Altruistic living donors: evaluation for nondirected kidney or liver donation

A program was established within our regional procurement organization to permit evaluation of altruistic living donors (LD) interested in nondirected kidney or liver segment donation prior to transplant center referral. During the initial 30 months of program operations, 731 donor inquiries were received of which 131 individuals called back after review of mailed information materials. Forty-seven candidates initiated and 19 completed the evaluation process. Seven underwent donation to include six kidneys and one liver segment, five are actively pending donation, five were excluded from donation following transplant center evaluation and two took no further action after their intended liver recipients received deceased donor (DD) transplants. Psychological evaluation of these 19 candidates found them to be free of psychopathology, highly cooperative and self-directed. They did not exhibit attention-seeking or religious motivations for their actions. All seven donors and recipients continue to do well postoperatively. This evaluation program has made possible large-scale screening and education of prospective altruistic LD within the general population and also provides a unique opportunity to further our understanding of those individuals interested in living-nondirected donation.

Functional MRI reveals an interhemispheric dissociation of frontal and temporal language regions in a patient with focal epilepsy

We report the case of a patient with frontal lobe epilepsy in whom the Wada test failed to lateralize representation of language (fluent speech was observed after amobarbital injection on both the right and left side). Functional magnetic resonance imaging (fMRI) during a lexical processing task revealed an atypical organization of language represented by an interhemispheric dissociation of language regions with a right frontal dominance and a left temporal dominance. Consistent with the fMRI results, the patient's ability to name pictures was not reliably impaired by electrocortical stimulation (ECS) of left frontal cortex. The findings from Wada, fMRI, and ECS were confirmed by a lack of language impairment after left frontal lobectomy for seizures. This case illustrates that fMRI can precisely map cortical language networks in epileptic patients and that fMRI may be used to help interpret laterality results provided by the Wada procedure.

Wada testing reveals frontal lateralization for the memorization of words and faces

Neuroimaging studies have suggested that specific regions of the frontal and medial temporal cortex are engaged during memory formation. Further, there is specialization across these regions such that verbal materials appear to preferentially engage the left regions while nonverbal materials primarily engage the right regions. An open question, however, has been to what extent frontal regions contribute to successful memory formation. The present study investigates this question using a reversible lesion technique known as the Wada test. Patients memorized words and unfamiliar faces while portions of their left and right hemispheres were temporarily anesthetized with sodium amytal. Subsequent memory tests revealed that faces were remembered better than words following left-hemisphere anesthesia, whereas words were remembered better than faces following right-hemisphere anesthesia. Importantly, inspection of the circulation affected by the amytal further suggests that these memory impairments did not result from direct anesthetization of the medial temporal regions. Taken in the context of the imaging findings, these results suggest that frontal regions may also contribute to memory formation in normal performance.

The association of irritable bowel syndrome and somatization disorder

BACKGROUND AND OBJECTIVE

Irritable bowel syndrome (IBS) and somatization disorder (SD) are defined by nonobjective symptoms that overlap considerably. Psychiatric symptoms associated with IBS may originate from SD in IBS patients. Previous studies of IBS have not considered SD separately from IBS.

METHODS

This study explored psychiatric symptoms and illness behavior in IBS in relation to SD. A total of 50 outpatients with IBS or ulcerative colitis (UC) were evaluated with the Diagnostic Interview Schedule and Illness Behavior Questionnaire.

RESULTS

Definite or probable SD was diagnosed in no UC patients and in 42% of IBS patients (confirmed in 25% and lacking one symptom in another 17%). IBS patients with probable or definite SD, but not those without SD, reported more psychiatric symptoms and abnormal illness behaviors than did UC patients. SD accounted for the association of psychiatric symptoms with IBS.

CONCLUSIONS

In this university-based office setting, the association of psychiatric features with IBS appears heterogeneous predicated on whether SD is present. Future studies of functional bowel diseases should distinguish between patients with and without SD to clarify its relationship to these disorders. Clinicians should consider whether patients with functional disorders have SD, a diagnosis that indicates specific clinical management strategies.

