Philip Morris - Academia.edu (original) (raw)

Papers by Philip Morris

Research paper thumbnail of fMRI responses to Jung's Word Association Test: implications for theory, treatment and research

Journal of Analytical Psychology, 2013

Jung's Word Association Test was performed under fMRI conditions by 12 normal subjects. Pooled co... more Jung's Word Association Test was performed under fMRI conditions by 12 normal subjects. Pooled complexed responses were contrasted against pooled neutral ones. The fMRI activation pattern of this generic 'complexed response' was very strong (corrected Z scores ranging from 4.90 to 5.69). The activation pattern in each hemisphere includes mirror neurone areas that track 'otherness' (perspectival empathy), anterior insula (both self-awareness and emotional empathy), and cingulated gyrus (self-awareness and conflict-monitoring). These are the sites described by Siegel and colleagues as the 'resonance circuitry' in the brain which is central to mindfulness (awareness of self) and empathy (sense of the other), negotiations between self awareness and the 'internal other'. But there is also an interhemispheric dialogue. Within 3 seconds, the left hemisphere overrides the right (at least in our normal subjects). Mindfulness and empathy are central to good psychotherapy, and complexes can be windows of opportunity if left-brain hegemony is resisted. This study sets foundations for further research: (i) QEEG studies (with their finer temporal resolution) of complexed responses in normal subjects (ii) QEEG and fMRI studies of complexed responses in other conditions, like schizophrenia, PTSD, disorders of self organization.

Research paper thumbnail of “GP Psych Opinion”: evaluation of a psychiatric consultation service

Medical Journal of Australia, 2005

Objective: To evaluate a hospital-based psychiatric consultation service for patients referred by... more Objective: To evaluate a hospital-based psychiatric consultation service for patients referred by general practitioners (GPs), and the effect on its use of a focused marketing strategy aimed at GPs. Design and setting: Postal survey of GPs in the catchment area (inner north Brisbane, Queensland), September to November 2003; and assessment of referrals, March to August 2003. Main outcome measures: Patient referrals, satisfaction among GPs who had referred, and awareness and opinions of the service among GPs who had not referred, compared with results of a similar survey conducted before marketing. Results: In the 6 months after marketing, 43 patients were referred by 23 GPs, an average of 7.2 patients per month, compared with 2.5 per month in the first 12 months of the service. Survey responses were received from 13 of 36 GPs who had referred patients and 97 of 282 GPs who had not (response rate, 35%). Satisfaction among GPs who had referred remained high, and 12/13 felt the service should continue. Among GPs who had not referred, 76% were aware of the service, up from 26% in the previous survey, and 99% liked the concept of the service. Conclusion: Given the ongoing low utilisation of this service, we question whether this model is accepted by most GPs in our district. Possibly, they prefer more traditional models, where treatment is taken over by psychiatrists in the public or private system. We believe there is a need to increase the capacity and scope of publicly funded MJA 2005; 183: 87-90 services to treat mental health problems.

Research paper thumbnail of A comparison of the efficacy and safety of olanzapine versus haloperidol during transition from intramuscular to oral therapy

Clinical Therapeutics, 2003

Background: Acutely agitated patients with schizophrenia who receive intramuscular (IM) medicatio... more Background: Acutely agitated patients with schizophrenia who receive intramuscular (IM) medications typically are switched to oral (PO) antipsychotic maintenance therapy. Objective: The goal of this study was to assess the efficacy and safety of olanzapine versus those of haloperidol during transition from IM to PO therapy. We used additional data from a previously reported trial to test the hypothesis that the reduction in agitation achieved by IM olanzapine 10 mg or IM haloperidol 7.5 mg would be maintained following transition to 4 days of PO olanzapine or PO haloperidol (5-20 mg/d for both). We also hypothesized that olanzapine would maintain its more favorable extrapyramidal symptom (EPS) safety profile. Methods: This was a multinational (hospitals in 13 countries), double-blind, randomized, controlled trial. Acutely agitated inpatients with schizophrenia were treated with 1 to 3 IM injections of olanzapine 10 mg or haloperidol 7.5 mg over 24 hours and were entered into a 4-day PO treatment period with the same medication (5-20 mg/d for both). The primary efficacy measurement was reduction in agitation, as measured by the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) score. Adverse events and scores on EPS rating scales were assessed. Results: A total of 311 patients (204 men, 107 women; mean [SD] age, 38.2 [11.6] years) were enrolled (131, 126, and 54 patients in the olanzapine, halo

