Showing papers in "Journal of Nervous and Mental Disease in 2009"

Quality of Early Care and Childhood Trauma: A Prospective Study of Developmental Pathways to Dissociation

Abstract: Kihlstrom (2005) has recently called attention to the need for prospective longitudinal studies of dissociation. The present study assesses quality of early care and childhood trauma as predictors of dissociation in a sample of 56 low-income young adults followed from infancy to age 19. Dissociation was assessed with the Dissociative Experiences Scale; quality of early care was assessed by observer ratings of mother-infant interaction at home and in the laboratory; and childhood trauma was indexed by state-documented maltreatment, self-report, and interviewer ratings of participants' narratives. Regression analysis indicated that dissociation in young adulthood was significantly predicted by observed lack of parental responsiveness in infancy, while childhood verbal abuse was the only type of trauma that added to the prediction of dissociation. Implications are discussed in the context of previous prospective work also pointing to the important contribution of parental emotional unresponsiveness in the development of dissociation.

Toxoplasma gondii antibody titers and history of suicide attempts in patients with recurrent mood disorders.

Abstract: Toxoplasma gondii (T.gondii) is an obligate intracellular protozoan parasite infecting one-third of the world population, residing relatively silently in the brain of the immunocompetent host. We hypothesized that T.gondii seropositivity and serointensity are associated with having a history of attempting suicide and, in those attempting suicide, a greater number of attempts. T.gondii seropositivity and antibody titers were compared between (a) patients with recurrent mood disorders with history of suicide attempt (99 individuals) versus (b) patients with recurrent mood disorders without history of suicide attempt (119 individuals), and (c) healthy controls (39 individuals). Diagnosis was made using the Structured Clinical Interview for DSM-IV. Statistical methods included chi square, analysis of variance, and linear and logistic regression analyses. Suicide attempters had higher T.gondii antibody titers than nonsuicide attempters (p = 0.004). The logistic regression analysis revealed a predictive association between titers of anti- T.gondii antibodies and history of suicide attempt with OR = 1.55 (1.14-2.12), p = 0.006. No significant relationship was found between T.gondii seropositivity and suicide attempt status, number of prior suicide attempts, and recurrent mood disorder diagnosis. Although preliminary and bearing replication, this is the first report, to our knowledge, of an association between attempting suicide and T. gondii.

The associations between depression, health-related quality of life, social support, life satisfaction, and disability in community-dwelling US adults.

Abstract: The purpose of this manuscript is to describe the associations among current depression, as measured by the Patient Health Questionnaire 8, health-related quality of life, social support, life satisfaction, and disability status, using the 2006 Behavioral Risk Factor Surveillance System. A dose-response relationship exists between depression severity and mean number of days in the past 30 days of physical distress, pain, anxiety symptoms, and activity limitations as well as the prevalence of fair/poor general health, life dissatisfaction, inadequate social support, and disability. These profound associations underscore the need for recognition and treatment of depression in all healthcare settings.

Routine work environment stress and PTSD symptoms in police officers.

Abstract: This study examined the relationship between routine work environment stress and posttraumatic stress disorder (PTSD) symptoms in a sample of police officers (N = 180) who were first assessed during academy training and reassessed 1-year later. In a model that included gender, ethnicity, traumatic exposure prior to entering the academy, current negative life events, and critical incident exposure over the last year, routine work environment stress was most strongly associated with PTSD symptoms. We also found that routine work environment stress mediated the relationship between critical incident exposure and PTSD symptoms and between current negative life events and PTSD symptoms. Ensuring that the work environment is functioning optimally protects against the effects of duty-related critical incidents and negative life events outside police service.

Posttraumatic stress disorder mediates the relationship between mild traumatic brain injury and health and psychosocial functioning in veterans of Operations Enduring Freedom and Iraqi Freedom.

