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A seasonal and circadian study of suicide over a 10-year period in the Seattle area
THURSDAY, MAY 18
BIOL PSYCHIATRY 1995;37:593-683
reduction of REM % (17 + 2, 15 +_5, respectively) when compared with Dex0 (20 + 5). There was no effect of Dex on the latency to REM, number of REM period or REM activity. A significant main effect of Dex was shown on the mean MSLT (p < 0.01). Dex I and Dex2 resulted in an increased level of alertness (14.9 _+ 2.8 and 15.7 _+ 1.8) when compared to Dex0 (12.2 _+ 3.6) The suppression of the HPA axis, by the exogenous administration of corticosteroids, resulted in an increased level of alertness. Whether this was the result of REM suppression, as shown in REM deprivation studies, or due to a direct effect on the mechanisms that control alertness remains to be elucidated.
61 t
(8.7%) subjects had a lifetime history of BDD. Those with comorbid BDD had an earlier age of onset of depression, with longer durations of the current episode but without a greater number of episodes or greater severity of depression. Both groups were similar with respect to age, gender, and marital status. Those with atypical depression had a higher proportion with BDD than nonatypical depression (I 5.5% compared to 5.5%; p - 0.024). We also found that subjects with BDD had higher proportions of anxiety and personality disorders but not obsessive-compulsive or eating disorders. We conclude that BDD is frequently comorbid with major depression, is associated with an earlier age of onset of depression and longer duration of episodes, and is found more frequently with atypical depression.
68. A SEASONAL AND CIRCADIAN STUDY OF SUICIDE OVER A 10-YEAR PERIOD IN THE SEATTLE AREA
70. THE EFFECT OF NORTRIPTYLINE ON VERBAL RECALL
D.H. Avery, D. Eder, A. Kazaras, M.A. Bolte, & D.T. Reay
N. Pomara 1,2, K. Nolan 1;2, D. Deptula, E. Peselow 2, & T.B. Cooper 1
Harborview Medical Center, D e p a r t m e n t o f Psychiatry and Behavioral Sciences, University of W a s h i n g t o n , Seattle, WA 9 8 1 0 4
1Nathan S. Kline Institute, O r a n g e b u r g , N Y 10962; 2New York University School o f M e d i c i n e , N e w York, N Y
Suicide has been shown to have a seasonal pattern, with most studies showing a peak suicide rate in April, May, or June; however, the relation to weather variables has rarely been studied, and certain types of major depression (the major cause of suicide) have seasonal patterns, such as a fall-winter pattern, may be very prevalent in cloudy environments such as Seattle. The King County Medical Examiner's database was used to study the 2052 suicides in the county over the years 1984-1993. The analysis of the circadian data show a bimodal distribution, with peaks at 4:00 AM to 6:00 AM and from 4:00 PM tO 6:00 PM The analysis found no dominant single seasonal peak for the data with three peaks being prominent at the following months: March-April, July, and October. Marked year-to-year variability in the seasonal pattem exists. The lack of a clear seasonal pattern has several possible interpretations including changing weather patterns. We will use autocorrelation to explore the possible relationships between changes in meteorological variables such as cloud cover, temperature, and barometric pressure and the suicide rates. We will also explore the influence of age, sex, method of suicide, and time of day of suicide on the seasonality of suicide. .
