Archives of General Psychiatry

doi: 10.1001/archpsyc.1984.01790040012001pmid: 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.1984.01790120012002pmid: 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.

Weissman, Myrna M.;Gershon, Elliot S.;Kidd, Kenneth K.;Prusoff, Brigitte A.;Leckman, James F.;Dibble, Eleanor;Hamovit, Joel;Thompson, W. Douglas;Pauls, David L.;Guroff, Juliet J.

doi: 10.1001/archpsyc.1984.01790120015003

Suarez, Brian K.;Reich, Theodore

doi: 10.1001/archpsyc.1984.01790120024004pmid: 6691781

Abstract • Fifteen unrelated multiplex families, each containing two or more offspring with a diagnosis of major affective disorder, were HLA typed to provide additional data bearing on the proposed linkage of affective disorder susceptibility genes with the major histocompatibility complex on chromosome 6. Altogether 19 parents, 38 affected children, and 13 unaffected children were typed. The distribution of shared HLA haplotypes among pairs of affected siblings, pairs of affectedunaffected siblings, and various diagnostic subsets of these families fails to lend any support for the HLA linkage hypothesis. References 1. Smeraldi E, Negri F, Melica AM, Scorza-Smeraldi R: HLA system and affective disorders: A sibship genetic study . Tissue Antigens 1978;12:270-274.Crossref 2. Smeraldi E, Bellodi L: Possible linkage between primary affective disorder susceptibility locus and HLA haplotypes . Am J Psychiatry 1981;138:1232-1234. 3. Weitkamp LR, Stancer HC, Persad E, Flood C, Guttormsen S: Depressive disorders and HLA: A gene on chromosome 6 that can affect behavior . N Engl J Med 1981;305:1301-1306.Crossref 4. Turner WJ, King S: Two genetically distinct forms of bipolar affective disorder? Biol Psychiatry 1981;16:417-439. 5. Turner WJ, King S: BPD2 an autosomal dominant form of bipolar affective disorder . Biol Psychiatry 1983;18:63-88. 6. Suarez BK, Rice J, Reich T: Methodology of high-risk research: Genetic approaches , in Tarter RE (ed): The Child at Psychiatric Risk . New York, Oxford University Press, 1983, pp 15-53. 7. Spitzer RL, Endicott J: Schedule for Affective Disorders and Schizophrenia (SADS) , ed 3. New York, New York State Psychiatric Institute, 1979. 8. Rodey GE, White NW, Frazer TE, Duquesnoy RJ, Santiago JV: HLA-DR specificities among black Americans with juvenile-onset diabetes . N Engl J Med 1979;301:810-812.Crossref 9. Morton NE: Sequential tests for the detection of linkage . Am J Hum Genet 1955;7:277-318. 10. Suarez BK, Van Eerdewegh P: Type I (insulin-dependent) diabetes mellitus: Is there strong evidence for a non-HLA linked gene? Diabetologia 1981;20:524-529.Crossref 11. Reich T, Cloninger CR, Suarez BK, Rice J: Genetics of the affective psychoses , in Wing JK, Wing L (eds): Handbook of Psychiatry . London, Cambridge University Press, 1982, vol 3: Psychoses of Uncertain Aetiology, pp 147-159. 12. Fishman P, Suarez BK, Hodge SE, Reich T: A robust method for the detection of linkage in familial diseases . Am J Hum Genet 1978;30:308-321. 13. Suarez BK: The affected sib pair IBD distribution for HLA linked disease susceptibility genes . Tissue Antigens 1978;12:87-93.Crossref 14. Suarez BK, Hodge SE, Reich T: Is juvenile diabetes determined by a single gene closely linked to HLA? Diabetes 1979;28:527-532.Crossref 15. Suarez BK, Hodge SE: A simple method for detecting linkage for rare recessive diseases: An application to juvenile diabetes . Clin Genet 1979;15:126-136.Crossref 16. Green JR, Woodrow JC: Sibling method for detecting HLA-linked genes in disease . Tissue Antigens 1977;9:31-35.Crossref 17. Suarez BK, Rice JP: The distribution of HLA haplotypes in families with one untyped parent . Tissue Antigens 1982;20:193-197.Crossref 18. Baur MP, Danilovs JA: Reference tables of two- and three-locus haplotype frequencies for HLA-A, B, C, DR, BF, and GLO , in Terasaki PI (ed): Histocompatibility Testing 1980 . Los Angeles, UCLA Tissue Typing Laboratory, 1980, pp 994-1126. 19. Vogel F, Motulsky AG: Human Genetics: Problems and Approaches . New York, Springer Publishing Co Inc, 1979. 20. Mourant AE, Kopec AC, Domaniewska-Sobczak K: Blood Groups and Diseases . New York, Oxford University Press, 1978. 21. James N, Carroll BJ, Haines RF, Smouse PE: Affective disorders: ABO and HLA , in Mendelwicz J, Shopsin B (eds): Genetic Aspects of Affective Illness . New York, Spectrum Publications, 1979, pp 35-44. 22. Suarez BK, Croughan J: Is the major histocompatibility complex linked to genes that increase susceptibility to affective disorder? A critical appraisal . Psychiatry Res 1982;7:19-27.Crossref 23. Mendlewicz J, Verbanck P, Linkowski P, Govaerts A: HLA antigens in affective disorders and schizophrenia . J Affective Disord 1981;3:17-24.Crossref 24. Wentzel J, Roberts DF, Whalley LJ: HLA in manic-depressive psychosis . Psychol Med 1982;12:275-278.Crossref 25. Suarez BK, Rice JP, Reich T: The generalized sib pair IBD distribution: Its use in the detection of linkage . Ann Hum Genet 1978;42:87-94.Crossref 26. Weitkamp LR: HLA and disease: Predictions for HLA haplotype sharing in families . Am J Hum Genet 1981;33:776-784. 27. Suarez BK, Crouse J, Van Eerdewegh P: HLA sharing in multiplex sibships . Ann Hum Genet 1983;47:153-159.Crossref 28. Suarez BK, Rice JP, Crouse J, Reich T: HLA and disease: Haplotype sharing in multiplex families . Clin Genet 1983;23:267-275.Crossref 29. Reich T, Clayton P, Winokur G: Family history studies: V. The genetics of mania . Am J Psychiatry 1969;125:1358-1369. 30. Mendlewicz J, Fleiss JL, Fieve RR: Evidence for X-linkage in the transmission of manic-depressive illness . JAMA 1972;222:1624-1627.Crossref 31. Mendlewicz J, Fleiss JL: Linkage studies with X-chromosome markers in bipolar (manic-depressive) and unipolar (depressive) illness . Biol Psychiatry 1974;9:261-294. 32. Mendlewicz J, Linkowski P, Guroff JJ, Van Praag HM: Color blindness linkage to bipolar manic-depressive illness: New evidence . Arch Gen Psychiatry 1979;36:1442-1447.Crossref 33. Baron M: Linkage between an X-chromosome marker (deutan color blindness) and bipolar affective illness . Arch Gen Psychiatry 1977;34:721-725.Crossref 34. Mendlewicz J, Fleiss JL, Fieve RR: Linkage studies in affective disorders: The Xg blood group and manic-depressive illness , in Fieve RR, Rosenthal D, Brill H (eds): Genetic Research in Psychiatry . Baltimore, Johns Hopkins University Press, 1975, pp 219-232. 35. Mendlewicz J, Linkowski P, Wilmotte J: Linkage between glucose-6phosphate dehydrogenase activity and manic-depressive illness . Br J Psychiatry 1980;137:337-342.Crossref 36. Johnson GPS, Leeman MM: Analysis of familial factors in bipolar affective illness . Arch Gen Psychiatry 1977;24:1074-1083.Crossref 37. Gershon ES, Targum SD, Matthysse S, Bunney W: Color blindness not closely linked to bipolar illness . Arch Gen Psychiatry 1979;36:1423-1430.Crossref 38. Leckman JF, Gershon ES, McGinniss MH, Targum SD, Dibble E: New data do not suggest linkage between the Xg blood group and bipolar illness . Arch Gen Psychiatry 1979;36:1435-1441.Crossref 39. Gershon ES, Bunney WE Jr: The question of X-linkage in bipolar manic-depressive illness . J Psychiatr Res 1976;13:99-117.Crossref 40. Gershon ES, Matthysse S: X-linkage: Ascertainment through doubly ill probands . J Psychiatr Res 1977;13:161-168.Crossref 41. Van Eerdewegh MM, Gershon ES, Van Eerdewegh PM: X-chromosome threshold models of bipolar manic-depressive illness . J Psychiatr Res 1980;15:215-238.Crossref 42. Targum SD, Gershon ES, Van Eerdewegh MM, Rogentine N: Human leukocyte antigen system not closely linked to or associated with bipolar manic-depressive illness . Biol Psychiatr 1979;14:615-636. 43. Johnson GFS, Hunt GE, Robertson S, Doran TJ: A linkage study of manic-depressive disorder with HLA antigens, blood groups, serum proteins and red cell enzymes . J Affective Disord 1981;3:43-58.Crossref 44. Goldin LR, Clerget-Darpoux F, Geshon ES: Relationship of HLA to major affective disorder not supported . Psychiatry Res 1982;7:29-45.Crossref 45. Risch N, Baron M: X-linkage and genetic heterogeneity in bipolarrelated major affective illness: Reanalysis of linkage data . Ann Hum Genet 1982;46:153-166.Crossref 46. Kruger SD, Turner WJ, Kidd KK: The effects of requisite assumptions on linkage analyses of manic-depressive illness with HLA . Biol Psychiatry 1982;17:1081-1099. 47. Weitkamp LR, Pardue LH, Huntzinger RS: Genetic marker studies in a family with unipolar depression . Arch Gen Psychiatry 1980;37:1187-1192.Crossref