Abstract: This study evaluated whether posttraumatic stress disorder (PTSD) mediated the relationship between mild traumatic brain injury (MTBI) and general health ratings, psychosocial functioning, and perceived barriers to receiving mental healthcare 2 years following return from deployment in veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). A total of 277 OEF/OIF veterans completed the Connecticut OEF/OIF Veterans Needs Assessment Survey; 18.8% of the sample screened positive for MTBI. Compared with respondents who screened negative for MTBI, respondents who screened positive for MTBI were younger, more likely to have PTSD, more likely to report fair/poor overall health and unmet medical and psychological needs, and scored higher on measures of psychosocial difficulties and perceived barriers to mental healthcare. Injuries involving loss of consciousness were associated with greater work-related difficulties and unmet psychological needs. PTSD mediated the relationship between MTBI and all of these outcomes. These results underscore the importance of assessing PTSD in OEF/OIF veterans who screen positive for MTBI.

Traditional healers in the treatment of common mental disorders in South Africa.

Abstract: There are few population-level insights into the use of traditional healers and other forms of alternative care for the treatment of common mental disorders in sub-Saharan Africa. We examined the extent to which alternative practitioners are consulted, and predictors of traditional healer visits. A national survey was conducted with 3651 adult South Africans between 2002 and 2004, using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate DSM-IV diagnoses for common mood, anxiety, and substance use disorders. A minority of participants with a lifetime DSM-IV diagnosis obtained treatment from Western (29%) or alternative (20%) practitioners. Traditional healers were consulted by 9% of the respondents and 11% consulted a religious or spiritual advisor. Use of traditional healers in the full sample was predicted by older age, black race, unemployment, lower education, and having an anxiety or a substance use disorder. Alternative practitioners, including traditional healers and religious advisors, appear to play a notable role in the delivery of mental health care in South Africa.

Auditory Hallucinations in Dissociative Identity Disorder and Schizophrenia With and Without a Childhood Trauma History: Similarities and Differences

Abstract: Little is known about similarities and differences in voice hearing in schizophrenia and dissociative identity disorder (DID) and the role of child maltreatment and dissociation. This study examined various aspects of voice hearing, along with childhood maltreatment and pathological dissociation in 3 samples: schizophrenia without child maltreatment (n = 18), schizophrenia with child maltreatment (n = 16), and DID (n = 29). Compared with the schizophrenia groups, the DID sample was more likely to have voices starting before 18, hear more than 2 voices, have both child and adult voices and experience tactile and visual hallucinations. The 3 groups were similar in that voice content was incongruent with mood and the location was more likely internal than external. Pathological dissociation predicted several aspects of voice hearing and appears an important variable in voice hearing, at least where maltreatment is present.

A review of dissociative disorders treatment studies.

Abstract: This review examines empirical reports of treatment for Dissociative Disorders (DD), including 16 DD treatment outcome studies and 4 case studies that used standardized measures. Collectively, these reports suggest that treatment for DD is associated with decreased symptoms of dissociation, depression, posttraumatic stress disorder, distress, and suicidality. Effect sizes, based on pre/post measures, are in the medium to large range across studies. Patients with dissociative disorder who integrated their dissociated self states were found to have reduced symptomatology compared with those who did not integrate. The magnitude of pre/post effect sizes for these DD studies are comparable to pre/post effect sizes in treatment studies of complex PTSD. There are significant methodological limitations in the current DD treatment outcome literature that reduce internal and external validity including regression towards the mean, limited sample sizes, and nonrandomized research designs. Implications for future research and treatment planning for patients suffering from DD are discussed.

Stressful life events, chronic difficulties, and the symptoms of clinical depression.

Abstract: Major life events and chronic difficulties have been found to be associated with the onset of depression. Little is known, however, about how exposure to such stressors is related to the clinical presentation of this disorder. We addressed this issue by administering an interview-based measure of life stress, the Beck Depression Inventory, and the Global Assessment of Functioning scale to 100 adults diagnosed with major depressive disorder. Participants who experienced a preonset severe life event exhibited greater overall levels of depression severity, endorsed more cognitive and somatic symptoms of depression, and functioned at lower levels than did their counterparts without preonset severe life events. In contrast, exposure to a preonset severe difficulty was unrelated to participants' severity of depression, cognitive and somatic symptoms, or level of global functioning. These findings highlight the potentially greater importance of acute stress compared with chronic stress for influencing these key clinical features of depression.

The relationship between self-reported attachment styles, interpersonal dysfunction, and borderline personality disorder.

