Showing papers in "Journal of Nervous and Mental Disease in 2000"

Acculturation and the lifetime risk of psychiatric and substance use disorders among Hispanics.

Abstract: Between 1981 and 1995, approximately 5 million people from either Mexico, Cuba, Central America, or South America immigrated to the United States. Some regional studies have suggested that as Hispanic immigrants become acculturated to American society, their risk of mental illness increases sharply.

Do specific neurocognitive deficits predict specific domains of community function in schizophrenia

Abstract: We examined whether specific neurocognitive deficits predicted specific domains of community outcome in 40 schizophrenic patients. Neuropsychological assessments were conducted before hospital discharge, and measures of functional outcome were obtained 1 to 3.5 years later. A priori hypotheses were generated based upon a recent review by Green (Green MF [1996] What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry, 153(3):321-330). As hypothesized, verbal memory predicted all measures of community outcome, vigilance predicted social outcomes, and executive functioning predicted work and activities of daily living (ADLs). However, in addition to the predicted relationships, many other associations were found between neuropsychological test scores and adaptive function. Furthermore, both cognitive and functional measures were intercorrelated. If deficits in adaptive functioning are neurocognitively multi-determined, utilizing compensatory strategies to bypass multiple areas of cognitive impairment may be more efficient than cognitive remediation in improving community outcomes.

Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS.

Abstract: HIV-AIDS is a prevalent medical diagnosis in U.S. cities, and symptoms of depression are common in persons with HIV infection. This study examined the effects of overlapping symptoms of HIV disease and somatic depression that can inflate scores on the Beck Depression Inventory (BDI) and the Centers for Epidemiological Studies Depression Scale (CESD). Results from 357 HIV positive men and women identified discrete subsets of depression symptoms that correspond with symptoms of HIV infection. Removing somatic subsets of depression symptoms improved the clinical utility of the BDI and CESD. Clearer symptom separation occurred with the BDI than the CESD, but the CESD may be more sensitive than the BDI to depression associated with progression of HIV disease. Findings suggest that depression scales that include somatic symptoms will inflate depression scores in people living with HIV infection, and available methods for distinguishing overlapping symptoms should be employed when assessing people living with HIV infection.

Temperament and character in women with anorexia nervosa.

Abstract: The present study examined temperament differences among anorexia nervosa (AN) subtypes and community controls, as well as the effect of body weight on personality traits in women with AN. Temperament and Character Inventory (TCI) scores were compared between 146 women with restrictor-type AN (RAN), 117 women with purging-type AN (PAN), 60 women with binge/purge-type AN (BAN), and 827 community control women (CW) obtained from an archival normative database. Women with AN scored significantly higher on harm avoidance and significantly lower on cooperativeness than CW. Subtype analyses revealed that women with RAN and PAN reported the lowest novelty seeking, RAN women the highest persistence and self-directedness, and PAN women the highest harm avoidance. Body mass index had a nominal effect on subgroup differences, suggesting that personality disturbances are independent of body weight. Findings suggest that certain facets of temperament differ markedly between women with AN, regardless of diagnostic subtype, and controls. More subtle temperament and character differences that were independent of body weight emerged that distinguish among subtypes of AN.

Personality predictors of injury-related posttraumatic stress disorder.

Abstract: This longitudinal, cohort study examined the effect of personality traits on the emergence of posttraumatic stress disorder (PTSD) in a recently traumatized, civilian, mixed-gender sample with significant injuries. Burn survivors (N = 70) were administered the NEO-Personality Inventory (NEO-PI) and the Structured Clinical Interview for DSM III-R (SCID) at hospital discharge and readministered the SCID 4 and 12 months later. Overall, the sample of burn survivors scored significantly higher on neuroticism and extraversion and lower on openness, agreeableness, and conscientiousness relative to a normative national sample. Furthermore, multivariate analysis of variance revealed that PTSD symptom severity groups (i.e., single symptom, multiple symptoms, subthreshold PTSD, PTSD) were differentially related to neuroticism and extraversion. Planned comparisons indicated that neuroticism was higher and extraversion was lower in those who developed PTSD compared with those who did not develop PTSD.

Individual predictors of traumatic reactions in firefighters.