Diagnosis of posttraumatic stress disorder with the MMPI: PK scale scores in somatization disorder

Clinic patients with diagnoses of either major depression or somatization disorder were given the MMPI. Women with somatization disorder had high scores on Keane's MMPI scale (PK) for posttraumatic stress disorder. Following the procedure for the MMPI-2 (46 of the 49 PK items and MMPI-2 norms), 59% of the women with somatization disorder and 21% of the women with major depression would have T scores > or = 65 on the MMPI-2 scale although none of them were known to have developed psychiatric disorder after exposure to a life threatening event. The PK scale has little use in the differential diagnosis of women patients with somatization disorder.

MMPI screening scales for somatization disorder

44 items on the MMPI were identified which appear to correspond to some of the symptoms in nine of the 10 groups on the Perley-Guze checklist for somatization disorder (hysteria). This list was organized into two scales, one reflecting the total number of symptoms endorsed and the other the number of organ systems with at least one endorsed symptom. Full MMPIs were then obtained from 29 women with primary affective disorder and 37 women with somatization disorder as part of a follow-up study of a consecutive series of 500 psychiatric clinic patients seen at Washington University. Women with the diagnosis of somatization disorder scored significantly higher on the somatization disorder scales created from the 44 items than did women with only major depression. These new scales appeared to be slightly more effective in identifying somatization disorder than the use of the standard MMPI scales for hypochondriasis and hysteria. Further development is needed.

Resuscitation 2000: the need for improved databases in regard to neurological outcomes

The Utstein protocol was developed to facilitate the collection of a consistent data base with which to evaluate the success or failure of resuscitative efforts. We urge redrafting of the section on neurological outcomes which should be an essential component of all outcome studies. Once this is accomplished, we believe that the use of this format should be demanded by every editor to whom an article on resuscitation is submitted.

Nonpsychotic thought disorder: objective clinical identification of somatization and antisocial personality in language patterns

This report describes a new method of using language patterns to identify somatization and antisocial personality (ASPD) disorders in clinical practice. A set of definitions describing characteristic speech patterns was developed to identify "nonpsychotic thought disorder" (NPTD). Speech patterns of subjects with somatization disorder and/or ASPD were compared with those of controls. Blind raters assessed audiotaped samples of speech obtained through open-ended interviews for instances of elements of NPTD. Women with somatization or ASPD had significantly more NPTD speech responses than controls, and women with both disorders showed the greatest amount. Antisocial men did not demonstrate more NPTD than controls, nor was somatization in men associated with NPTD. Clinical attention to speech patterns in patients may help alert clinicians to these disorders in women and serve as indicators for screening for these disorders. More study is needed to develop psychometric properties of the instruments on larger samples, and to identify speech indicators of personality disorder in men. It is likely that other personality disorders, e.g., borderline personality disorder, can be identified through speech patterns, and they deserve study with these methods.

Cognitive behavior therapy, relaxation training, and tricyclic antidepressant medication in the treatment of depression

Outcomes of seven treatment trials comparing cognitive behavioral therapy to treatment with tricyclic antidepressant medication in major depressive disorder have been quite similar to one another. This led us to question whether treatment outcome in time-limited studies reflected a unique effect of cognitive behavioral therapy. To test the uniqueness hypothesis, relaxation training, a nonpharmacologic, noncognitive treatment, was chosen as a comparison for cognitive behavioral therapy as well as drug therapy. Treatment duration was 16 weeks. The sample of 37 patients treated for major depressive disorder was less depressed than those previously studied. For both cognitive behavioral therapy and relaxation training, outcome of depression was superior to that of tricyclic antidepressant medication by endpoint analysis. The posttreatment scores on the Beck Depression Inventory of 82% of the group receiving cognitive behavioral therapy improved to a Beck Depression Inventory score < or = 9 which was not significantly greater than that for the group receiving relaxation training (73%), so a unique effect was not demonstrated for cognitive behavioral therapy. The outcome for tricyclic antidepressant medication (29% improved to criteria) was significantly worse than that for cognitive behavioral therapy. The patient's pretreatment initial expectancy was not predictive.