Abstract: Clinical theories of borderline personality disorder (BPD) identify attachment insecurity as the basis of its characteristic disturbed interpersonal functioning The purpose of this study was to compare attachment ratings in rigorously diagnosed BPD, depressed (MDD), and nonborderline comparison groups and their correlations to features of interpersonal disturbance Subjects self-reported ratings on attachment styles using the relationship questionnaire BPD subjects reported higher scores on both preoccupied and fearful attachment styles than both MDD and nonborderline comparison groups A mixed model of preoccupied and fearful attachment was more prevalent in the BPD group and was associated with 3 to 20 times greater risk for diagnosis of BPD Scores on preoccupied and fearful attachment styles were correlated with features of interpersonal disturbance in BPD A combination of preoccupied and fearful self-reported attachment styles is more specific to BPD than either style alone or attachment insecurity in general

Depression among methamphetamine users: association with outcomes from the Methamphetamine Treatment Project at 3-year follow-up.

Abstract: Although depression is highly comorbid with substance use disorders, little is known about the clinical course and outcomes of methamphetamine (MA) users with depressive symptoms and syndromes. In this study of MA-dependent individuals entering psychosocial treatment, we predicted that (1) depressive symptoms would decline during treatment, an effect that would vary as a function of MA use and (2) depression diagnoses post-treatment would be associated with poorer outcomes. Participants (N = 526) were assessed for depression, substance use, and psychosocial outcomes at baseline, treatment discharge, and 3-year follow-up. Depressive symptoms declined significantly during treatment, an effect that was greatest among those who abstained from MA. Major depression at follow-up was associated with poorer MA use outcomes and impairment across multiple domains of functioning. The findings highlight the relationship of depressive symptoms and diagnoses to treatment outcomes, and suggest a need for further studies of depression in populations using MA.

Does cannabis use affect treatment outcome in bipolar disorder? A longitudinal analysis.

Abstract: Research suggests that cannabis use affects negatively on onset and outcome of schizophrenia, but less is known about possible effects in mood disorders. Bipolar in- and outpatients (N = 3459) were enrolled in an observational study. The influence of cannabis exposure on clinical and social treatment outcome measures was examined over the course of 1 year, as well as the effects on these associations of third mediating variables. Over 12 months of treatment, cannabis users exhibited less compliance and higher levels of overall illness severity, mania, and psychosis compared with nonusers. Additionally, cannabis users experienced less satisfaction with life and had a lower probability of having a relationship compared with nonusers. There was little evidence that cannabis-outcome associations were mediated by third variables. An independent impact of cannabis use on psychopathologic outcomes in patients with bipolar disorder was apparent, whereas the impact on social outcomes was modest.

Interpersonal and emotional experiences of social interactions in borderline personality disorder.

Abstract: General Aim:We examined interpersonal experiences of patients with borderline personality disorder (BPD) using a time-contingent diary procedure to collect information about social interactions for 7 days.Method:We examined the (1) quantity of social interactions and (2) interpersonal and emotional

The role of mindfulness in borderline personality disorder features.

Abstract: This study investigated whether deficits in mindfulness (attention, awareness, and acceptance of the present moment) underlie variability in borderline personality disorder (BPD) features and related impairments in interpersonal functioning, impulsivity, and emotion regulation. A path analytic approach was used to examine the relationships of trait mindfulness with BPD features, interpersonal effectiveness, impulsive and passive emotion-regulation, and neuroticism in a psychiatric sample of adults (N = 70). As hypothesized, mindfulness was associated inversely with BPD features and core areas of dysfunction, and these associations continued when controlling for neuroticism. Furthermore, mindfulness deficits continued to predict BPD features even when interpersonal effectiveness, passive and impulsive emotion-regulation, and neuroticism were controlled. These findings suggest that mindfulness may be a unique predictor for the expression of BPD pathology. An emphasis on mindfulness may thus be crucial in enhancing the formulation and treatment of BPD.

Theory of mind in borderline and cluster-C personality disorder.