Abstract: Increasingly, theorists and researchers in the area of trauma are pointing to the importance of individual differences in resilience and vulnerability as key determinants of the intensity and duration of trauma-related symptoms. Determining the relative influence of individual predictors is important for the further development of theoretical models for understanding trauma responses and for the subsequent development of intervention strategies that are sensitive to individual differences. This study explores the influence of individual factors and social support on traumatic reactions in firefighters exposed to tragic events in the line of duty. A total of 164 Australian firefighters completed questionnaires targeting locus of control, self-efficacy, patterns of interpersonal relating, social support and level of emotional distress. Results indicate that individuals with feelings of insecurity, lack of personal control, and alienation from others were more likely to experience higher levels of depression and posttraumatic stress symptoms subsequent to exposure to traumatic events on the job.

The relationship between social support and major depression: cross-sectional, longitudinal, and genetic perspectives.

Abstract: Although social support (SS) is associated with risk for major depression (MD), we are uncertain of the extent to which a) low SS increases risk for MD, b) MD lowers SS, or c) both variables reflect a common genetic liability. Using two waves of interview data on female twin pairs from a population-based registry, we examine the cross-sectional and longitudinal association of eight dimensions of perceived SS and MD. Risk for MD in the last year was inversely associated with supportive spouse and relative relationships, and directly associated with problems in these relationships (e.g., too many demands, criticism, tension, and disagreements). Significant cross-time associations were seen only for spousal variables. The history of MD in one twin significantly predicted low relative and spouse support, and relative and friend problems, in her co-twin (MZ > DZ pairs). The relationship between SS and MD in women is complex and due to at least the three separate mechanisms outlined above that operate to varying degrees in different dimensions of SS.

Self-injurious behavior in anorexia nervosa.

Abstract: Recent reports have postulated the existence of two different types of self-injurious behavior: impulsive and compulsive. The aim of the present study is to analyze the dimensionality of self-injurious behavior and to study the link between self-injurious behavior and clinical features in anorexia nervosa. The study involved 236 consecutive patients with anorexia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-reported questionnaires, such as the Eating Disorders Inventory and Hopkins Symptom Checklist. A principal component analysis was used to study the dimensionality of different types of self-injurious behavior, including purging. Our findings confirm the distinction between impulsive and compulsive self-injurious behavior. The dimensions appear to be represented as a continuum in both the anorexia nervosa diagnostic subgroups. A third distinct dimension emerged that included self-induced vomiting and laxative/diuretics abuse. Childhood sexual abuse and anxiety significantly predict the presence of impulsive self-injury, whereas obsessionality and age predict compulsive self-injury. The coexistence of a positive score on both dimensions of self-injurious behavior was the strongest predictor of treatment dropout. The present study highlights the importance of self-injurious behavior; it should be given due consideration in future outcome studies on anorexia nervosa

Impact of ethnicity, violence and acculturation on displaced migrants: psychological distress and psychosomatic complaints among refugees in Sweden.

Abstract: This study uses data collected in 1996 by the Swedish National Board of Health and Welfare. By means of interviews with 1980 foreign-born immigrants, an attempt was made to determine the impact of a) migration status (country of birth/ethnicity), b) exposure to violence, c) Antonovsky's sense of coherence, d) acculturation status (knowledge of Swedish), e) sense of control over one's life, f) economic difficulties, and g) education, both on psychological distress (using General Health Questionnaire 12) and psychosomatic complaints (daytime fatigue, sleeping difficulties, and headache/migraine). Iranians and Chileans (age-adjusted) were at great risk for psychological distress as compared with Poles, whereas Turks and Kurds exhibited no such risk. When the independent factors were included in the model, the migration status effect decreased to insignificance (with the exception of Iranian men). A low sense of coherence, poor acculturation (men only), poor sense of control, and economic difficulties were strongly associated with the outcomes, generally accounting for a convincing link between migration status and psychological distress. Furthermore, a low sense of coherence, poor acculturation (men only), poor sense of control, and economic difficulties in exile seemed to be stronger risk factors for psychological distress in this group than exposure to violence before migration.

Parental style and vulnerability to depression: the role of core beliefs.

