A method for measuring depression: validity studies on a depression questionnaire

Mind wandering and depression: A status report

While many clinical studies and overviews on the contribution of rumination to depression exist, relatively little information regarding the role of mind wandering (MW) in general is available. Therefore, it remains an open question whether patterns of MW are altered in depression and, if so, how these alterations are related to rumination. Here, we review and discuss studies investigating MW in cohorts, showing either a clinically significant depression or with clinically significant disorders accompanied by depressive symptoms. These studies yield first tentative insights into major issues. However, further investigations are required, specifically studies which: i) compare patients with a primary diagnosis of major depression with healthy and appropriately matched controls, ii) implement measures of both MW and rumination, iii) are based on experience sampling (in combination with other key approaches), iv) compare experience sampling during daily life, resting state and attentional tasks, v) explore possible biases in the assessment of MW, vi) acquire data not only related to the propensity and contents of MW, but also regarding meta-awareness and intentionality.

The Impact of Physical Activity on Non-Motor Symptoms in Parkinson's Disease: A Systematic Review

Parkinson's disease (PD) is a neurological disorder that is associated with both motor and non-motor symptoms (NMS). The management of PD is primarily via pharmaceutical treatment; however, non-pharmaceutical interventions have become increasingly recognized in the management of motor and NMS. In this review, the efficacy of physical activity, including physiotherapy and occupational therapy, as an intervention in NMS will be assessed. The papers were extracted between the 20th and 22nd of June 2016 from PubMed, Web of Science, Medline, Ovid, SportsDiscuss, and Scopus using the MeSH search terms "Parkinson's," "Parkinson," and "Parkinsonism" in conjunction with "exercise," "physical activity," "physiotherapy," "occupational therapy," "physical therapy," "rehabilitation," "dance," and "martial arts." Twenty studies matched inclusion criteria of having 10 or more participants with diagnosed idiopathic PD participating in the intervention as well as having to evaluate the effects of physical activity on NMS in PD as controlled, randomized intervention studies. The outcomes of interest were NMS, including depression, cognition, fatigue, apathy, anxiety, and sleep. Risk of bias in the studies was evaluated using the Cochrane Collaboration's tool for assessing risk of bias. Comparability of the various intervention methods, however, was challenging due to demographic variability and methodological differences. Nevertheless, physical activity can positively impact the global NMS burden including depression, apathy, fatigue, day time sleepiness, sleep, and cognition, thus supporting its therapeutic potential in neurodegenerative conditions such as PD. It is recommended that further adequately powered studies are conducted to assess the therapeutic role of physical activity on both motor and non-motor aspects of PD. These studies should be optimally designed to assess non-motor elements of disease using instruments validated in PD.

Estimation of psychological stress in humans: a combination of theory and practice

Stress has long been known to increase susceptibility to health disorders. In 2009, American Psychological Association further established association of stress to serious health problems. However, a quantitative and accurate way to evaluate and estimate stress status of individuals is still a big challenge. It has been shown, in large animal models using cattle, that psychological stress can be quantified as well as disease susceptibility could be predicted through biomarker discovery. Taking cue from those studies, we have evaluated and estimated psychological stress level of individuals theoretically and validated experimentally. Various biomarkers have also been identified which can be associated to psychological stress to predict stress status of unknown individuals.