Abstract: Borderline Personality Disorder (BPD) is associated with interpersonal problems, such as intense, unstable relationships and fears of abandonment. It has been hypothesized that deficits in social cognitive capacities explain these difficulties. One important aspect of social cognition is theory of mind (ToM)-the capacity to infer others' mental state. We tested ToM capacities with Happe's advanced ToM-test in 16 BPD patients, 16 Cluster-C PD patient controls, and 28 nonpatients. Social reasoning (WAIS Picture Arrangement), general intelligence, and current mood were also assessed. With and without controlling for intelligence, social reasoning, and mood, no evidence for deficits in ToM in BPD patients was found. In fact, both Cluster B and Cluster C patient groups tended to show generally superior performance to the nonpatients on the subscales of Happe ToM-test. All tests correlated similarly with intelligence in the 3 groups. These findings do not support the hypothesis that BPD patients have inferior theory of mind capacities.

Relationships between stigma, depression, and treatment in white and African American primary care patients

Abstract: Although many depressed patients are treated in primary care, depression in these settings has been underdetected and undertreated, which may be influenced by mental health beliefs such as stigma. This study examined the relationships among depression, mental health stigma, and treatment in African American and white primary care patients. Data were collected at 3 primary care settings from 1103 patients who completed surveys measuring depression, stigma, and treatment use. Overall, African American patients reported greater mental health stigma than whites. African American women reported greater stigma than white women. White patients were found to be more likely to use depression treatment than African American patients. Multivariate analyses showed that greater depression severity fully mediated the relationship between stigma and treatment use, and that patients with the highest depression scores had significantly higher stigma scores as well. These results suggest that greater severity of depressive symptoms may override stigma and other beliefs about mental health in determining treatment use, but may be important to address for patients with more moderate levels of symptomatology.

Impact of sleep disturbances on PTSD symptoms and perceived health.

Abstract: :More than two-thirds of individuals with PTSD report significant sleep difficulties that correlate positively with PTSD symptom severity. The aim of the study was to assess the impact of sleep disturbances on PTSD symptom severity and perceived health. Ninety-two volunteer treatment-seeking

Older Adults Are Less Accurate Than Younger Adults at Identifying Symptoms of Anxiety and Depression

Abstract: The present study examined age differences in the identification of anxiety and depressive symptoms in a community sample of 374 adults, ages 18 to 93. Older adults were less accurate and more likely than younger adults to label symptoms as neither anxiety nor depression. Both older and younger adults were more accurate in their classification of depressive than anxiety symptoms. These findings suggest that additional efforts are needed to educate the general public, particularly older adults, about anxiety and its symptoms.

Religious involvement and risk of major depression in a prospective nationwide study of African American adults

Abstract: This study investigated the association between religious involvement and major depression in 607 African American adults, using longitudinal data from the National Survey of Black Americans. Logistic regression found that survey participants who reported receiving "a great deal" of guidance from religion in their day-to-day lives at Time 1 (1988-1989) were roughly half as likely (OR = 0.47, p < 0.01) to have major depression at Time 2 (1992), controlling for sociodemographic and psychological factors, and major depression at baseline. The odds of major depression were also lower for persons with high self-esteem (OR = 0.41, p < 0.01) and those who reported having satisfying relationships with friends and family members (OR = 0.51, p < 0.05) at baseline. No association was found between religious attendance or church support and major depression. The possible mechanisms through which religious involvement may protect against depression, especially among African Americans, are discussed.

Awareness of stigma among persons with schizophrenia: marking the contexts of lived experience.

Abstract: This article investigates the subjective experience of stigma attached to schizophrenia-related disorders. We examine data from anthropological interviews from a community sample of 90 out-patients residing in a metropolitan area of the United States. Patients were under treatment with atypical antipsychotic medication, and their symptoms were for the most part relatively well controlled. Overall, 96% of participants reported an awareness of stigma that permeated their daily life. Based on an understanding of stigma as a product of interpersonal, reciprocal social processes, we identify 6 types of social relations and 5 identity domains in which social stigma is routinely encountered by participants. We describe the experience of stigma in each of these 11 subcategories, and suggest that taken together they constitute a framework of social and personal factors involved in the struggle to recover from psychotic illness. Among types of social relations, anonymous social interactions most commonly generated an awareness of stigma. Among identity domains, being a person who regularly takes medication was most commonly associated with an awareness of stigma. The finding that multiple forms of stigma are encountered irrespective of substantial symptomatic, functional, and subjectively perceived improvement creates a complex situation of stigma despite recovery.

