Showing papers in "Journal of Nervous and Mental Disease in 2001"

Cognitive behavioral therapy for schizophrenia: an empirical review.

Abstract: Early case studies and noncontrolled trial studies focusing on the treatment of delusions and hallucinations have laid the foundation for more recent developments in comprehensive cognitive behavioral therapy (CBT) interventions for schizophrenia. Seven randomized, controlled trial studies testing the efficacy of CBT for schizophrenia were identified by electronic search (MEDLINE and PsychInfo) and by personal correspondence. After a review of these studies, effect size (ES) estimates were computed to determine the statistical magnitude of clinical change in CBT and control treatment conditions. CBT has been shown to produce large clinical effects on measures of positive and negative symptoms of schizophrenia. Patients receiving routine care and adjunctive CBT have experienced additional benefits above and beyond the gains achieved with routine care and adjunctive supportive therapy. These results reveal promise for the role of CBT in the treatment of schizophrenia although additional research is required to test its efficacy, long-term durability, and impact on relapse rates and quality of life. Clinical refinements are needed also to help those who show only minimal benefit with the intervention.

Drug treatment outcomes for adolescents with comorbid mental and substance use disorders.

Abstract: This study compared the pretreatment characteristics and posttreatment outcomes of substance-abusing adolescents with and without comorbid mental disorders in the Drug Abuse Treatment Outcome Studies for Adolescents. Subjects (N = 992) were sampled from 23 adolescent drug treatment programs across three modalities (residential, short-term inpatient, outpatient drug-free). Nearly two thirds (64%) of the sample had at least one comorbid mental disorder, most often conduct disorder. Comorbid youth were more likely to be drug or alcohol dependent and had more problems with family, school, and criminal involvement. Although comorbid youth reduced their drug use and other problem behaviors after treatment, they were more likely to use marijuana and hallucinogens, and to engage in illegal acts in the 12 months after treatment, as compared with the noncomorbid adolescents. Integrated treatment protocols need to be implemented within drug treatment programs in order to improve the outcomes of adolescents with comorbid substance use and mental disorders.

Cognitive treatment of pathological gambling.

Abstract: This study evaluated the efficacy of a cognitive treatment package for pathological gambling. Sixty-six gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment or wait-list control conditions. Cognitive correction techniques were used first to target gamblers' erroneous perceptions about randomness and then to address issues of relapse prevention. The dependent measures used were the South Oaks Gambling Screen, the number of DSM-IV criteria for pathological gambling met by participants, as well as gamblers' perception of control, frequency of gambling, perceived self-efficacy, and desire to gamble. Posttest results indicated highly significant changes in the treatment group on all outcome measures, and analysis of data from 6- and 12-month follow-ups revealed maintenance of therapeutic gains. Recommendations for clinical interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.

Developmental aspects of obsessive compulsive disorder: findings in children, adolescents, and adults.

Abstract: Although juvenile obsessive compulsive disorder (OCD) is increasingly recognized as a putative developmental subtype of the disorder, comparisons among children, adolescents, and adults with OCD have been lacking. We aimed to evaluate clinical correlates of OCD in three developmentally distinct groups. Subjects comprised children, adolescents, and adults meeting DSM-III-R and DSM-IV criteria for OCD referred to separate specialized OCD clinics. All subjects were systematically evaluated with structured diagnostic interviews and clinical assessments by OCD experts. Specific clinical correlates and symptom profiles were associated with the disorder in different age groups. These findings support a hypothesis of developmental discontinuity between juvenile and adult OCD and identify age specific correlates of the disorder across the life cycle. Further work is needed to validate whether juvenile-onset OCD represents a true developmental subtype of the disorder.

Anger, impulsivity, social support, and suicide risk in patients with posttraumatic stress disorder.