A controlled study of facial mobility treatment in Parkinson's disease

The aim of this study was to evaluate the effects of orofacial physiotherapeutic treatment (OPT) on the facial mobility of Parkinson's disease (PD) sufferers. Sixteen participants with PD were allocated randomly to either the Treatment group or the Control group. A short interview between the physiotherapist and each subject was videotaped, and 10 random frames of the videotape were selected to be used in the facial expression assessment. The quantification of facial expressions was achieved by using an objective microcomputer-based measurement system, based on a mathematical model of the face (FACEM). A facial outline is obtained, as well as 12 facial measures, which represent distances between key facial landmarks. The facial assessment was performed on 3 separate occasions, that is, baseline (pretreatment), posttreatment, and follow-up (4 weeks later). A repeated measures analysis of variance (MANOVA) revealed a significant main effect of Time and a significant interaction effect between Time and Group for the Mouth-Opening Measure, suggesting that after treatment, members of the Treatment group opened their mouths to a greater degree than members of the Control group. Within the Treatment group, significant differences between pretreatment and posttreatment scores (MANOVA) were found for Mouth-Opening Measure and Mid-Top-Lip Measure. Similarly, Mouth-Opening Measure, Mid-Top-Lip Measure, Lower-Lip Thickness Measure, Top Eyelid/Iris Intersect Measure and Lower Eyelid/Iris Intersect Measure were significant across time from baseline to follow-up in the Treatment group only. No significant differences were found on any of the facial measures during the same period for members of the Control group. These findings suggest that OPT can improve facial movement and that this benefit extends in time, beyond the period of OPT itself. Such an increase in facial mobility can be expected to modify the "Parkinsonian facies" and facilitate the display of facial expressions.

Out-patient cognitive-behavioural therapy with amitriptyline for chronic non-malignant pain: a comparative study with 6-month follow-up

A study was carried out in a multidisciplinary pain clinic with the purpose of comparing the effectiveness of outpatient cognitive-behavioural therapy (CBT) with amitriptyline (AMI) to that of supportive therapy with AMI. The treatments were given weekly over 8 weeks. Global and continuous outcome measures were used. Analysis was by chi-square for global data and MANOVA with baseline scores as covariants for continuous variables. No significant differences could be demonstrated. The scores over a 6-month follow-up period suggested a delayed positive advantage for CBT but this only approached and did not achieve statistical significance. The findings are discussed.

Psychometrics in temporomandibular disorders. An overview

The purpose of this paper is to review the methods and results of psychometric testings in temporomandibular disorders (TMD) during the past decade. Assessments of psychologic and behavioral factors have been performed for various reasons. The results are often ambiguous and comparisons troublesome. No encompassing psychologic TMD profile has been identified, but small elevations in anxiety, depression, somatization, and stress are often reported; they may be cause or effect. Subcategorization of the patients into diagnostic subgroups suggests that psychologic differences exist but may be small; myogenic patients may have more psychologic difficulties than 'joint' patients. More distinct, robust psychologic subsets of patients, unrelated to the structural diagnosis, have been identified by means of clustering techniques. Irrespective of clinical signs, a certain proportion of the patients are psychologically distressed, whereas others easily adapt to the pain and dysfunction. No single variable has been identified that can predict outcome or compliance. Several psychometric instruments are described.

Problems of subject inclusion in psychiatric research: observations from research with psychiatric inpatients

In a recent study of psychiatric disturbance and decision making behaviour, it was observed that a significant number of psychiatric inpatients experienced difficulties in addressing themselves to the experimental tasks at hand. Despite the large number of studies that have used psychiatric inpatients as subjects, little, if any mention has been made of these difficulties. The following report describes the difficulties that have been observed in the above research project, and examines their possible implications for clinical assessment, research, and for clinical investigations and evaluation of treatment regimes (e.g. effectiveness of particular drug therapies), which use psychiatric inpatient populations as subject sources.

Short-term course of depression following attempted suicide: a preliminary report

The course of depression over 1 week in patients admitted to hospital following an attempted suicide was examined utilizing a clinical interview, the Zung Self-Rating Depression Scale, the Levine-Pilowsky Depression (LPD) Questionnaire and the Hamilton Rating Scale for Depression. On all measures the group had depression of moderate to marked severity at the time of attempted suicide. In males there was a statistically and clinically significant reduction in severity of depression over 1 week. This trend was also observed in the younger patients. There was no significant change in the frequency of the LPD category endogenous depression, but examination of changes in DSM-III diagnostic frequencies revealed a significant reduction in major affective disorder over 1 week. Symptom changes were also examined. Factors that may have contributed to the observed changes in depression are discussed. Therapeutic implications and further research directions are outlined.