Silverman, Joseph Shepsel;Silverman, Julia Ann;Eardley, David A.

doi: 10.1001/archpsyc.1984.01790120030005pmid: 6691782

Abstract • The Dysfunctional Attitude Scale (DAS) is an inventory of beliefs about life. These beliefs attribute happiness to external events and reflect absolute expectations for one's own behavior and that of others. Such beliefs, according to some cognitive theorists, predispose persons to depression. To test this theory, we administered the DAS to private psychiatric outpatients. Thirty-five patients were tested when they were depressed and again when they were asymptomatic. Dysfunctional thinking was found to be more prominent during depression; this finding implies that the dysfunctional thinking of depressed persons is a symptom of their illness rather than a character trait. Next, we compared DAS scores for recovered depressives with scores for other stabilized psychiatric patients and for normal persons. Bipolar patients demonstrated less maladaptive thinking than all other groups. Only the bipolars showed significantly less maladaptive thinking than the major depressives. References 1. Kovacs M, Beck AT: Maladaptive cognitive structures in depression . Am J Psychiatry 1978;135:525-533. 2. Schreiber MT: Depressive cognitions . Am J Psychiatry 1978;135:1570. 3. Kovacs M, Beck AT: Drs Kovacs and Beck reply . Am J Psychiatry 1978;135:1570-1571. 4. Weissman AN: The Dysfunctional Attitude Scale: A Validation Study, thesis. University of Pennsylvania Graduate School of Arts and Science, Philadelphia, 1979. 5. Feinberg M, Carroll BJ, Steiner M, Commorato AJ: Misdiagnoses of endogenous depression with Research Diagnostic Criteria . Lancet 1979;1:267.Crossref 6. Myers JT: Fundamentals of Experimental Design . Boston, Allyn & Bacon Inc, 1966, pp 51-80. 7. Games PA, Grey GS, Herron WL, Pitz GF: ANOVR, FORTRAN IV, revised program . University Park, Pa, The Pennsylvania State University, February 1974. 8. Yancey JM, Howell JF, Games PA, Serapiglia T: FOLUP, FORTRAN IV, revised program . University Park, Pa, The Pennsylvania State University, September 1974. 9. Games PA, Klare G: Elementary Statistics: Data Analysis for the Behavioral Sciences . New York, McGraw-Hill Book Co, 1967, p 535. 10. Mac Vane JR, Lange JD, Brown WA, Zayat M: Psychological functioning of bipolar manic-depressives in remission . Arch Gen Psychiatry 1978;35:1351-1354.Crossref 11. Hirschfeld RMA, Klerman G: Personality attributes and affective disorders . Am J Psychiatry 1979;136:67-70. 12. Kovacs M, Rush AJ, Beck AT, Hollon SD: Depressed outpatients treated with cognitive therapy or pharmacotherapy: A one-year follow-up . Arch Gen Psychiatry 1981;38:33-39.Crossref