Research paper thumbnail of Intramuscular olanzapine and intramuscular haloperidol in acute schizophrenia: antipsychotic efficacy and extrapyramidal safety during the first 24 hours of treatment

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2003

To determine the antipsychotic efficacy and extrapyramidal safety of intramuscular (i.m.) olanzap... more To determine the antipsychotic efficacy and extrapyramidal safety of intramuscular (i.m.) olanzapine and i.m. haloperidol during the first 24 hours of treatment of acute schizophrenia. Patients (n = 311) with acute schizophrenia were randomly allocated (2:2:1) to receive i.m. olanzapine (10.0 mg, n = 131), i.m. haloperidol (7.5 mg, n = 126), or i.m. placebo (n = 54). After the first injection, i.m. olanzapine was comparable to i.m. haloperidol and superior to i.m. placebo for reducing mean change scores from baseline on the Brief Psychiatric Rating Scale (BRPS) Positive at 2 hours (-2.9 olanzapine, -2.7 haloperidol, and -1.5 placebo) and 24 hours (-2.8 olanzapine, -3.2 haloperidol, and -1.3 placebo); the BPRS Total at 2 hours (-14.2 olanzapine,-13.1 haloperidol, and -7.1 placebo) and 24 hours (-12.8 olanzapine, -12.9 haloperidol, and -6.2 placebo); and the Clinical Global Impressions (CGI) scale at 24 hours (-0.5 olanzapine, -0.5 haloperidol, and -0.1 placebo). Patients treated with...

Research paper thumbnail of fMRI responses to Jung's Word Association Test: implications for theory, treatment and research

Journal of Analytical Psychology, 2013

Jung's Word Association Test was performed under fMRI conditions by 12 normal subjects. Pooled co... more Jung's Word Association Test was performed under fMRI conditions by 12 normal subjects. Pooled complexed responses were contrasted against pooled neutral ones. The fMRI activation pattern of this generic 'complexed response' was very strong (corrected Z scores ranging from 4.90 to 5.69). The activation pattern in each hemisphere includes mirror neurone areas that track 'otherness' (perspectival empathy), anterior insula (both self-awareness and emotional empathy), and cingulated gyrus (self-awareness and conflict-monitoring). These are the sites described by Siegel and colleagues as the 'resonance circuitry' in the brain which is central to mindfulness (awareness of self) and empathy (sense of the other), negotiations between self awareness and the 'internal other'. But there is also an interhemispheric dialogue. Within 3 seconds, the left hemisphere over-rides the right (at least in our normal subjects).

Research paper thumbnail of Pharmacological management of posttraumatic stress disorder

Current Opinion in Psychology, 2017

Posttraumatic stress disorder (PTSD) has been conceptualized as an inability to cope with overwhe... more Posttraumatic stress disorder (PTSD) has been conceptualized as an inability to cope with overwhelming stress that is followed by a distinctive pattern of symptoms. This concept has made it possible to develop therapeutic approaches for PTSD that include medication and psychotherapy options. In this article we summarize research studies on pharmacotherapies for PTSD and review new findings in the neurobiology of PTSD that are promoting the development of targeted treatment options. Research findings that have improved our understanding of psychobiological abnormalities associated with PTSD offer clinicians improved treatment strategies. We review those findings, the developments in the medication management of PTSD and common co-occurring disorders, and new areas of pharmacological research on PTSD treatment.

