CNCS Center for Nonlinear and Complex Systems
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Andrew D. Krystal, Professor Emeritus of Psychiatry and Behavioral Sciences and CNCS: Center for nonlinear and complex systems and Member of Duke Clinical Research Institute

Andrew D. Krystal

My research is focused on better understanding the pathophysiology of sleep disorders and mood disorders and developing improved treatments for these conditions. My primary research tools are: electroencepahlography (EEG), polysomnography (PSG), computer signal analysis and modeling, functional magnetic resonance imaging (fMRI), and positron emission tomograophy (PET). Nearly all of my projects have been carried out with humans, however, projects are ongoing with gene knock-out models in mice, and lemurs in collaboration with the Duke Primate Center. A few representative current studies are: 1) Defining physiologic (EEG, PSG, PET, fMRI) correlates of sleep complaints and subtyping insomnia on the basis of the associated pathophysiology, 2) Studying the relationship of EEG data recorded during non-REM sleep, daytime function, and insomnia treatment response, 3) Developing new pharmacologic and non-pharmacologic treatments for insomnia, 4) Studying the relationship of natural sleep and hibernation-like phenomena (torpor), 5) Predicting depression treatment response on the basis of pre-treatment EEG and structural MRI data.

Contact Info:
Office Location:  54221 Hosp South, Durham, NC 27710
Office Phone:  (919) 681-8742
Email Address: send me a message
Web Page:  http://faculty.duhs.duke.edu/faculty/info?pid=1061

Education:

M.D.Duke University1987
Research Interests:

My research is focused on better understanding the pathophysiology of sleep disorders and mood disorders and developing improved treatments for these conditions. My primary research tools are: electroencepahlography (EEG), polysomnography (PSG), computer signal analysis and modeling, functional magnetic resonance imaging (fMRI), and positron emission tomograophy (PET). Nearly all of my projects have been carried out with humans, however, projects are ongoing with gene knock-out models in mice, and lemurs in collaboration with the Duke Primate Center. A few representative current studies are: 1) Defining physiologic (EEG, PSG, PET, fMRI) correlates of sleep complaints and subtyping insomnia on the basis of the associated pathophysiology, 2) Studying the relationship of EEG data recorded during non-REM sleep, daytime function, and insomnia treatment response, 3) Developing new pharmacologic and non-pharmacologic treatments for insomnia, 4) Studying the relationship of natural sleep and hibernation-like phenomena (torpor), 5) Predicting depression treatment response on the basis of pre-treatment EEG and structural MRI data.

Keywords:

Activities of Daily Living • Adolescent • Adult • Adverse Drug Reaction Reporting Systems • Affect • Age Factors • Aged • Aged, 80 and over • Alcoholism • Algorithms • Alleles • Ambulatory Care • Amnesia • Analysis of Variance • Anesthesia, General • Anesthesia, Intravenous • Animal Experimentation • Animal Rights • Animals • Anti-Anxiety Agents • Anti-Anxiety Agents, Benzodiazepine • Antidepressive Agents • Antidepressive Agents, Tricyclic • Antipsychotic Agents • Anxiety • Anxiety Disorders • Apathy • Area Under Curve • Arousal • Arthroplasty, Replacement, Knee • Attention • Attitude of Health Personnel • Attitude to Health • Australia • Autism spectrum disorders • Azabicyclo Compounds • Azepines • Behavior Therapy • Behavior, Addictive • Benzodiazepines • Biological Markers • Biomedical Research • Bipolar Disorder • Body Mass Index • Body Temperature • Brain • Brain Diseases • Brain Mapping • Brain stimulation • Canada • Caregivers • Case-Control Studies • Cerebral Cortex • Chi-Square Distribution • Child • Child Development Disorders, Pervasive • Chronic Disease • Chronobiology Disorders • Circadian Rhythm • Climacteric • Clinical Trials as Topic • Cluster Analysis • Cognition Disorders • Cognitive Therapy • Cohort Studies • Combined Modality Therapy • Comorbidity • Computer Simulation • Consensus • Controlled Clinical Trials as Topic • Cost of Illness • Crime • Cross-Sectional Studies • Cues • Culture • Delayed-Action Preparations • Delirium • Delirium, Dementia, Amnestic, Cognitive Disorders • Demography • Depression • Depressive Disorder • Depressive Disorder, Major • Diagnosis, Computer-Assisted • Diagnosis, Differential • Diagnostic and Statistical Manual of Mental Disorders • Diagnostic Errors • Differential Threshold • Disease Models, Animal • Disease Susceptibility • Disorders of Excessive Somnolence • Dominance, Cerebral • Dose-Response Relationship, Drug • Dose-Response Relationship, Radiation • Double-Blind Method • Doxepin • Drug Administration Schedule • Drug Approval • Drug Delivery Systems • Drug Design • Drug Resistance • Drug Synergism • Drug Therapy • Drug Therapy, Combination • Drug Tolerance • Eating • Electric Stimulation • Electrocardiography • Electroconvulsive Therapy • Electrodes • Electroencephalography • Electromagnetic Fields • Empiricism • Ethanol • Ethics, Research • Evidence-Based Medicine • Evoked Potentials • Exanthema • Excitatory Amino Acid Antagonists • Factor Analysis, Statistical • Family Health • Fatigue • Female • Fibromyalgia • Flumazenil • Focus Groups • Follow-Up Studies • Fourier Analysis • Fractals • Frontal Lobe • Functional Laterality • GABA Modulators • gamma-Aminobutyric Acid • Genotype • Geriatric Assessment • Health Promotion • Health Records, Personal • Health Status • Histamine • Histamine H1 Antagonists • HIV Infections • Homeostasis • Humans • Hypnotics and Sedatives • Incidence • Insomnia • International Classification of Diseases • Interview, Psychological • Interviews as Topic • Intracellular Signaling Peptides and Proteins • Kaplan-Meier Estimate • Ketamine • Long-Term Care • Male • Medical Records • Melatonin • Menstruation Disturbances • Mental Disorders • Meta-Analysis as Topic • Methohexital • Middle Aged • Models, Biological • Models, Neurological • Models, Statistical • Monitoring, Physiologic • Monoamine Oxidase • Motivation • Multivariate Analysis • Mutation • Myography • Neoplasms • Nerve Growth Factors • Nerve Net • Nerve Tissue Proteins • Neurobiology • Neuroimaging • Neuroleptic Malignant Syndrome • Neurons • Neuropeptides • Neuropsychological Tests • Neurotransmitter Agents • Nipecotic Acids • Nonlinear Dynamics • Obesity • Observer Variation • Orientation • Outpatients • Oxidative Stress • Oxygen • Pain • Pain Management • Patient Compliance • Patient Satisfaction • Patient Selection • Personality Inventory • Physician's Practice Patterns • Pilot Projects • Piperazines • Placebos • Polymorphism, Genetic • Polysomnography • Post-traumatic stress disorder • Postoperative Complications • Practice Guidelines • Predictive Value of Tests • Prefrontal Cortex • Pregnancy • Premedication • Prevalence • Primates • Prognosis • Promoter Regions, Genetic • Prospective Studies • Psychiatric Status Rating Scales • Psychomotor Performance • Psychopharmacology • Psychotic Disorders • Pyridines • Quality of Life • Questionnaires • Randomized Controlled Trials as Topic • Reaction Time • Receptors, GABA-A • Receptors, Histamine • Recurrence • Reference Values • Regression Analysis • Reproducibility of Results • Research Design • Research Personnel • Retrospective Studies • Rhabdomyolysis • Riluzole • Risk • Risk Assessment • ROC Curve • Schizophrenia • Schizophrenic Psychology • Seizures • Self Report • Sensitivity and Specificity • Sensory Thresholds • Serotonin • Serotonin Plasma Membrane Transport Proteins • Severity of Illness Index • Sex Distribution • Signal Processing, Computer-Assisted • Single-Blind Method • Sleep • Sleep Apnea Syndromes • Sleep Apnea, Obstructive • Sleep Disorders • Sleep Disorders, Circadian Rhythm • Sleep Initiation and Maintenance Disorders • Sleep Stages • Sleep, REM • Sleepiness • Smoking • Social Adjustment • Stochastic Processes • Stress, Psychological • Substance Withdrawal Syndrome • Substance-Related Disorders • Suprachiasmatic Nucleus • Surgical Procedures, Elective • Synapses • Tandem Repeat Sequences • Terrorism • Time Factors • Tobacco Use Disorder • Transcranial Magnetic Stimulation • Transcutaneous Electric Nerve Stimulation • Translational Medical Research • Treatment Outcome • Triazines • United States • United States Food and Drug Administration • Urinary Bladder • Veterans • Wakefulness • Women's Health • Work Capacity Evaluation • Work Schedule Tolerance • Young Adult

Representative Publications   (More Publications)

  1. Singh, J; Zarate, CA; Krystal, AD, Case report: Successful riluzole augmentation therapy in treatment-resistant bipolar depression following the development of rash with lamotrigine., Psychopharmacology, vol. 173 no. 1-2 (April, 2004), pp. 227-228, ISSN 0033-3158 [14722708], [doi]
  2. Ancoli-Israel, S; Benca, RM; Edinger, JD; Krystal, AD; Mendelson, W; Moldofsky, H; Petrie, J; Roth, T; Walsh, JK; Winkelman, J; Special Issues Board Panel Members,, Panel discussion: changing how we think about insomnia., The Journal of Clinical Psychiatry, vol. 65 Suppl 8 (2004), pp. 44-46, ISSN 0160-6689 [15153067]
  3. Krystal, AD, The changing perspective on chronic insomnia management., The Journal of Clinical Psychiatry, vol. 65 Suppl 8 (2004), pp. 20-25, ISSN 0160-6689 [15153064]  [abs]
  4. Krystal, AD; Walsh, JK; Laska, E; Caron, J; Amato, DA; Wessel, TC; Roth, T, Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia., Sleep, vol. 26 no. 7 (November, 2003), pp. 793-799, ISSN 0161-8105 [14655910], [doi]  [abs]
  5. Edinger, JD; Krystal, AD, Subtyping primary insomnia: is sleep state misperception a distinct clinical entity?, Sleep Medicine Reviews, vol. 7 no. 3 (June, 2003), pp. 203-214, ISSN 1087-0792 [12927120], [doi]  [abs]
  6. Krystal, AD, Insomnia in women., Clinical Cornerstone, vol. 5 no. 3 (2003), pp. 41-50, ISSN 1098-3597 [14626540], [doi]  [abs]
  7. Krystal, AD; Weiner, RD; Dean, MD; Lindahl, VH; Tramontozzi, LA; Falcone, G; Coffey, CE, Comparison of seizure duration, ictal EEG, and cognitive effects of ketamine and methohexital anesthesia with ECT., The Journal of Neuropsychiatry and Clinical Neurosciences, vol. 15 no. 1 (2003), pp. 27-34, ISSN 0895-0172 [12556568], [doi]  [abs]
  8. Krystal, AD; Edinger, JD; Wohlgemuth, WK; Marsh, GR, NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes., Sleep, vol. 25 no. 6 (September, 2002), pp. 630-640, ISSN 0161-8105 [12224842]  [abs]
  9. Prado R, West M, Krystal AD  Multichannel electroencephalographic analyses via dynamic regression models with time-varying lag-lead structure J. Royal Statistical Society C-APP Part I. 2001;50: 95-109.