A controlled study of psychotherapy and amitriptyline used individually and in combination in the treatment of chronic intractable, 'psychogenic' pain

This paper reports an investigation into the efficacy of flexible dosage amitriptyline (AMI) and brief psychotherapy individually and together in the treatment of chronic 'psychogenic' pain. The patients included in the study were drawn from those referred to a pain clinic and were randomly assigned to 1 of 4 groups: (1) AMI + psychotherapy (N = 26), twelve 45 min weekly sessions; (2) AMI + support (N = 26), six 15 min fortnightly sessions; (3) placebo tablet + psychotherapy (N = 26), twelve 45 min weekly sessions; (4) placebo tablet + support (N = 24), six 15 min fortnightly sessions. Outcome was assessed on categorical and continuous variables administered immediately post treatment. The results indicate that amitriptyline is effective in increasing the patients' activity level and the reduction of pain intensity. Psychotherapy increases pain intensity, but tends to improve productivity. There also appears to be a role for the use of amitriptyline in combination with psychotherapy, but their interaction is a complex one. Baseline factors associated with withdrawal from treatment are reported, as well as those associated with a positive response to amitriptyline and psychotherapy respectively. Our findings offer tentative guidelines for choosing between therapies and also underline the importance of assessing more than one outcome variable in evaluating outcome. The importance of carrying treatments out in the context of a multidisciplinary pain clinic is emphasised.

A study of depression in two cultures: a transcultural study with Japanese and Australian clinically depressed patients

Recently there has emerged a growing interest in transcultural aspects of depressive disorders. Unlike earlier studies, recent research has concentrated on using standardized assessment and evaluation procedures in an effort to reduce "differences" associated with research techniques. The following paper reports a study which, using the WHO developed Standardized Assessment of Depressive Disorders (WHO/SADD) schedule, examines the nature of depressive symptomatology in Australian and Japanese clinically depressed patients. While results supported the presence of a "symptom core" common to both cultures, some unexpected findings in relation to "feelings of guilt" and "severity of depression" were noted.

Depression and attempted suicide: a comparative study

The Levine-Pilowsky depression questionnaire was used to compare the qualitative and quantitative characteristics of depression in 176 patients admitted to a general hospital following a suicide attempt and 65 psychiatric inpatients with a diagnosis of major affective disorder. The study showed that despite significant age and sex differences there was a striking similarity between the groups on all measures of depression. Diagnostic and therapeutic implications of these findings are discussed, and further research directions are suggested.

A simplified psychologic questionnaire as a treatment planning aid for patients with temporomandibular joint disorders

Psychologic factors are often believed to have a significant role in the etiology and maintenance of temporomandibular joint disorders. Anxiety and depression have received the greatest focus. Approximately 132 patients with temporomandibular joint disorders completed seven self-administered depression questionnaires and four anxiety questionnaires. Correlation among all 11 questionnaires was significant. Factor analysis was interpreted as indicating the 11 questionnaires were measuring a single factor. For preliminary screening diagnosis, two questions were suggested to be a good approximation of the total battery of questionnaires.

Circadian rhythms in patients with abdominal pain syndromes

Circadian rhythms for cortisol, 6-sulphatoxy melatonin and core body temperature were compared in control subjects and patients with functional abdominal pain. There were 20 patients with biliary pain after cholecystectomy, ten with biliary pain without cholecystectomy and 14 with irritable bowel syndrome. Rhythms were determined by urine collections at intervals of 4 h for 48 h and by overnight monitoring of core body temperature using the Vitalog system. Data were fitted to a sine curve to yield the time of maximal urinary excretion/lowest temperature and the amplitude of each rhythm. Urinary excretion of free cortisol was similar in patients and control subjects. For urinary 6-sulphatoxy melatonin, the timing (phase) of rhythms was similar in patients and controls but those with pain had a lower urinary excretion of 6-sulphatoxy melatonin (p less than 0.05) and a rhythm of lower amplitude (p less than 0.02). The amplitude of the temperature rhythm was also lower in patients with biliary pain with and without prior cholecystectomy (p less than 0.05). Functional abdominal pain is associated with 6-sulphatoxy melatonin and temperature rhythms of low amplitude, presumably because of suppression of circadian oscillators.