Abstract: An emerging literature suggests that posttraumatic stress disorder (PTSD) patients are at an increased risk for suicide The objective of this study was: a) to reexamine the relationship between PTSD and suicide by comparing suicide risks of persons with PTSD, to persons with anxiety disorder and to matched controls; and b) to examine the relationship between anger, impulsivity, social support and suicidality in PTSD and other anxiety disorders Forty-six patients suffering from PTSD were compared with 42 non-PTSD anxiety disorder patients and with 50 healthy controls on measures of anger, impulsivity, social support, and suicide risk Persons with PTSD had the highest scores on the measures of suicide risk, anger, and impulsivity and the lowest scores on social support Multivariate analysis revealed that in the PTSD group, impulsivity was positively correlated with suicide risk and anger was not PTSD symptoms of intrusion and avoidance were only mildly correlated with suicide risk at the bivariate level but not at the multivariate level For the PTSD and anxiety disorder groups, the greater the social support, the lower the risk of suicide For the controls, social support and impulsivity were not related to suicide risk, whereas anger was These findings suggest that persons with PTSD are at higher risk for suicide and that in assessing suicide risk among persons with PTSD, careful attention should be paid to levels of impulsivity, which may increase suicide risk, and to social support, which may reduce the risk

Cross-cultural validity and reliability testing of a standard psychiatric assessment instrument without a gold standard.

Abstract: The objective of this study was to assess the cross-culture validity and reliability of a standard psychiatric assessment instrument without the usual "gold standards." Normally criterion validity testing requires comparison with such a standard--usually another instrument or a professional diagnosis. Instead local informants identified persons with and without "agahinda gakabije" (a locally described grief syndrome) who were then asked if they thought they had this syndrome and also interviewed using the depression section of the Hopkins Symptom Checklist (DHSCL). To assess criterion validity, interviews where respondent and informant agreed on the presence or absence of agahinda gakabije were compared with depression diagnosis using the DHSCL. We also assessed construct validity (using factor analysis), internal reliability (Cronbach's alpha), and test-retest reliability using results from a subsequent community-based survey employing the DHSCL. We found a similar relationship between depression and agahinda gakabije as between depression and grief in western countries, which supports criterion validity. Construct validity and internal reliability were good (Cronbach's alpha = 0.87). Test-retest reliability of a DHSCL-based scale was less adequate (0.67). Although not replacing the usual gold standards for testing criterion validity, this approach may prove useful where these standards are unavailable. As this includes much of the developing world, this could result in more accurate mental health assessments among populations for whom this has hitherto not been possible.

Combat trauma: trauma with highest risk of delayed onset and unresolved posttraumatic stress disorder symptoms, unemployment, and abuse among men.

Abstract: Little is known about the risk and course of posttraumatic stress disorder (PTSD), and other forms of dysfunction, associated with combat trauma relative to other traumas. Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and Composite International Diagnostic Interview were administered to a representative national sample of 5,877 persons 15-54 years old in the part 2 subsample of the National Comorbidity Survey. Of the weighted subsample, 1,703 men reported a traumatic event. The risk of PTSD and other forms of dysfunction were compared for men who nominated combat as their worst trauma versus men nominating other traumas as worst, controlling for confounding influences. Men reporting combat as their worst trauma were more likely to have lifetime PTSD, delayed PTSD symptom onset, and unresolved PTSD symptoms, and to be unemployed, fired, divorced, and physically abusive to their spouses than men reporting other traumas as their worst experience.

Is clinical depression distinct from subthreshold depressive symptoms? A review of the continuity issue in depression research.

Abstract: Resolving whether subthreshold depressive symptoms exist on a continuum with unipolar clinical depression is important for progress on both theoretical and applied issues. To date, most studies have found that individuals with subthreshold depressive symptoms resemble cases of major depressive disorder along many important dimensions (e.g., in terms of patterns of functional impairment, psychiatric and physical comorbidity, familiality, sleeping EEG, and risk of future major depression). However, such manifest similarities do not rule out the possibility of a latent qualitative difference between subthreshold and diagnosable depression. Formal taxonomic analyses, intended to resolve the possibility of a latent qualitative distinction, have so far yielded contradictory findings. Several large-sample latent class analyses (LCA) have identified latent clinical and nonclinical classes of unipolar depression, but LCA is vulnerable to identification of spurious classes. Paul Meehl's taxometric methods provide a potentially conservative alternative way to identify latent classes. The one comprehensive taxometric analysis reported to date suggests that self-report depression symptoms occur along a latent continuum but exclusive reliance on self-report depression measures and incomplete information regarding sample base rates of depression makes it difficult to draw strong inferences from that report. We conclude that although most of the evidence at this time appears to favor both a manifest and latent continuum of unipolar depression symptomatology, several important issues remain unresolved. Complete resolution of the continuity question would be speeded by the application of both taxometric techniques and LCA to a single large sample with a known base rate of lifetime diagnosed depressives.