Murphy, George E.;Simons, Anne D.;Wetzel, Richard D.;Lustman, Patrick J

doi: 10.1001/archpsyc.1984.01790120037006pmid: 6691783

Abstract • Eighty-seven moderately to severely depressed psychiatric outpatients were randomly assigned to 12 weeks of cognitive therapy (CT) (n = 24), pharmacotherapy (n = 24), CT plus pharmacotherapy (n = 22), or CT plus active placebo (n =17). Seventy patients completed the treatment protocol. Seventeen dropped out before the end of the treatment period. Patients who completed treatment showed significant improvement in mean scores on two common measures of severity of depression (the Beck Depression Inventory and the Hamilton Rating Scale for Depression) between evaluation and termination. Improvement did not differ as a function of the different treatment modalities. Inclusion of dropout patients' end-point scores did not alter these results. Treatment gains in all groups were maintained at one-month follow-up assessment. A portion of this study replicated an earlier study. While the results were not identical, they indicated that either CT or antidepressant drug treatment can be effective in treating outpatients with primary, nonbipolar depression of moderate or greater severity. Combining treatments did not lead either to additive effects or negative interactions. References 1. American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 2. Covi L, Lipman RS, Derogatis LR, Smith LE, Pattison JH: Drugs and group psychotherapy in neurotic depression . Am J Psychiatry 1974;131:191-198. 3. Friedman AS: Interaction of drug therapy with martial therapy in depressive patients . Arch Gen Psychiatry 1975;32:619-637.Crossref 4. Klerman GL, DiMascio A, Weissman M, Prusoff B, Paykel ES: Treatment of depression by drugs and psychotherapy . Am J Psychiatry 1974;131:186-191. 5. Rush AJ, Beck AT, Kovacs M, Hollon S: Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients . Cog Ther Res 1977;1:17-37.Crossref 6. Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R: Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 1972;26:57-63.Crossref 7. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression . Arch Gen Psychiatry 1961;4:561-571.Crossref 8. Hamilton M: A rating scale for depression . J Neurol Neurosurg Psychiatry 1960;23:56-62.Crossref 9. Blackburn IM, Bishop S, Glen AIM, Whalley LJ, Christie JE: The efficacy of cognitive therapy in depression: A treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination . Br J Psychiatry 1981;139:181-189.Crossref 10. Blackburn IM, Bishop S: Is there an alternative to drugs in the treatment of depressed ambulatory patients? Behav Psychother 1981;9:96-104.Crossref 11. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;35:773-782.Crossref 12. Robins LN, Helzer JE, Croughan J, Ratcliff KS: National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity . Arch Gen Psychiatry 1981;38:381-389.Crossref 13. Raskin A, Schulterbrandt JG, Reatig N, McKeon JJ: Differential response to chlorpromazine, imipramine, and placebo . Arch Gen Psychiatry 1970;23:164-173.Crossref 14. Robins LN, Helzer JE, Ratcliff KS, Seyfried W: Validity of the Diagnostic Interview Schedule, Version II: DSM-III diagnoses . Psychol Med 1982;12:855-870.Crossref 15. Singerman B, Stoltzman RK, Robins LN, Helzer JE, Croughan JL: Diagnostic concordance between DSM-III, Feighner, and RDC . J Clin Psychiatry 1981;42:422-426. 16. Beck AT, Rush AJ, Shaw BF, Emery G: Cognitive Therapy of Depression . New York, Guilford Press, 1979. 17. Biggs JT, Holland WH, Chang S, Hipps PP, Sherman WR: Electron beam ionization mass fragmentographic analysis of tricyclic antidepressants in human plasma . J Pharm Sci 1976;65:261-268.Crossref 18. Forrest AD, Affleck JW, Gibb IA, Priest RG: Comparative trial of nortriptyline and amitriptyline . Scott Med J 1964;9:341-344. 19. Leahy MR, Martin ICA: Double-blind comparison of nortriptyline and amitriptyline in depressive illness . Br J Psychiatry 1967;113:1433-1434.Crossref 20. Mendels J: Comparative trial of nortriptyline and amitriptyline in 100 depressed patients . Am J Psychiatry 1958;124:59-62. 21. Rose JT, Leahy MR, Martin ICA, Westhead TT: A comparison of nortriptyline and amitriptyline in depression . Br J Psychiatry 1965;111:1101-1103.Crossref 22. Ziegler VE, Clayton PJ, Biggs JT: A comparison study of amitriptyline and nortriptyline with plasma levels . Arch Gen Psychiatry 1977;34:607-612.Crossref 23. Kessell A, Pearce TAA, Holt NF: A controlled study of nortriptyline and imipramine . Am J Psychiatry 1970;126:938-945. 24. Åsberg M, Crönholm B, Sjögvist F, Tuck D: Relationship between plasma level and therapeutic effect of nortriptyline . Br Med J 1971;3:331-334.Crossref 25. Kragh-Sørensen P, Åsberg M, Eggert-Hansen C: Plasma-nortriptyline levels in endogenous depression . Lancet 1973;1:113-115.Crossref 26. Ziegler VE, Clayton PJ, Taylor JR, Co BT, Biggs JT: Nortriptyline plasma levels and therapeutic response . Clin Pharmacol Ther 1976;20:458-463. 