Original Articles
Transitions to adulthood and psychological distress in young adults born 12 years apart: constraints on and resources for development
- A. Sacker, N. Cable
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- Published online by Cambridge University Press:
- 17 June 2009, pp. 301-313
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Background
Later transitions to adult roles and responsibilities have been linked with better psychological well-being yet psychological distress has risen despite young people making the transition to adulthood at older ages over recent years.
MethodWe examine the role of structural constraints and adolescent resources in the relationship between the timing of transitions and psychological distress in early adult life in the 1958 National Child Development Study and the 1970 British Cohort Study. Graphical chain models were used to examine the influences on timing of four key transitions and their relationship with psychological distress (Malaise Inventory). The role of structural factors at birth (gender, social class) and adolescent resources (psychosocial problems, exam grades) were modelled.
ResultsAn earlier transition to adult roles was associated with an increased risk for psychological distress but so was failing to make some key transitions. Structural constraints had negative effects on successful development. Persistent social class and gender inequalities in psychological distress were evident in both cohorts. Social class constraints were mediated by educational resources whereas gender constraints were mediated by psychosocial resources. The influence of structural constraints on the timing of transitions to adult roles was more complex with evidence of positive and negative mediation and moderation effects.
ConclusionsDelaying transition to adulthood promotes psychological health but failure of transition to independent living is associated with psychological distress. Life-course transitions are constrained by social origin and gender and possibly economic environment. Adolescent resources help young adults to make timely transitions to adult roles.
Outreach and screening following the 2005 London bombings: usage and outcomes
- C. R. Brewin, N. Fuchkan, Z. Huntley, M. Robertson, M. Thompson, P. Scragg, P. d'Ardenne, A. Ehlers
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- Published online by Cambridge University Press:
- 09 March 2010, pp. 2049-2057
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Background
Little is known about how to remedy the unmet mental health needs associated with major terrorist attacks, or what outcomes are achievable with evidence-based treatment. This article reports the usage, diagnoses and outcomes associated with the 2-year Trauma Response Programme (TRP) for those affected by the 2005 London bombings.
MethodFollowing a systematic and coordinated programme of outreach, the contact details of 910 people were obtained by the TRP. Of these, 596 completed a screening instrument that included the Trauma Screening Questionnaire (TSQ) and items assessing other negative responses. Those scoring ⩾6 on the TSQ, or endorsing other negative responses, received a detailed clinical assessment. Individuals judged to need treatment (n=217) received trauma-focused cognitive-behaviour therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Symptom levels were assessed pre- and post-treatment with validated self-report measures of post-traumatic stress disorder (PTSD) and depression, and 66 were followed up at 1 year.
ResultsCase finding relied primarily on outreach rather than standard referral pathways such as primary care. The effect sizes achieved for treatment of DSM-IV PTSD exceeded those usually found in randomized controlled trials (RCTs) and gains were well maintained an average of 1 year later.
ConclusionsOutreach with screening, linked to the provision of evidence-based treatment, seems to be a viable method of identifying and meeting mental health needs following a terrorist attack. Given the failure of normal care pathways, it is a potentially important approach that merits further evaluation.
A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events
- K. L. Alcorn, A. O'Donovan, J. C. Patrick, D. Creedy, G. J. Devilly
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- Published online by Cambridge University Press:
- 11 January 2010, pp. 1849-1859
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Background
Childbirth has been linked to postpartum impairment. However, controversy exists regarding the onset and prevalence of post-traumatic stress disorder (PTSD) after childbirth, with seminal studies being limited by methodological issues. This longitudinal prospective study examined the prevalence of PTSD following childbirth in a large sample while controlling for pre-existing PTSD and affective symptomatology.
MethodPregnant women in their third trimester were recruited over a 12-month period and interviewed to identify PTSD and anxiety and depressive symptoms during the last trimester of pregnancy, 4–6 weeks postpartum, 12 weeks postpartum and 24 weeks postpartum.