Research paper thumbnail of Prolactin response to d-fenfluramine in combat-related post-traumatic stress disorder

The International Journal of Neuropsychopharmacology, 2004

Central serotonergic function can be investigated by measuring the prolactin response to the sero... more Central serotonergic function can be investigated by measuring the prolactin response to the serotonin releasing/uptake agent, d-fenfluramine. This study investigated the effect of diagnosis, depressive symptoms and history of alcohol or tobacco abuse or dependence on the d-fenfluramine test in combatrelated post-traumatic stress disorder (PTSD). Male, non-hospitalized combat-exposed veterans diagnosed with PTSD (DSM-III-R) and a similarly aged combat-exposed control group were assessed for both PTSD and depressive symptoms and prolactin responses to a 30-mg d-fenfluramine challenge test. Ninetyfive subjects were studied ; 23 were controls, 46 subjects met the criteria for current PTSD and 26 for past PTSD. There were no significant differences between the three groups for baseline prolactin, peak prolactin, and time to reach peak, delta prolactin or area under the curve of the prolactin vs. time curve. Depressive symptoms and history of alcohol or tobacco abuse or dependence did not have a confounding effect on the prolactin responses to d-fenfluramine. This study suggests that a blunted prolactin response to d-fenfluramine may be a consequence of combat exposure rather than PTSD. To confirm this, further studies involving both healthy and combat-exposed control groups in addition to subjects with PTSD of similar ages are required.

Research paper thumbnail of Posttraumatic Stress Disorder, Antipsychotic Use and Risk of Dementia in Veterans

Journal of the American Geriatrics Society, Jan 17, 2017

To examine the risk of dementia associated with posttraumatic stress disorder (PTSD) and the cont... more To examine the risk of dementia associated with posttraumatic stress disorder (PTSD) and the contribution of antipsychotic use to this risk. Retrospective cohort study SETTING: Australia. Administrative claims data from the Australian Government Department of Veterans' Affairs were used. Male Vietnam veterans aged 55 to 65 at baseline (2001-02) with no preexisting dementia diagnosis (N = 15,612). The association between PTSD and dementia was assessed over 12 years of follow-up. Dementia was identified as a hospital diagnosis, dementia record in service disability data, or dispensing of medicines for dementia. Cox-proportional hazards models were used, with age as the time-scale. Results were stratified according to baseline antipsychotic use. No greater risk of dementia was observed with PTSD. In veterans who received antipsychotics, dementia risk was significantly higher than in those who did not (hazard ratio (HR) = 2.1, 95% confidence interval (CI) = 1.4-3.3). Dementia risk w...

Research paper thumbnail of The modified dexamethasone suppression test (mDST) in chronic PTSD

European Neuropsychopharmacology, 1996

Research paper thumbnail of The relationship between the perception of social support and post-stroke depression in hospitalized patients

Psychiatry: …, 1991

APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...

Research paper thumbnail of Stress and dementia

International Psychogeriatrics, 2014

The causes of dementia continue to be the subject of huge research efforts, and post-traumatic st... more The causes of dementia continue to be the subject of huge research efforts, and post-traumatic stress disorder (PTSD) has recently gained attention as a possible contributor. PTSD is considered to be present if the sufferer develops persistent re-experiencing, avoidance and emotional numbing and symptoms of increased arousal not present before the sufferer was exposed to a traumatic incident. PTSD is now classified in DSM-5 as a trauma- and stressor-related disorder, unlike DSM-IV where it was previously categorized as an anxiety disorder, lending it more prominence now as a stress-related condition. However, it remains placed near the anxiety, obsessive compulsive and dissociative disorders in recognition of the close relationship with these other diagnoses. The nosology of PTSD is interesting as the symptoms can vary considerably. Some individuals with PTSD exhibit anxious or fear-based symptoms, while others can experience anhedonic, dysphoric, aggressive or dissociative symptoms...