A study of facial expression in Parkinson's disease using a novel microcomputer-based method

The aim of this study was to compare the smiling behaviour of a group of Parkinson's disease sufferers with a control group of a similar age using a novel microcomputer-based approach, which utilises a mathematical model of the face to quantify facial expression. The findings indicate that the Parkinson's group differed from the control group in the frequency of smiling while watching a series of cartoons and in the degree of mouth opening during smiling. Both groups completed the Levine-Pilowsky Depression questionnaire, and patients with Parkinson's disease had significantly higher depression scores than those of the control group. Significant negative correlations between depression score and frequency of smiling, and depression score and inner eyebrow separation were also found.

Phenomenology of depression in epilepsy

Sixty-six patients with epilepsy and depression were studied. Thirty-four had a family history of psychiatric illness; depression was the most common condition. Assessed using standardised rating scales, the severity of the depression was moderate and was endogenous in approximately 40% of patients. Attendant features were high state and trait anxiety and hostility. The EEGs of the patients and a control group were not significantly different. Patients receiving phenobarbital (PB) were more depressed, whereas those taking carbamazepine (CBZ) were both less depressed and less anxious. The phenomenology of the depression was not clearly influenced by epilepsy variables. We suggest that the depression in patients with epilepsy represents the outcome of multiple factors in genetically predisposed individuals.

A comparative trial of a new antidepressant, fluoxetine

This clinical trial of a new antidepressant, fluoxetine, shows it to be as effective as a standard tricyclic drug, imipramine. It is effective as a single daily dose and is free of any significant side-effects. It is less sedative and appears to cause fewer problems of weight increase. The three scales used to assess efficacy showed a very positive correlation.

Predicting treatment completion in a behavioral therapy program for chronic temporomandibular pain

The aim of this study was to identify factors useful in predicting whether chronic temporomandibular pain patients would complete a behavioral treatment program. Detailed clinical examination and interviews regarding demographic and social factors were given to 78 patients on week prior to treatment. They also completed a number of personality measures (depression, anxiety, locus of control) at that time and kept a pain diary during the following week to establish baseline levels. Motivation was also assessed. Patients were classified as completing (54%) or failing to complete (46%) the program. Social factors (family and generalized others' attitudes towards the patient's pain) were the only significant predictors of treatment completion. In a multiple regression analysis, these factors accounted for 43% of the variance. These results suggest the usefulness of including social-environmental factors when considering patient compliance. Implications for the conceptualization of social support are discussed.

Psychological normality and abnormality in persistent headache patients

One hundred and three patients referred to a neurological outpatient clinic were examined to assess the relationship between persistent headache, not due to significant physical illness, and emotional disturbance. Overall, the patients showed slightly more evidence of emotional disturbance than a general practice population but less than psychiatric outpatients. Thus, with cut-off points of 4/5 and 9/10 on the General Health Questionnaire (GHQ 28) the whole group had 52% or 20% of psychiatric 'cases' respectively. On the Crown-Crisp Experiential Index the 70 females had mean total scores of 37.19 +/- 11.11 and the 33 males had scores of 31.79 +/- 11.36. In addition the childhood experiences measured by the Parental Bonding Instrument appeared to be normal. Seven patients had significant depressive illness, according to the Levine-Pilowsky Depression Questionnaire. Statistically significant differences in psychological state did not emerge between the diagnoses of cluster headache, classical migraine, common migraine, tension headache or combined headache. However, negative correlations were found between the duration of illness and measures of anxiety. It is concluded that although the emotional state contributes to the development of pain and headache in some patients, there are others in whom comparable headaches are unlikely to be due to emotional factors. Selection effects are held to be important and some of the emotional changes will vary at different phases of a chronic disorder. A new symptom may initially cause anxiety but when a condition persists some patients will be increasingly concerned or depressed whilst others develop tolerance for the situation.

