Jack Maser - Academia.edu (original) (raw)

Papers by Jack Maser

Research paper thumbnail of The acquisition of a Pavlovian conditioned response in septally damaged rabbits: Role of a competing response

Physiological Psychology, 1974

Enhanced acquisition of a classically conditioned eyelid response was found following septal inju... more Enhanced acquisition of a classically conditioned eyelid response was found following septal injury in rabbits. Eye-opening behavior was four times more frequent in the control Ss. This suggests that faster acquisition is a function of fewer competing responses which might interfere with elaboration of the conditioned response.

Research paper thumbnail of Cross-cultural validity of the Structured Clinical Interview for Panic-Agoraphobic Spectrum

Social Psychiatry and Psychiatric Epidemiology, 2005

Research paper thumbnail of Relative potency of tetrahydrocannabinol derivatives on tonic immobility in chickens

Pharmacology Biochemistry and Behavior, 1975

Research paper thumbnail of Validity and reliability of a new instrument for assessing mood symptomatology: the Structured Clinical Interview for Mood Spectrum (SCI‐MOODS)

International Journal of Methods in Psychiatric Research, 1999

We evaluated the internal consistency, discriminant validity, inter‐rater reliability and test–re... more We evaluated the internal consistency, discriminant validity, inter‐rater reliability and test–retest reliability of a new instrument for the assessment of lifetime symptoms related to mood spectrum disorders: the Structured Clinical Interview for Mood Spectrum (SCI‐MOODS). We report on results obtained from 491 subjects assessed across eight psychiatric centres in Italy who were given the SCI‐MOODS and the Mini International Neuropsychiatric Interview (MINI). The study sample consisted of four groups: 141 students, 116 gastrointestinal (GI) patients, 112 bipolar patients and 122 patients with recurrent depression. To evaluate the inter‐rater reliability and the test–retest reliability, an additional group of 30 subjects (10 non‐psychiatric patients enrolled in an orthopaedic clinic, 10 unipolar patients and 10 bipolar patients) was given the SCI‐MOODS at a baseline assessment and six to eight days later. At the baseline assessment, these subjects were also interviewed using the Str...

Research paper thumbnail of Measuring social anxiety and obsessive-compulsive spectra: Comparison of interviews and self-report instruments

Comprehensive Psychiatry, 2002

The present report analyzes the agreement between the interview and the self-report formats of th... more The present report analyzes the agreement between the interview and the self-report formats of the instruments Structured Clinical Interview for Social Anxiety Spectrum (SCI-SHY) and Structured Clinical Interview for Obsessive Compulsive Spectrum (SCI-OBS), already validated, in three psychiatric patient samples and controls. Thirty patients (10 with obsessive-compulsive disorder [OCD], 10 with social anxiety disorder [SAD], 10 with recurrent unipolar depression in remission) and 20 control subjects (10 university students, 10 ophthalmologic patients) were assessed using the SCI-SHY, the SCI-OBS, and the self report version of the two instruments. Agreement between the two versions was very good for the seven SCI-OBS domains (with intraclass correlation coefficients [ICCs] ranging from 0.80 to 0.96) and the four SCI-SHY domains (ICCs from 0.74 to 0.90). When items were analyzed individually, subjects tended to under-report some phobia-related problems in the interview. The total number of items endorsed in the SCI-SHY, but not in the SCI-OBS, was affected by the order of administration: when the SCI-SHY interview was administered first, subjects reported a median of five more symptoms; when the self-report was administered first, there was no significant difference in the number of symptoms endorsed in the two formats. However, this difference is not clinically important, given the large number of items comprising the instruments, and might be explained by the fact that subjects are likely to overemphasize occasional symptoms or behaviors when they are asked by the interviewer to answer a long series of "new" questions as accurately as possible. Given the high agreement between domain scores in the two formats of the instruments and the fact that scores are virtually identical when the self-report is administered first, we recommend the use of the self-report versions in clinical and research settings.

Research paper thumbnail of Anxiety and posttraumatic stress disorder in the context of human brain evolution: A role for theory in DSM-V?

Clinical Psychology: Science and Practice, 2008

The "hypervigilance, escape, struggle, tonic immobility" evolutionarily hardwired acute peritraum... more The "hypervigilance, escape, struggle, tonic immobility" evolutionarily hardwired acute peritraumatic response sequence is important for clinicians to understand. Our commentary supplements the useful article on human tonic immobility (TI) by Marx, Forsyth, Gallup, Fusé, and Lexington (2008). A hallmark sign of TI is peritraumatic tachycardia, which others have documented as a major risk factor for subsequent posttraumatic stress disorder (PTSD). TI is evolutionarily highly conserved (uniform across species) and underscores the need for DSM-V planners to consider the inclusion of evolution theory in the reconceptualization of anxiety and PTSD. We discuss the relevance of evolution theory to the DSM-V reconceptualization of acute dissociativeconversion symptoms and of epidemic sociogenic disorder (epidemic "hysteria"). Both are especially in need of attention in light of the increasing threat of terrorism against civilians. We provide other pertinent examples. Finally, evolution theory is not ideology driven (and makes testable predictions regarding etiology in "both directions"). For instance, it predicted the unexpected finding that some disorders conceptualized in DSM-IV-TR as innate phobias are conditioned responses and thus better conceptualized as mild forms of PTSD. Evolution theory may offer a conceptual framework in DSM-V both for treatment and for research on psychopathology.