ResultsOf the 1067 women approached, 933 were recruited into the study. In total, 866 (93%) were retained to 4–6 weeks, 826 (89%) were retained to 12 weeks and 776 (83%) were retained to 24 weeks. Results indicated that, uncontrolled, 3.6% of women met PTSD criteria at 4–6 weeks postpartum, 6.3% at 12 weeks postpartum and 5.8% at 24 weeks postpartum. When controlling for PTSD and partial PTSD due to previous traumatic events as well as clinically significant anxiety and depression during pregnancy, PTSD rates were less at 1.2% at 4–6 weeks, 3.1% at 12 weeks and 3.1% at 24 weeks postpartum.
ConclusionsThis is the first study to demonstrate the occurrence of full criteria PTSD resulting from childbirth after controlling for pre-existing PTSD and partial PTSD and clinically significant depression and anxiety in pregnancy. The findings indicate that PTSD can result from a traumatic birth experience, though this is not the normative response.
Gender differences in immediate memory in bipolar disorder
- D. Carrus, T. Christodoulou, M. Hadjulis, M. Haldane, A. Galea, A. Koukopoulos, V. Kumari, S. Frangou
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- Published online by Cambridge University Press:
- 06 November 2009, pp. 1349-1355
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Background
Gender is known to modulate the clinical course and severity of bipolar disorder (BD). Although cognitive abnormalities are an established feature of BD, there is limited information regarding whether gender also influences the pattern and severity of cognitive impairment.
MethodWe evaluated the performance of 86 remitted patients with BD, type 1, (BD-I) (36 male and 50 female) and 46 healthy participants (21 male and 25 female) on tasks of general intellectual ability, memory encoding, recognition and retrieval, response inhibition and executive function (abstraction and perseveration). The impact of illness severity in patients was assessed using the global assessment of functioning (GAF).
ResultsWe found a gender effect and an interaction between diagnosis and gender on immediate memory, implicating encoding and retrieval processes, both showing male BD-I patients being disadvantaged compared with female patients and healthy controls. Immediate memory correlated with GAF scores and this association was statistically significant for male BD-I patients.
ConclusionsOur findings suggest that gender differences in BD-I are associated with memory function, particularly processes relating to encoding and retrieval, and may contribute to poor functional outcome particularly in men.
Mind-mindedness and maternal responsiveness in infant–mother interactions in mothers with severe mental illness
- S. Pawlby, C. Fernyhough, E. Meins, C. M. Pariante, G. Seneviratne, R. P. Bentall
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- Published online by Cambridge University Press:
- 27 January 2010, pp. 1861-1869
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Background
Previous cross-diagnosis studies of interaction between mothers with severe mental illness and their babies have concluded that mothers with schizophrenia have deficits in interaction, but these studies have not included healthy controls.
MethodIn-patients on a mother and baby unit, with diagnoses of schizophrenia (n=15), depressive mood disorders with or without psychosis (n=23), or mood disorders where mania was the predominant feature, with or without psychosis (n=12), were observed interacting with their infants on admission and discharge. Mothers' mind-mindedness and other measures of the quality of maternal and infant behaviour were coded. Findings from this sample were compared with those from healthy mothers and their infants (n=49).
ResultsCompared with healthy controls, on admission depressed mothers were marginally less likely to comment appropriately on their infants' mental states. Both the depressed and mania groups were more likely to touch their babies and engage in attention-seeking behaviours. Interactional behaviours of mothers in the schizophrenia group were not markedly different from healthy controls. On discharge there were fewer differences between the clinical and healthy groups, although the depressed group continued to engage in more attention-seeking and touching behaviour and the mania group continued to touch their infants more. Only mothers in the schizophrenia group showed changes in interactional behaviours between admission and discharge, talking more to their infants.