27. Beck AT, Schuyler D, Herman I: Development of suicidal intent scales , in Beck AT, Resnick HLP, Lettieri D (eds): The Prediction of Suicide . Bowie, Md, The Charles Press Publishers Inc, 1974, pp 45-56. 28. Beck AT, Weissman A, Lester D, Trexler L: The measurement of pessimism: The hopelessness scale . J Consult Clin Psychol 1974;42:861-865.Crossref 29. Aitken RC: Measurement of feeling using visual analogue scales . Proc Roy Soc Med 1969;62:989-993. 30. Zung WWK: The measurement of affect: Depression and anxiety . Mod Probl Pharmacopsychiatry 1974;7:170-188. 31. Hollon SD, Kendall PC: Cognitive self statements in depression: Development of an automatic thoughts questionnaire . Cog Ther Res 1980;4:383-395.Crossref 32. Weissman A, Beck AT: The dysfunctional attitudes scale: A validation study. Presented at the meeting of the Association for Advancement of Behavior Therapy, Chicago, 1978. 33. Watkins JJ, Rush AJ: Cognitive response test . Cog Ther Res , in press. 34. Rosenbaum M: A schedule for assessing self control behaviors: Preliminary findings . Behav Ther 1980;11:109-121.Crossref 35. Weissman MM, Bothwell S: Assessment of social adjustment by patient self-report . Arch Gen Psychiatry 1976;33:1111-1115.Crossref 36. Simons AD, Garfield SL, Murphy GE: The process of change in cognitive therapy and pharmacotherapy of depression: Changes in mood and cognition . Arch Gen Psychiatry 1984;41:45-51.Crossref 37. Schwab J, Bialow M, Clemmons R, Martin P, Holzer C: The Beck Depression Inventory with medical inpatients . Acta Psychiatr Scand 1967;43:255-266.Crossref 38. Bailey J, Coppen A: A comparison between the Hamilton Rating Scale and the Beck Inventory in the measurement of depression . Br J Psychiatry 1976;128:486-489.Crossref 39. Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG: Quantitative rating of depressive states . Acta Psychiatr Scand 1975;51:161-170.Crossref 40. Ziegler VE, Co BT, Taylor JR, Clayton PJ, Biggs JT: Amitriptyline plasma levels and therapeutic response . Clin Pharmacol Ther 1976;19:795-801. 41. Knesevich JW, Biggs JT, Clayton PJ, Ziegler VE: Validity of the Hamilton Rating Scale for depression . Br J Psychiatry 1977;131:49-52.Crossref 42. Hamilton M: The effect of treatment on the melancholias (depressions) . Br J Psychiatry 1982;140:223-230.Crossref 43. Wilson PH, Goldin JC, Charbonneau-Powis M: Comparative efficacy of behavioral and cognitive treatments of depression . Cog Ther Res 1983;7:111-124.Crossref 44. Lewinsohn PM, Biglan A, Zeiss AM: Behavioral treatment of depression , in Davidson PO (ed): The Behavioral Management of Anxiety, Depression and Pain . New York, Brunner/Mazel Inc, 1976, pp 54-90. 45. McLean PD, Hakstian AR: Clinical depression: Comparative efficacy of outpatient treatments . J Consult Clin Psychol 1979;47:818-836.Crossref 46. Marmor J: Psychiatry in Transition . New York, Brunner/Mazel Inc, 1973. 47. Marmor J: Academic lecture: The nature of the psychotherapeutic process revisited . Can J Psychiatry 1975;20:557-565. 48. Wolberg LR: Short-term Psychotherapy . New York, Grune & Stratton Inc, 1957. 49. McLean PD: Decision-making in the behavioral management of depression , in Davidson PO (ed): The Behavioral Management of Anxiety, Depression and Pain . New York, Brunner/Mazel Inc, 1976, pp 91-146. 50. Shaw BF: Comparison of cognitive therapy and behavior therapy in the treatment of depression . J Consult Clin Psychol 1977;45:543-551.Crossref 51. Taylor FG, Marshall WL: Experimental analysis of a cognitivebehavioral therapy for depression . Cog Ther Res 1977;1:59-72.Crossref 52. DiMascio A, Weissman MM, Prusoff BA, Neu C, Zwilling M, Klerman GL: Differential symptom reduction by drugs and psychotherapy in acute depression . Arch Gen Psychiatry 1979;36:1450-1456.Crossref 53. Beck AT: Depression, Causes and Treatment . Philadelphia, University of Pennsylvania Press, 1970. 54. Kovacs M, Beck AT: Maladaptive cognitive structures in depression . Am J Psychiatry 1978;135:525-533. 55. Bellack AS, Hersen M, Himmelhoch J: Social skills training compared with pharmacotherapy and psychotherapy in the treatment of unipolar depression . Am J Psychiatry 1981;138:1562-1567. 56. Herceg-Baron RL, Prusoff BA, Weissman MM, DiMascio A, Neu C, Klerman GL: Pharmacotherapy and psychotherapy in acutely depressed patients: A study of attrition patterns in a clinical trial . Compr Psychiatry 1979;20:315-325.Crossref 57. Kovacs M, Rush AJ, Beck AT, Hollon SD: Depressed outpatients treated with cognitive therapy or pharmacotherapy: A one-year follow-up . Arch Gen Psychiatry 1981;38:33-39.Crossref 58. Rosenbaum M: Learned resourcefulness as a behavioral repertoire for the self regulation of internal events: Issues and speculations , in Rosenbaum M, Frank CM, Jaffe Y (eds): Perspectives on Behavior Therapy in the 80s . New York, Springer Publishing Co Inc, in press.