69. BODY DYSMORPHIC DISORDER IS COMORBID WITH MAJOR DEPRESSION A.A. Nierenberg 1'2, K.A. Phillips 3, L.A. Uebelacker I, J.E. Alpert 1,2, J.J. Worthington t'2, & M. Fava 1,2 1Massachusetts General Hospital, Boston, M A 02114; 2Harvard Medical School, Boston, M A 02115; 3Department of Psychiatry, Brown University, Providence, RI 0 2 9 0 6 Body dysmorphic disorder (BDD) is a preoccupation with imagined or slight defects in appearance that has been found by our group to occur as a comorbid condition in 13.8% of patients with atypical depression. The purpose of this study was to evaluate the prevalence of BDD in a separate cohort of patients with typical and atypical major depressive disorder. One-hundred seventy-two consecutive outpatient subjects with major depression who entered into a study of fluoxetine adjuncts were evaluated drug-free with the SCID-P and a diagnostic module for BDD. Depressed subjects with comorbid BDD were compared to those without BDD with regard to demographics, depressive course, and other relevant measures. Unpaired t tests and chi square statistics were used as appropriate. Fifteen
Nortriptyline (NT) is one of the first-generation tricyclic antidepressants that is still widely used in the treatment of depression in the elderly because of its lower tendency to produce anticholinergic side effects and orthostatie hypotension. In spite of this relatively favorable side effects profile, some reports suggest that NT may produce cognitive toxicity in the elderly; however, surprisingly little systematic research supports this view. With this in mind, our group sought to evaluate the effects of NT on a variety of cognitive and psychomotor tasks. For the purposes of this report, we will focus on Buschke Total Recall. Seventy-eight patients (age range 21-81, mean age 49.95) who met RDC and DSM-III criteria for major depression (mean Hamilton score 20.82) voluntarily agreed to participate in a 6-week, double-blind lrial whereby they received either NT or placebo (PBO) following a 1 week, single-blind placebo. At each weekly visit, the patient received a comprehensive neuropsychological battery that included the Buschke Selective Reminding Task (BSRT). In addition, at baseline the patient was acutely challenged with the medication to which he was randomized (either PBO or 50 mg NT), and the neuropsychological battery including the BSRT was repeated at 1.5 and 4 hr. All patients received another acute challenge (either placebo or 50 mg NT) after 6 weeks of chronic treatment. Doses of NT were adjusted weekly to maintain therapeutic plasma levels. Data were analyzed by an analysis of variance with age group (young vs. old 55 was the cutoff) and drug status (drug vs. PBO) as the between-subject factors and time of assessment (weekly for the chronic effect and 1.5 and 4 hr for the acute effect) as the within-subject factor. In view of the effect of depression on memory, we used the weekly Hamilton depression score as a covariate. The results indicated that there was no statistically significant difference between the NT (mean plasma level 87.94 ng/ml at week 6) vs. PBO group with respect to the chronic effects on total recall. There was also no difference between NT vs. PBO with respect to Buschke Total Recall after acute challenge at baseline and after acute rechallenge following 6 weeks chronic treatment with either NT or PBO.
71. EFFICACY OF CLINICAL MANAGEMENT Vs. DRUG TREATMEMT IN DEPRESSION
U.F. Malt l, O.H. Robak, H-P. Madsbu, O. Bakke, M. Loeb, & T. Smedsrud 2 1U n i v e r s i t y o f Oslo, D e p a r t m e n t g r o u p o f P s y c h i a t r y , the National Hospital, Oslo, Norway;2Pfizer N o r w a y , Lysaker, N o r w a y
BIOL PSYCHIATRY 1995;37:593-683
reduction of REM % (17 + 2, 15 +_5, respectively) when compared with Dex0 (20 + 5). There was no effect of Dex on the latency to REM, number of REM period or REM activity. A significant main effect of Dex was shown on the mean MSLT (p < 0.01). Dex I and Dex2 resulted in an increased level of alertness (14.9 _+ 2.8 and 15.7 _+ 1.8) when compared to Dex0 (12.2 _+ 3.6) The suppression of the HPA axis, by the exogenous administration of corticosteroids, resulted in an increased level of alertness. Whether this was the result of REM suppression, as shown in REM deprivation studies, or due to a direct effect on the mechanisms that control alertness remains to be elucidated.
61 t
(8.7%) subjects had a lifetime history of BDD. Those with comorbid BDD had an earlier age of onset of depression, with longer durations of the current episode but without a greater number of episodes or greater severity of depression. Both groups were similar with respect to age, gender, and marital status. Those with atypical depression had a higher proportion with BDD than nonatypical depression (I 5.5% compared to 5.5%; p - 0.024). We also found that subjects with BDD had higher proportions of anxiety and personality disorders but not obsessive-compulsive or eating disorders. We conclude that BDD is frequently comorbid with major depression, is associated with an earlier age of onset of depression and longer duration of episodes, and is found more frequently with atypical depression.