Effect of reducing cut-off scores on Keane's Posttraumatic Stress Disorder scale

Application of cut-off scores of 30, 35, and 40 on Keane's 46- and 49-item PK scales of the MMPI for a convenience sample of 1708 psychiatric patients shows a cut-off of 28 endorsed items of a 46-item scale increases classification as test positives by less than 3%.

Briquet's syndrome (hysteria) is both a somatoform and a "psychoform" illness: a Minnesota Multiphasic Personality Inventory study

We describe the results of a follow-up study on patients with hysteria using the Minnesota Multiphasic Personality Inventory (MMPI) to evaluate the multiple complaints of these patients. MMPIs were obtained from 29 women with primary affective disorder and 37 women with Briquet's syndrome as part of a follow-up study of the St. Louis clinic 500. Patients with Briquet's syndrome were significantly less consistent and logical in answering MMPIs and were more likely to emphasize personal psychopathological conditions. They reported many more symptoms in many more problem areas than did women with primary affective disorder. Patients with Briquet's syndrome reported significantly more somatic symptoms and psychological/interpersonal problems than did the depressed group. It was suggested that such patients mimic multiple psychiatric and somatic disorders.

Briquet's syndrome, dissociation, and abuse

OBJECTIVE

To help clarify the complex association between childhood abuse and adult psychopathology, the authors examined the relationship among abuse, Briquet's syndrome (somatization disorder), and dissociative symptoms.

METHOD

Ninety-nine female psychiatric clinic outpatients with a history of somatic complaints were assessed for Briquet's syndrome, dissociative symptoms, adult and childhood sexual abuse, childhood physical abuse, and childhood emotional abuse.

RESULTS

Women with high dissociation scores and many somatic symptoms were more likely to report abuse than were subjects with low dissociation scores or with few somatic complaints.

CONCLUSIONS

Briquet's syndrome, dissociation, and abuse are significantly associated. Awareness of this association may have a significant effect on the treatment of psychiatric patients.

Correlates of Tridimensional Personality Questionnaire Scales with selected Minnesota Multiphasic Personality Inventory Scales

The pattern of correlations between selected MMPI scales and the scales of the Tridimensional Personality Questionnaire were examined in a convenience sample of 88 patients who had received both tests. Time between tests (usually less than one year) did not affect the correlations, but MMPI response-set variables (L, F, K, F-K) did. The Tridimensional Personality Questionnaire harm avoidance scale and subscales had many correlates on the MMPI. The Novelty seeking scale and subscales showed a number of moderate correlations with a smaller number of MMPI scales; these correlations did not significantly exceed the correlations with MMPI response-set variables. The Tridimensional Personality Questionnaire reward dependence scale and subscales had few, if any, significant MMPI correlates. It was also noted that no Tridimensional Personality Questionnaire scales were related to MMPI repression factor scores.

Prescribing therapy for depression: the role of learned resourcefulness, a failure to replicate

Work in 1985 by Simons, Lustman, Wetzel, and Murphy showed that a patient's score on Rosenbaum's self-control scale predicted differential response to treatments for depression, with a high score predicting a good outcome with talking therapy and a low score a good outcome with drug therapy. This study of 37 patients did not replicate those findings. Using the same paradigm, we predicted response correctly 7 times and incorrectly 16 times, a clear failure. A valid method for choosing the best treatment for a patient with major depression remains to be found.