Simons, Anne D.;Garfield, Sol L.;Murphy, George E.

doi: 10.1001/archpsyc.1984.01790120049007pmid: 6691784

Abstract • Twenty-eight moderately depressed outpatients were randomly assigned to 12 weeks of cognitive therapy (N =14) or pharmacotherapy (N =14). Significant changes in mood, cognitive processes, and content were similar to those found in previous studies demonstrating effectiveness of cognitive therapy. Patients treated with medication, however, demonstrated nearly identical change on all measures, including cognitive measures, despite the absence of direct focus on cognitive activity. Further analyses disclosed that cognitive change may be an important feature of overall clinical improvement, as patients whose conditions did not improve (regardless of treatment modality) showed significantly less change on cognitive measures. These findings suggest that cognitive change may be more accurately seen as a part of improvement rather than the primary cause of improvement. This suggests a more complex conceptualization of the role of cognitions in the change secured by cognitive therapy. References 1. Rush AJ, Beck AT, Kovacs M, et al: Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients . Cognit Ther Res 1977;1:17-37.Crossref 2. Shaw B: Comparison of cognitive therapy and behavior therapy in the treatment of depression . J Consult Clin Psychol 1977;45:543-551.Crossref 3. Taylor F, Marshall W: Experimental analysis of a cognitive-behavioral therapy for depression . Cognit Ther Res 1977;1:59-72.Crossref 4. Blackburn IM, Bishop S, Glenn ME, et al: The efficacy of cognitive therapy in depression: A treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination . Br J Psychiatry 1981; 139:181-189.Crossref 5. Beck AT, Rush AJ, Shaw N, et al: Cognitive Therapy of Depression . New York, Guilford Press, 1979. 6. Zeiss A, Lewinsohn P, Munoz R: Nonspecific improvement effects in depression using interpersonal skills training, pleasant activities schedules or cognitive training . J Consult Clin Psychol 1979;47:427-439.Crossref 7. Rush AJ, Beck AT, Kovacs M, et al: Comparison of the effects of cognitive therapy on hopelessness and self concept . Am J Psychiatry 1982;139:862-866. 8. Blackburn IM: Changes in cognitions with pharmacotherapy and cognitive therapy. Read before the Society for Psychotherapy Research, Smugglers Notch, Vt, June 1982. 9. Murphy GE, Simons AD, Wetzel RD, et al: Cognitive therapy and pharmacotherapy, singly and together in the treatment of depression . Arch Gen Psychiatry 1984;41:33-41.Crossref 10. Robins LN, Helzer JE, Croughan J, et al: National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity . Arch Gen Psychiatry 1981;38:381-389.Crossref 11. Feighner JP, Robins E, Guze S, et al: Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 1972;26:57-63.Crossref 12. Beck AT, Ward CE, Mendelson M, et al: An inventory for measuring depression . Arch Gen Psychiatry 1961;4:561-571.Crossref 13. Hamilton M: A rating scale for depression . J Neurol Neurosurg Psychiatry 1969;23:56-61.Crossref 14. Aitken RC: Measurement of feeling using visual analogue scales . Proc R Soc Med 1969;62:989-993. 15. Watkins JT, Rush AJ: Cognitive Response Test . Cognit Ther Res , in press. 16. Weissman AN, Beck AT: The Dysfunctional Attitudes Scale, thesis. University of Pennsylvania, Philadelphia, 1979. 17. Hollon SD, Kendall PC: Cognitive self statements in depression: Development of an automatic thoughts questionnaire . Cognit Ther Res 1980;4:383-395.Crossref 18. Beck AT, Beamesderfer A: Assessment of depression: The depression inventory . Mod Probt Pharmacopsychiatry 1974;7:151-169. 19. Bumberry W, Oliver J, McClure J: Validation of the Beck Depression Inventory in a university population using psychiatric estimate as the criterion . J Consult Clin Psychol 1978;46:150-155.Crossref 20. Knesevich JM, Biggs JT, Clayton PJ, et al: Validity of the Hamilton Rating Scale for Depression . Br J Psychiatry 1977;131:49-52.Crossref 21. deJong R, Henrich G, Treiber R, et al: Treatment effects of a three component programme for depressive inpatients. Read before the World Conference on Behavior Therapy, Jerusalem, July 1980. 22. Kovacs M, Beck AT: Maladaptive cognitive structures in depression . Arch Gen Psychiatry 1978;135:525-533. 23. Åsberg M, Crönholm B, Sjöqvist F, et al: Relationship between plasma level and therapeutic effect of nortriptyline . Br Med J 1971;3:331-334.Crossref 24. Ziegler VE, Clayton PJ, Taylor JR, et al: Nortriptyline plasma levels and therapeutic response . Clin Pharmacol Ther 1976;20:458-463. 25. Coyne JC: A critique of cognitions as causal entities with particular reference to depression . Cognit Ther Res 1980;6:3-13.Crossref 26. Akiskal HS, McKinney WT: Overview of recent research in depression . Arch Gen Psychiatry 1975;32:285-305.Crossref