Abstract: This study considers the potential role of core beliefs (unconditional schema-level representations) in the relationship between recalled parenting in childhood and major depression in adulthood, comparing a group of depressed outpatients (N = 60) with a healthy community sample (N = 67). The depressed group were differentiated by poorer perceived parenting (low care and high overprotection) and by three unhealthy core beliefs (defectiveness/shame, self-sacrifice, and insufficient self-control). Among nonclinical participants, it appears that vulnerability to harm beliefs act as a partial mediator of the relationship between poor paternal care and the development of depressive features. In contrast, a broader set of core beliefs appears to mediate the relationship of maternal bonding and paternal overprotection with depressive symptoms among the depressed group. The findings suggest that clinical work with adults with major depression might need to take account of parental style. Where parents are reported to be uncaring or overprotective, cognitive-behavioral therapy might need to include a schema-focused component.

Quality of life for patients with body dysmorphic disorder.

Abstract: Body dysmorphic disorder (BDD) is a relatively common, distressing, and impairing disorder. Quality of life in BDD, however, has not been investigated. In this study, 62 consecutive outpatients with BDD were evaluated with the self-report Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and other scales. SF-36 scores were descriptively compared to published norms for several populations. Physical health-related quality of life scores were generally worse than general U.S. population norms and better than norms for outpatients with a medical illness or depression. However, in all mental health domains, BDD subjects' scores were notably worse than norms for the general U.S. population and for patients with depression, diabetes, or a recent myocardial infarction. More severe BDD symptoms and greater delusionality were associated with poorer mental health-related quality of life. These results indicate that patients with BDD have notably poor mental health status and mental health-related quality of life.

PTSD and utilization of medical treatment services among male Vietnam veterans.

Abstract: This study investigated the effect of posttraumatic stress disorder (PTSD) on help-seeking for physical problems. Merging two large data sets resulted in a sample of 1773 male Vietnam veterans from white, black, Hispanic, Native Hawaiian, and Japanese American ethnic groups. Predictors of utilization included PTSD, other axis I disorders, and substance abuse. In analyses that adjusted only for age, PTSD was related to greater utilization of recent and lifetime VA medical services, and with recent inpatient care from all sources. Further analysis showed that the increased utilization associated with PTSD was not merely due to the high comorbidity between PTSD and other axis I disorders. The uniqueness of the association between PTSD and medical utilization is discussed in terms of somatization and physical illness.

Effect of stimulant medication on driving performance of young adults with attention-deficit hyperactivity disorder: a preliminary double-blind placebo controlled trial

Abstract: Driving performance of adult males with attention-deficit hyperactivity disorder (ADHD) was compared with matched controls in a double-blind (Ritalin vs. placebo) cross-over design, using a high-fidelity driving simulator. Seven ADHD and six non-ADHD drivers (mean age 22) were screened to rule out comorbidity and assess for ADHD, and then admitted to the General Clinical Research Center to control diet and sleep before testing. At 0800 and 1530, subjects consumed either a placebo or Ritalin pill in a counter-balanced manner, and at 0930 and 1700, subjects drove the simulator. After both drives, subjects rated their driving performance. Compared with non-ADHD subjects, ADHD subjects had more career driving accidents (p < .04) and motor vehicle violations (p = .059), drove worse on the simulator under placebo condition (p < .05), demonstrated significant improvement under the Ritalin condition (p < .05), rated themselves as driving poorer during the placebo condition (p = .05), and tended to perceive their driving to be better during the Ritalin condition (p = .07). This would suggest that individuals with ADHD should have the therapeutic benefit of a stimulant medication when operating a vehicle.

Obsessive and Compulsive Symptoms in Schizophrenia: Clinical and Neurocognitive Correlates

Abstract: Although research suggests that the presence of obsessive and compulsive symptoms in schizophrenia is associated with graver levels of psychosocial dysfunction, it is unclear whether it is also related to clinical features of illness. Accordingly, the present study compared the symptom levels and neurocognitive function of participants with schizophrenia who had and did not have significant obsessive or compulsive symptoms. Analyses of variance revealed that participants with significant levels of either obsessive or compulsive symptoms (N = 21) had higher levels of positive and emotional discomfort symptoms on the Positive and Negative Syndrome Scale (PANSS) and performed more poorly on the Wisconsin Card Sorting Test, a measure of executive function, than participants without obsessions or compulsions (N = 25). ANCOVAs controlling for level of obsessions also revealed that participants with significant levels of compulsions (N = 12) in particular had higher levels of negative and positive symptoms on the PANSS than participants without compulsions (N = 34). The impact of obsessive-compulsive phenomena on the course and outcome of schizophrenia is discussed.