Sleep disturbance in pain clinic patients

One hundred out-patients, referred to a multidisciplinary pain clinic for the management of chronic pain, were questioned regarding their sleeping habits and were grouped according to whether they reported 'good,' 'fair' or 'poor' sleep. All patients were administered questionnaires to measure illness behaviour, depression and anxiety. Information was also obtained regarding the site, intensity and quality of pain as well as amount of general activity. 'Good' and 'poor' sleepers were found to differ on most measures, particularly depression, pain intensity, activity levels and hypochondriasis. These findings suggest that reported sleep disturbance may provide an index of impairment and act as an indicator of psychological disturbance in chronic pain patients.

Description and measurement of concentration problems in depressed patients

Depressed patients commonly complain of concentration problems, yet these have seldom been the focus of systematic investigation. A structured interview about concentration problems was administered to a group of relatively severely depressed patients. Problems in reading and watching television were the most common, and were highly correlated with each other. Direct report of the number of concentration lapses on a reading task was the most generally satisfactory task-performance correlate of complaints of reading/TV concentration problems. Evidence both from this task and from the interview suggests that depressive concentration problems may often be due to 'mind-wandering'. The correlations with concentration problems with the severity and endogeneity of depression and with state anxiety were generally similar.

Parasuicide and depression: a comparison of clinical and questionnaire diagnoses

The frequency with which depressive disorder is diagnosed in parasuicide varies. It has been suggested that when observer bias is removed and a depression questionnaire employed, a greater number of young women who attempt suicide will be designated as depressed than would be expected on the basis of previous clinical reports. Our study compared clinical diagnoses made according to Feighner's research diagnostic criteria or DSM III with the categorisations obtained by the Levine-Pilowsky Depression questionnaire (LPD). Fifty-one patients, 34 female and 17 male, were studied, 31.4% having a primary Major Depressive Disorder and 23.5% secondary depression as clinical diagnoses. The LPD categorised 72.5% as depressed. Comparison of the clinical diagnoses with questionnaire data suggests that the LPD is overinclusive and not as specific as clinical diagnosis. Alcohol and substance abuse disorders accounted for almost one-third of the diagnoses and are therefore an important concomitant of parasuicide.

Assessment of depression by questionnaire compared to DSM-III diagnosis

The LPD, a self-report questionnaire which provides a quantitative and qualitative measure of depression, was examined in relation to a criterion-based system of diagnosis, the DSM-III. Results from 190 psychiatric inpatients suggest that the LPD distinguishes depressive from non-depressive syndromes in terms of severity of depression and that patients with melancholic major depression are more severely depressed than those with non-melancholic major depression. Furthermore, major depression with melancholia and major depression without melancholia, both conform to the LPD profile of endogenous depression whereas other depressive syndromes do not. A comparison of the two systems of categorizing depression also suggests that the LPD is a relatively sensitive predictor of the diagnosis of major depressive disorder.

