Life events and onset of primary affective disorders. A study of 40 hospitalized patients and 40 controls

The characteristic signs and symptoms of mania and depression according to Kraepelin circa 1905: a comparison with DSM-III

Although the rise of operationalized diagnostic criteria and the creation of DSM-III were influenced in the USA by a neo-Kraepelinian 'revival' of interest in psychiatric nosology, Kraepelin was only a distal influence on the specific diagnostic criteria proposed. The historical origins of the DSM-III criteria for mania and major depression (MD) are traceable back to the 1950s and contain no direct link to Kraepelin's writings. George Dreyfus, a student and assistant to Kraepelin, authored in 1907 a monograph on Involutional Melancholia which reviewed cases seen by Kraepelin in Heidelberg. In this monograph, Dreyfus presents the 'characteristic' symptoms for mania and depression 'as described by Kraepelin.' This historical finding provides the unprecedented opportunity to examine the resemblance between the criteria proposed for mania and depression in DSM-III, inspired by Kraepelin's nosologic vision, and those specifically suggested by Kraepelin 73 years earlier. Kraepelin's symptoms and signs for mania paralleled seven of the eight DSM-III criteria (except the decreased need for sleep), with two not included in DSM-III (increased mental activity and short bursts of sadness). Kraepelin's signs and symptoms paralleled six of the nine DSM-III criteria for MD, lacking suicidal ideation and changes in appetite/weight and sleep but including obsessions, reduced expressive movements, and decreased mood responsiveness. Although Kraepelin's overall approach to mania and depression emphasized their close inter-relationship in the cyclic course of manic-depressive illness, it is noteworthy Kraepelin's 'characteristic' symptoms for mania and depression as described by Dreyfus, bear substantial but incomplete resemblance to the criteria proposed in DSM-III.

Affective and Psychotic Disorders in War-Torn Eastern Part of the Democratic Republic of the Congo: A Cross-Sectional Study

BACKGROUND

There is lack of information about prevalence of affective and psychotic disorders triggered by traumatic events among people living in war-affected regions. This study is aimed at determining the prevalence rate of affective and psychotic disorders and the associated factors in a war-torn eastern part of Democratic Republic of the Congo.

METHODS

This epidemiological cross-sectional descriptive study was carried out from 1^st January 2019 to 31^st December 2019 at Cepima and Muyisa health centers. This study enrolled 344 patients that had experienced traumatic events in Eastern Democratic Republic of the Congo from the 1119 participants, of whom 229 had positive bipolar affective disorder and 115 patients had psychotic disorders.

RESULTS

The results revealed that bipolar affective disorders were two times more than psychotic disorders. Sexual abuse, sudden death of a relative, kidnapping, the physical torture, and childhood trauma were the psychological factors correlated to the occurrence of bipolar affective and psychotic disorders.

CONCLUSIONS

It was concluded that the traumatic experiences were precursors for the occurrence of bipolar affective and psychotic spectrum disorders.

The genealogy of the clinical syndrome of mania: signs and symptoms described in psychiatric texts from 1880 to 1900

In 1800, mania was conceptualized as an agitated psychotic state. By 1900, it closely resembled its modern form. This paper reviews the descriptions of mania in Western psychiatry from 1880 to 1900, when Kraepelin was training and developing his concept of manic-depressive illness. Psychiatric textbooks published 1900-1960 described 22 characteristic manic symptoms/signs the presence of which were recorded in 25 psychiatric textbooks and three other key documents published 1880-1900. Descriptions of mania in these nineteenth century textbooks closely resembled those in the twentieth century, recording a mean (s.d.) of 15.9 (2.3) and 17.0 (2.3) of the characteristic symptoms, respectively (p = 0.12). The frequency with which individual symptoms were reported was substantially correlated in these two periods (r = +0.64). Mendel's 1881 monograph, Kraepelin's first description of mania in 1883 and the entry for mania in Tuke's Dictionary of Psychological Medicine (1892) described a mean (s.d.) of 19 (1.7) of these characteristic symptoms. These descriptions of mania often contained phenomenologically rich descriptions of euphoria, hyperactivity, grandiosity, flight of ideas, and poor judgment. They also emphasized several features not in DSM criteria including changes in character, moral standards and physical appearance, and increased sense of humor and sexual drive. Fifteen authors described key symptoms/signs of mania most reporting elevated mood, motoric hyperactivity and accelerated mental processes. By 1880, the syndrome of mania had been largely stabilized in its modern form. In the formation of his concept of manic-depressive illness, Kraepelin utilized the syndrome of mania as described in the psychiatric community in which he was trained.