Research paper thumbnail of A Prospective Investigation of the Natural History of the Long-term Weekly Symptomatic Status of Bipolar II Disorder

Archives of General Psychiatry, 2003

Research paper thumbnail of Psychosocial Disability in the Course of Bipolar I and II Disorders

Archives of General Psychiatry, 2005

Evidence of psychosocial disability in bipolar disorder is based primarily on bipolar I disorder ... more Evidence of psychosocial disability in bipolar disorder is based primarily on bipolar I disorder (BP-I) and does not relate disability to affective symptom severity and polarity or to bipolar II disorder (BP-II). Objective: To provide detailed data on psychosocial disability in relation to symptom status during the longterm course of BP-I and BP-II. Design: A naturalistic study with 20 years of prospective, systematic follow-up. Setting: Inpatient and outpatient treatment facilities at 5 US academic centers. Patients: One hundred fifty-eight patients with BP-I and 133 patients with BP-II who were followed up for a mean (SD) of 15 (4.8) years in the National Institute of Mental Health Collaborative Depression Study. Main Outcome Measures: The relationship, by random regression, between Range of Impaired Functioning Tool psychosocial impairment scores and affective symptom status in 1-month periods during the longterm course of illness from 6-month and yearly Longitudinal Interval Follow-up Evaluation interviews. Results: Psychosocial impairment increases significantly with each increment in depressive symptom severity for BP-I and BP-II and with most increments in manic symptom severity for BP-I. Subsyndromal hypomanic symptoms are not disabling in BP-II, and they may even enhance functioning. Depressive symptoms are at least as disabling as manic or hypomanic symptoms at corresponding severity levels and, in some cases, significantly more so. At each level of depressive symptom severity, BP-I and BP-II are equally impairing. When asymptomatic, patients with bipolar disorder have good psychosocial functioning, although it is not as good as that of well controls. Conclusions: Psychosocial disability fluctuates in parallel with changes in affective symptom severity in BP-I and BP-II. Important findings for clinical management are the following: (1) depressive episodes and symptoms, which dominate the course of BP-I and BP-II, are equal to or more disabling than corresponding levels of manic or hypomanic symptoms; (2) subsyndromal depressive symptoms, but not subsyndromal manic or hypomanic symptoms, are associated with significant impairment; and (3) subsyndromal hypomanic symptoms appear to enhance functioning in BP-II.

Research paper thumbnail of Dracula and the Afterlife. A Psychological Explanation

Journal of Dracula Studies, 2005

Until relatively recently, the primary psychological approach to understanding Bram Stoker's... more Until relatively recently, the primary psychological approach to understanding Bram Stoker's Dracula and the folklore of vampires has been psychoanalysis. Maurice Richardson asserted in 1956 that Dracula must be seen from a Freudian standpoint, since “from no other does ...

Research paper thumbnail of Comorbidity of mood and anxiety disorders

Depression and Anxiety, 2000

This article reviews data on the prevalence of panic, social phobia, generalized anxiety, and pos... more This article reviews data on the prevalence of panic, social phobia, generalized anxiety, and posttraumatic stress disorder, and research documenting the comorbidity of these disorders with major depression (MDD). These anxiety disorders are frequently comorbid with MDD, and 50-60% of individuals with MDD report a lifetime history of one or more of these anxiety disorders. The anxiety disorders are also highly correlated with one another, and approximately one-quarter to one-half of individuals with each of the anxiety disorders report a lifetime history of an alcohol or substance use disorder. Anxiety disorders rarely exist in isolation, with several studies reporting that over 90% of individuals with anxiety disorders have a lifetime history of other psychiatric problems. Implications for research are discussed, including the potential benefit of using combined categorical and dimensional rating scale approaches in future genetic, biochemical, neuroimaging, and treatment studies. The clinical implications of the findings are also discussed, and the results of recent clinical trials summarized. Available data suggests selective serotonin reuptake inhibitors are the first-line pharmacological treatment for these disorders, and that newer serotonin and norepinephrine reuptake inhibitors show significant promise, especially for comorbid cases. Comorbidity among depression and anxiety disorders is associated with greater symptom severity, and a considerably higher incidence of suicidality. Increased public awareness about these disorders and the availability of effective treatments is sorely needed.