The attribution of affect in pain clinic patients: a psychophysiological study of the conversion process

In a study to examine the relationship between the conversion process and physiological correlates of emotional arousal, three key elements of conversion were assessed separately in patients experiencing chronic pain for which no adequate somatic cause could be demonstrated. Thirty-seven patients referred to a pain clinic were categorized as members of either high, intermediate, or low conversion groups on the basis of their scores on the Disease Conviction, Affective Disturbance and Denial scales of the Illness Behaviour Questionnaire (IBQ). All patients scored in the high range on Disease Conviction. High conversion patients acknowledge little dysphoric affect and denied life problems apart from physical illness. Intermediate conversion patients also denied life problems other than somatic, but acknowledged high levels of dysphoria. Low conversion patients reported dysphoria and acknowledged life problems which they did not attribute to physical illness. The prediction that the high conversion group would show lower levels of resting skin conductance than the low conversion group was confirmed. Patients in the intermediate conversion group resembled those in the high conversion group in that their resting skin conductance was significantly lower than that observed in members of the low conversion group. These findings are consistent with those of previous studies of conversion disorders. They point to the importance in these conditions of the interaction between dysphoria and the cause to which it is attributed by the patient.

A study of brief psychotherapy for chronic pain

Twenty-six patients attending the pain clinic of a large metropolitan general hospital were randomly assigned to receive either twelve sessions of psychodynamic psychotherapy or six sessions of cognitively orientated supportive psychotherapy. Questionnaires measuring aspects of illness behaviour, depression and anxiety were administered before and after treatment, but did not reveal any significant differences between the treatment groups at any time. Global subjective estimates of outcome reported to an independent observer were made after completion of therapy and showed no significant differences. All measures were repeated six and twelve months after completion of therapy and revealed significant improvement in the dynamic therapy group only with respect to levels of activity. These findings suggest that brief psychodynamically oriented psychotherapy may have a role in the management of chronic pain but further evaluation of this approach is clearly necessary, involving larger numbers of patients, before a more definitive conclusion can be reached.

Factors associated with successful outcome from behavioral therapy for chronic temporomandibular joint (TMJ) pain

A total of 42 chronic temporomandibular joint pain patients completed behavioral therapy for their pain. The role of clinical, sociodemographic, and psychosocial factors was examined in relation to treatment outcome (immediately following treatment and at 2-yr follow-up). Psychosocial factors were better predictors of treatment outcome than clinical and demographic factors. Patients who had the most successful outcomes (both short- and long-term) were more motivated and less depressed than other patients and were internal with respect to their health locus of control.

Effects of the introduction of the dexamethasone suppression test on diagnosis and treatment of depression by psychiatrists

A review of case notes before and after the introduction of the DST into clinical psychiatric practice revealed considerable changes in diagnosis and management. Specifically there were increases in the diagnosis of biological depression and treatment with somatic antidepressant therapy. There was no association between DST results and particular management plans. There was a strong association between requesting the DST and management with antidepressants. It is suggested that the introduction of laboratory tests for psychiatric disorders may firm the belief of psychiatrists in the biological basis of some forms of depression and thus alter their diagnostic and treatment practice.

Depressive illness and dependency

The relationship has been examined in depressed in-patients between type of depression (as categorised by the Levine-Pilowsky Depression Questionnaire) and dependency (as measured by the Interpersonal Dependency Inventory) at time of discharge. No relationship could be demonstrated between dependency and depressive category.

A controlled study of amitriptyline in the treatment of chronic pain

This paper reports a study in which a double-blind controlled cross-over study of amitriptyline vs. placebo was carried out in a group of patients referred to a multidisciplinary pain clinic for the management of chronic intractable pain for which no substantial organic cause could be demonstrated. Of 52 patients entering the 12-week trial, 20 withdrew before completion. No differences were found in terms of global improvement on either agent. Subjective reports indicated a greater reduction in pain at 2 and 4 weeks on amitriptyline, but no difference at 6 weeks. None of the baseline measures was predictive of response.

Pain and depression

This paper explores the relationship between depression and chronic intractable pain in which somatic pathology is playing a minor role. In this study, 114 patients with chronic pain were compared with 53 patients with depression. Patients with chronic pain were older, more likely to be married, more frequently attributed difficulties in activity and sleep to pain, and reported greater impairment of motor functions. They had less dysphoria and an illness behaviour profile (on the Illness Behaviour Questionnaire) suggestive of a conversion reaction. Depressed patients recalled more life events in the year prior to presentation, whilst pain patients recalled more events of nine and ten years earlier. It is concluded that the two patient groups cannot be considered identical. It is argued that the concept of abnormal illness behavior helps to distinguish the two groups.