The Spanish version of the quality of life index: presentation and validation.

Abstract: Latino or Spanish-speaking individuals constitute a substantial and growing population in the United States, in addition to their general presence, with cultural variations, throughout Latin America and the Iberian Peninsula. To respond to the needs of this population, a Spanish version of the Quality of Life Index (QLI-Sp) was developed. The QLI, in its various language versions, is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-rated quality of life. It is composed of 10 dimensions collated from the international literature, including aspects ranging from physical well-being to spiritual fulfillment, as well as a global perception of quality of life. Each item is to be rated on a 10-point line by Latino subjects according to their culture-informed understanding of that concept. The study samples included 60 Latino psychiatric patients (20 outpatient, 20 inpatient, and 20 partial hospitalization) and 20 Latino actively working hospital professionals. Mean time of completion was 2.4 minutes among health professionals and 3.6 minutes among patients. The vast majority of respondents (72% of patients and 1000% of professionals) judged the instrument as easy to use. The test-retest reliability correlation coefficient of the QLI-Sp mean score was .89. The discriminant validity of the QLI-Sp was documented by the highly significant difference obtained between the mean scores of the two samples selected to represent quite different levels of quality of life.

Psychotic features in chronic posttraumatic stress disorder and schizophrenia: comparative severity.

Abstract: Psychotic features are frequent in combat veterans with chronic posttraumatic stress disorder (PTSD), may correlate with severity of PTSD symptoms, and may reflect a distinct subtype of the disorder. These psychotic features include auditory and visual hallucinations and delusional thinking that is usually paranoid in nature. Psychotic features may be under-recognized in chronic PTSD because patients are reluctant to report these symptoms and because they may not have overt changes in affect or bizarre delusions characteristic of other psychoses, e.g., schizophrenia. To further assess these phenomena, we compared clinical ratings on the Positive and Negative Syndrome Scale (PANSS) and other assessments, including the Clinical Global Impression Scale and the Structured Clinical Interview with Psychotic Screen, in veterans meeting DSM-IV criteria for chronic PTSD with well-defined comorbid psychotic features (N = 40) or chronic schizophrenia (N = 40). The patients with schizophrenia had modestly higher composite PANSS scores and positive symptom scores although average scores in both groups were moderate to severe in intensity. Negative symptom and general psychopathology subscale scores were comparable in both groups. Regarding specific positive symptoms, hallucinations were comparable between groups in severity; however, schizophrenia patients had slightly more intense delusions and conceptual disorganization. These data further validate the occurrence of positive as well as negative symptoms of psychosis in chronic PTSD in a range of severity that may approach that of patients with schizophrenia. Although meeting DSM-IV criteria for two different major psychiatric disorders, these two patient populations were remarkably similar with respect to not only positive but also negative symptoms.

The effect of participation in religious activities on suicide versus natural death in adults 50 and older.

Abstract: This study tests the hypothesis that older persons dying by suicide, compared with natural death, are less likely to have participated in religious activities. Data from the 1993 National Mortality Followback Survey were used to compare the frequency of participation in religious activities of 584 suicides to those of 4279 natural deaths occurring among women and men ages 50 and older. Adjusting for sex, race, marital status, age, and frequency of social contact, the odds for having never participated in religious activities are greater among suicide victims, compared with natural deaths. Participation in religious activities does appear to reduce the odds of the occurrence of suicide. This effect remains even after controlling for the frequency of social contact. The identification of specific factors contributing to this intrinsic benefit of religious participation requires further investigation.

Childhood emotional trauma and chronic posttraumatic stress disorder in adult outpatients with treatment-resistant depression.

Abstract: The intent of this study was to test the hypothesis that patients with treatment-resistant depression are more likely than treatment responsive patients to suffer from sequelae of childhood trauma that may perpetuate depression despite adequate medication treatment. Twenty participants with treatment-resistant depression and 20 participants with treatment-responsive depression were administered a structured interview and a battery of psychological tests to assess levels of current depression, confirm diagnosis, and quantify childhood trauma and presence of dissociative phenomena. Tests used include the Beck Depression Inventory, the Mini International Neuropsychiatric Interview, the Minnesota Multiphasic Personality Inventory-2, the Childhood Trauma Questionnaire, and the Trauma Symptom Inventory. Compared with treatment responders, the treatment-resistant participants were significantly more depressed, had significantly more comorbid anxiety disorders, reported significantly greater levels of childhood emotional abuse, and experienced current-day sequelae of childhood emotional abuse. The hypothesis was partially supported by these results. This study suggests that reported history of childhood emotional abuse and sequelae of that abuse may be associated with treatment resistance in depressed outpatients.