Phobic, panic, and major depressive disorders and the five-factor model of personality.

Abstract: This study investigated five-factor model personality traits in anxiety (simple phobia, social phobia, agoraphobia, and panic disorder) and major depressive disorders in a population-based sample. In the Baltimore Epidemiologic Catchment Area Follow-up Study, psychiatrists administered the Schedules for Clinical Assessment in Neuropsychiatry to 333 adult subjects who also completed the Revised NEO Personality Inventory. All of the disorders except simple phobia were associated with high neuroticism. Social phobia and agoraphobia were associated with low extraversion. In addition, lower-order facets of extraversion, agreeableness, and conscientiousness were associated with certain disorders (i.e., low positive emotions in panic disorder; low trust and compliance in certain phobias; and low competence, achievement striving, and self-discipline in several disorders). This study emphasizes the utility of lower-order personality assessments and underscores the need for further research on personality/psychopathology etiologic relationships.

Effects of Gender and Ethnicity on Duty-Related Posttraumatic Stress Symptoms among Urban Police Officers

Abstract: We studied 655 urban police officers (21% female, 48% white, 24% black, and 28% Hispanic) to assess ethnic and gender differences in duty-related symptoms of posttraumatic stress disorder (PTSD). We obtained self-report measures of: a) PTSD symptoms, b) peritraumatic dissociation, c) exposure to duty-related critical incidents, d) general psychiatric symptoms, e) response bias due to social desirability, and f) demographic variables. We found that self-identified Hispanic-American officers evidenced greater PTSD symptoms than both self-identified European-American and self-identified African-American officers. These effects were small in size but they persisted even after controlling for differences in other relevant variables. Contrary to expectation, we found no gender differences in PTSD symptoms. Our findings are of note because: a) they replicate a previous finding of greater PTSD among Hispanic-American military personnel and b) they fail to replicate the well-established finding of greater PTSD symptoms among civilian women.

Posttraumatic stress disorder and major depressive disorder: investigating the role of overlapping symptoms in diagnostic comorbidity.

Abstract: Studies of posttraumatic stress disorder (PTSD) have found high levels of comorbid major depressive disorder (MDD). One reason suggested for the comorbidity is the symptom overlap (contaminated symptoms) between the disorders. The present study investigated the contribution of contaminated symptoms (anhedonia, concentration, and sleep problems) to the comorbidity of PTSD and MDD. PTSD symptoms were subdivided into two groups: the contaminated symptoms and the 14 unique symptoms. It was speculated that if the contaminated symptoms are responsible for the comorbidity, then they will show less specificity than the unique symptoms, will be less highly correlated with a PTSD symptom total count, and be more frequently endorsed in PTSD patients with than without MDD. These hypotheses were tested in a sample (N = 1300) of psychiatric outpatients, 260 of whom had lifetime PTSD. None of the hypotheses were supported, thereby suggesting that the comorbidity between PTSD and MDD is not an artifact of symptom overlap.

Insecure attachment and alexithymia in young men with mood symptoms.

Abstract: According to attachment theorists, affect regulation and quality of attachment are closely linked. As a personality trait associated with deficits in the cognitive processing and regulation of affects, alexithymia has been hypothesized to correlate with insecure attachment. To test this hypothesis,

Local perceptions of the mental health effects of the Rwandan genocide.