A case of pre-chronic paroxysmal hemicrania

We describe a patient with neck pain of twelve years' duration whom we believe to have an early form of chronic paroxysmal hemicrania. Her pain was severe, frequent and brief and was greatly relieved by Indomethacin. There were two atypical features in this case—predominance of pain in the neck, and a change of pain from the right to the left side.

Depression in young women who have attempted suicide. An international replication study

In accord with a recent Australian study, a greater proportion of young women who attempted suicide in 4 centres in Australia, Canada and New Zealand were designated as manifesting a depressive syndrome by a depression questionnaire than would have been anticipated on the basis of previous clinical reports. Furthermore, on the basis of a decision-rule applied to the questionnaire responses, one-third of subjects in each centre were allocated to the "endogenous' category of depression.

Depression in young women who have attempted suicide

Findings from a questionnaire assessment of depression in three groups of young women whose suicide attempts were of widely differing medical lethality are reported. No significant difference in the degree of depression between patients whose suicide attempt required intensive care unit resuscitation, those who required some cautionary medical observation, and those whose attempt produced negligible physical effect was found. Furthermore, on the basis of a decision-rule applied to their questionnaire responses, one-third of patients in each lethality group were allocated to the "endogenous" category of depression. Recent literature delineating depression in younger patients is noted, and comment is made on the possible therapeutic implications.

Further validation of a questionnaire method for classifying depressive illness

A total of 367 patients admitted to a psychiatric facility completed the LPD questionnaire. By application a decision rule to their responses, they were classified as 'non-endogenous depression', 'endogenous depression' and 'non-depressive syndrome'. This classification was found to be associated significantly with their categorization on the basis of clinical diagnosis. The findings suggest that this method of classification on the basis of responses to the LPD may have a useful research and clinical role.

Personality and depressive illness

This paper reports an investigation into the relationship between personality (as measured by the Sixteen Personality Factor Questionnaire) and depressive illness type, as determined by responses to the Levine-Pilowsky Depression Questionnaire. When the effects of age and depressive severity are accounted for, a significant difference emerges between "endogenous" and "non-endogenous" depressive states in that the former are associated with a lower score on Factor E, indicating a more submissive, dependent personality. The possible implications of this finding are discussed.

Illness behavior and depression compared in pain center and private practice patients

Recent descriptions of illness behavior and personality factors in chronic pain patients reflect patient populations at clinics dealing with refractory, multiple referral pain problems. Pain patients from the University of Washington Pain Center were compared with patients from a private practice clinic with regard to illness behavior and depression. Private practice patients were significantly less depressed, showed less conviction of disease, general hypochondriasis, affect disturbance and were less somatically focussed than the Pain Center patients. Physicians in general practice treating pain patients should avoid forming stereotypes of chronic pain patients based on the experiences of referral clinics, for such characterizations may lead them to weigh psychologic factors too heavily in diagnosis.

A controlled comparative trial of a new antidepressant, ciclazindol

The author describes a controlled, double-blind, comparative trial of a new tetracyclic compound, ciclazindol (WY 23409), against amitriptyline in the treatment of thirty-five patients admitted to hospital with depressive illness. Each patient was randomly allocated to three weeks treatment with either 50 mg b.d. ciclazindol or 50 mg b.d. amitriptyline. In the event of a poor response the dose level was raised to 75 mg b.d. Separation of cases of endogenous depression and severity of depression were assessed by the Levine-Pilowsky Depression Questionnaire, a self-rating technique. Severity of depression was also assessed using the Hamilton Rating Scale. No significant difference was noted between the drugs in either the degree or the rate of response nor when the endogenous cases alone were studied. The interesting observation was made that only one-third of ciclazindol patients gained weight compared to almost three-quarters of the amitriptyline group and the mean weight gain of the latter was over double that of the ciclazindol group. The author concludes that ciclazindol offers promise and merits further study using higher dosage levels once its full safety trials have been completed.