Associations among symptoms of depression and posttraumatic stress disorder and self-reported health in sexually assaulted women.

Abstract: Symptoms of depression and posttraumatic stress disorder (PTSD) were examined for their association with health status in a sample of sexual assault victims. Hypotheses were that symptoms of each disorder would account for unique variance in health status among individuals exposed to traumatic stressors. Fifty-seven sexually assaulted college women were assessed for prior victimization history, assault characteristics, and depressive and PTSD symptoms. When prior history of sexual victimization, assault severity, and physical reactions during the assault were controlled, hierarchical multiple regression models indicated that symptoms of PTSD and depression were significantly associated with global health perceptions and severity of self-reported health symptoms. Only PTSD symptoms were significantly associated with reproductive health symptoms. The results suggest that both symptoms of PTSD and depression account for the relationship between exposure and health impairment among sexual assault victims.

Personality traits in schizophrenia: comparison with a community sample.

Abstract: The objective of this study was to compare personality trait profiles in patients with schizophrenia and healthy controls. Male outpatients with schizophrenia (N = 24) and a male nonpsychiatric community sample (N = 46) completed the NEO-FFI personality questionnaire. Multivariate analyses were used to compare mean scale scores and scale profiles for each group. The overall personality profile of clinically stable patients with schizophrenia differed significantly from that of a community sample. On individual scales, patients scored significantly higher on neuroticism and significantly lower on conscientiousness. These results confirm and extend those of previous studies that used normative data for comparison and a much longer version of the same personality questionnaire. Prospective studies of populations at risk are needed to determine whether group differences reflect a premorbid diathesis for schizophrenia or a secondary effect of serious mental illness.

A comparison of posttraumatic stress disorder with and without borderline personality disorder among women with a history of childhood sexual abuse: etiological and clinical characteristics.

Abstract: The overlap in definition and presentation between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) has raised questions about the relationship of these disorders. Are they separate disorders, variants of the same disorder, or comorbid conditions? The present study examined etiological variables and current functioning among two groups of outpatient women with a history of childhood sexual abuse: those with PTSD only (N = 45) and those with PTSD and BPD (N = 26). The groups did not differ in severity, frequency, or number of perpetrators of their childhood sexual abuse, or whether the perpetrator was a family member or not. The additional diagnosis of BPD was associated with earlier age of abuse onset and significantly higher rates of physical and verbal abuse by mother. Severity and frequency of PTSD symptoms were not affected by BPD diagnosis, suggesting that the personality disorder and PTSD are independent symptom constructs. The PTSD+BPD group scored higher on several other clinical measures including anger, dissociation, anxiety, and interpersonal problems. They did not differ in their frequency of use of mental health services but tended to be less compliant in their treatment. These and other findings are discussed, and implications for treatment are considered.

Psychosocial treatments in schizophrenia: a review of the past 20 years.

Abstract: Pharmacotherapy can improve some of the symptoms of schizophrenia but has limited effect on the social impairments that characterize the disorder and limit functioning and quality of life. Through computerized literature searches and bibliographies of published reports we identified peer reviewed studies of group, family, and individual therapy with schizophrenia and schizoaffective disorder patients. We identified 70 studies: 26 on group therapy, 18 on family therapy, and 11 on individual therapy. Additionally, treatment models were compared in 4 studies and combined in 11 others. Controls were included in 61 and all studies included medication. Benefits in symptoms as well as social and vocational functioning were associated with psychosocial treatments. Family therapy demonstrated the most promising findings and traditional social skills treatment yielded the least robust results. Adjunctive psychosocial treatments augment the benefits of pharmacotherapy and enhance functioning in psychotic disorders. Although these positive results have led to increased enthusiasm about psychosocial treatments for schizophrenia, questions remain about comparative benefits of specific treatment methods and additional benefits of multiple treatments.