Nelson, J. Craig;Jatlow, Peter I.;Quinlan, Donald M.

doi: 10.1001/archpsyc.1984.01790120059008pmid: 6691785

Abstract • Subjective complaints, including those traditionally considered tricyclic antidepressant side effects, were studied in 43 depressed inpatients during a three-week trial of desipramine hydrochloride. Multiple regression analysis was employed to examine the independent relationship of pretreatment symptoms, concurrent depression, and plasma drug concentrations to subjective complaints reported during treatment. As a group, subjective complaints were positively associated with pretreatment symptoms and the concurrent severity of depression, but not with plasma desipramine concentration. Of the 23 individual complaints studied, three increased during treatment and nine improved. Only two complaints, tremors and light-headedness, were significantly associated with plasma drug concentration. The data indicate that during initial treatment of severe depression with desipramine, subjective complaints are more likely to be symptoms of depression than side effects of the drug and that plasma desipramine determinations would not be useful for predicting or avoiding these complaints. The best management of most symptoms studied was adequate treatment of the depression. References 1. Cassidy WL, Norris BF, Spellman M, et al: Clinical observations in manic-depressive disease . JAMA 1957;164:1535-1546.Crossref 2. Mathew RJ, Weinman ML, Mirabi M: Physical symptoms of depression . Br J Psychiatry 1981;139:293-296.Crossref 3. Walter CJS: Drug plasma levels and clinical effect . Proc R Soc Med 1971;64:282-285. 4. Asberg M, Cronholm B, Sjoqvist F, et al: Correlation of subjective side effects with plasma concentrations of nortriptyline . Br Med J 1970;4:18-21.Crossref 5. Ziegler VE, Taylor JR, Wetzel RD, et al: Nortriptyline plasma levels and subjective side effects . Br J Psychiatry 1978;132:55-60. 6. Peterson GR, Blackwell B, Hostetler RM, et al: Anticholinergic activity of the tricyclic antidepressants desipramine and doxepin in nondepressed volunteers . Commun Psychopharmacol 1978;2:145-150. 7. Blackwell B, Stefopoulos A, Enders P, et al: Anticholinergic activity of two tricyclic antidepressants . Am J Psychiatry 1978;135:722-724. 8. Gaszner P, Szabadi E, Bradshaw CM: Comparison of the peripheral anticholinergic activities of desipramine and amitriptyline in healthy volunteers . Br J Psychiatry 1980;9:123-124. 9. Arnold SE, Kahn RJ, Faldetta LL, et al: Tricyclic antidepressants and peripheral anticholinergic activity . Psychopharmacology 1981;74:325-328.Crossref 10. Snyder SH, Yamamura HI: Antidepressants and the muscarinic acetylcholine receptor . Arch Gen Psychiatry 1977;34:236-239.Crossref 11. Richelson E: Tricyclic antidepressants and histamine H1 receptors . Mayo Clin Proc 1979;54:669-674. 12. Sjoqvist F, Hammer W, Idestrom CM, et al: Plasma level of monomethylated tricyclic antidepressants and side effects in man , in Proceedings of the European Society for the Study of Drug Toxicity: Toxicity and Side-Effects of Psychotropic Drugs . Amsterdam, Excerpta Medica, 1968, pp 246-257. 13. Nelson JC, Jatlow PI, Bock J, et al: Major adverse reactions during desipramine treatment: Relationship to drug plasma concentrations, concomitant antipsychotic treatment, and patient characteristics . Arch Gen Psychiatry 1982;39:1055-1061.Crossref 14. American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 15. Guy W (ed): ECDEU Assessment Manual for Psychopharmacology , publication Adm 76-338. Rockville, Md, Dept of Health, Education, and Welfare, 1976. 16. Hamilton M: A rating scale for depression . J Neurol Neurosurg Psychiatry 1960;23:56-62.Crossref 17. Bailey DN, Jatlow PI: Gas-chromatographic analysis for therapeutic concentrations of imipramine and desipramine in plasma with use of a nitrogen detector . Clin Chem 1976;22:1697-1701. 18. Proelss HF, Logman HJ, Miles DG: High performance liquid chromatographic simultaneous determination of commonly used antidepressants . Clin Chem 1978;24:1948-1953. 19. Rudorfer MV, Young RC: Anticholinergic effects and plasma desipramine levels . Clin Pharmacol Ther 1980;28:703-706.Crossref 20. Asberg M, Germanis M: Ophthalmological effects of nortriptyline: Relationship to plasma level . Pharmacology 1972;7:349-356.Crossref 21. Rudorfer MV, Young RC: Desipramine: Cardiovascular effects and plasma levels . Am J Psychiatry 1980;137:984-986. 22. Veith RC, Friedel RO, Bloom V, et al: Electrocardiogram changes and plasma desipramine levels during treatment of depression . Clin Pharmacol Ther 1980;27:796-802.Crossref 23. Nelson JC, Jatlow P, Quinlan DM, et al: Desipramine plasma concentration and antidepressant response . Arch Gen Psychiatry 1982;39:1419-1422.Crossref 24. Asberg M, Cronholm B, Sjoqvist F, et al: Relationship between plasma level and therapeutic effect of nortriptyline . Br Med J 1971;3:331-334.Crossref