Depression: The predisposing influence of stress

Aversive experiences have been thought to provoke or exacerbate clinical depression. The present review provides a brief survey of the stress-depression literature and suggests that the effects of stressful experiences on affective state may be related to depletion of several neurotransmitters, including norepinephrine, dopamine, and serotonin. A major element in determining the neurochemical changes is the organism's ability to cope with the aversive stimuli through behavioral means. Aversive experiences give rise to behavioral attempts to cope with the stressor, coupled with increased utilization and synthesis of brain amines to contend with environmental demands. When behavioral coping is possible, neurochemical systems are not overly taxed, and behavioral pathology will not ensue. However, when there can be no behavioral control over the stressful stimuli, or when the aversive experience is perceived as uncontrollable, increased emphasis is placed on coping through endogenous neurochemical mechanisms. Amine utilization increases appreciably and may exceed synthesis, resulting in a net reduction of amine stores, which in turn promotes or exacerbates affective disorder. The processes governing the depletions may be subject to sensitization or conditioning, such that exposure to traumatic experiences may have long-term repercussions when the organism subsequently encounters related stressful stimuli. With continued uncontrollable stimulation, adaptation occurs in the form of increased activity of synthetic enzymes, and levels of amines approach basal values. It is suggested that either the initial amine depletion provoked by aversive experiences or a dysfunction of the adaptive processes, resulting in persistent amine depletion, contributes to behavioral depression. Aside from the contribution of behavioral coping, several organismic, experiential, and environmental variables will influence the effects of aversive experiences on neurochemical activity, and may thus influence vulnerability to depression.

Hospitalization for mental illness among parents after the death of a child

BACKGROUND

The loss of a child is considered one of the most stressful events in the life of a parent. We hypothesized that parental bereavement increases the risk of hospital admission for a psychiatric disorder, especially for affective disorders.

METHODS

We studied a cohort of 1,082,503 persons identified from national registers in Denmark who were born between 1952 and 1999 and had at least one child under 18 years of age during the follow-up period, from 1970 to 1999. Parents who lost a child during follow-up were categorized as "bereaved" from the date of death of the child.

RESULTS

As compared with parents who did not lose a child, parents who lost a child had an overall relative risk of a first psychiatric hospitalization for any disorder of 1.67 (95 percent confidence interval, 1.53 to 1.83). Bereaved mothers had a higher relative risk of being hospitalized for any psychiatric disorder than bereaved fathers (relative risks, 1.78 [95 percent confidence interval, 1.60 to 1.98] and 1.38 [95 percent confidence interval, 1.17 to 1.63], respectively; P value for interaction, 0.01). The relative risks of hospitalization specifically for affective disorders were 1.91 (95 percent confidence interval, 1.59 to 2.30) and 1.61 (95 percent confidence interval, 1.15 to 2.27) for bereaved mothers and fathers, respectively. Among mothers, the relative risk of being hospitalized for any psychiatric disorder was highest during the first year after the death of the child but remained significantly elevated five years or more after the death.

CONCLUSIONS

The risk of psychiatric hospitalization was increased among parents, especially mothers, who lost a child.

Social influences on bipolar affective disorders

The impact of psychosocial adversity on the onset and course of bipolar disorder has been assessed in studies that have relied on methods of eliciting life event histories and evaluating family atmosphere. The results of life event studies have been inconsistent, perhaps because the relationship between bipolar disorder and major stress is only pronounced in first or early episodes. If this is so, this phenomenon itself invites explanation, whether in social or biological terms. The two studies to data of family atmosphere suggest an association between high expressed emotion and relapse. The relationship between psychosocial stress and bipolar disorder requires further and more detailed research.