Multiple risk factors predict suicide in alcoholism

From a study of the lives of 50 alcoholics who committed suicide, seven nonacute clinical/historical features were identified post hoc that appear to be intimately linked to suicide. They included continued drinking, major depressive episode, suicidal communication, poor social support, serious medical illness, unemployment, and living alone. This study examined whether these features are common to alcoholics generally and/or to nonalcoholics who commit suicide or if they may be specifically predictive of suicide in alcoholics. The frequencies of these factors were compared with those in an earlier sample of 32 alcoholics who committed suicide, then with data from two St Louis studies of living alcoholics and a cohort of individuals with major depressive disorder who committed suicide. The frequency of the identified items was replicated among the 32 alcoholics in a larger community sample of individuals who committed suicide. The white men from those two samples of alcoholics who committed suicide were then combined for the advantage of sample size. Six of the seven factors could be compared with a population survey sample of 106 living alcoholics and five with a clinically identified sample of 142 living alcoholics. All compared factors were significantly more frequent among those who committed suicide than among controls. Any four of the six factors identified 46 (69%) of the 67 individuals who committed suicide with few false-positive results among the controls. Regarding all seven of the identified factors, 54 (81%) of the 67 men and 64 (83%) of the entire sample of 82 individuals who committed suicide had four or more risk factors. Alcoholic women and blacks showed the same pattern as white men.(ABSTRACT TRUNCATED AT 250 WORDS)

The lifetime risk of suicide in alcoholism

Current estimates of the lifetime risk of suicide in alcoholism (11% to 15%) are shown statistically to be untenable. Examination of the mortality from suicide in all published follow-up studies of alcoholics containing the requisite data permits calculation of a much smaller lifetime suicide risk: about 2% in untreated and 2.21% in outpatient-treated probands. Studies of alcoholics identified from hospital admissions yield a lifetime risk of about 3.4% for the United States, the United Kingdom, and other English-speaking countries. It is higher in the Scandinavian and European countries with high suicide rates, but not in those with low national suicide rates. The population at risk is shown to be about half of that commonly estimated, and consists of seriously affected alcoholics. While the annual incidence of suicide in the United States is about 1.3% currently, only that quarter of the population identifiably psychiatrically ill is at significant risk. Despite the seemingly miniscule lifetime risk of 2% to 3.4%, the likelihood of suicide in conservatively diagnosed alcoholism is between 60 and 120 times that of the non-psychiatrically ill. Such alcoholism contributes about 25% of the suicides.

The cognitive triad and suicide intent in depressed in-patients

Daily ratings of self-esteem, hopelessness and suicide intent were made by senior psychiatric residents on 60 patients hospitalized for depression. Both hopelessness and low self-esteem correlated highly with suicide intent and both contributed independently to suicide intent. This suggested that self-esteem may be important in the development of suicide intent as well as hopelessness.

The safety of ECT in geriatric psychiatry

Electroconvulsive therapy (ECT) is often described as an effective and safe treatment of depression in the elderly. However, we have previously reported that there may be increased morbidity in this population, particularly in the very old. This paper extends this work to a second, larger sample of 136 subjects of whom 40 are over 60 years of age. We have again found that while ECT is efficacious, complications increase with age (r = .26; P less than or equal to .003), occurring in 35% of the elderly as opposed to 18% of the younger group. This increased rate of complications appears to be accounted for by problems in the very old; six of eight subjects over 75 years of age had some untoward event. Common complications in the elderly included severe confusion, falls, and cardiorespiratory problems. Complications in the whole sample were related to health status (r = .22; P less than or equal to .008) which in turn correlated with age (r = .50; P less than or equal to .0001). Those taking a greater total number of medications and a greater number of cardiovascular medications had significantly more complications during ECT. There was no relationship between either complications and outcome or complications and the number or laterality of treatments. These findings confirm the effectiveness of ECT in the elderly but suggest there may be unappreciated risks of ECT in this population. At particular risk are the very old, those in poor general health, and those taking multiple medications, particularly cardiovascular agents.

Depressive symptomatology and treatment in patients with end-stage renal disease

A sample of 60 patients selected at random from an adult population of 419 patients with end-stage renal disease was assessed for major depression. Diagnoses were based on a structured interview using DSM-III criteria. Eighteen patients (30%) met criteria for a major depression on a lifetime basis. In addition, depressive symptoms and treatment for each depressed patient are reported.