Siever, Larry J.;Uhde, Thomas W.;Jimerson, David C.;Post, Robert M.;Lake, C. Raymond;Murphy, Dennis L.

doi: 10.1001/archpsyc.1984.01790120067009pmid: 6691786

Abstract • Plasma cortisol responses to the intravenous administration of clonidine hydrochloride and placebo were evaluated in depressed patients and controls. Depressed patients had higher mean baseline cortisol levels than controls. Cortisol levels decreased during the morning study period following both placebo and 2 μg/kg of clonidine hydrochloride in the depressed patients, but the cortisol decrease was sixfold greater on the day of clonidine administration; these placeboclonidine differences were statistically significant, whether calculated on an absolute decrement basis or as a percent change. In contrast, controls responded to clonidine with only a 1.5-fold greater cortisol reduction than that found after placebo, a nonsignificant difference from the day of placebo administration. Reductions in the concentration of plasma 3-methoxy-4-hydroxyphenylglycol following clonidine administration were significantly negatively correlated with baseline plasma cortisol levels, raising the possibility that abnormalities in the responsiveness of the α2-norad renerg ic system may be associated with the hypothalamo-pituitary-adrenal (HPA) axis dysfunction found in depressed patients. References 1. Sachar EJ, Hellman L, Roffway HP, et al: Disrupted 24-hour patterns of cortisol secretion in psychotic depression . Arch Gen Psychiatry 1973;18:19-24.Crossref 2. Carroll BJ, Mendels J: Neuroendocrine regulation in affective disorders , in Sachar EJ (ed): Hormones, Behavior and Psychopathology . New York, Raven Press, 1976, pp 193-224. 3. Carroll BJ, Feinberg M, Greden JF, et al: A specific laboratory test for the diagnosis of melancholia: Standardization, validation, and clinical utility . Arch Gen Psychiatry 1981;38:15-22.Crossref 4. Schildkraut JJ, Orsulak PJ, LaBrie RA, et al: Toward a biochemical classification of depressive disorders: II. Application of multivariate discriminant function to analysis of data on urinary catecholamines and metabolites . Arch Gen Psychiatry 1978;35:1436-1439.Crossref 5. Schildkraut JJ, Orsulak PJ, Schatzberg AF, et al: Toward a biochemical classification of depressive disorders: I. Differences in urinary excretion of MHPG and other catecholamine metabolites on clinically defined subtypes of depression . Arch Gen Psychiatry 1978;35:1427-1433.Crossref 6. Matussek N, Ackenheil M, Hippius H, et al: Effect of clonidine on growth hormone release in psychiatric patients and controls . Psychiatry Res 1980;2:25-36.Crossref 7. Siever LJ, Insel T, Uhde T: Noradrenergic challenges in the affective disorders . J Clin Psychopharmacol 1981;1:193-206.Crossref 8. Checkley SA, Slade AP, Shur E: Growth hormone and other responses to clonidine in patients with endogenous depression . Br J Psychiatry 1981; 138:51-55.Crossref 9. Siever LJ, Uhde TW, Silberman EK, et al: The growth hormone response to clonidine as a probe of noradrenergic receptor responsiveness in affective disorder patients and controls . Psychiatry Res 1982;6:171-183.Crossref 10. Siever LJ, Pickar D, Lake CR, et al: Extreme elevations in plasma norepinephrine associated with decreased a-adrenergic responsivity: Two case reports . J Clin Psychopharmacol 1983;3:39-41.Crossref 11. van Loon R: Brain catecholamines and ACTH serotonin , in Martin L, Ganong WF (eds): Frontiers in Neuroendocrinology . Oxford, England, Oxford University Press, 1973, pp 209-246. 12. Scapagnini U, Preziosi P: Receptor involvement in the central noradrenergic inhibition of ACTH secretion in the rat . Neuropharmacology 1973;12:57-62.Crossref 13. Hillhouse EW, Burden J, Jones MT: The effect of various putative neurotransmitters on the release of corticotrophin releasing hormone from the hypothalamus of the rat in vitro: I. The effect of acetylcholine and noradrenaline . Neuroendocrinology 1975;17:1-11.Crossref 14. Guillemin R: A re-evaluation of acetylcholine, adrenaline, nor-adrenaline and histamine as possible mediators of the pituitary adrenocorticotrophic activation by stress . Endocrinology 1955;56:249-255.Crossref 15. Krieger PH, Krieger DT: Chemical stimulation of the brain: Effect on adrenal corticoid release . Am J Physiol 1970;218:1632-1641. 16. Naumenko EV: Hypothalamic chemoreactive structure and regulation of pituitary-adrenal function: Effects of local injection of norepinephrine, carbechol and serotonin into the brain of guinea pigs with intact brain and after mesencephalic transection . Brain Res 1968;11:1-10.Crossref 17. Naumenko EV: Role of adrenergic and cholinergic structures in the control of the pituitary-adrenal system . Endocrinology 1967;80:69-76.Crossref 18. Abe K, Hiroshige T: Changes in plasma corticosterone and hypothalamic CRF levels following intraventricular injection or drug-induced changes of brain biogenic amines in the rat . Neuroendocrinology 1974;14:195-211.Crossref 19. Nakai Y, Imura H, Yoshimi T, et al: Adrenergic control mechanism for ACTH secretion in man . Acta Endocrinol 1973;74:263-270. 