Abstract: The objectives of this study were to investigate how Rwandans perceive the mental health effects of the 1994 genocide, to investigate the local validity of western mental illness concepts, and (if these concepts were found to be valid) to provide data to adapt existing mental health assessment instruments for local use. We used three ethnographic methods to interview people in two rural areas in Rwanda: first, free listing provided a list of local terms for mental symptoms and disorders; second, key informant interviews then provided more detailed information about these disorders; and finally, pile sorts confirmed the relationships among symptoms and disorders that emerged from the other methods. We found that interviewees described the diagnostic symptoms of depression and posttraumatic stress disorder as results of the genocide and also described associated "local" symptoms not included in the established diagnostic criteria. They divided symptoms into a "mental trauma" syndrome that included the posttraumatic stress disorder symptoms and some depression and local symptoms, and a grief syndrome that included other depression and local symptoms. In the pile sorts, we focused on investigating mood disorders and confirmed that four of the locally described symptoms formed part of a local depression-like illness. The results suggest that depression occurs among this population and support the local content validity of depression assessment instruments, such as the Depression section of the Hopkins Symptom Checklist. Similar independent evidence of validity is missing from most cross-cultural surveys. Our work supports the need and feasibility for collecting this supporting evidence prior to conducting cross-cultural surveys using existing instruments.

Trauma-related sleep disturbance and self-reported physical health symptoms in treatment-seeking female rape victims.

Abstract: The purpose of the study was to assess the relationship between trauma-related sleep disturbance and physical health symptoms in treatment-seeking female rape victims. A total of 167 participants were assessed for PTSD symptoms, depression, sleep disturbance, and frequency of self-reported health symptoms. Results demonstrated that trauma-related sleep disturbance predicted unique variance in physical health symptoms after other PTSD and depression symptoms were controlled. The findings suggest that trauma-related sleep disturbance is one potential factor contributing to physical health symptoms in rape victims with PTSD.

Family functioning in subjects with pseudoseizures and epilepsy.

Abstract: The purpose of this study was to identify differences in family functioning between subjects with pseudoseizures and their families, and control subjects with epilepsy Thirty-one adult subjects with pseudoseizures and 31 controls with intractable epilepsy, whose diagnoses were confirmed using video-EEG, were recruited from the epilepsy unit of a tertiary care hospital over a 4-year period Each study participant and their first-degree adult family members completed two standardized questionnaires designed to measure family functioning: the McMaster Family Assessment Device (FAD) and the Beavers Self-Report Family Inventory (SFI) Individuals with pseudoseizures, when compared with epileptic subjects, exhibited significantly elevated scores in three scales of the FAD and in one scale of the SFI, indicating greater psychopathology within the family, as perceived by the individual Statistically significant differences with the FAD were on measures of affective involvement (p = 044), communication (p = 004), and general functioning (p = 013) The SFI revealed significantly greater difficulty with conflict (p = 050) No differences were noted between subjects with both pseudoseizures and epilepsy and subjects with pseudoseizures alone In comparison with the families of the epileptic group, the families of subjects with pseudoseizures displayed statistically significant elevations in their responses on the roles scale (p = 003) of the FAD The responses of the family members did not differ in regard to the role they assumed within the family unit (ie, spouse, parent) In summary, individuals with pseudoseizures view their families as being more dysfunctional, particularly in the area of communication, whereas their family members perceived difficulties in defining roles This suggests that family education and interventions focusing on these areas, may be an important aspect of the treatment of patients with pseudoseizures

The incidence of schizotypy among cannabis and alcohol users.

Abstract: Schizotypy research has revealed associations between positive schizotypal symptomatology and substance use but has not related substance use to important schizotypal traits such as anhedonia. Users and nonusers of cannabis and alcohol completed the Oxford-Liverpool Inventory of Feelings and Experie

A population-based twin study of generalized anxiety disorder in men and women.