Research paper thumbnail of Prevalence and course of depressive disorders in hospitalized stroke patients

The International Journal of …, Jan 1, 1990

In a sample of ninety-nine patients seen two months post-stroke, 18 percent were diagnosed as hav... more In a sample of ninety-nine patients seen two months post-stroke, 18 percent were diagnosed as having minor depression and 14 percent major depression. At follow-up, fifteen months later, the prevalence of depressive disorder had declined substantially, to 12 percent overall. Major depression was characterized by an average duration of thirty-nine weeks, a mortality rate of 23 percent and was associated with positive family history of affective or anxiety disorder. Among patients with left hemisphere lesions, major depression was associated with cognitive impairment. Minor depression had a shorter average duration (twelve weeks) and was more common in males. These two syndromes may define distinct types of post-stroke depression with implications for treatment interventions.

Research paper thumbnail of Association of depression with 10-year poststroke mortality

American Journal of …, Jan 1, 1993

Depression has been linked to higher than expected mortality from natural causes, particularly am... more Depression has been linked to higher than expected mortality from natural causes, particularly among elderly patients with physical illness. The authors examined the effect of depression on mortality among a group of stroke patients followed up for 10 years. A consecutive series of 103 patients was assessed for major or dysthymic (minor) depression approximately 2 weeks after stroke with the use of a structured mental status examination and DSM-III diagnostic criteria. Vital status was determined for 91 of these patients 10 years later. Forty-eight (53%) of the 91 patients had died. Patients with diagnoses of either major or minor depression were 3.4 times more likely to have died during the follow-up period than were nondepressed patients, and this relationship was independent of other measured risk factors such as age, sex, social class, type of stroke, lesion location, and level of social functioning. The mortality rate among depressed patients with few social contacts was especially high: over 90% had died. These results indicate that depressed mood following stroke is associated with an increased risk of subsequent mortality. Patients who are depressed and socially isolated seem to be particularly vulnerable.

Research paper thumbnail of fMRI responses to Jung's Word Association Test: implications for theory, treatment and research

Journal of Analytical Psychology, 2013

Jung's Word Association Test was performed under fMRI conditions by 12 normal subjects. Pooled co... more Jung's Word Association Test was performed under fMRI conditions by 12 normal subjects. Pooled complexed responses were contrasted against pooled neutral ones. The fMRI activation pattern of this generic 'complexed response' was very strong (corrected Z scores ranging from 4.90 to 5.69). The activation pattern in each hemisphere includes mirror neurone areas that track 'otherness' (perspectival empathy), anterior insula (both self-awareness and emotional empathy), and cingulated gyrus (self-awareness and conflict-monitoring). These are the sites described by Siegel and colleagues as the 'resonance circuitry' in the brain which is central to mindfulness (awareness of self) and empathy (sense of the other), negotiations between self awareness and the 'internal other'. But there is also an interhemispheric dialogue. Within 3 seconds, the left hemisphere overrides the right (at least in our normal subjects). Mindfulness and empathy are central to good psychotherapy, and complexes can be windows of opportunity if left-brain hegemony is resisted. This study sets foundations for further research: (i) QEEG studies (with their finer temporal resolution) of complexed responses in normal subjects (ii) QEEG and fMRI studies of complexed responses in other conditions, like schizophrenia, PTSD, disorders of self organization.