ConclusionsThe findings challenge previous conclusions that mothers with schizophrenia have deficits in their interactions with their babies, and demonstrate that mothers with severe mental illness are able to respond appropriately to their infants' cues.
The genetic and environmental relationship between major depression and the five-factor model of personality
- K. S. Kendler, J. Myers
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- Published online by Cambridge University Press:
- 07 September 2009, pp. 801-806
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Background
Certain personality traits have long been suspected to reflect an enduring vulnerability to major depression (MD) in part because of shared genetic risk factors. Although many have agreed that normative personality is well captured by the ‘Big-Five’ personality traits of Openness (O), Conscientiousness (C), Extraversion (E), Agreeableness (A) and Neuroticism (N), to date genetically informative studies have only examined the relationship between MD and N and E.
MethodQuestionnaires were completed on a website, yielding a sample of 44 112 subjects including both members of 542 same-sex twin pairs. Personality was measured by the Big Five Inventory. Structural modeling was performed by Mx.
ResultsThree of the big-five personality traits – O, E and A – had small phenotypic associations with risk for MD and small genetic correlations. Two traits – N and C – had stronger phenotypic associations (positive for N and negative for C) with the following estimates of the genetic correlation with MD: +0.43 for N and −0.36 for C. N and C were moderately negatively correlated. Controlling for N reduced the genetic correlation between C and MD more than controlling for C reduced the genetic correlation between N and MD.
ConclusionsA large proportion of the genetic risk for MD that is expressed via personality is captured by N, with a modest amount due to C, and small amounts from O, E and A.
Functioning and disability levels in primary care out-patients with one or more anxiety disorders
- C. D. Sherbourne, G. Sullivan, M. G. Craske, P. Roy-Byrne, D. Golinelli, R. D. Rose, D. A. Chavira, A. Bystritsky, M. B. Stein
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- Published online by Cambridge University Press:
- 11 February 2010, pp. 2059-2068
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Background
Anxiety disorders are the most prevalent mental health disorders and are associated with substantial disability and reduced well-being. It is unknown whether the relative impact of different anxiety disorders is due to the anxiety disorder itself or to the co-occurrence with other anxiety disorders. This study compared the functional impact of combinations of anxiety disorders in primary care out-patients.
MethodA total of 1004 patients with panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD) or post-traumatic stress disorder (PTSD) provided data on their mental and physical functioning, and disability. Multivariate regressions compared functional levels for patients with different numbers and combinations of disorders.
ResultsOf the patients, 42% had one anxiety disorder only, 38% two, 16% three and 3% all four. There were few relative differences in functioning among patients with only one anxiety disorder, although those with SAD were most restricted in their work, social and home activities and those with GAD were the least impaired. Functioning levels tended to deteriorate as co-morbidity increased.
ConclusionsOf the four anxiety disorders examined, GAD appears to be the least disabling, although they all have more in common than in distinction when it comes to functional impairment. A focus on unique effects of specific anxiety disorders is inadequate, as it fails to address the more pervasive impairment associated with multiple anxiety disorders, which is the modal presentation in primary care.
Impairment, disability, social support and depression among older parents in rural Thailand
- S. Suttajit, S. Punpuing, T. Jirapramukpitak, K. Tangchonlatip, N. Darawuttimaprakorn, R. Stewart, M. E. Dewey, M. Prince, M. A. Abas
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- Published online by Cambridge University Press:
- 08 January 2010, pp. 1711-1721
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Background
It is not known whether social support modifies the association between depression and impairment or disability in older people from developing countries in Asia.
MethodWe used a Thai version of the EURO-D scale to measure depression in 1104 Thai rural community-dwelling parents aged ⩾60 years. These were all those providing data on depression who were recruited as part of a study of older adults with at least one living child (biological, stepchild or adopted child). Logistic regression modelling was used to determine: (a) whether impairment, disability and social support deficits were associated with depression; (b) whether social support modified this association.
