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Substance abuse may be present in up to 19% of this sample and contribute to high rates of depression. There may be greater risk of harm due to substance abuse in people with MS because of the potential magnification of motor and cognitive impairments. Comprehensive MS care should include substance abuse screening and advice to cut down or abstain.

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The relationship between perceived criticism from one’s relative and attributions about that relative’s behavior was examined in two studies. In Study 1, 50 community couples volunteered to participate in a study of marital interaction. Participants rated their interaction-specific perceived criticism after a 10-min problem-solving interaction and their attributions for their spouses’ behavior during a review of the videotaped interaction. In Study 2, 70 outpatients with obsessive-compulsive disorder (n = 41) or panic disorder with agoraphobia (n = 29) completed a measure of global perceived criticism in their relationship with their spouse or other family member and on another occasion participated in a 10-min problem-solving interaction with that relative. Using interaction transcripts, coders extracted and coded attributions from patients’ speech and, using the videotapes themselves, rated relatives’ observable criticism. In both studies higher scores on negative attributions were related to higher perceived criticism ratings. In Study 2, negative attributions contributed to the prediction of perceived criticism above and beyond the contribution of observed criticism. These findings suggest that targeting attributions about perceived criticism may be fruitful in reducing the negative impact of perceived criticism on treatment outcome for a variety of psychiatric disorders.

In this paper we describe the use of systematic retrospective and prospective life chart methodology and document the substantial morbidity experienced even in closely monitored and aggressively treated bipolar patients rated on a daily basis for 1 year. 35 BP I (n = 26) and BP II (n = 9) patients were recruited for an ongoing treatment study comparing the prophylactic effects of lithium or carbamazepine for 1 year with a crossover to the other drug in the second year, and a third year on the combination of the two. Adjuncts such as antidepressants and neuroleptics were allowed in each phase when clinically required. The results of the combined cohort for the first year are presented in this manuscript. All patients also had a retrospective life chart completed to map affective episodes based on the degree of functional incapacity (mild, moderate, severe). For prospective ratings patients were usually interviewed biweekly (but at a minimum of every 4 weeks), and daily ratings integrating degree of functional incapacity and self‐rated mood based on the Life Chart Method and Manual (the NIMH‐LCM) were obtained. In the first year of treatment 12 patients (34.3%) had to have their treatment phase (lithium or carbamazepine) discontinued far the fallowing reasons: jive were hospitalized, five had severe dysfunction without hospitalization, and two had treatment‐limiting side effects. Adjunctive treatment was required by 71.4%. The mean number of days ill for each level of severity for all the patients was as follows (in days): 66.1, mild depression; 31.1, moderate depression; 2.8, severe depression; and 28.7, mild mania; 5.4, moderate mania; 0.9, severe mania; or a mean of 40.2 d/year with moderate to severe illness‐related dysfunction. The duration of illness prior to study entry correlated with time depressed in the prospective year. These findings suggest that closely‐monitored bipolar patients followed with prospective daily ratings during treatment with a primary mood stabilizer (carbamazepine or lithium) experience a substantial degree of morbidity and the need far adjunctive antidepressants and neuroleptics. There was notable continuity between course of illness life charted in the retrospective year and that observed prospectively. Depression 2:95–104 (1994). ©1994 Wiley‐Liss, Inc.

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