20. Silverberg AB, Shah SD, Haymond MW, et al: Norepinephrine: Hormone and neurotransmitter in man . Am J Physiol 1978;234:E252-E256. 21. Few JD, Gawel MJ, Imms FJ, et al: The influence of the infusion of noradrenaline on plasma cortisol levels in man . J Physiol 1980;309:375-389. 22. Besser GM, Butler PWP, Landon J, et al: Influence of amphetamines on plasma corticosteroid and growth hormone levels in man . Br Med J 1969; 4:528-530.Crossref 23. Rees L, Butler PWP, Gosling C, et al: Adrenergic blockade and the corticosteroid and growth hormone responses to methylamphetamine . Nature 1970;228:565-566.Crossref 24. Checkley SA: Corticosteroid and growth hormone responses to methylamphetamine in depressive illness . Psychol Med 1979;9:107-116.Crossref 25. Checkley SA, Crammer JL: Hormonal responses to methylamphetamine in depression: A new approach to the noradrenaline depletion hypothesis . Br J Psychiatry 1977;131:582-586.Crossref 26. Sachar EJ, Asnis G, Nathan RS, et al: Dextroamphetamine and cortisol on depression . Arch Gen Psychiatry 1980;37:755-757.Crossref 27. Brown WA, Corriveau PP, Ebert MH: Acute psychologic and neuroendocrine effects of dextroamphetamine and methylphenidate . Psychopharmacology 1978;58:189-193.Crossref 28. Feinberg M, Greden JF, Carroll BJ: The effect of amphetamine on plasma cortisol in patients with endogenous and non-endogenous depression . Psychoneuroendocrinology 1981;6:355-357.Crossref 29. Chambers JW, Brown GM: Neurotransmitter regulation of growth hormone and ACTH in the rhesus monkey: Effects of biogenic amines . Endocrinology 1976;98:420-428.Crossref 30. Lal S, de la Vega CE, Sourkes TL, et al: Effect of clonidine on growth hormone, prolactin, luteinizing hormone and follicle stimulating hormone levels in the serum of normal men . J Clin Endocrinol Metabol 1975;41:827-832.Crossref 31. Jimerson DC, Markey SP, Oliver JA, et al: Simultaneous measurement of plasma 3-methoxy-4hydroxyphenylglycol (MHPG) and 3,4-dihy-droxyphenylglycol (DHPG) by gas chromatography-mass spectrometry (GCMS) . Biomed Mass Spectrom 1981;8:256-259.Crossref 32. Lake CR, Ziegler HG, Kopin IJ: Use of plasma norepinephrine for evaluation of sympathetic neuronal function in man . Life Sci 1976;18:1315-1326.Crossref 33. Rudolph CD, Kaplan SL, Ganong WF: Sites at which clonidine acts to affect blood pressure and the secretion of renin, growth hormone and ACTH . Neuroendocrinology 1980;31:121-128.Crossref 34. U'Prichard DC, Bechtel WD, Rouot B, et al: Multiple apparent α-noradrenergic receptor binding sites in rat brain: Effects of 6-hydroxy dopamine . Mol Pharmacol 1979;16:47-60. 35. Langer SZ: Modern concepts of adrenergic transmission , in Legg N (ed): Neurotransmitter Systems and Their Clinical Disorders . New York, Academic Press Inc, 1980, pp 29-51. 36. Siever LJ, Uhde TW: New studies and perspectives on the noradrenergic receptor system in depression: Effects of the α-adrenergic agonist clonidine . Bio Psychiatry , in press. 37. Doerr P, Berger M: Physostigmine-induced escape from dexamethasone suppression in normal adults . Biol Psychiatry 1983;18:261-268. 38. Jimerson DC, Insel TR, Reus VI, et al: Increased plasma MHPG related to dexamethasone-resistant depressed patients . Arch Gen Psychiatry 1983;40:173-176.Crossref 39. Rosenbaum AH, Maruta T, Schatzberg AF, et al: Toward a biochemical classification of depressive disorders: VII. Urinary free cortisol and urinary MHPG in depression . Am J Psychiatry 1983;140:314-318. 40. Davis KL, Hollister LE, Mathe AA, et al: Neuroendocrine and neurochemical measurements in depression . Am J Psychiatry 1981;138:1555-1562. 41. Guellaen G, Yates-Aggerbeck M, Vaugvelin G: Characterization with [3H] dihydroergocryptine of the α-adrenergic receptor of the hepatic plasma membrane: Comparison with the β-adrenergic receptor in normal and adrenalectomized rats . J Biol Chem 1978;253:1114-1120. 42. Hoffman BB, Dukes DF, Lefkowitz RJ: α-Adrenergic receptors in liver membranes: Delineation with subtype selective radioligands . Life Sci 1981;28:265-272.Crossref 43. Sternbach H, Gwirtsman H, Gerner RH: The dexamethasone suppression test and response to methylphenidate in depression . Am J Psychiatry 1981;138:1629-1631. 44. Sotsky SM, Lake CR, Goodwin FK: Adrenocortical function and plasma norepinephrine in normal human subjects . Biol Psychiatry 1981;16:643-651.

Rosenthal, Norman E.;Sack, David A.;Gillin, J. Christian;Lewy, Alfred J.;Goodwin, Frederick K.;Davenport, Yolande;Mueller, Peter S.;Newsome, David A.;Wehr, Thomas A.

doi: 10.1001/archpsyc.1984.01790120076010pmid: 6581756