Abstract: This study aimed to a) assess whether genetic or environmental effects are of similar magnitude in the etiology of GAD in men and women, and b) investigate whether familial (genetic or common environmental) risk factors are the same in men and women, or whether there are gender-specific effects. We obtained a lifetime history of DSM-IIII-R GAD, via face-to-face and telephone interviews, from 3100 complete male-male, female-female, and male-female twin pairs, ascertained through a population-based registry. Biometrical twin modeling was utilized to estimate the relative contributions of genetic and environmental factors to liability for GAD, allowing for gender-specific effects. The familial aggregation of GAD in this sample was only modest. In the best-fitting models, the heritability of GAD was the same in men and women, estimated at about 15% to 20%, with no effects of gender-specific genes detected.

Traumatic experiences and the mental health of Senegalese refugees.

Abstract: The purpose of our study was to conduct a preliminary investigation into the experiences and mental health of Senegalese refugees. Although research has established that refugees are more prone to psychiatric illnesses than the general population, little has been written about West African refugees. Our focus was on adult refugees (18 years of age and older) from the Casamance region of Senegal. A total of 80 participants (39 women, 41 men) were randomly selected from refugee camps in The Gambia. The Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 were used to assess levels of traumatization and mental health status. Typical of refugees of war, participants reported suffering a large number of various traumas. High prevalence rates of anxiety, depression, and posttraumatic stress disorder were also found in this group. A substantial mental health problem exists within the Senegalese refugee population that may signify a potential human crisis.

Evaluations of others by borderline patients

Abstract: This study investigated evaluations of other people in specific emotional situations by patients with borderline personality disorder (BPD). BPD patients (N = 16), control patients with cluster C personality disorder (PD; N = 12) and normal controls (N = 15) saw film clips with emotional themes centering on abandonment, rejection and abuse, hypothesized to be specific for borderline pathology. Subjects wrote down their spontaneous reactions to six film personalities, divided over three clips, including what they thought to be characteristic traits of these persons. Spontaneous reactions were coded on two dimensions, based on earlier studies by Westen and colleagues: a) affect-tone of ascribed qualities and b) complexity of evaluations of people. The number of trait dimensions constituted the third scale. The overall pattern of findings suggests that the BPD group, as well as the cluster C group, show poorly differentiated evaluations with a low number of dimensions. Thus, this seems characteristic for personality disorders in general. The BPD group shows a lower affect-tone, reflecting a stronger tendency to view others negatively, compared with both control groups.

The association between antisaccade task and working memory task performance in schizophrenia and bipolar disorder.

Abstract: To date, the research literature has yielded conflicting reports regarding the specificity of antisaccade deficits to schizophrenia. We sought to examine antisaccade and working memory task performance in schizophrenia patients and bipolar patients, as well as to examine the relationship between the two tasks in both patient populations. Thirty-four schizophrenia patients, 20 bipolar patients, and 30 nonpatient controls were administered saccadic inhibition (antisaccade), working memory, and sensorimotor tasks. Compared with the controls, the schizophrenia patients displayed both antisaccade deficits and working memory deficits. In contrast, the bipolar patients produced significantly more errors on the antisaccade task than the controls, though the bipolar group performed similarly to the control group on the working memory task. Mediational analyses demonstrated that working memory partially mediates the relationship between patients' diagnostic group status and antisaccade task performance; working memory performance contributed uniquely to the prediction of antisaccade task performance in the two patient groups. Antisaccade deficits do not appear specific to schizophrenia. The results suggest that in schizophrenia, working memory and antisaccade tasks are tapping similar cognitive processes, whereas in bipolar patients the processes underlying antisaccade and working memory performance are disparate.

Prevalence of dissociative disorders among psychiatric inpatients in a German university clinic.