Research paper thumbnail of “GP Psych Opinion”: evaluation of a psychiatric consultation service

Medical Journal of Australia, 2005

Objective: To evaluate a hospital-based psychiatric consultation service for patients referred by... more Objective: To evaluate a hospital-based psychiatric consultation service for patients referred by general practitioners (GPs), and the effect on its use of a focused marketing strategy aimed at GPs. Design and setting: Postal survey of GPs in the catchment area (inner north Brisbane, Queensland), September to November 2003; and assessment of referrals, March to August 2003. Main outcome measures: Patient referrals, satisfaction among GPs who had referred, and awareness and opinions of the service among GPs who had not referred, compared with results of a similar survey conducted before marketing. Results: In the 6 months after marketing, 43 patients were referred by 23 GPs, an average of 7.2 patients per month, compared with 2.5 per month in the first 12 months of the service. Survey responses were received from 13 of 36 GPs who had referred patients and 97 of 282 GPs who had not (response rate, 35%). Satisfaction among GPs who had referred remained high, and 12/13 felt the service should continue. Among GPs who had not referred, 76% were aware of the service, up from 26% in the previous survey, and 99% liked the concept of the service. Conclusion: Given the ongoing low utilisation of this service, we question whether this model is accepted by most GPs in our district. Possibly, they prefer more traditional models, where treatment is taken over by psychiatrists in the public or private system. We believe there is a need to increase the capacity and scope of publicly funded MJA 2005; 183: 87-90 services to treat mental health problems.

Research paper thumbnail of A comparison of the efficacy and safety of olanzapine versus haloperidol during transition from intramuscular to oral therapy

Clinical Therapeutics, 2003

Background: Acutely agitated patients with schizophrenia who receive intramuscular (IM) medicatio... more Background: Acutely agitated patients with schizophrenia who receive intramuscular (IM) medications typically are switched to oral (PO) antipsychotic maintenance therapy. Objective: The goal of this study was to assess the efficacy and safety of olanzapine versus those of haloperidol during transition from IM to PO therapy. We used additional data from a previously reported trial to test the hypothesis that the reduction in agitation achieved by IM olanzapine 10 mg or IM haloperidol 7.5 mg would be maintained following transition to 4 days of PO olanzapine or PO haloperidol (5-20 mg/d for both). We also hypothesized that olanzapine would maintain its more favorable extrapyramidal symptom (EPS) safety profile. Methods: This was a multinational (hospitals in 13 countries), double-blind, randomized, controlled trial. Acutely agitated inpatients with schizophrenia were treated with 1 to 3 IM injections of olanzapine 10 mg or haloperidol 7.5 mg over 24 hours and were entered into a 4-day PO treatment period with the same medication (5-20 mg/d for both). The primary efficacy measurement was reduction in agitation, as measured by the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) score. Adverse events and scores on EPS rating scales were assessed. Results: A total of 311 patients (204 men, 107 women; mean [SD] age, 38.2 [11.6] years) were enrolled (131, 126, and 54 patients in the olanzapine, halo

Research paper thumbnail of Intramuscular olanzapine and intramuscular haloperidol in acute schizophrenia: antipsychotic efficacy and extrapyramidal safety during the first 24 hours of treatment

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2003

To determine the antipsychotic efficacy and extrapyramidal safety of intramuscular (i.m.) olanzap... more To determine the antipsychotic efficacy and extrapyramidal safety of intramuscular (i.m.) olanzapine and i.m. haloperidol during the first 24 hours of treatment of acute schizophrenia. Patients (n = 311) with acute schizophrenia were randomly allocated (2:2:1) to receive i.m. olanzapine (10.0 mg, n = 131), i.m. haloperidol (7.5 mg, n = 126), or i.m. placebo (n = 54). After the first injection, i.m. olanzapine was comparable to i.m. haloperidol and superior to i.m. placebo for reducing mean change scores from baseline on the Brief Psychiatric Rating Scale (BRPS) Positive at 2 hours (-2.9 olanzapine, -2.7 haloperidol, and -1.5 placebo) and 24 hours (-2.8 olanzapine, -3.2 haloperidol, and -1.3 placebo); the BPRS Total at 2 hours (-14.2 olanzapine,-13.1 haloperidol, and -7.1 placebo) and 24 hours (-12.8 olanzapine, -12.9 haloperidol, and -6.2 placebo); and the Clinical Global Impressions (CGI) scale at 24 hours (-0.5 olanzapine, -0.5 haloperidol, and -0.1 placebo). Patients treated with...

