The impaired and disruptive physician: the Missouri Physicians' Health Program--an update (1995-2002).

Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians' Health Program has been established to help impaired physicians return to healthy personal and professional lives.

Substance abuse and dependence in physicians: the Missouri Physicians Health Program--an update (1995-2001).

Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians Health Program has been established to help impaired physicians return to healthy personal and professional lives.

Substance abuse and dependence in physicians: the Missouri Physicians' Health Program.

Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians' Health Program has been established to help impaired physicians return to healthy personal and professional lives.

The impaired physician, Part II: Missouri State Physicians Health Program.

Missouri Physicians Health Program (MPHP) was established to help impaired physicians return to healthy personal and professional lives. One percent of Missouri physicians will suffer some sort of impairment; ie: substance abuse, or dependency of drugs or alcohol within a year. This is a confidential voluntary program.

Substance abuse and dependence in physicians: an overview of the effects of alcohol and drug abuse.

Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. Early intervention followed by appropriate treatment can often help return physicians to healthy personal and professional lives. Current scientific evidence suggests the prevalence of substance abuse or dependence among the medical profession over a lifetime is approximately 10-15%, slightly in excess of the general population.

Specificity of mixed affective states: clinical comparison of dysphoric mania and agitated depression.

To investigate the clinical specificity of mixed affective states, we compared clinical characteristics of mixed (dysphoric) manics to those of agitated depressed patients. The subjects were inpatients studied in the NIMH Clinical Research Branch Collaborative Study on the Psychobiology of Depression, Biological Studies. Behavior and symptom ratings for depressive and manic symptoms were obtained during a 15-day placebo washout period.

Response to treatment with antidepressants of patients with severe or moderate nonpsychotic depression and of patients with psychotic depression.

Hospitalized patients were divided into nonpsychotic severely depressed (N = 53), nonpsychotic moderately depressed (N = 54), and psychotic depressed (N = 25) groups and treated with either imipramine or amitriptyline, up to 250 mg/day, for 4 weeks. Good response occurred in 39% of the 38 severely depressed, 67% of the 49 moderately depressed, and 32% of the 19 psychotic depressed patients who completed treatment. The response of the patients with nonpsychotic severe depression did not differ significantly from the response of those with psychotic depression, and both groups fared worse than the group with nonpsychotic moderate depression.

Stress, depression, and mania: relationship between perceived role of stressful events and clinical and biochemical characteristics.

We investigated the perceived role of stressful events in episodes of major affective disorder in patients studied in the NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression (Biological Studies). Using items from the Schedule for Affective Disorders and Schizophrenia (SADS), episodes were divided into environment-sensitive (high perceived role of stressful events) and autonomous (minimal or no perceived role of stressful events). Patients with environment-sensitive episodes had fewer previous episodes and a longer index episode.

Cortisol measures in primary major depressive disorder with hypersomnia or appetite increase.

Morning plasma cortisol response to the 1 mg dexamethasone suppression test along with cortisol levels in blood, cerebrospinal fluid (CSF), and urine were measured in hospitalized male and female patients with primary major depressive disorder who reported hypersomnia (n = 23), or increase in appetite (n = 22). Comparisons were drawn to cortisol levels in patients with primary major depressive disorder who did not report hypersomnia or appetite increase (n = 23) and to normal controls (n = 23), all age- and sex-matched. Depressives with hypersomnia or increased appetite showed higher than normal 24-h urinary free cortisol concentrations.

Sociodemographic and prior clinical course characteristics associated with treatment response in depressed patients.

A sociodemographic and clinical picture is presented of 82 depressed subjects who had an unequivocal response or lack of response to treatment with amitriptyline or imipramine. Patients with less severe depressive illness were found more likely to respond to treatment, while those with psychotic features were more likely to be treatment resistant. Sociodemographic and other prior and current clinical course variables were not predictive of treatment response in depressed patients.

The timing, specificity and clinical prediction of tricyclic drug effects in depression.

This research was aimed at studying the rate of action of tricyclic drugs in depressive disorders, specifying the behavioural effects associated with recovery, and predicting clinical response. The research design involved comparison of a recovered group with a group treated for the equivalent four weeks, who showed minimal to no response. The findings indicated significant differences in baseline characteristics between responders and non-responders.

Diagnosis and treatment of mixed mania.

In a study of 19 manic patients, the authors found that eight suffered from mixed mania, a condition in which depressive symptoms are found in the context of classic manic features. The presence of a mixed manic state predicted at least a slower and possibly a poor response to lithium therapy. The authors suggest that the delineation of a subgroup of mixed manic patients might help to identify potential lithium-resistant patients.

Mania. Diagnosis, state measurement and prediction of treatment response.

The phenomenology of the manic state and its response to lithium drug treatment were intensively studied as part of a larger NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression. In view of the weaknesses in current methods for measuring the components of the manic state, a new instrument was developed, the Manic Diagnostic and Severity Scale (MADS). Its sensitivity in diagnosis and in measuring change was compared to other scales already in use.

Association of alcoholism and antisocial personality in a narcotic-dependent population: the Lexington addicts.

Men with antisocial personality have a higher prevalence of alcoholism than men without. This relationship was examined in a narcotic-dependent sample, and it was found that narcotic-dependent men with antisocial personality had a rate of alcoholism comparable to that of narcotic-dependent men without antisocial personality. The methodological and clinical explanations for this finding are discussed along with the neurophysiological implications.

Psychiatric diagnosis and prediction of drug and alcohol dependence.

Some sociodemographic variables that have distinguished the future addict from the general population have not been found to predict outcome in those already dependent. This study demonstrates that a past history of specific psychiatric disorders is predictive of outcome in narcotic addicts. Future research should focus on interactions among past histories, past and present personality and motivation, and situational variables in the search for reliable clinical prognostic factors.

Is the major histocompatibility complex linked to genes that increase susceptibility to affective disorder? A critical appraisal.

The evidence implicating genes linked to the major histocompatibility complex in the pathogenesis of affective disorder is reviewed, and 10 new multiplex families containing 26 affected siblings are presented. It is shown that when the data are properly analyzed by not dismantling multiplex sibships into all possible sib pairs, no individual data set presents compelling evidence of linkage. The present study is also negative.

Psychiatric illness in male and female narcotic addicts.

This report describes the results of initial psychiatric interviews on 100 male and 100 female narcotic addicts who were matched by age, race, and geographic origin. The majority met criteria for antisocial personality whereas about one in four males and one in seven females met criteria for alcoholism. Between one-third and one-half of the subjects met criteria for secondary depression.

Behavioural measurement and drug response characteristics of unipolar and bipolar depression.

This research is part of the NIMH--CRB Collaborative Study on the psychobiology of depression. The main objective of the research programme is to test hypotheses concerning the interaction of neurobiological mechanisms and behaviour in the depressive disorders. Part I of the report describes the rationale and the overall approach to measuring behavioural state and outcome in the research programme.