Life events, social support and depression

This paper reviews current findings regarding social stress and support in clinical depression. Comparisons of recent life events at depressive onset and in general population controls show consistently raised event rates. The events span a range of threatening and undesirable experiences, with limited selectivity to exit events and interpersonal losses. Effects are similar in endogenous and non-endogenous symptom pictures, and there are suggestive findings in bipolar disorder, but these require further study. Events are also related to outcome and to relapse. Effects are moderate in degree, but relatively short-term of over six months to a year. For social support there are greater problems in the extent to which social support may be determined by the individual's own behaviour. Absence of social support appears to be associated with onset and relapse of depression, both acting independently and modifying effects of life events. Social stress findings have implications for prevention. The occurrence of major life events signals a period of increased risk when supportive interventions may prevent evolution of distress to disorder.

Life events and the 1-year prevalence of major depressive episode, generalized anxiety disorder, and panic disorder in a community sample

A community survey was conducted in Edmonton, Alberta, Canada, in which 3,070 respondents completed the Diagnostic Interview Schedule (DIS) and the Life Events Scale (LES) of Paykel. During the year before the interview, there were 222, 234, and 38 cases of major depressive episode (MDE), generalized anxiety disorder (GAD), and panic disorder (PD), respectively, where individuals may have had more than one disorder. It was not possible to time the onset of the disorder relative to the occurrence of life events, and so correlations, no casual relationships, were examined. The LES score showed an increasing trend across disorder categories defined as follows: MDE and GAD both absent; MDE absent and GAD present; MDE present and GAD absent; and MDE and GAD both present. A similar trend was observed for most of the LES subscales studied, but only in the case of events classified as "entrance," "undesirable," and "marital" was there statistical significance. The results suggest that stressful life events are correlated with both MDE and GAD, that individuals with MDE only tend to have a greater burden of stressful events and comorbid disorders than persons with GAD only, and that the presence of both disorders is associated with an even greater level of stress and number of comorbid disorders. The similar patterns across LES subscales suggest that MDE and GAD are not related to specific types of live events, at least not those covered by the LES questionnaire.

Life events and psychosis. Initial results from the Camberwell Collaborative Psychosis Study

Data from the Camberwell Collaborative Psychosis Study were used to examine the proposition that there is an excess of life events preceding the onset of psychoses of all types. Of 97 patients from the study who had episodes within the past year that were datable, 51 had developed psychotic symptoms from an essentially symptom-free state, 29 had been suffering only from neurotic symptoms, and 17 had experienced a marked exacerbation of psychotic symptoms. DSM-III diagnoses were collapsed into three major groups: 51 cases of schizophrenia; 31 cases of mania; and 14 cases of depressive psychosis. Life-event histories were taken for the six months before onset, and when these were compared with equivalent histories from a psychiatrically healthy sample from the local general population, there was a significant excess of life events, particularly in the three months before onset of psychosis. This was apparent in all groups, and remained even when events were restricted to the independent category. The excess of events began rather earlier than has been found in previous studies. In our view, this study provides some of the strongest evidence for a link between life events and the emergence of psychotic symptoms.

Psychosocial stress and minor psychiatric morbidity: a community study in Taiwan

The relationship between acute life events, chronic psychosocial stressors, sociodemographic variables, and minor psychiatric morbidity (MPM) was investigated in a community sample (n = 489) in Taiwan. A higher risk of MPM was found among women with chronic stressors and respondents with both events and stressors. There was no sex difference over the impact of events on such morbidity. The relative odds of MPM for respondents exposed to event(s) was found to be 8.9.