Research paper thumbnail of fMRI responses to Jung's Word Association Test: implications for theory, treatment and research

Journal of Analytical Psychology, 2013

Jung's Word Association Test was performed under fMRI conditions by 12 normal subjects. Pooled co... more Jung's Word Association Test was performed under fMRI conditions by 12 normal subjects. Pooled complexed responses were contrasted against pooled neutral ones. The fMRI activation pattern of this generic 'complexed response' was very strong (corrected Z scores ranging from 4.90 to 5.69). The activation pattern in each hemisphere includes mirror neurone areas that track 'otherness' (perspectival empathy), anterior insula (both self-awareness and emotional empathy), and cingulated gyrus (self-awareness and conflict-monitoring). These are the sites described by Siegel and colleagues as the 'resonance circuitry' in the brain which is central to mindfulness (awareness of self) and empathy (sense of the other), negotiations between self awareness and the 'internal other'. But there is also an interhemispheric dialogue. Within 3 seconds, the left hemisphere over-rides the right (at least in our normal subjects).

Research paper thumbnail of Pharmacological management of posttraumatic stress disorder

Current Opinion in Psychology, 2017

Posttraumatic stress disorder (PTSD) has been conceptualized as an inability to cope with overwhe... more Posttraumatic stress disorder (PTSD) has been conceptualized as an inability to cope with overwhelming stress that is followed by a distinctive pattern of symptoms. This concept has made it possible to develop therapeutic approaches for PTSD that include medication and psychotherapy options. In this article we summarize research studies on pharmacotherapies for PTSD and review new findings in the neurobiology of PTSD that are promoting the development of targeted treatment options. Research findings that have improved our understanding of psychobiological abnormalities associated with PTSD offer clinicians improved treatment strategies. We review those findings, the developments in the medication management of PTSD and common co-occurring disorders, and new areas of pharmacological research on PTSD treatment.

Research paper thumbnail of Prolactin response to d-fenfluramine in combat-related post-traumatic stress disorder

The International Journal of Neuropsychopharmacology, 2004

Central serotonergic function can be investigated by measuring the prolactin response to the sero... more Central serotonergic function can be investigated by measuring the prolactin response to the serotonin releasing/uptake agent, d-fenfluramine. This study investigated the effect of diagnosis, depressive symptoms and history of alcohol or tobacco abuse or dependence on the d-fenfluramine test in combatrelated post-traumatic stress disorder (PTSD). Male, non-hospitalized combat-exposed veterans diagnosed with PTSD (DSM-III-R) and a similarly aged combat-exposed control group were assessed for both PTSD and depressive symptoms and prolactin responses to a 30-mg d-fenfluramine challenge test. Ninetyfive subjects were studied ; 23 were controls, 46 subjects met the criteria for current PTSD and 26 for past PTSD. There were no significant differences between the three groups for baseline prolactin, peak prolactin, and time to reach peak, delta prolactin or area under the curve of the prolactin vs. time curve. Depressive symptoms and history of alcohol or tobacco abuse or dependence did not have a confounding effect on the prolactin responses to d-fenfluramine. This study suggests that a blunted prolactin response to d-fenfluramine may be a consequence of combat exposure rather than PTSD. To confirm this, further studies involving both healthy and combat-exposed control groups in addition to subjects with PTSD of similar ages are required.