Research paper thumbnail of Origins of the Panic-Agoraphobic Spectrum and Its Implications for Comorbidity

CNS Spectrums, 1998

Available data from the literature supporting the hypothesis that partial manifestations of the p... more Available data from the literature supporting the hypothesis that partial manifestations of the panic-agoraphobic spectrum may be as clinically relevant as a full-fledged syndrome were reviewed. These partial expressions of disorder may occur singly or in connection with other mental disorders. In particular, we have examined evidences indicating relationships of panic-agoraphobic spectrum with other mental disorders in childhood and adolescence and with psychotic disorders. Their importance in childhood and adolescence is significant because we believe that these symptoms influence adult behavior and are viewed, at a later time, as atypical symptoms. Panic-agoraphobic spectrum syndromes, both in their full-fledged and partial manifestations frequently co-occur with other mental disorders and are likely to be associated with significant impairment either when occurring singly, partially, or comorbidly. Several conditions typical of childhood, such as separation anxiety, school phobi...

Research paper thumbnail of Tryptophan and tonic immobility in chickens: Effects of dietary and systemic manipulations

Journal of Comparative and Physiological Psychology, 1977

Consistent with a serotonergic-midbrain raphe model of tonic immobility, four experiments designe... more Consistent with a serotonergic-midbrain raphe model of tonic immobility, four experiments designed to affect changes in serum tryptophan produced reliable effects on the duration of the response in chickens. Systemic injections of tryptophan, the dietary precursor to serotonin, led to a dose-dependent increase in immobility, with optimal effects being observed within 30 rain after injection. Dietary depletion of endogenous tryptophan served to attenuate the duration of immobility, and a diet completely free of tryptophan, but supplemented with niacin, practically abolished the reaction. Dietary replacement served to reinstate the response. In a fifth experiment, tryptamine, an alternative metabolic by-product of tryptophan, was found to have no effect on immobility. The data are discussed in light of evidence showing serotonergic involvement in tonic immobility.

Research paper thumbnail of Tonic immobility in chickens: Possible involvement of monoamines

Journal of Comparative and Physiological Psychology, 1975

Tonic immobility in chickens was affected by a variety of drugs that act on monoaminergic systems... more Tonic immobility in chickens was affected by a variety of drugs that act on monoaminergic systems. Compounds that enhanced the duration of tonic immobility were d-LSD, BOL-148, pargyline, and iproniazid; 5-hydroxytryptophan, p-CPA, and atropine had no effect. Injections of serotonin depressed response duration. A suggestive parallel was noted between the results of the present study and those of previous work reporting druginduced suppression of raphe 1 electrical activity. The data appear to implicate monoamines, especially serotonin, in the mediation of behavioral activation and suppression.

Research paper thumbnail of Archistriatal lesions enhance tonic immobility in the chicken (Gallus gallus)

Physiology & Behavior, 1973

... Although Kappers, Huber and Crosby [8] consider the archistriatum to be an avian homolog of t... more ... Although Kappers, Huber and Crosby [8] consider the archistriatum to be an avian homolog of the mammalian amygdala, functional [27] and ... the possible role of the avian archistriatum and septal region in the mediation of a species-typical response tendency, tonic immobility. ...

Research paper thumbnail of International use and attitudes toward DSM-III and DSM-III—R: Growing consensus in psychiatric classification

Journal of Abnormal Psychology, 1991

A survey of the uses and attitudes of 146 mental health professionals, primarily psychiatrists an... more A survey of the uses and attitudes of 146 mental health professionals, primarily psychiatrists and psychologists, in 42 countries (not including the United States) toward the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and its revision (DSM-III-R; American Psychiatric Association, 1980,1987) is reported. The results revealed widespread endorsement of the multiaxial system, theoretical neutrality, descriptive symptom criteria forming discrete categories, and the placement of personality disorders on a separate axis. We report that the DSM-III and DSM-III-R are more widely used around the world than the International Classification of Diseases for teaching, research, and clinical practice. Opinions about various dimensions of the DSM's usefulness and shortcomings are presented. An orderly presentation of the facts alone is a real diagnosis. Whenever groups of facts occur often enough they naturally lead to the formulation of a terminology.-Adolph Meyer The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) and its revision (DSM-III-R; American Psychiatric Association, 1987) will soon be history. By this time the field trials for DSM-IVa.K ongoing, and increasingly, attention is focused on the tentative diagnostic criteria of the new edition. There are many reports in the literature from the United States that discuss the relative merits of the DSM-III and the DSM-III-R. There have been many fewer publications from foreign countries. We assess the foreign impact of the DSM-III and DSM-III-R, so that the designers of the DSM-IV may be aided in their complex task (see Frances et al., 1991; Widiger, Frances, Pincus, Davis, & First, 1991). The DSM-III broke with the format of previous editions by attempting to be theoretically neutral, using descriptive symptom criteria, placing the diagnostic classification system in a multiaxial format (see Williams, 1985a, 1985b), and separating the personality and specific developmental disorders (Axis II) from other mental disorders (Axis I). Moreover, the classification system was often polythetic: Not all of the diagnostic criteria for a given syndrome were necessary to define a patient as having that syndrome. Thus, for example, two patients might have markedly different symptoms on Criterion B and on the fifth-digit subclassification yet still be diagnosed as having an episode of major depression. Along with variability of symptoms within many of the disorders, each disorder was itself a rather fuzzy set. No assumption was made that each menial disorder was a discrete entity, The opinions expressed in this article are those of the authors only and do not necessarily reflect those of the National Institute of Mental Health.