Depression among medical students

304 first- and second-year medical students were prospectively assessed for depression with a monthly Beck Depression Inventory (BDI). Students scoring above nine on the BDI and a control group were then interviewed with the NIMH Diagnostic Interview Schedule. The incidence of major depression or probable major depression by DSM-III criteria during the first two years of medical school was 12%. The lifetime prevalence was 15%, three times greater than the rate in the general population. An episode of depression prior to medical school was much more common among the depressed students (69 vs. 8%, P less than 0.001) as was a family history of treated depression (46 vs. 21%, P less than 0.025). The elevated rate of depression during medical school does not appear to be a result of the medical school experience alone. Rather, it suggests a positive bias of unknown nature in the selection of students predisposed to depression.

The relationship between depression and aerobic capacity in hemodialysis patients

Depression and a reduction in the performance of pleasant activities have been reported in patients with end-stage renal disease receiving hemodialysis therapy. The purpose of this study was to examine the relationship between depression and the patients' capacity to engage in physical activity. The patients' VO2max, or maximal oxygen consumption, was found to be positively associated with three standardized self-report measures of depression in a sample of 15 patients receiving hemodialysis. The clinical and theoretical implications of this finding are considered.

Cognitive therapy and pharmacotherapy for depression. Sustained improvement over one year

Seventy patients with nonbipolar affective disorder who completed a 12-week course of either cognitive therapy (CT), pharmacotherapy, CT plus active placebo, or CT plus pharmacotherapy were assessed one month, six months, and one year after termination of active treatment. Of the 44 patients who had originally responded to treatment, 16 relapsed as defined by reentry into treatment or by self-reported depression scores in the moderately depressed range. Twenty-eight patients remained well during the one-year follow-up. Patients with relatively high levels of remaining depressive symptoms on completion of treatment relapsed more often than those who had little or no residual depression. Further, at treatment termination, patients who relapsed had significantly higher scores on a measure of dysfunctional attitudes. Patients who had received CT (with or without tricyclic antidepressants) were less likely to relapse in the one-year follow-up period than patients who received pharmacotherapy.

Plasma nortriptyline and clinical response in depression

Plasma levels of nortriptyline below 50 ng/ml or above 150 ng/ml have been reported to yield results inferior to intermediate levels. In the present study, patients with uncomplicated primary, nonbipolar depression were randomly assigned to 12 weeks of treatment with NT alone or with cognitive therapy. Nine of 35 patients had mean NT plasma levels less than 50 ng/ml. Five of them improved clinically to the criterion level of less than or equal to 7 on the Hamilton Rating Scale for Depression. This improvement rate was not at all different from that of patients with mean plasma levels within the presumed therapeutic window. The upper limit of 150 ng/ml was not tested. This study is presented in the hope of reviving the apparently dormant search for optimal therapeutic plasma levels of antidepressants.

Primary and secondary affective disorder: Part III. Longitudinal differences in depression symptoms

Depressed inpatients (29 primary and 31 secondary) were blindly rated at several time points on 137 depressive symptoms. Of the 7 high-frequency symptoms or symptom clusters analyzed, significantly greater symptom persistence was seen for secondary depressives on low mood, pessimism, change in usual interests, and suicidal ideation. Day-to-day variability in symptoms did not differ between groups. Scalability of symptoms (Guttman scales) was acceptable for primary but not secondary depressives. Suicidal ideation tended to be the first symptom to remit in primary depression but persisted in the secondary group, even after remission of the most severe symptom. Implications for treatment are discussed.

Cognitive therapy and pharmacotherapy. Singly and together in the treatment of depression

Eight-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.

Tricyclic antidepressants and delirium

Some patients who take tricyclic antidepressants (TCAs) develop delirium. Charts were reviewed of 125 inpatients whose TCA plasma levels had been assayed. Delirium was documented in 10 cases. The occurrence of delirium was statistically related to age, race, and loge plasma TCA levels.

Social network characteristics of hospitalized depressed patients

22 patients with primary or secondary affective disorder and 22 hospitalized control patients with no history of psychiatric disorder completed questionnaires about their relationships with other people. Similar questionnaires were completed by one friend or relative of 20 patients and 20 control subjects about the subjects' social network. Depressed patients reported that significantly fewer people were available who would offer them help or who had similar interests. They reported less contact with members of their social network. The friends or relatives of depressed patients reported the patients had fewer friends who shared values or were concerned than did those of the control group. The data were interpreted as consistent with both the helplessness and behavioral models of depression.