ResultsThere were strong graded relationships between impairment, disability, social support deficits and EURO-D caseness. Level of impairment, but not disability, interacted with poor social support in that depression was especially likely in those who had more physical impairments as well as one or more social support deficits (p value for interaction=0.018), even after full adjustment.
ConclusionsSocial support is important in reducing the association between physical impairment and depression in Thai older adults, especially for those with a large number of impairments. Enhancing social support as well as improving healthcare and disability facilities should be emphasized in interventions to prevent depression in older adults.
Affective symptoms as predictors of Alzheimer's disease in subjects with mild cognitive impairment: a 10-year follow-up study
- I. H. G. B. Ramakers, P. J. Visser, P. Aalten, A. Kester, J. Jolles, F. R. J. Verhey
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- Published online by Cambridge University Press:
- 11 November 2009, pp. 1193-1201
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Background
Affective symptoms are common in subjects with mild cognitive impairment (MCI), but there is disagreement whether these symptoms are predictive for Alzheimer's disease (AD). We investigated the predictive accuracy of affective symptoms for AD during a follow-up study in subjects with MCI, and whether the predictive accuracy was modified by age, the presence of amnestic MCI or the length of follow-up.
MethodNewly referred subjects (n=263) with MCI older than 55 years were selected from a memory clinic and followed up after 2, 5 and 10 years. Predictors investigated were: symptoms of depression, anxiety, apathy and sleeping problems.
ResultsAffective symptoms were present in 50–70% of the subjects. The average follow-up period was 5.4 years and 79 subjects (29%) developed AD. Sleeping problems were associated with a decreased risk for AD [odds ratio (OR) 0.35, p<0.001]. Symptoms of depression (OR 0.61, p=0.059) and anxiety (OR 0.58, p=0.051) showed a trend in the same direction. The OR of apathy for AD was 0.67 (p=0.14). Depression was associated with a decreased risk for AD only in subjects without amnestic MCI, but not in subjects with amnestic MCI. Moreover, anxiety was related to the risk for AD differently between subjects diagnosed with AD at the 5-year follow-up (OR 0.23) and subjects diagnosed with AD at the 10-year follow-up (OR 1.7).
ConclusionsAffective symptoms are associated with a decreased risk for AD. The risk may be dependent on MCI subtype or length of follow-up, but it does not depend on age.
The evaluation of training in patient-centred interviewing skills for psychiatric residents
- M. Rimondini, L. Del Piccolo, C. Goss, M. Mazzi, M. Paccaloni, C. Zimmermann
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- 23 July 2009, pp. 467-476
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Background
Communication skills are considered ‘core skills’ in the curriculum of psychiatry but studies evaluating the effectiveness of a time-limited training course in interviewing skills in psychiatry have remained rare. The aim was to assess the effectiveness of training in patient-centred interviewing on the interview performance of psychiatric residents.
MethodPsychiatric residents (n=10) each interviewed 12 different anonymized standardized patients (SPs), eight before and another four after training. SPs simulated psychiatric out-patients who attended for a first visit to the psychiatric out-patient clinic. The consultations were videotaped, transcribed and coded with a classification scheme developed for psychiatric consultations from which an interview performance index was derived. An interrupted time-series design and a segmented regression analysis with multilevel analysis explored the performance trend within the series of consultations.
ResultsThe regression model evidenced a horizontal slope at pre- and post-training, with a significant level change. These findings excluded the presence of a practice effect and indicated a significant effect of training. Performance variability between and within residents over the series of consultations increased at post-training.
ConclusionsThe training improved patient-centred interviewing performance. More post-training exercise time and supervised practice are necessary to establish consistent performance patterns at a higher skill level.