Research paper thumbnail of Internal consistency and discriminant validity of the Structured Clinical Interview for Panic Agoraphobic Spectrum (SCI-PAS)

International Journal of Methods in Psychiatric Research, 1999

This paper reports on the feasibility, acceptability and psychometric properties of the Structure... more This paper reports on the feasibility, acceptability and psychometric properties of the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS). This interview was designed to assess the lifetime presence of symptoms and other clinical features considered to comprise the panic-agoraphobic spectrum. The interview has 114 items grouped into nine domains. A total of 422 subjects, from 11 centres located throughout Italy, participated in this study. Data were collected from three groups of subjects: psychiatric patients meeting DSM-IV criteria for panic disorder (n = 141), cardiovascular patients (n = 140), including 29 with post-myocardial infarction, and university students (n = 141). The inter-rater reliability and the internal consistency of the SCI-PAS measures were assessed using the intra-class correlation coefficient and the Kuder-Richardson coefficient, respectively. Discriminant validity was assessed by comparing results in patients with panic disorder to those in the other groups. The interview required an average of 25 (±5) minutes to administer. Patients and clinicians found the scale to be highly useful, providing information not previously obtained. Internal consistency was good (>0.70) for six out of nine SCI-PAS domains. The inter-rater reliability was excellent (>0.70) for all the domains except for 'other phobias' (0.467). Patients with panic disorder scored significantly higher on each domain, and on the overall panic spectrum, than did the control subjects. In conclusion, the SCI-PAS is a useful clinical interview, which can be administered in a reasonable period of time. This assessment further demonstrates good internal consistency, discriminant validity, and inter-rater reliability.

Research paper thumbnail of Standardized Assessment for Panic Disorder Research

Archives of General Psychiatry, 1994

Lively controversies related to panic disorder are under active investigation by research groups ... more Lively controversies related to panic disorder are under active investigation by research groups around the world. However, publications from different laboratories are difficult to compare since there has been little consistency in measures or even in types of assessment used to characterize and follow up patients. Participants in the recently convened National Institutes of Health Consensus Development Conference on the Treatment of Panic Disorder noted this problem and recommended establishment of procedures to ensure comparability of studies. We organized a conference of clinical investigators whose objective was to develop a standard assessment package. Participants represented biological and psychosocial panic disorder treatment research sites in the United States and Canada. The 2-day conference resulted in agreement on a battery of assessments considered essential for panic disorder studies. The purposes of our report are to disseminate the conference conclusions and to encourage adoption of the proposed standards by clinical researchers, journal editors, Public Health Service peer review committees, and the Food and Drug Administration. We also identify some problematic issues that require further work.

Research paper thumbnail of Recurrently situational (reactive) depression: A study of course, phenomenology and familial psychopathology

Journal of Affective Disorders, 1994

Probands with non-bipolar major depressive disorder (MDD) were grouped according to the consisten... more Probands with non-bipolar major depressive disorder (MDD) were grouped according to the consistency across episodes with which depression appeared to arise from situational factors. Situational depression showed significant diagnostic stability across the second and third recurrences in a 10-year follow-up. The relatives of recurrently situational probands had higher neuroticism scores, higher lifetime rates of MDD and, when depressed, fewer endogenous symptoms than did the relatives of non-situational probands. This study joins two others in finding an association between stress-related depression and high familial loadings for MDD. It also illustrates the value of diagnostic consistency across episodes as a means of refining groups for the study of diagnostic subtypes.

Research paper thumbnail of Switching From 'Unipolar' to Bipolar II

Archives of General Psychiatry, 1995

ABSTRACT

Research paper thumbnail of Personality traits in subjects with bipolar I disorder in remission

Journal of Affective Disorders, 1996

This study compared the personality traits of subjects with bipolar I disorder in remission to th... more This study compared the personality traits of subjects with bipolar I disorder in remission to the personality traits of subjects with no history of any mental illness. Subjects were assessed as part of a prospective, multicenter, naturalistic study of mood disorders. Diagnoses were rendered according to Research Diagnostic Criteria, through use of the Schedule for Affective Disorders and Schizophrenia-Lifetime Version. A total of 30 euthymic bipolar I subjects were compared to 974 never-ill subjects on 17 personality scales selected for their relevance to mood disorders. The subjects with bipolar I disorder in remission had more aberrant scores on 6 of the 17 personality measures, including Emotional Stability, Objectivity, Neuroticism, Ego Resiliency, Ego Control, and Hysterical Factor. These findings indicate that patients with bipolar I disorder in remission have personality traits that differ from those of normal controls.