Family history of suicidal behavior among suicide attempters

Efforts to predict suicide and attempted suicide are hampered by their relative rarity on the one hand and the inadequate specificity of clinical characteristics and relevant antecedent events on the other; that is, these features are found widely among the nonsuicidal as well. In an effort to further understand these phenomena, the authors studied family history of suicidal behaviors (suicide, attempted suicide, and suicide threats) in 127 patients hospitalized following a suicide attempt. Patients with personality disorders (antisocial personality disorder, alcoholism, somatization disorder, and narcotic addiction), comprising 45 per cent of the sample, frequently reported a family history of these behaviors, most notably attempted suicide. Patients with primary affective disorder reported a family history of suicidal behaviors somewhat less often. The diagnoses grouped here as personality disorders (excepting alcoholism) contribute little to the suicide rate, while primary affective disorder contributes substantially. Although further data are needed, it is suggested that a family history of suicidal behavior in primary affective disorder should alert the clinician to heightened suicide risk, while a similar history in nonalcoholics with other psychiatric diagnoses is not particularly significant.

Hopelessness, depression, and suicide intent

Seventy-three inpatients completed Beck's Suicide Ideator Scale, Beck's Hopelessness Scale and the MMPI Depression Scale. As hypothesized, suicide intent was significantly more correlated with hopelessness than with depression. When the effect of hopelessness was removed statistically, there was no relationship between suicide intent and depression.

Suicide risk by birth cohort in the United States, 1949 to 1974

Following the demonstration by Solomon and Hellon that in the past 30 years, successive birth cohorts in Alberta, Canada, carry successively higher suicide risks as they age, we examined data by birth cohort in the Vital Statistics of the United States by race and sex over a similar period. We found the same phenomenon, in reduced magnitude, in birth cohorts of much greater size. Not only does each successive birth cohort start with a higher suicide rate, at each successive five-year interval it has a higher rate than the preceding cohort had at that age. The regularity of this phenomenon over the past 25 years in the United States implies continually rising suicide rates in these birth cohorts. It suggests that whatever the cause of this effect, it is early and lasting. Birth cohort analysis appears to offer an important new tool for studying suicide. Its implications have only begun to be examined.

Attitudes toward issues in psychiatry among third-year residents: a brief survey

The authors surveyed 378 third-year psychiatric residents on their attitudes toward psychiatric training, forms of psychotherapy, and the medical model; their treatment preferences for 4 given psychiatric disorders; and their career plans. Correlation coefficients and analysis of variance indicated clustering of attitudes along a dynamic-biological continuum, with medical education and experience with drug therapy rated highest of the training aspects and personal analysis or psychotherapy, training in psychoanalysis, and research rated lowest.

Factor structure of Beck's Suicide Intent Scales

Data obtained from 48 suicide attempters and 56 suicide threateners on three of Beck's suicide intent scales were factor analyzed. The scale, attempt suicide intent, yielded four orthogonal factors reflecting seriousness of intent, lethality of the act, precautions against interference and failure to initiate rescue after the attempt. The current scale of suicidal intent yielded four factors, bur one, the still suicidal factor, accounted for 44% of the variance. The suicide ideators scale yielded a general factor, called specificity of planning, accounting for more than half the variation. Factor scores were computed and correlated with diagnostic groupings. Character disordered subjects were more likely to report both more serious intent at time of suicide attempt and at interview than other attempters.

Hopelessness, depression, and suicide intent

One hundred fifty-four suicide attempters, threateners, and psychiatric controls were rated on suicide intent scales and given tests to assess hopelessness, depression and self-rated suicide risk. Ninety-four subjects were retested one month later. Both hopelessness and depression were significantly greater in suicidal subjects. In threatenets, hopelessness and depression scores differed significantly between high and low suicide intent subjects. In attempters ranked by suicide intent at time of testing, more and less suicidal subjects differed significantly in hopelessness and depression scores. Both depression and hopelessness were sensitive to changes in suicide risk during the one-month follow-up. In all analyses, hopelessness correlated more highly with suicide intent than did depression. The data were regarded as supporting the hypothesis that hopelessness is more closely related to suicide intent than is depression.