68. A SEASONAL AND CIRCADIAN STUDY OF SUICIDE OVER A 10-YEAR PERIOD IN THE SEATTLE AREA
70. THE EFFECT OF NORTRIPTYLINE ON VERBAL RECALL
D.H. Avery, D. Eder, A. Kazaras, M.A. Bolte, & D.T. Reay
N. Pomara 1,2, K. Nolan 1;2, D. Deptula, E. Peselow 2, & T.B. Cooper 1
Harborview Medical Center, D e p a r t m e n t o f Psychiatry and Behavioral Sciences, University of W a s h i n g t o n , Seattle, WA 9 8 1 0 4
1Nathan S. Kline Institute, O r a n g e b u r g , N Y 10962; 2New York University School o f M e d i c i n e , N e w York, N Y
Suicide has been shown to have a seasonal pattern, with most studies showing a peak suicide rate in April, May, or June; however, the relation to weather variables has rarely been studied, and certain types of major depression (the major cause of suicide) have seasonal patterns, such as a fall-winter pattern, may be very prevalent in cloudy environments such as Seattle. The King County Medical Examiner's database was used to study the 2052 suicides in the county over the years 1984-1993. The analysis of the circadian data show a bimodal distribution, with peaks at 4:00 AM to 6:00 AM and from 4:00 PM tO 6:00 PM The analysis found no dominant single seasonal peak for the data with three peaks being prominent at the following months: March-April, July, and October. Marked year-to-year variability in the seasonal pattem exists. The lack of a clear seasonal pattern has several possible interpretations including changing weather patterns. We will use autocorrelation to explore the possible relationships between changes in meteorological variables such as cloud cover, temperature, and barometric pressure and the suicide rates. We will also explore the influence of age, sex, method of suicide, and time of day of suicide on the seasonality of suicide. .
69. BODY DYSMORPHIC DISORDER IS COMORBID WITH MAJOR DEPRESSION A.A. Nierenberg 1'2, K.A. Phillips 3, L.A. Uebelacker I, J.E. Alpert 1,2, J.J. Worthington t'2, & M. Fava 1,2 1Massachusetts General Hospital, Boston, M A 02114; 2Harvard Medical School, Boston, M A 02115; 3Department of Psychiatry, Brown University, Providence, RI 0 2 9 0 6 Body dysmorphic disorder (BDD) is a preoccupation with imagined or slight defects in appearance that has been found by our group to occur as a comorbid condition in 13.8% of patients with atypical depression. The purpose of this study was to evaluate the prevalence of BDD in a separate cohort of patients with typical and atypical major depressive disorder. One-hundred seventy-two consecutive outpatient subjects with major depression who entered into a study of fluoxetine adjuncts were evaluated drug-free with the SCID-P and a diagnostic module for BDD. Depressed subjects with comorbid BDD were compared to those without BDD with regard to demographics, depressive course, and other relevant measures. Unpaired t tests and chi square statistics were used as appropriate. Fifteen
Nortriptyline (NT) is one of the first-generation tricyclic antidepressants that is still widely used in the treatment of depression in the elderly because of its lower tendency to produce anticholinergic side effects and orthostatie hypotension. In spite of this relatively favorable side effects profile, some reports suggest that NT may produce cognitive toxicity in the elderly; however, surprisingly little systematic research supports this view. With this in mind, our group sought to evaluate the effects of NT on a variety of cognitive and psychomotor tasks. For the purposes of this report, we will focus on Buschke Total Recall. Seventy-eight patients (age range 21-81, mean age 49.95) who met RDC and DSM-III criteria for major depression (mean Hamilton score 20.82) voluntarily agreed to participate in a 6-week, double-blind lrial whereby they received either NT or placebo (PBO) following a 1 week, single-blind placebo. At each weekly visit, the patient received a comprehensive neuropsychological battery that included the Buschke Selective Reminding Task (BSRT). In addition, at baseline the patient was acutely challenged with the medication to which he was randomized (either PBO or 50 mg NT), and the neuropsychological battery including the BSRT was repeated at 1.5 and 4 hr. All patients received another acute challenge (either placebo or 50 mg NT) after 6 weeks of chronic treatment. Doses of NT were adjusted weekly to maintain therapeutic plasma levels. Data were analyzed by an analysis of variance with age group (young vs. old 55 was the cutoff) and drug status (drug vs. PBO) as the between-subject factors and time of assessment (weekly for the chronic effect and 1.5 and 4 hr for the acute effect) as the within-subject factor. In view of the effect of depression on memory, we used the weekly Hamilton depression score as a covariate. The results indicated that there was no statistically significant difference between the NT (mean plasma level 87.94 ng/ml at week 6) vs. PBO group with respect to the chronic effects on total recall. There was also no difference between NT vs. PBO with respect to Buschke Total Recall after acute challenge at baseline and after acute rechallenge following 6 weeks chronic treatment with either NT or PBO.
71. EFFICACY OF CLINICAL MANAGEMENT Vs. DRUG TREATMEMT IN DEPRESSION
U.F. Malt l, O.H. Robak, H-P. Madsbu, O. Bakke, M. Loeb, & T. Smedsrud 2 1U n i v e r s i t y o f Oslo, D e p a r t m e n t g r o u p o f P s y c h i a t r y , the National Hospital, Oslo, Norway;2Pfizer N o r w a y , Lysaker, N o r w a y