Neural correlates of worry in generalized anxiety disorder and in normal controls: a functional MRI study
- E. Paulesu, E. Sambugaro, T. Torti, L. Danelli, F. Ferri, G. Scialfa, M. Sberna, G. M. Ruggiero, G. Bottini, S. Sassaroli
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- Published online by Cambridge University Press:
- 07 May 2009, pp. 117-124
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Background
Worry is considered a key feature of generalized anxiety disorder (GAD), whose neural correlates are poorly understood. It is not known whether the brain regions involved in pathological worry are similar to those involved in worry-like mental activity in normal subjects or whether brain areas associated with worry are the same for different triggers such as verbal stimuli or faces. This study was designed to clarify these issues.
MethodEight subjects with GAD and 12 normal controls underwent functional magnetic resonance imaging (fMRI) mood induction paradigms based on spoken sentences or faces. Sentences were either neutral or designed to induce worry. Faces conveyed a sad or a neutral mood and subjects were instructed to empathize with those moods.
ResultsWe found that the anterior cingulate and dorsal medial prefrontal cortex [Brodmann area (BA) 32/23 and BA 10/11] were associated with worry triggered by sentences in both subjects with GAD and normal controls. However, GAD subjects showed a persistent activation of these areas even during resting state scans that followed the worrying phase, activation that correlated with scores on the Penn State Worry Questionnaire (PSWQ). This region was activated during the empathy experiment for sad faces.
ConclusionsThe results show that worry in normal subjects and in subjects with GAD is based on activation of the medial prefrontal and anterior cingulate regions, known to be involved in mentalization and introspective thinking. A dysregulation of the activity of this region and its circuitry may underpin the inability of GAD patients to stop worrying.
Genetic contribution to the relationship between personality and depressive symptoms among older women
- I. Pakkala, S. Read, J. Kaprio, M. Koskenvuo, M. Kauppinen, T. Rantanen
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- Published online by Cambridge University Press:
- 08 October 2009, pp. 1357-1366
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Background
Prior studies suggest that certain types of personality are at higher risk for developing depressive disorders. This study examined the relationship between old age depressive symptoms and two middle-age personality dimensions, neuroticism and extraversion.
MethodThe present study is part of the Finnish Twin Study on Aging, where altogether 409 female twins who had completed the Eysenck Personality Inventory at the age of 38–51 years were studied for depressive symptoms 28 years later using Center for the Epidemiologic Studies Depression Scale. Logistic regression analysis suitable for dependent data and univariate and Cholesky models for decomposing the genetic and environmental factor were used.
ResultsMiddle age extraversion protected from later depressive symptoms while neuroticism increased the risk. Twin modeling indicated that the association between neuroticism and depressive symptoms resulted from shared genetic risk factors common to both traits. However, a substantial proportion of the genetic vulnerability was specific to old age depressive symptoms and was not shared with neuroticism. Middle age extraversion had no genetic relationship with old age depressive symptoms.
ConclusionsThe relationship between middle age neuroticism and old age depressive symptoms is strong but only partly the result of genetic factors that predispose to both neuroticism and depressive symptoms. Extraversion, by contrast, has no genetic relationship with depressive symptoms experienced in old age.
Early maternal and paternal bonding, childhood physical abuse and adult psychopathic personality
- Y. Gao, A. Raine, F. Chan, P. H. Venables, S. A. Mednick
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- 15 September 2009, pp. 1007-1016
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Background
A significant gap in the literature on risk factors for psychopathy is the relative lack of research on parental bonding.
MethodThis study examines the cross-sectional relationship between maternal and paternal bonding, childhood physical abuse and psychopathic personality at age 28 years in a community sample of 333 males and females. It also assesses prospectively whether children separated from their parents in the first 3 years of life are more likely to have a psychopathic-like personality 25 years later.
ResultsHierarchical regression analyses indicated that: (1) poor parental bonding (lack of maternal care and low paternal overprotection) and childhood physical abuse were both associated with a psychopathic personality; (2) parental bonding was significantly associated with psychopathic personality after taking into account sex, social adversity, ethnicity and abuse; (3) those separated from parents in the first 3 years of life were particularly characterized by low parental bonding and a psychopathic personality in adulthood; and (4) the deviant behavior factor of psychopathy was more related to lack of maternal care whereas the emotional detachment factor was related to both lack of maternal care and paternal overprotection.