Depressed mothers and their children

This paper reviews the current state of research on the relationship between depressed mothers and their children. Several issues are considered: how depressed women function as mothers; the possible origins of depression in the childhood experiences of the mothers; the impact of maternal depression upon the child; the potential consequences for the child's ultimate development; the induction in the child of a depression and the causes of depression in children; the interaction between depressed mothers and their children; and the question of whether there are certain children invulnerable to their mothers' depression. Based on the author's intensive case-design study of 10 mother-child dyads, a model of the interaction between the depressed mother and her child is described. The implications are considered in terms of the need for further research on outcome, risk, and vulnerability, the application to paediatrics, and the broader social and cultural considerations.

The Camberwell Collaborative Depression Study. I. Depressed probands: adversity and the form of depression

The Camberwell Collaborative Depression Study is an investigation of a series of 130 patients (76 female; 54 male) attending the Maudsley Hospital Services with unipolar depression of recent onset (the probands), and of their first-degree relatives. This paper describes the first element of the study, the investigation of the index cases or probands, which was carried out by members of the MRC Social Psychiatry Unit over the period 1982-1985. A description of the methods of the study is followed by an analysis of life events in relation to the symptomatic pattern of the depressive state. An 'endogenous' group was defined as cases of depression falling within Catego classes D and R, and compared with a 'neurotic' group conforming to classes N and A. The hypothesis that the 'endogenous' group of disorders would be relatively independent of prior life stress was not confirmed. Depressed women were more likely to have experienced life events or difficulties than their male counterparts, and there was some evidence that sex, but not age or social class, influenced the relationship between adversity and the type of depression. Examination of the timing of life events was strongly suggestive of a causal effect, with a pronounced rise in the month before onset. This was not limited to the most severe events. Differences between the 'endogenous' and 'neurotic' groups in the temporal patterning of events before onset are discussed. The findings are interpreted in terms of the literature on the topic.

Adversity and the symptoms of depression

Data from a community survey were used to test the proposition that pathological guilt and vegetative symptoms of depression were less likely to be associated with stressful life events and difficulties than non-specific symptoms like tension and worry. Two types of analysis were carried out: the first took only cases, defined as ID5+ on the Index of Definition program, the second was based on all subjects. Only the second analysis provided support for our predictions.

Life events and relapse in bipolar disorder: the impact of a catastrophic event

The literature on life events and the precipitation of bipolar disorder is reviewed. The authors describe an unexpected increase in bipolar relapses in a Lithium Clinic following a catastrophic life event, a hurricane, and contrast the patients who relapsed with an age and sex matched control of bipolars who did not. Though retrospective, the study avoids the question of the independence of life events. The results suggest that certain bipolar patients, especially those recently unstable, may be more vulnerable to the impact of life events.

Type A, hardiness, and psychological distress

This study examined the effects of hardiness and Type A behavior to burnout and psychological distress in the face of daily life hassles. Measures of hassles, hardiness, Type A behavior, and psychological distress were collected for 193 employees in the human services over 4 months. Analyses of covariance revealed that cognitively hardly Type A individuals experienced significantly less burnout and psychological distress than their less hardy Type B counterparts. The conceptual overlap and inherent confound between the hassles and the psychological distress measures are discussed in light of the research findings.

[Life change events preceding acute psychiatric diseases]

A sample of 112 psychiatric inpatients were examined in comparison to 70 somatic inpatients with respect to the question, how frequent psychiatric diseases were in correlation with stressful life-events. There were significant discrepancies concerning life-event stress between the diagnostic subgroups. The life-event stress was most important in the neurotic patients, also patients suffering from endogenous psychoses, especially schizophrenics, showed an increased life-event stress. Different methods (objective stress scores suggested by Paykel, self-rating scores concerning negative experiences, and a synthesis between these two methods) led to similar results. Experiences, rated positive by the patients, showed no correlation with psychiatric diseases.

The validity of animal models of depression

Eighteen animal models of depression are reviewed in relation to three sets of validating criteria. Of the 18 models, five could only be assessed for predictive validity, seven could be assessed for predictive and face validity, and six could potentially have predictive, face and construct validity. Some traditional models (reserpine reversal, amphetamine potentiation) are rejected as invalid; the models with the highest overall validity are the intracranial self-stimulation, chronic stress and learned helplessness models in rats, and the primate separation model.