Research paper thumbnail of The acquisition of a Pavlovian conditioned response in septally damaged rabbits: Role of a competing response

Physiological Psychology, 1974

Enhanced acquisition of a classically conditioned eyelid response was found following septal inju... more Enhanced acquisition of a classically conditioned eyelid response was found following septal injury in rabbits. Eye-opening behavior was four times more frequent in the control Ss. This suggests that faster acquisition is a function of fewer competing responses which might interfere with elaboration of the conditioned response.

Research paper thumbnail of Cross-cultural validity of the Structured Clinical Interview for Panic-Agoraphobic Spectrum

Social Psychiatry and Psychiatric Epidemiology, 2005

Research paper thumbnail of Relative potency of tetrahydrocannabinol derivatives on tonic immobility in chickens

Pharmacology Biochemistry and Behavior, 1975

Research paper thumbnail of Validity and reliability of a new instrument for assessing mood symptomatology: the Structured Clinical Interview for Mood Spectrum (SCI‐MOODS)

International Journal of Methods in Psychiatric Research, 1999

We evaluated the internal consistency, discriminant validity, inter‐rater reliability and test–re... more We evaluated the internal consistency, discriminant validity, inter‐rater reliability and test–retest reliability of a new instrument for the assessment of lifetime symptoms related to mood spectrum disorders: the Structured Clinical Interview for Mood Spectrum (SCI‐MOODS). We report on results obtained from 491 subjects assessed across eight psychiatric centres in Italy who were given the SCI‐MOODS and the Mini International Neuropsychiatric Interview (MINI). The study sample consisted of four groups: 141 students, 116 gastrointestinal (GI) patients, 112 bipolar patients and 122 patients with recurrent depression. To evaluate the inter‐rater reliability and the test–retest reliability, an additional group of 30 subjects (10 non‐psychiatric patients enrolled in an orthopaedic clinic, 10 unipolar patients and 10 bipolar patients) was given the SCI‐MOODS at a baseline assessment and six to eight days later. At the baseline assessment, these subjects were also interviewed using the Str...

Research paper thumbnail of Measuring social anxiety and obsessive-compulsive spectra: Comparison of interviews and self-report instruments

Comprehensive Psychiatry, 2002

The present report analyzes the agreement between the interview and the self-report formats of th... more The present report analyzes the agreement between the interview and the self-report formats of the instruments Structured Clinical Interview for Social Anxiety Spectrum (SCI-SHY) and Structured Clinical Interview for Obsessive Compulsive Spectrum (SCI-OBS), already validated, in three psychiatric patient samples and controls. Thirty patients (10 with obsessive-compulsive disorder [OCD], 10 with social anxiety disorder [SAD], 10 with recurrent unipolar depression in remission) and 20 control subjects (10 university students, 10 ophthalmologic patients) were assessed using the SCI-SHY, the SCI-OBS, and the self report version of the two instruments. Agreement between the two versions was very good for the seven SCI-OBS domains (with intraclass correlation coefficients [ICCs] ranging from 0.80 to 0.96) and the four SCI-SHY domains (ICCs from 0.74 to 0.90). When items were analyzed individually, subjects tended to under-report some phobia-related problems in the interview. The total number of items endorsed in the SCI-SHY, but not in the SCI-OBS, was affected by the order of administration: when the SCI-SHY interview was administered first, subjects reported a median of five more symptoms; when the self-report was administered first, there was no significant difference in the number of symptoms endorsed in the two formats. However, this difference is not clinically important, given the large number of items comprising the instruments, and might be explained by the fact that subjects are likely to overemphasize occasional symptoms or behaviors when they are asked by the interviewer to answer a long series of "new" questions as accurately as possible. Given the high agreement between domain scores in the two formats of the instruments and the fact that scores are virtually identical when the self-report is administered first, we recommend the use of the self-report versions in clinical and research settings.

Research paper thumbnail of Anxiety and posttraumatic stress disorder in the context of human brain evolution: A role for theory in DSM-V?

Clinical Psychology: Science and Practice, 2008

The "hypervigilance, escape, struggle, tonic immobility" evolutionarily hardwired acute peritraum... more The "hypervigilance, escape, struggle, tonic immobility" evolutionarily hardwired acute peritraumatic response sequence is important for clinicians to understand. Our commentary supplements the useful article on human tonic immobility (TI) by Marx, Forsyth, Gallup, Fusé, and Lexington (2008). A hallmark sign of TI is peritraumatic tachycardia, which others have documented as a major risk factor for subsequent posttraumatic stress disorder (PTSD). TI is evolutionarily highly conserved (uniform across species) and underscores the need for DSM-V planners to consider the inclusion of evolution theory in the reconceptualization of anxiety and PTSD. We discuss the relevance of evolution theory to the DSM-V reconceptualization of acute dissociativeconversion symptoms and of epidemic sociogenic disorder (epidemic "hysteria"). Both are especially in need of attention in light of the increasing threat of terrorism against civilians. We provide other pertinent examples. Finally, evolution theory is not ideology driven (and makes testable predictions regarding etiology in "both directions"). For instance, it predicted the unexpected finding that some disorders conceptualized in DSM-IV-TR as innate phobias are conditioned responses and thus better conceptualized as mild forms of PTSD. Evolution theory may offer a conceptual framework in DSM-V both for treatment and for research on psychopathology.