  10. Krystal, AD; Holsinger, T; Weiner, RD; Coffey, CE, Prediction of the utility of a switch from unilateral to bilateral ECT in the elderly using treatment 2 ictal EEG indices., The Journal of Ect, vol. 16 no. 4 (December, 2000), pp. 327-337, ISSN 1095-0680 [11314870], [doi]  [abs]
  11. KRYSTAL, A, The development and retrospective testing of an electroencephalographic seizure quality-based stimulus dosing paradigm with ECT, J. Ect, vol. 16 no. 4 (2000), pp. 338-349, ISSN 1095-0680 [11314871], [doi]  [abs]
  12. Krystal, AD; Dean, MD; Weiner, RD; Tramontozzi, LA; Connor, KM; Lindahl, VH; Massie, RW, ECT stimulus intensity: are present ECT devices too limited?, The American Journal of Psychiatry, vol. 157 no. 6 (June, 2000), pp. 963-967, ISSN 0002-953X [10831477], [doi]  [abs]
  13. Krystal, AD; West, M; Prado, R; Greenside, H; Zoldi, S; Weiner, RD, EEG effects of ECT: implications for rTMS., Depression and Anxiety, vol. 12 no. 3 (2000), pp. 157-165, ISSN 1091-4269 [11126190], [doi]  [abs]
  14. Zoldi, SM; Krystal, A; Greenside, HS, Stationarity and redundancy of multichannel EEG data recorded during generalized tonic-clonic seizures., Brain Topography, vol. 12 no. 3 (2000), pp. 187-200, ISSN 0896-0267 [10791682], [doi]  [abs]
  15. Krystal, AD; Prado, R; West, M, New methods of time series analysis of non-stationary EEG data: eigenstructure decompositions of time varying autoregressions., Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology, vol. 110 no. 12 (December, 1999), pp. 2197-2206, ISSN 1388-2457 [10616127], [doi]  [abs]
  16. Asnis, GM; Chakraburtty, A; DuBoff, EA; Krystal, A; Londborg, PD; Rosenberg, R; Roth-Schechter, B; Scharf, MB; Walsh, JK, Zolpidem for persistent insomnia in SSRI-treated depressed patients., The Journal of Clinical Psychiatry, vol. 60 no. 10 (October, 1999), pp. 668-676, ISSN 0160-6689 [10549683]  [abs]
  17. Krystal, AD; Weiner, RD, EEG correlates of the response to ECT: a possible antidepressant role of brain-derived neurotrophic factor., The Journal of Ect, vol. 15 no. 1 (March, 1999), pp. 27-38, ISSN 1095-0680 [10189617]  [abs]
  18. West, M. Prado, R. and Krystal, A.  Evaluation and comparison of EEG traces: Latent structure in non-staionary time series.  Journal of the American Statistical Association, 94:375-387, 1999.
  19. Krystal, AD; Greenside, HS, Low-dimensional chaos in bipolar disorder?, Archives of General Psychiatry, vol. 55 no. 3 (March, 1998), pp. 275-276, ISSN 0003-990X [9510223], [doi]
  20. Krystal, AD; Watts, BV; Weiner, RD; Moore, S; Steffens, DC; Lindahl, V, The use of flumazenil in the anxious and benzodiazepine-dependent ECT patient., The Journal of Ect, vol. 14 no. 1 (March, 1998), pp. 5-14, ISSN 1095-0680 [9661088]  [abs]
  21. Krystal AD. The clinical utility of ictal EEG seizure adequacy models. Psychiatric Annals 1:30- 35, 1998.
  22. Krystal, A.D., (member of the U.S. Modafinil in Narcolepsy Study Group). HLA-DQB1*0602 homozygosity increases relative risk for narcolepsy but not disease severity in two ethnic groups. Tissue Antigens 51:96-100, 1998.
  23. Krystal, A.D., (member of the U.S. Modafinil in Narcolepsy Study Group). Randomized trial of modafinil for the treatment of pathological somnolence in narcolepsy. Annals of Neurology 43:88-97, 1998.
  24. Krystal, A.D., Edinger, J., Wohlgemuth, W., Marsh, G.R. Sleep in peri-menopausal and post- menopausal women. Sleep Medicine Reviews, 2:243-253, 1998.
  25. Krystal, A.D., Zoldi, S., Greenside, H., Prado, R., West, M., Weiner, R. The effects of ECT on the EEG: implicatons for rTMS. Progress in Neuro-Psychopharmacology & Biological Psychiatry, in press.
  26. Krystal, AD; Coffey, CE; Weiner, RD; Holsinger, T, Changes in seizure threshold over the course of electroconvulsive therapy affect therapeutic response and are detected by ictal EEG ratings., The Journal of Neuropsychiatry and Clinical Neurosciences, vol. 10 no. 2 (1998), pp. 178-186, ISSN 0895-0172 [9608406], [doi]  [abs]
  27. Krystal, AD; Zaidman, C; Greenside, HS; Weiner, RD; Coffey, CE, The largest Lyapunov exponent of the EEG during ECT seizures as a measure of ECT seizure adequacy., Electroencephalography and Clinical Neurophysiology, vol. 103 no. 6 (December, 1997), pp. 599-606, ISSN 0013-4694 [9546486], [doi]  [abs]
  28. Edinger, J.D., Fins, A.I., Goeke, J.M., McMillan, D.K., Gersh, T.L., Krystal, A.D., McCall, W.V. The empirical identification of insomnia subtypes: A cluster analytic approach. Sleep (in press).