ConclusionsFindings draw attention to the importance of different components of early bonding in relation to adult psychopathy, and may have potential implications for early intervention and prevention of psychopathy.
The interaction between perinatal factors and childhood abuse in the risk of developing anorexia nervosa
- A. Favaro, E. Tenconi, P. Santonastaso
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- Published online by Cambridge University Press:
- 12 August 2009, pp. 657-665
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Background
Perinatal factors seem to be implicated in the pathogenesis of anorexia nervosa (AN) and may be involved in the programming of stress response systems in humans. Our aim was to explore one of the possible pathways to explain the association between perinatal complications and a psychiatric disorder. In particular, we tested the hypothesis that neonatal immaturity may confer an enhanced vulnerability to AN after exposure to a severe stressful event, such as childhood abuse.
MethodThe sample was composed of subjects who took part in a prevalence study carried out on a representative sample of the general population and cases of AN referred to an out-patient specialist unit. All subjects (n=663) were born in the two obstetric wards of Padua Hospital between 1971 and 1979. We analysed data using both a case-control and a cohort design.
ResultsWe found that functional signs of neonatal dysmaturity, but not a low birthweight or prematurity, had a significant additive interaction with childhood abuse in determining the risk for this illness. In normal subjects, but not in subjects with AN, neonatal dysmaturity was associated with being small, short or thin for gestational age at birth.
ConclusionsThe synergistic effect of neonatal dysmaturity and childhood abuse in increasing the risk for AN provides evidence for the hypothesis that a prenatal programming of stress response systems can result in an impairment of the individual's resilience to severe stressful events.
Psychiatric morbidity associated with same-sex sexual behaviour: influence of minority stress and familial factors
- T. Frisell, P. Lichtenstein, Q. Rahman, N. Långström
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- Published online by Cambridge University Press:
- 22 May 2009, pp. 315-324
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Background
Increased psychiatric morbidity has been widely reported among non-heterosexual individuals (defined as reporting a homosexual/bisexual identity and/or same-sex sexual partners). However, the causes of this psychiatric ill-health are mostly unknown.
MethodWe attempted to estimate the influence of minority stress and familial factors on psychiatric disorder among adults with same-sex sexual partners. Self-report data from a 2005 survey of adults (age 20–47 years, n=17 379) in the population-based Swedish Twin Registry were analysed with regression modelling and co-twin control methodology.
ResultsRates of depression, generalized anxiety disorder (GAD), eating disorders, alcohol dependence and attention deficit hyperactivity disorder (ADHD) were increased among men and women with same-sex sexual experiences. Adjusting for perceived discrimination and hate crime victimization lowered this risk whereas controlling for familial (genetic or environmental) factors in within-twin pair comparisons further reduced or eliminated it.
ConclusionsComponents of minority stress influence the risk of psychiatric ill-health among individuals with any same-sex sexual partner. However, substantial confounding by familial factors suggests a common genetic and/or environmental liability for same-sex sexual behaviour and psychiatric morbidity.
Executive function in body dysmorphic disorder
- J. Dunai, I. Labuschagne, D. J. Castle, M. Kyrios, S. L. Rossell
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- Published online by Cambridge University Press:
- 02 December 2009, pp. 1541-1548
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Background
Body dysmorphic disorder (BDD) is a poorly understood disorder that involves a preoccupation with imagined or minor bodily defects. Only a few studies of neuropsychological function have been conducted. Two previous studies have indicated executive dysfunction in BDD. The current study sought to further define these executive deficits.