Research paper thumbnail of A Prospective Investigation of the Natural History of the Long-term Weekly Symptomatic Status of Bipolar II Disorder

Archives of General Psychiatry, 2003

Research paper thumbnail of Psychosocial Disability in the Course of Bipolar I and II Disorders

Archives of General Psychiatry, 2005

Evidence of psychosocial disability in bipolar disorder is based primarily on bipolar I disorder ... more Evidence of psychosocial disability in bipolar disorder is based primarily on bipolar I disorder (BP-I) and does not relate disability to affective symptom severity and polarity or to bipolar II disorder (BP-II). Objective: To provide detailed data on psychosocial disability in relation to symptom status during the longterm course of BP-I and BP-II. Design: A naturalistic study with 20 years of prospective, systematic follow-up. Setting: Inpatient and outpatient treatment facilities at 5 US academic centers. Patients: One hundred fifty-eight patients with BP-I and 133 patients with BP-II who were followed up for a mean (SD) of 15 (4.8) years in the National Institute of Mental Health Collaborative Depression Study. Main Outcome Measures: The relationship, by random regression, between Range of Impaired Functioning Tool psychosocial impairment scores and affective symptom status in 1-month periods during the longterm course of illness from 6-month and yearly Longitudinal Interval Follow-up Evaluation interviews. Results: Psychosocial impairment increases significantly with each increment in depressive symptom severity for BP-I and BP-II and with most increments in manic symptom severity for BP-I. Subsyndromal hypomanic symptoms are not disabling in BP-II, and they may even enhance functioning. Depressive symptoms are at least as disabling as manic or hypomanic symptoms at corresponding severity levels and, in some cases, significantly more so. At each level of depressive symptom severity, BP-I and BP-II are equally impairing. When asymptomatic, patients with bipolar disorder have good psychosocial functioning, although it is not as good as that of well controls. Conclusions: Psychosocial disability fluctuates in parallel with changes in affective symptom severity in BP-I and BP-II. Important findings for clinical management are the following: (1) depressive episodes and symptoms, which dominate the course of BP-I and BP-II, are equal to or more disabling than corresponding levels of manic or hypomanic symptoms; (2) subsyndromal depressive symptoms, but not subsyndromal manic or hypomanic symptoms, are associated with significant impairment; and (3) subsyndromal hypomanic symptoms appear to enhance functioning in BP-II.

Research paper thumbnail of Dracula and the Afterlife. A Psychological Explanation

Journal of Dracula Studies, 2005

Until relatively recently, the primary psychological approach to understanding Bram Stoker's... more Until relatively recently, the primary psychological approach to understanding Bram Stoker's Dracula and the folklore of vampires has been psychoanalysis. Maurice Richardson asserted in 1956 that Dracula must be seen from a Freudian standpoint, since “from no other does ...

Research paper thumbnail of Comorbidity of mood and anxiety disorders

Depression and Anxiety, 2000

This article reviews data on the prevalence of panic, social phobia, generalized anxiety, and pos... more This article reviews data on the prevalence of panic, social phobia, generalized anxiety, and posttraumatic stress disorder, and research documenting the comorbidity of these disorders with major depression (MDD). These anxiety disorders are frequently comorbid with MDD, and 50-60% of individuals with MDD report a lifetime history of one or more of these anxiety disorders. The anxiety disorders are also highly correlated with one another, and approximately one-quarter to one-half of individuals with each of the anxiety disorders report a lifetime history of an alcohol or substance use disorder. Anxiety disorders rarely exist in isolation, with several studies reporting that over 90% of individuals with anxiety disorders have a lifetime history of other psychiatric problems. Implications for research are discussed, including the potential benefit of using combined categorical and dimensional rating scale approaches in future genetic, biochemical, neuroimaging, and treatment studies. The clinical implications of the findings are also discussed, and the results of recent clinical trials summarized. Available data suggests selective serotonin reuptake inhibitors are the first-line pharmacological treatment for these disorders, and that newer serotonin and norepinephrine reuptake inhibitors show significant promise, especially for comorbid cases. Comorbidity among depression and anxiety disorders is associated with greater symptom severity, and a considerably higher incidence of suicidality. Increased public awareness about these disorders and the availability of effective treatments is sorely needed.

