Depressive Illness

Depressive Illness

PSYCHOSOMATICS tional psychometric instruments and appraisals which utilize projective techniques and self report questionnaires that lead to diagnost...

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PSYCHOSOMATICS tional psychometric instruments and appraisals which utilize projective techniques and self report questionnaires that lead to diagnostic labeling and personality trait analyses. Instead, emphasis is on specification of target responses, stimulus events, environmental contingencies, pertinent observable behavioral variables, the frequency or duration of specific behaviors, and "a wide range of historical, social, cognitive, and biological factors." Section VII introduces a relatively new domain, "behavior therapy in groups." Here, target behaviors are identified and modified among members who are homogeneous in their complaints. The focus is "behavior therapy in groups rather than through the group." Section VIII, "Clinical Studies and Case Reports," includes papers on anorexia nervosa and obesity; stuttering; nocturnal enuresis; asthma; bodily injury phobia; heroin addiction; tics; clinical abulia; and depression. Section IX, "Biofeedback and Other New Directions," includes an important paper by Neal Miller dealing with learned and physical factors in mental illness. The closing section reviews inexpensive equipment available to the behavioral clinician or researcher for use in the classroom, hospital and consulting office. It is clear that this volume deserves to be studied by every clinician who seeks to expand his knowledge and expertise in this area. The book will be equally useful to the research oriented clinician or the practitioner who wishes to become familiar with therapeutic techniques that exceed and complement systematic desensitization and the more traditional behavioral therapy strategies. LLOYD K. DANIELS, ED.D.. WEST HARTFORD. CONNECTICUT

DEPRESSIVE ILLNESS, edited by P. Kielholz, Basle, The Williams & Wilkins Company, Baltimore, Publishers, Copyright 1972 by Hans Huber Publishers Bern. Printed in Switzerland by Basler-Druck- und Verlagsansta/t, Bas/e. The proceedings of an International Symposium in SI. Moritz in January 1972 resulted in this 282 page book edited by P. Kielholz. It comprises a series of eight major papers on research in the field of depressive disorders including the biochemical (N. Matussek), genetic, (1. Angst), clinical (1.J. Lopez-Ibor), therapeutic (H. Hippius), methodological (K. Rickels and R.W. Downing) and related dimensions (rating scales, suicide, etc.). Following the overview on depression another series of papers are presented on a new tricyclic antidepressant compound called Ludiomil (maprotiline - Ciba 34.276 - Ba). Kielholz observes that during the last 15 years there has been an increasing tendency toward somatisation of depressive affect. Masked depressions and depressive equivalents are reviewed by J.J. Lopez-Ibor who explores the relationship between depression and somatic conditions such as thyrotoxicosis, rheumatoid arthritis, diabetes, lupus erythematosus, cardiac arrhythmias, various neuralgias and pain syndromes, paraesthesias and several other disorders. H. Hippius, in his paper on treatment, emphasizes the multifactorial etiology of the syndrome: "it is essential that somatotherapeutic, psychotherapeutic and sociotherapeutic factors should always be considered collectively and conjointly." He points out that the effect of antidepressant drugs may vary depending on: 1. Hereditary factors 2. Course of the disease 44

3. Configuration of the psychopathological syndrome (e.g. a drug may be effective only in retarded depression and not in agitated forms) 4. Sex of the patient In the studies presented at the Symposium, LudiomiJ does not differ significantly from imipramine or amitriptyline in its antidepressant activity. It deserves an intermediate place, like imipramine, between the two poles formed by anxiety reducing compounds (amitriptyline, thioridazine and levomepromazine) and the drive-enhancing compounds (drugs of the desmethyl-imipramine type). A. Coppen et al. examined the effect of lithium both in cases of unipolar as well as in bipolar manic-depressive patients, and they found that prophylactically it was effective in both groups. Matussek brought forward recent findings that Lithium salts (like MAO I and E C T) activates the metabolism of serotonin by raising the tryptophan content in the brain. N. Matussek traces the recent advances of the biochemistry of depression. Since 1959 when Everett and Toman first postulated that catecholamines and serotonin may play an important role in connection with depression a host of investigators made important contributions. The observation that reserpine and methyldopa are liable to precipitate depression and that MAO I and tricyclic thymoleptics have antidepressant properties launched a new era in the history of psychiatry. New evidence is accumulating to support the biochemical model of depression based on studies on the brain tissue of depressive patients obtained at autopsy, also of levels of 5 hydroxy-indoleacetic acid, homovanillic acid and methoxyhydroxy-phenyl-glycol levels in the e.S.F. of depressive patients. In longitudinal studies (Bunney et a\) found an increase in the urinary concentration of noradrenaline to occur on the day preceding the onset of mania. whereas no changes were detected in the concentration of dopamine. methoxyhydroxy-phenyl-glycol or 5 H I A A measured in the urine.

J. Angst distinguished bipolar psychosis, endogenous (recurrent) depression, and depression of late onset (involutional melancholia) on various parameters although the latter two constitute a continuum of purely depressive psychosis. His statistical material showed that endogenous depression in contrast to manic depressive diseases-is at least twice as frequent in women as in men. Fourteen and a half per cent of close relatives were alcoholics in the families of endogenous depressives as compared with 8.7% in the families of manic depressives. The risk for suicide is greatest in the case of manic depressive psychoses and schizoaffective diseases. The studies presented by P. Pichot on quantification of depressive symptoms, by K. Rickels and R.W. Downing on methodology of drug research and by M. Hamilton on Rating scales are noteworthy. Rickels and Downing look at the endogenous versus reactive dicholony, the Overall and Hollister typology and the outcome-related typologies based on differential treatment response (Lubin). The non-specific factors in drug response may be contributing to patient heterogeneity. It is a highly recommended book for its clarity and its phenomenological and clinical foundations. Controversial areas are not tackled such as the relationship between depression and synthetic oestrogens, the role of pyridoxine, folic acid, B-12 and megavitamin therapy.

H.

WARNES, M.D. MONTREAL

Volume XVI