Research paper thumbnail of Posttraumatic Stress Disorder, Antipsychotic Use and Risk of Dementia in Veterans

Journal of the American Geriatrics Society, Jan 17, 2017

To examine the risk of dementia associated with posttraumatic stress disorder (PTSD) and the cont... more To examine the risk of dementia associated with posttraumatic stress disorder (PTSD) and the contribution of antipsychotic use to this risk. Retrospective cohort study SETTING: Australia. Administrative claims data from the Australian Government Department of Veterans' Affairs were used. Male Vietnam veterans aged 55 to 65 at baseline (2001-02) with no preexisting dementia diagnosis (N = 15,612). The association between PTSD and dementia was assessed over 12 years of follow-up. Dementia was identified as a hospital diagnosis, dementia record in service disability data, or dispensing of medicines for dementia. Cox-proportional hazards models were used, with age as the time-scale. Results were stratified according to baseline antipsychotic use. No greater risk of dementia was observed with PTSD. In veterans who received antipsychotics, dementia risk was significantly higher than in those who did not (hazard ratio (HR) = 2.1, 95% confidence interval (CI) = 1.4-3.3). Dementia risk w...

Research paper thumbnail of The modified dexamethasone suppression test (mDST) in chronic PTSD

European Neuropsychopharmacology, 1996

Research paper thumbnail of The relationship between the perception of social support and post-stroke depression in hospitalized patients

Psychiatry: …, 1991

APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...

Research paper thumbnail of Stress and dementia

International Psychogeriatrics, 2014

The causes of dementia continue to be the subject of huge research efforts, and post-traumatic st... more The causes of dementia continue to be the subject of huge research efforts, and post-traumatic stress disorder (PTSD) has recently gained attention as a possible contributor. PTSD is considered to be present if the sufferer develops persistent re-experiencing, avoidance and emotional numbing and symptoms of increased arousal not present before the sufferer was exposed to a traumatic incident. PTSD is now classified in DSM-5 as a trauma- and stressor-related disorder, unlike DSM-IV where it was previously categorized as an anxiety disorder, lending it more prominence now as a stress-related condition. However, it remains placed near the anxiety, obsessive compulsive and dissociative disorders in recognition of the close relationship with these other diagnoses. The nosology of PTSD is interesting as the symptoms can vary considerably. Some individuals with PTSD exhibit anxious or fear-based symptoms, while others can experience anhedonic, dysphoric, aggressive or dissociative symptoms...

Research paper thumbnail of Prevalence and course of depressive disorders in hospitalized stroke patients

The International Journal of …, Jan 1, 1990

In a sample of ninety-nine patients seen two months post-stroke, 18 percent were diagnosed as hav... more In a sample of ninety-nine patients seen two months post-stroke, 18 percent were diagnosed as having minor depression and 14 percent major depression. At follow-up, fifteen months later, the prevalence of depressive disorder had declined substantially, to 12 percent overall. Major depression was characterized by an average duration of thirty-nine weeks, a mortality rate of 23 percent and was associated with positive family history of affective or anxiety disorder. Among patients with left hemisphere lesions, major depression was associated with cognitive impairment. Minor depression had a shorter average duration (twelve weeks) and was more common in males. These two syndromes may define distinct types of post-stroke depression with implications for treatment interventions.

Research paper thumbnail of Association of depression with 10-year poststroke mortality

American Journal of …, Jan 1, 1993

Depression has been linked to higher than expected mortality from natural causes, particularly am... more Depression has been linked to higher than expected mortality from natural causes, particularly among elderly patients with physical illness. The authors examined the effect of depression on mortality among a group of stroke patients followed up for 10 years. A consecutive series of 103 patients was assessed for major or dysthymic (minor) depression approximately 2 weeks after stroke with the use of a structured mental status examination and DSM-III diagnostic criteria. Vital status was determined for 91 of these patients 10 years later. Forty-eight (53%) of the 91 patients had died. Patients with diagnoses of either major or minor depression were 3.4 times more likely to have died during the follow-up period than were nondepressed patients, and this relationship was independent of other measured risk factors such as age, sex, social class, type of stroke, lesion location, and level of social functioning. The mortality rate among depressed patients with few social contacts was especially high: over 90% had died. These results indicate that depressed mood following stroke is associated with an increased risk of subsequent mortality. Patients who are depressed and socially isolated seem to be particularly vulnerable.