  29. Krystal, A.D. The clinical utility of ictal EEG seizure adequacy models. Psychiatric Annals, 1:30-35, 1998.
  30. Krystal, A.D., Coffey, C.E. Neuropsychiatric considerations in the use of Electroconvulsive Therapy. Journal of Neuropsychiatry and Clinical Neurosciences 9:283-292, 1997.
  31. Krystal, A.D., Greenside, H.S. Low Dimensional Chaos in Bipolar Disorders? (Letter to the Editor) Arch. Gen. Psychiatry (in press).
  32. Krystal, A.D., Zaidman, C., Greenside, H.S., Weiner, R.D., Coffey, C.E. The largest Lyapunov exponent of the EEG during ECT seizures as a measure of therapeutic adequacy. Electroencephalography and Clinical Neurophysiology 103:599-606, 1997.
  33. Krystal, AD; Coffey, CE, Neuropsychiatric considerations in the use of electroconvulsive therapy., The Journal of Neuropsychiatry and Clinical Neurosciences, vol. 9 no. 2 (1997), pp. 283-292, ISSN 0895-0172 [9144111], [doi]  [abs]
  34. Krystal, AD; Greenside, HS; Weiner, RD; Gassert, D, A comparison of EEG signal dynamics in waking, after anesthesia induction and during electroconvulsive therapy seizures., Electroencephalography and Clinical Neurophysiology, vol. 99 no. 2 (August, 1996), pp. 129-140, ISSN 0013-4694 [8761049], [doi]  [abs]
  35. Edinger, JD; Fins, AI; Goeke, JM; McMillan, DK; Gersh, TL; Krystal, AD; McCall, WV, The empirical identification of insomnia subtypes: a cluster analytic approach., Sleep, vol. 19 no. 5 (June, 1996), pp. 398-411, ISSN 0161-8105 [8843531]  [abs]
  36. Krystal, AD; Weiner, RD; Coffey, CE; McCall, WV, Effect of ECT treatment number on the ictal EEG., Psychiatry Research, vol. 62 no. 2 (May, 1996), pp. 179-189, ISSN 0165-1781 [8771615], [doi]  [abs]
  37. Krystal, AD; Weiner, RD; Gassert, D; McCall, WV; Coffey, CE; Sibert, T; Holsinger, T, The relative ability of three ictal EEG frequency bands to differentiate ECT seizures on the basis of electrode placement, stimulus intensity, and therapeutic response., Convulsive Therapy, vol. 12 no. 1 (March, 1996), pp. 13-24, ISSN 0749-8055 [8777648]  [abs]
  38. Krystal, A.D., Coffey, C.E., Weiner, R.D., Holsinger, T. Changes in seizure threshold over the ECTcourse affect therapeutic response and are detected by ictal EEG ratings.
  39. Krystal, A.D., Greenside, H.S., Weiner, R.D., Gassert, D. A comparison of EEG signal dynamics in waking, after anesthesia induction and during ECT seizures. Electroencephalography and Clinical Neurophysiology 99:129-140, 1996.
  40. Krystal, AD; Weiner, RD, ECT seizure duration: reliability of manual and computer-automated determinations., Convulsive Therapy, vol. 11 no. 3 (September, 1995), pp. 158-169, ISSN 0749-8055 [8528657]  [abs]
  41. Coffey, CE; Lucke, J; Weiner, RD; Krystal, AD; Aque, M, Seizure threshold in electroconvulsive therapy (ECT) II. The anticonvulsant effect of ECT., Biological Psychiatry, vol. 37 no. 11 (June, 1995), pp. 777-788, ISSN 0006-3223 [7647162], [doi]  [abs]
  42. Coffey, CE; Lucke, J; Weiner, RD; Krystal, AD; Aque, M, Seizure threshold in electroconvulsive therapy: I. Initial seizure threshold., Biological Psychiatry, vol. 37 no. 10 (May, 1995), pp. 713-720, ISSN 0006-3223 [7640326], [doi]  [abs]
  43. Edinger, JD; Erwin, CW; Fins, AI; Marsh, GR; Krystal, AD, Ambulatory cassette polysomnography: findings from a large cohort of drug-free insomnia patients., Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society, vol. 12 no. 3 (May, 1995), pp. 302-309, ISSN 0736-0258 [11221789]  [abs]
  44. Krystal, A.D., Weiner, R.D., Coffey, C.E. The ictal EEG as a marker of adequate stimulus intensity with unilateral ECT. J. Neuropsychiatr. and Clin. Neurosciences 7:295-303, 1995.