Premenstrual affective syndrome and psychiatric disorder

The relationship between premenstrual affective syndrome and psychiatric disorder was investigated, using 81 women presenting to a Neurology Clinic with functional headache. Premenstrual affective syndrome was significantly associated with a history of depressive syndrome in the population studied. Patients judged to have a non-affective psychiatric disorder reported no greater frequency of definite or probable premenstrual affective syndrome than patients considered psychiatrically normal. The premenstrual occurrence or exacerbation of affective symptoms has been noted. This symptom exacerbation maybe sufficient to require hospitalization. Data presented by Coppen indicate that women with affective disorder are more likely to report the premenstrual symptom of depression than women with other psychiatric disorders. These findings suggest that there may be some relationship between depressive disorder and premenstrual affective symptoms. As part of a larger study on the personality and psychiatric correlates of functional headache, data on the relationship between depressive syndrome and premenstrual affective symptoms were obtained.

Semantic differential ratings of concepts and suicide intent

Ninety-four Ss (28 attempters, 32 threateners and 34 psychiatric controls) rated 10 concepts twice 1 month apart. Extreme rating scores and factor (attitude) scores were derived from the ratings. Suicidal Ss made no more use of extreme ratings than did control Ss. Highly suicidal Ss did not differ from less suicidal Ss in extremeness of ratings. Suicidal Ss did report less favorable attitudes to the concepts life and myself and more favorable attitudes toward suicide. Highly suicidal Ss could be differentiated from less suicidal Ss on these concepts. Contrary to the theory of Neuringer and Lettieri, it was suggested that suicidal Ss do not show a general difference in cognitive style from other psychiatric patients. Concept rated and direction of rating are crucial. Significant changes in ratings occurred over time in conjunction with hopelessness, depression and self-rated suicide intent. It was suggested that these changes indicate that the ratings are a function of a state, rather than a stable trait.

Ratings of life and death and suicide intent

154 Ss rated the concepts life and death with the semantic differential. Ratings of life and life minus death significantly discriminated between suicidal and non-suicidal Ss and between more and less suicidal Ss. Changes in evaluation of life were significantly associated with changes in self-rated suicide intent. Evaluation of life was more sensitive than other life factor scores to suicide behavior and suicide intent.

Premenstrual affective syndrome and affective disorder

Sixty-four per cent of 874 freshmen and sophomore women sent questionnaires about premenstrual and menstrual symptoms returned them. They differed from those not returning the questionnaires only in year of school. As predicted, women reporting premenstrual affective symptoms were more likely than those who did not report them to seek psychiatric care at the Student Health Service and to be diagnosed as affective disorder at the service.

Self-concept and suicide intent

154 Ss rated the concept myself on a semantic differential. Ratings of myself distinguished between suicidal and non-suicidal Ss and between more and less suicidal Ss. Changes in ratings of myself were significantly associated with changes in suicide risk.

Premenstrual symptoms in self-referrals to a suicide prevention service

Two studies have been made of the relationship between premenstrual tension and phase of the menstrual cycle at the time of suicide attempt. Tonks et al. (1968) reported a negative relationship. Women without premenstrual symptoms accounted for the premenstrual increase in suicide attempts. Zacco et al. (1960) reported a significant positive relationship, women with the premenstrual syndrome being more likely to attempt premenstrually.

Premenstrual symptoms as an indicator of bipolar affective disorder

The premenstrual occurrence or exacerbation of affective symptoms has been noted (Dalton, 1964). This symptom exacerbation may be sufficient to require hospitalization (Dalton, 1959; Janowsky et al., 1966). Data presented by Coppen (1965) indicate that women with affective disorder are more likely to report the premenstrual symptom of depression than women with other psychiatric disorders. These findings suggest that there may be some relationship between depressive disorder and premenstrual symptoms. However, we are aware of no previous report that would suggest any relationship between premenstrual symptoms and bipolar affective disorder.