Am J Psychiatry 1996; 153:248-255
Copyright © 1996 by American Psychiatric Association
Demographics, family history, premorbid functioning, developmental characteristics, and course of patients with deteriorated affective disorder
C Vocisano, DN Klein, RS Keefe, ER Dienst and MM Kincaid
California School of Professional Psychology, Berkeley/Alameda, USA.
OBJECTIVE: This exploratory study examined the characteristics of a group
of unusual and previously undescribed patients with major affective
disorder who not only had been continuously symptomatic for prolonged
periods of time but were also so functionally impaired that they required
years of continuous care in psychiatric facilities or by family members.
METHOD: Twenty-seven inpatients with major mood disorders and 29 inpatients
with schizophrenia were recruited from a large state hospital; 27
outpatients with major mood disorders were recruited from an affiliated
outpatient facility. The research battery included the Structured Clinical
Interview for DSM-III-R--Patient Version, the Premorbid Adjustment Scale,
and a semistructured interview designed to assess demographic, family
history, developmental, and course information. RESULTS: Inpatients with
deteriorated affective disorder differed from outpatients with
nondeteriorated affective disorder along several important dimensions,
including family history of mental illness, birth-related problems,
physical disorders in infancy, premorbid functioning, presence of mixed
episodes and rapid cycling, and medication non-compliance between
hospitalizations. Inpatients with deteriorated affective disorder differed
from inpatients with schizophrenia on the Premorbid Adjustment Scale.
Patients with bipolar affective disorder differed from those with unipolar
disorder on many of the variables associated with deterioration of
functioning. CONCLUSIONS: Birth-related problems, physical disorders in
infancy, and poor premorbid adjustment in childhood and adolescence appear
to play an important role in deterioration of functioning among patients
with unipolar depression. Disruption in treatment because of medication
noncompliance and the appearance of mixed episodes and rapid cycling are
associated with functional decline in bipolar affective disorder. Several
characteristics previously considered specific to deterioration of
functioning in schizophrenia, such as a high rate of birth complications
and poor premorbid adjustment, appear to be associated with functional
deterioration among patients with major depression as well.