  45. Krystal, AD; Weiner, RD; Coffey, CE, The ictal EEG as a marker of adequate stimulus intensity with unilateral ECT., The Journal of Neuropsychiatry and Clinical Neurosciences, vol. 7 no. 3 (1995), pp. 295-303, ISSN 0895-0172 [7580187], [doi]  [abs]
  46. Krystal, AD; Weiner, RD, ECT seizure therapeutic adequacy., Convulsive Therapy, vol. 10 no. 2 (June, 1994), pp. 153-164, ISSN 0749-8055 [8069641]  [abs]
  47. Krystal AD, Weiner RD, McCall WV, Shelp F, Arias R, Smith P: The effects of ECT stimulus dose and electrode placement on the ictal electroencehpalogram: An intraindividual crossover study. Biological Psychiatry 34: 759-767, 1993.
  48. Krystal AD, Weiner RD: Low frequency ictal EEG activity and ECT therapeutic impact. Convulsive Therapy 9: 220-224, 1993.
  49. McCall WV, Edinger JD, Krystal AD, Marsh GR: Ambulatory polysomnogrophic differences in healthy and insomniac older men. Ambulatory monitoring 6: 135-140, 1993.
  50. Weiner RD, Krystal AD: EEG monitoring of ECT seizures. In (ed Coffey CE), The Clinical Science of Electroconvulsive Therapy. Washington DC: American Psychiatric Press, Inc., pp 93-109, 1993.
  51. Weiner, RD; Krystal, AD, The present use of electroconvulsive therapy., Annual Review of Medicine, vol. 45 (1994), pp. 273-281, ISSN 0066-4219 [8198383], [doi]  [abs]
  52. Krystal, AD; Weiner, RD; McCall, WV; Shelp, FE; Arias, R; Smith, P, The effects of ECT stimulus dose and electrode placement on the ictal electroencephalogram: an intraindividual crossover study., Biological Psychiatry, vol. 34 no. 11 (December, 1993), pp. 759-767, ISSN 0006-3223 [8292679], [doi]  [abs]
  53. KRYSTAL, A, EEG evidence of more "intense"seizure activity with bilateral ECT, Biol Psychiatry, vol. 31 no. 6 (1992), pp. 617-621, ISSN 0006-3223 [1581442], [doi]
  54. McCall, WV; Erwin, CW; Edinger, JD; Krystal, AD; Marsh, GR, Ambulatory polysomnography: technical aspects and normative values., Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society, vol. 9 no. 1 (January, 1992), pp. 68-77, ISSN 0736-0258 [1552010]  [abs]
  55. Weiner, RD; Krystal, AD; Coffey, CE; Smith, P, The electrophysiology of ECT: relevance to mechanism of action., Clinical Neuropharmacology, vol. 15 Suppl 1 Pt A (1992), pp. 671A-672A, ISSN 0362-5664 [1498995]
  56. Weiner, RD; Coffey, CE; Krystal, AD, The monitoring and management of electrically induced seizures., The Psychiatric Clinics of North America, vol. 14 no. 4 (December, 1991), pp. 845-869, ISSN 0193-953X [1771151], [doi]  [abs]
  57. Krystal, AD; McEvoy, JP, Shared features of neuroleptic malignant syndrome and alcohol abuse complications., The Journal of Clinical Psychiatry, vol. 51 no. 12 (December, 1990), pp. 523, ISSN 0160-6689 [2258367]
  58. Krystal, A; Krishnan, KR; Raitiere, M; Poland, R; Ritchie, JC; Dunnick, NR; Hanada, K; Nemeroff, CB, Differential diagnosis and pathophysiology of Cushing's syndrome and primary affective disorder., The Journal of Neuropsychiatry and Clinical Neurosciences, vol. 2 no. 1 (1990), pp. 34-43, ISSN 0895-0172 [1967010], [doi]  [abs]