Smeraldi E, Negri F, Melica AM: A genetic study of affective disorders . Acta Psychiatr Scand 1977;56:382-398.Crossref 12. Tsuang MT: Familial subtyping of schizophrenia and affective disorder , in Spitzer RL, Klein DF (eds): Critical Issues in Psychiatric Diagnosis . New York, Raven Press, 1978, pp 203-211. 13. Winokur G, Morrison J, Clancy J, et al: The Iowa 500: II. A blind family history comparison of mania, depression, and schizophrenia . Arch Gen Psychiatry 1972;27:462-464.Crossref 14. Karlsson JL: An Icelandic family study of schizophrenia . Br J Psychiatry 1973;123:549-554.Crossref 15. Tsuang MT: Heterogenity in schizophrenia . Biol Psychiatry 1975; 10:465-474. 16. Brockington IF, Leff JP: Schizo-affective psychosis: Definitions and incidence . Psychol Med 1979;9:91-99.Crossref 17. Abrams R, Taylor MA: The importance of schizophrenic symptoms in the diagnosis of mania . Am J. Psychiatry . to be published. 18. Schlesser MA, Winokur G, Sherman BM: Genetic subtypes of unipolar primary depressive illness distinguished by hypothalamic-pituitary-adrenal axis activity . Lancet 1979;2:739-741.Crossref 19. Dalen P: Family history, the electroencephalogram and perinatal factors in manic conditions . Acta Psychiatr Scand 1965;41:527-563.Crossref 20. Schou M: Lithium in psychiatric therapy . Psychopharmacologia 1959;1:65-78.Crossref 21. Taylor MA, Abrams R: Acute mania: Clinical and genetic study of responders and nonresponders to treatments . Arch Gen Psychiatry 1975;32:863-865.Crossref 22. Abrams R, Taylor MA: Catatonia: Prediction of response to somatic treatments . Am J Psychiatry 1977;134:78-80. 23. Krishna NR, Taylor MA, Abrams R: Response to lithium carbonate . Biol Psychiatry 1978;13:601-606. 24. Feighner JP, Robins E, Guze SB, et al: Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 1972;26:57-63.Crossref 25. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders , ed 2. New York, Biometrics Research Division, New York State Psychiatric Institute, 1975. 26. American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980, pp 208-210. 27. Gibbs FA, Gibbs EL: Medical Electroencephalography . Reading, Mass, Addison-Wesley Publishing Co Inc, 1967. 28. Abrams R, Taylor MA: Differential EEG patterns in affective disorder and schizophrenia . Arch Gen Psychiatry 1979;36:1355-1358.Crossref 29. Wheeler L, Reitan RM: Presence and laterality of brain damage predicted from responses to a short aphasia screening test . Percept Mot Skills 1962;15:783-799.Crossref 30. Heimburger RF, Reitan RM: Early administered written test for lateralizing brain lesions . J Neurosurg 1961;18:301-302.Crossref 31. Reitan RM: Psychological deficits resulting from cerebral lesions in man , in Warren J, Albert K (eds): The Frontal Granular Cortex and Behavior . New York, McGraw-Hill Book Co, 1964, pp 295-312. 32. Luria AR: The Working Brain: An Introduction to Neuropsychology , New York, Basic Books Inc Publishers, 1973. 33. Taylor MA, Greenspan B, Abrams R: Lateralized neuropsychological dysfunction in affective disorder and schizophrenia . Am J Psychiatry 1979;136:1031-1034. 34. Murphy DL, Beigel A: Depression, elation, and lithium carbonate responses in manic patient subgroups . Arch Gen Psychiatry 1974;31:643-648.Crossref 35. Dunner DL, Fieve RR: Clinical factors in lithium carbonate prophylaxis failure . Arch Gen Psychiatry 1974;30:229-233.Crossref 36. Dunner DL, Stallone F, Fieve RR: Lithium carbonate and affective disorders: V. A double-blind study of prophylaxis of depression in bipolar illness . Arch Gen Psychiatry 1976;33:117-120.Crossref 37. Stokes PE, Stoll PM, Shamoian CA, et al: Efficacy of lithium as acute treatment of manic-depressive illness . Lancet 1971;1:1319-1325.Crossref 38. Cade JFJ: Lithium salts in the treatment of psychotic excitement . Med J Aust 1949;2:349-352. 39. Taylor MA, Abrams R: The phenomenology of mania: A new look at some old patients . Arch Gen Psychiatry 1973;29:520-522.Crossref 40. Biederman J, Lerner Y, Belmaker RH: Combination of lithium carbonate and haloperidol in schizo-affective disorder . Arch Gen Psychiatry 1979;36:327-333.Crossref 41. Folstein M, Folstein S, McHugh PR: Clinical predictors of improvement after electroconvulsive therapy of patients with schizophrenia, neurotic reactions and affective disorders . Biol Psychiatry 1973;7:147-152. 42. Prien RF, Caffey EM Jr, Klett CJ: Factors associated with treatment success in lithium carbonate prophylaxis: Report of the Veterans Administration and National Institute of Mental Health Collaborative Study Group . Arch Gen Psychiatry 1974;31:189-192.Crossref 43. Davis JM: Overview: Maintenance therapy in psychiatry: II. Affective disorders . Am J Psychiatry 1976;133:1-13. 44. Mendlewicz J, Fieve RR, Stallone F: Relationship between the effectiveness of lithium therapy and family illness . Am J Psychiatry 1973;130:1011-1013. 45. Mendlewicz J: Prediction of treatment outcome: Family and twin studies in lithium prophylaxis and the question of lithium red blood cell/plasma ratios , in Cooper TB, Gershon S, Kline NS, et al (eds): Lithium Controversies and Unresolved Issues . Amsterdam, Excerpta Medica, to be published.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Jul 1, 1981

References