MethodFourteen DSM-IV BDD patients and 14 age- and sex-matched control participants took part. Because of the high incidence of co-morbidity in BDD, patients with co-morbid Axis I disorders were not excluded. Control participants had no history of psychiatric illness. All participants completed the following executive function (EF) tests: Spatial Span (SS), Spatial Working Memory (SWM) and the Stockings of Cambridge (SOC) task. They also completed the Pattern Recognition (PR) test, a test of visual memory (VM).
ResultsBDD participants made significantly more between-search errors on the SWM task, an effect that increased with task difficulty. Between-search errors are an example of poor maintenance and manipulation of information. SOC results indicated slower subsequent thinking times (i.e. the time taken to plan) in BDD participants. There were no group differences in SS or PR scores. The severity of BDD, depressive or anxiety symptoms was not correlated with performance on any of the cognitive tasks.
ConclusionsThe results of this study indicate that BDD patients have EF deficits in on-line manipulation, planning and organization of information. By contrast, spatial memory capacity, motor speed and visual memory were intact. Considered with evidence from lesion and neuroimaging studies, these results suggest frontal lobe dysfunction in BDD.
Impact of severity and type of depression on quality of life in cases identified in the community
- R. Nuevo, C. Leighton, G. Dunn, C. Dowrick, V. Lehtinen, O. S. Dalgard, P. Casey, J. L. Vázquez-Barquero, J. L. Ayuso-Mateos
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- Published online by Cambridge University Press:
- 11 February 2010, pp. 2069-2077
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Background
The impact of different levels of depression severity on quality of life (QoL) is not well studied, particularly regarding ICD-10 criteria. The ICD classification of depressive episodes in three levels of severity is also controversial and the less severe category, mild, has been considered as unnecessary and not clearly distinguishable from non-clinical states. The present work aimed to test the relationship between depression severity according to ICD-10 criteria and several dimensions of functioning as assessed by Medical Outcome Study (MOS) 36-item Short Form general health survey (SF-36) at the population level.
MethodA sample of 551 participants from the second phase of the Outcome of Depression International Network (ODIN) study (228 controls without depression and 313 persons fulfilling ICD criteria for depressive episode) was selected for a further assessment of several variables, including QoL related to physical and mental health as measured with the SF-36.
ResultsStatistically significant differences between controls and the depression group were found in both physical and mental markers of health, regardless of the level of depression severity; however, there were very few differences in QoL between levels of depression as defined by ICD-10. Regardless of the presence of depression, disability, widowed status, being a woman and older age were associated with worse QoL in a structural equation analysis with covariates. Likewise, there were no differences according to the type of depression (single-episode versus recurrent).
ConclusionsThese results cast doubt on the adequacy of the current ICD classification of depression in three levels of severity.
Temperamental and acute symptoms of borderline personality disorder: associations with normal personality traits and dynamic relations over time
- C. J. Hopwood, M. B. Donnellan, M. C. Zanarini
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- Published online by Cambridge University Press:
- 17 December 2009, pp. 1871-1878
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Background
Recent research suggests the utility of distinguishing temperamental and acute symptoms of borderline personality disorder (BPD). Temperamental symptoms, such as chronic anger and odd thinking, remit relatively slowly and have been hypothesized to reflect a hyperbolic predisposition to emotional pain and negativistic cognitions, whereas acute symptoms, such as substance abuse and chaotic relationships, remit relatively quickly and have been hypothesized to represent the consequences of maladaptations to triggering environmental events.
MethodThe relationships of temperamental and acute BPD symptoms with normal personality traits and stability and dynamic associations over time across these symptom sets were tested in a 10-year longitudinal study of 362 patients with personality disorders.
ResultsTemperamental symptoms were associated with high neuroticism, whereas acute symptoms were associated with low agreeableness. These symptoms had similar rank-order stabilities and relative changes in symptom sets were reciprocally linked in a cross-lagged path model suggesting dynamic associations between temperamental and acute symptoms over time.