Research paper thumbnail of Origins of the Panic-Agoraphobic Spectrum and Its Implications for Comorbidity

CNS Spectrums, 1998

Available data from the literature supporting the hypothesis that partial manifestations of the p... more Available data from the literature supporting the hypothesis that partial manifestations of the panic-agoraphobic spectrum may be as clinically relevant as a full-fledged syndrome were reviewed. These partial expressions of disorder may occur singly or in connection with other mental disorders. In particular, we have examined evidences indicating relationships of panic-agoraphobic spectrum with other mental disorders in childhood and adolescence and with psychotic disorders. Their importance in childhood and adolescence is significant because we believe that these symptoms influence adult behavior and are viewed, at a later time, as atypical symptoms. Panic-agoraphobic spectrum syndromes, both in their full-fledged and partial manifestations frequently co-occur with other mental disorders and are likely to be associated with significant impairment either when occurring singly, partially, or comorbidly. Several conditions typical of childhood, such as separation anxiety, school phobi...

Research paper thumbnail of Tryptophan and tonic immobility in chickens: Effects of dietary and systemic manipulations

Journal of Comparative and Physiological Psychology, 1977

Consistent with a serotonergic-midbrain raphe model of tonic immobility, four experiments designe... more Consistent with a serotonergic-midbrain raphe model of tonic immobility, four experiments designed to affect changes in serum tryptophan produced reliable effects on the duration of the response in chickens. Systemic injections of tryptophan, the dietary precursor to serotonin, led to a dose-dependent increase in immobility, with optimal effects being observed within 30 rain after injection. Dietary depletion of endogenous tryptophan served to attenuate the duration of immobility, and a diet completely free of tryptophan, but supplemented with niacin, practically abolished the reaction. Dietary replacement served to reinstate the response. In a fifth experiment, tryptamine, an alternative metabolic by-product of tryptophan, was found to have no effect on immobility. The data are discussed in light of evidence showing serotonergic involvement in tonic immobility.

Research paper thumbnail of Tonic immobility in chickens: Possible involvement of monoamines

Journal of Comparative and Physiological Psychology, 1975

Tonic immobility in chickens was affected by a variety of drugs that act on monoaminergic systems... more Tonic immobility in chickens was affected by a variety of drugs that act on monoaminergic systems. Compounds that enhanced the duration of tonic immobility were d-LSD, BOL-148, pargyline, and iproniazid; 5-hydroxytryptophan, p-CPA, and atropine had no effect. Injections of serotonin depressed response duration. A suggestive parallel was noted between the results of the present study and those of previous work reporting druginduced suppression of raphe 1 electrical activity. The data appear to implicate monoamines, especially serotonin, in the mediation of behavioral activation and suppression.

Research paper thumbnail of Archistriatal lesions enhance tonic immobility in the chicken (Gallus gallus)

Physiology & Behavior, 1973

... Although Kappers, Huber and Crosby [8] consider the archistriatum to be an avian homolog of t... more ... Although Kappers, Huber and Crosby [8] consider the archistriatum to be an avian homolog of the mammalian amygdala, functional [27] and ... the possible role of the avian archistriatum and septal region in the mediation of a species-typical response tendency, tonic immobility. ...

Research paper thumbnail of International use and attitudes toward DSM-III and DSM-III—R: Growing consensus in psychiatric classification

Journal of Abnormal Psychology, 1991

A survey of the uses and attitudes of 146 mental health professionals, primarily psychiatrists an... more A survey of the uses and attitudes of 146 mental health professionals, primarily psychiatrists and psychologists, in 42 countries (not including the United States) toward the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and its revision (DSM-III-R; American Psychiatric Association, 1980,1987) is reported. The results revealed widespread endorsement of the multiaxial system, theoretical neutrality, descriptive symptom criteria forming discrete categories, and the placement of personality disorders on a separate axis. We report that the DSM-III and DSM-III-R are more widely used around the world than the International Classification of Diseases for teaching, research, and clinical practice. Opinions about various dimensions of the DSM's usefulness and shortcomings are presented. An orderly presentation of the facts alone is a real diagnosis. Whenever groups of facts occur often enough they naturally lead to the formulation of a terminology.-Adolph Meyer The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) and its revision (DSM-III-R; American Psychiatric Association, 1987) will soon be history. By this time the field trials for DSM-IVa.K ongoing, and increasingly, attention is focused on the tentative diagnostic criteria of the new edition. There are many reports in the literature from the United States that discuss the relative merits of the DSM-III and the DSM-III-R. There have been many fewer publications from foreign countries. We assess the foreign impact of the DSM-III and DSM-III-R, so that the designers of the DSM-IV may be aided in their complex task (see Frances et al., 1991; Widiger, Frances, Pincus, Davis, & First, 1991). The DSM-III broke with the format of previous editions by attempting to be theoretically neutral, using descriptive symptom criteria, placing the diagnostic classification system in a multiaxial format (see Williams, 1985a, 1985b), and separating the personality and specific developmental disorders (Axis II) from other mental disorders (Axis I). Moreover, the classification system was often polythetic: Not all of the diagnostic criteria for a given syndrome were necessary to define a patient as having that syndrome. Thus, for example, two patients might have markedly different symptoms on Criterion B and on the fifth-digit subclassification yet still be diagnosed as having an episode of major depression. Along with variability of symptoms within many of the disorders, each disorder was itself a rather fuzzy set. No assumption was made that each menial disorder was a discrete entity, The opinions expressed in this article are those of the authors only and do not necessarily reflect those of the National Institute of Mental Health.