Effects of doxepin on perception of laboratory-induced pain in man

Beneficial effects have been observed in University of Washington Pain Clinic patients treated with tricyclic antidepressants, but such effects occur much earlier than predicted mood elevation. A laboratory investigation of pain perception was employed to test the hypothesis that doxepin, a tricyclic antidepressant, has analgesic properties. Healthy, normal volunteers were tested over a 4-week period during which they repeatedly performed Sensory Decision Theory tasks while undergoing painful dental stimulation. Doxepin and a placebo were administered after baseline measurement for 4 weeks under double blind conditions. No significant changes due to drug administration were observed in detection threshold or sensory sensitivity indices, but response bias against reporting the stimuli as painful changed dramatically after subjects began ingesting capsules. This effect was evident in both drug and placebo groups, and it was maintained across repeated weeks of testing. These observations suggest that the instructions given patients when the drug is administered have a profound effect on pain report.

Pain as abnormal illness behaviour

In this article, the concept of abnormal illness behaviour is described, and chronic pain syndromes which represent variants of such behaviour are reviewed. Research using the Illness Behaviour Questionnaire has helped to elucidate aspects of chronic pain states, especially where a discrepancy exists between the patient's illness behaviour and the objectively assessed somatic pathology. Some comments are offered concerning the management of patients showing abnormal illness behaviour.

Pain, depression, and illness behavior in a pain clinic population

The relationship between depression, illness behavior and persistent pain was studied in 100 patients referred to the University of Washington Hospital Pain Clinic. The instruments used were the Illness Behavior Questionnaire (IBQ) and the Levine-Pilowsky Depression Questionnaire (LPD). To delineate those aspects of illness behavior characteristic of the Pain Clinic group, their scores were compared to those attained on the IBQ by a Family Medicine Clinic sample. The Pain Clinic group showed greater conviction of disease and somatic preoccupation than the comparison group. Further, they were reluctant to consider their health problems in psychologic terms, and denied current life problems. The Pain Clinic group's performance on the LPD indicated a low degree of depressive affect overall and few patients manifesting a depressive syndrome. The association between IBQ and depression scores suggests that the predominant clinical pattern presented by pain clinic patients is best characterized as a form of "abnormal illness behavior".

Risk-taking propensity, depression and parasuicide

One hundred patients admitted consecutively to an inpatient psychiatric unit were given questionnaires to measure risk-taking propensity and depression. The purpose was to study the relationship between risk-taking, depression, and recent suicide attempts. It was found that depressed patients showed a bimodal clustering towards the extremes of risk-taking. There was a history of suicide attempts only when a certain threshold of risk-taking was exceeded. These findings are discussed with relation to defensive styles of psychological adaptation and to arousal thresholds.

Some preliminary observations on a questionnaire technique for classifying depressive illness: its relationship with clinical diagnosis and a biological technique for depressive classification

A questionnaire designed to assist in the classification of depressive illness, was administered to 20 acute depressive patients and 10 normal controls. Patient classification according to the decision rules employed by the questionnaire, were compared with patient classification arrived at by symptomatic (diagnostic) and physiological (G.S.R. inhibition threshold) means. It was found that a preponderance of patients classified as "endogenous depressives" by the questionnaire technique, also had clinical diagnoses of endogenous depression, and had low G.S.R. inhibition thresholds relative to normals. Furthermore a preponderance of patients classified as "non-endogenous depressives" by the questionnaire technique, had clinical diagnoses of neurotic depressive illness, and had high G.S.R. inhibition thresholds relative to normals. This supports the assertion that the questionnaire technique has some validity in the classification of depressive illness.