ConclusionsThe distinction between temperamental and acute BPD symptoms is supported by differential relations of these symptom sets to normal personality traits. Moreover, these symptoms appear to be linked in a mutually reinforcing dynamic over time. This distinction should be kept in mind in future studies of the aetiology of BPD and in diagnostic and treatment considerations.
Trajectories of change in depression severity during treatment with antidepressants
- R. Uher, B. Muthén, D. Souery, O. Mors, J. Jaracz, A. Placentino, A. Petrovic, A. Zobel, N. Henigsberg, M. Rietschel, K. J. Aitchison, A. Farmer, P. McGuffin
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- Published online by Cambridge University Press:
- 29 October 2009, pp. 1367-1377
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Background
Response and remission defined by cut-off values on the last observed depression severity score are commonly used as outcome criteria in clinical trials, but ignore the time course of symptomatic change and may lead to inefficient analyses. We explore alternative categorization of outcome by naturally occurring trajectories of symptom change.
MethodGrowth mixture models were applied to repeated measurements of depression severity in 807 participants with major depression treated for 12 weeks with escitalopram or nortriptyline in the part-randomized Genome-based Therapeutic Drugs for Depression study. Latent trajectory classes were validated as outcomes in drug efficacy comparison and pharmacogenetic analyses.
ResultsThe final two-piece growth mixture model categorized participants into a majority (75%) following a gradual improvement trajectory and the remainder following a trajectory with rapid initial improvement. The rapid improvement trajectory was over-represented among nortriptyline-treated participants and showed an antidepressant-specific pattern of pharmacogenetic associations. In contrast, conventional response and remission favoured escitalopram and produced chance results in pharmacogenetic analyses. Controlling for drop-out reduced drug differences on response and remission but did not affect latent trajectory results.
ConclusionsLatent trajectory mixture models capture heterogeneity in the development of clinical response after the initiation of antidepressants and provide an outcome that is distinct from traditional endpoint measures. It differentiates between antidepressants with different modes of action and is robust against bias due to differential discontinuation.
Symptom dimensions of post-myocardial infarction depression, disease severity and cardiac prognosis
- E. J. Martens, P. W. Hoen, M. Mittelhaeuser, P. de Jonge, J. Denollet
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- Published online by Cambridge University Press:
- 20 August 2009, pp. 807-814
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Background
Individual symptoms of post-myocardial infarction (MI) depression may be differentially associated with cardiac prognosis, in which somatic/affective symptoms appear to be associated with a worse cardiovascular prognosis than cognitive/affective symptoms. These findings hold important implications for treatment but need to be replicated before conclusions regarding treatment can be drawn. We therefore examined the relationship between depressive symptom dimensions following MI and both disease severity and prospective cardiac prognosis.
MethodPatients (n=473) were assessed on demographic and clinical variables and completed the Beck Depression Inventory (BDI) within the first week of hospital admission for acute MI. Depressive symptom dimensions were associated with baseline left ventricular ejection fraction (LVEF) and prospective cardiac death and/or recurrent MI. The average follow-up period was 2.8 years.
ResultsFactor analysis revealed two symptom dimensions – somatic/affective and cognitive/affective – in the underlying structure of the BDI, identical to previous results. There were 49 events attributable to cardiac death (n=23) or recurrent MI (n=26). Somatic/affective (p=0.010) but not cognitive/affective (p=0.153) symptoms were associated with LVEF and cardiac death/recurrent MI. When controlling for the effects of previous MI and LVEF, somatic/affective symptoms remained significantly predictive of cardiac death/recurrent MI (hazard ratio 1.31, 95% confidence interval 1.02–1.69, p=0.038). Previous MI was also an independent predictor of cardiac death/recurrent MI.
ConclusionsWe confirmed that somatic/affective, rather than cognitive/affective, symptoms of depression are associated with MI severity and cardiovascular prognosis. Interventions to improve cardiovascular prognosis by treating depression should be targeted at somatic aspects of depression.