Research paper thumbnail of Internal consistency and discriminant validity of the Structured Clinical Interview for Panic Agoraphobic Spectrum (SCI-PAS)

International Journal of Methods in Psychiatric Research, 1999

This paper reports on the feasibility, acceptability and psychometric properties of the Structure... more This paper reports on the feasibility, acceptability and psychometric properties of the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS). This interview was designed to assess the lifetime presence of symptoms and other clinical features considered to comprise the panic-agoraphobic spectrum. The interview has 114 items grouped into nine domains. A total of 422 subjects, from 11 centres located throughout Italy, participated in this study. Data were collected from three groups of subjects: psychiatric patients meeting DSM-IV criteria for panic disorder (n = 141), cardiovascular patients (n = 140), including 29 with post-myocardial infarction, and university students (n = 141). The inter-rater reliability and the internal consistency of the SCI-PAS measures were assessed using the intra-class correlation coefficient and the Kuder-Richardson coefficient, respectively. Discriminant validity was assessed by comparing results in patients with panic disorder to those in the other groups. The interview required an average of 25 (±5) minutes to administer. Patients and clinicians found the scale to be highly useful, providing information not previously obtained. Internal consistency was good (>0.70) for six out of nine SCI-PAS domains. The inter-rater reliability was excellent (>0.70) for all the domains except for 'other phobias' (0.467). Patients with panic disorder scored significantly higher on each domain, and on the overall panic spectrum, than did the control subjects. In conclusion, the SCI-PAS is a useful clinical interview, which can be administered in a reasonable period of time. This assessment further demonstrates good internal consistency, discriminant validity, and inter-rater reliability.

Research paper thumbnail of Standardized Assessment for Panic Disorder Research

Archives of General Psychiatry, 1994

Lively controversies related to panic disorder are under active investigation by research groups ... more Lively controversies related to panic disorder are under active investigation by research groups around the world. However, publications from different laboratories are difficult to compare since there has been little consistency in measures or even in types of assessment used to characterize and follow up patients. Participants in the recently convened National Institutes of Health Consensus Development Conference on the Treatment of Panic Disorder noted this problem and recommended establishment of procedures to ensure comparability of studies. We organized a conference of clinical investigators whose objective was to develop a standard assessment package. Participants represented biological and psychosocial panic disorder treatment research sites in the United States and Canada. The 2-day conference resulted in agreement on a battery of assessments considered essential for panic disorder studies. The purposes of our report are to disseminate the conference conclusions and to encourage adoption of the proposed standards by clinical researchers, journal editors, Public Health Service peer review committees, and the Food and Drug Administration. We also identify some problematic issues that require further work.

Research paper thumbnail of Recurrently situational (reactive) depression: A study of course, phenomenology and familial psychopathology

Journal of Affective Disorders, 1994

Probands with non-bipolar major depressive disorder (MDD) were grouped according to the consisten... more Probands with non-bipolar major depressive disorder (MDD) were grouped according to the consistency across episodes with which depression appeared to arise from situational factors. Situational depression showed significant diagnostic stability across the second and third recurrences in a 10-year follow-up. The relatives of recurrently situational probands had higher neuroticism scores, higher lifetime rates of MDD and, when depressed, fewer endogenous symptoms than did the relatives of non-situational probands. This study joins two others in finding an association between stress-related depression and high familial loadings for MDD. It also illustrates the value of diagnostic consistency across episodes as a means of refining groups for the study of diagnostic subtypes.

Research paper thumbnail of Switching From 'Unipolar' to Bipolar II

Archives of General Psychiatry, 1995

ABSTRACT

Research paper thumbnail of Personality traits in subjects with bipolar I disorder in remission

Journal of Affective Disorders, 1996

This study compared the personality traits of subjects with bipolar I disorder in remission to th... more This study compared the personality traits of subjects with bipolar I disorder in remission to the personality traits of subjects with no history of any mental illness. Subjects were assessed as part of a prospective, multicenter, naturalistic study of mood disorders. Diagnoses were rendered according to Research Diagnostic Criteria, through use of the Schedule for Affective Disorders and Schizophrenia-Lifetime Version. A total of 30 euthymic bipolar I subjects were compared to 974 never-ill subjects on 17 personality scales selected for their relevance to mood disorders. The subjects with bipolar I disorder in remission had more aberrant scores on 6 of the 17 personality measures, including Emotional Stability, Objectivity, Neuroticism, Ego Resiliency, Ego Control, and Hysterical Factor. These findings indicate that patients with bipolar I disorder in remission have personality traits that differ from those of normal controls.