Abstract: The aim of the study was to determine the frequency of dissociative disorders among psychiatric inpatients in Germany and to investigate the relationship between childhood trauma and dissociation. The German version of the Dissociative Experiences Scale (DES), the Fragebogen fur Dissoziative Symptome (FDS), was used to screen 115 consecutive inpatients admitted to the psychiatric clinic of a university hospital. Patients with FDS scores higher than 20 were interviewed by a trained clinician, using the German translation of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). The German version of the Childhood Trauma Questionnaire (CTQ) was administered to investigate prevalence of childhood trauma and relations between childhood trauma and dissociation in adult life. Twenty-five of the 115 patients (21.7%) had a score higher than 20 on the FDS. Of these, 15 patients were interviewed with the SCID-D-R. One patient was diagnosed with a dissociative identity disorder, three with dissociative disorders not otherwise specified, and one patient with depersonalization disorder. All diagnoses were confirmed clinically. A significant positive relationship was found between the severity of childhood trauma and dissociation. Dissociative disorders are common among German psychiatric inpatients. Clinicians who work in psychiatric inpatient units should be mindful of these disorders.

The course of postpartum psychiatric disorders in women and their partners.

Abstract: This study examined the course of postpartum psychiatric disorders in a community sample of mothers and their partners to determine whether sociodemographic variables, life stress, and psychiatric history were related to persistence of mental health problems. At 6 months postpartum, 48 index couples where the wife had a psychiatric disorder at 2 months postpartum and 50 control couples with no such diagnosis underwent diagnostic interviews and completed questionnaires on psychological symptoms, life stress, and treatment history. The results indicate that at follow-up, 54% of the index mothers still had a psychiatric diagnosis, as did 60% of their partners who had had a psychiatric diagnosis at 2 months postpartum. Socioeconomic status, country of origin, and life stress were related to persistence, as were diagnosis and timing of onset of the disorder. About a third of the parents were referred for treatment. It is concluded that for many families, postpartum psychiatric disorders are not a transient phenomenon.

Risk factors for posttrauma reactions in police officers: a longitudinal study.

Abstract: This prospective, longitudinal study investigated risk factors in the development of psychological ill health and posttraumatic stress symptoms in a sample of 223 junior police officers Participants were assessed using a self-report methodology during training and again 12 months later on a range of personality, trauma exposure, and symptom measures Risk factors for general psychological ill health at phase 2 of the research were found to comprise mostly stable, preexisting characteristics such as personality style, gender, and trait dissociation Conversely, specific traumatic stress symptoms were more heavily influenced by experiences in the intervening 12 months, such as severity of incident exposure and peritraumatic dissociation The implications for differential intervention are discussed

Characteristics of people lost to attrition in psychiatric follow-up studies.

Abstract: In a large (N = 1,744) study of previously hospitalized psychiatric patients, multiple follow-up attempts were made to contact the ex-patients over a 1-year period after their discharges. When contacted they were asked to provide information about their posthospital adjustment; 59.5% of the sample was reached at least once and usable data obtained either in a telephone interview or from a mailed survey form. The contacted and noncontacted people represented very different subpopulations, both demographically and in terms of typical psychiatric descriptors. Those who were of lower socioeconomic status, male, unmarried, racial minorities, and those with records of substance abuse or assaultiveness, and who were generally more severely impaired during the baseline hospitalization were underrepresented in the contacted group. Possible reasons for these sample biases, the implications for hospitals conducting outcome assessments (i.e., for research and program evaluation purposes), and strategies for dealing with this kind of methodological problem are discussed.

Correlates of insight in serious mental illness.

Abstract: This study extends research into insight by examining its relationship to a variety of demographic, clinical, neurocognitive, and psychosocial variables among a broad diagnostic sample of 211 adults with serious mental illness. Participants completed a full battery of instruments measuring these variables. Results support a relationship between ratings of poor insight and a psychotic (vs. mood) diagnosis, increased psychiatric symptoms, poorer social skills, and negative medication attitudes. Minorities and those with a substance abuse diagnosis were also more likely to be rated as having poor insight. No relationship was found between level of insight and age, gender, education level, neurocognitive deficits, hospitalization history, size of one's social network, or quality of life measures. Results are discussed in the context of improving the measurement and assessment of insight, conceptualizing interventions aimed at addressing level of insight, and improving outcomes for patients with severe and persistent mental illness. Findings also support a need for continued investigation of how mental illness is understood, experienced, and expressed across diverse groups of people living with mental illness.