Significance of endorsement of psychotic symptoms by US Latinos.

Abstract: In US regional studies, Latinos frequently endorse psychotic symptoms associated with impairment and mental health service use, yet do not meet criteria for psychotic disorder. Using a nationally representative Latino sample (N = 2554), we examined the prevalence of psychotic symptoms, their relationship to psychotic disorder, their correlates, and their relationship to mental health outcomes. In this sample, 9.5% (SE = 0.7) endorsed 1 or more lifetime psychotic symptoms, yet 93% of endorsers did not meet Structured Clinical Interview for DSM-IV criteria for psychotic disorders. Endorsement was associated with physical and emotional distress, particularly lifetime anxiety and current substance use disorder. Acculturation to US society and reliance on spiritual/religious help were also associated with psychotic symptom endorsement. These symptoms have substantial clinical significance, being independently associated with suicidal ideation, mental health-related disability, and outpatient mental health service utilization. Endorsed psychotic symptoms in Latinos may constitute a clinically significant marker of general psychiatric vulnerability rather than a sign of psychotic disorder.

Personality characteristics of adults with autism spectrum disorders or attention deficit hyperactivity disorder with and without substance use disorders.

Abstract: We examined temperament and character profiles of 128 adults with autism spectrum disorder (ASD) or attention deficit and hyperactivity disorder (ADHD). Participants completed the abbreviated Temperament and Character Inventory. The ASD and ADHD groups showed distinct temperament profiles (ADHD: high novelty seeking, ASD: low reward dependence, high harm avoidance) and low character scores in both groups. We then stratified ASD and ADHD into current substance use disorder (SUD+), former (SUD;), or no history of Substance Use Disorder (SUD-). Novelty seeking and reward dependence were only significantly lower for ASD/SUD-, but normal for ASD/SUD; and ASD/SUD+ subgroups. Persistence scores were highest in both SUD; subgroups. We concluded that temperament profiles of ASD and ADHD patients differ significantly, and are similar to profiles reported in earlier studies, but appear to depend on the SUD status. Surprisingly, normal social orientation is found in ASD patients with former or current SUD. High persistence scores characterize patients who overcome SUD.

Issues for DSM-V: the role of culture in psychiatric diagnosis.

Abstract: Renato D. Alarcón, MD, MPH,* Anne E. Becker, MD, PhD, ScM,†‡ Roberto Lewis-Fernández, MD,§¶ Robert C. Like, MD, MS, Prakash Desai, MD,** Edward Foulks, MD, PhD,†† Junius Gonzales, MD, MPH,‡‡ Helena Hansen, MD, PhD,§§ Alex Kopelowicz, MD,¶¶ Francis G. Lu, MD, María A. Oquendo, MD,*** and Annelle Primm, MD, MPH†††‡‡‡ for the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry

Understanding the relationships between self-esteem, experiential avoidance, and paranoia: structural equation modelling and experience sampling studies.

Abstract: Hypothesized relationships between experiential avoidance (EA), self-esteem, and paranoia were tested using structural equation modeling in a sample of student participants (N = 427). EA in everyday life was also investigated using the Experience Sampling Method in a subsample of students scoring high (N = 17) and low (N = 15) on paranoia. Results showed that paranoid students had lower self-esteem and reported higher levels of EA than nonparanoid participants. The interactive influence of EA and stress predicted negative self-esteem: EA was particularly damaging at high levels of stress. Greater EA and higher social stress independently predicted lower positive self-esteem. Low positive self-esteem predicted engagement in EA. A direct association between EA and paranoia was also found. These results suggest that similar mechanisms may underlie EA and thought suppression. Although people may employ EA to regulate self-esteem, this strategy is maladaptive as it damages self-esteem, incurs cognitive costs, and fosters paranoid thinking.

Sorting out the competing effects of acculturation, immigrant stress, and social support on depression: a report on Korean women in California.

Abstract: This research identifies stressors that correlate with depression, focusing on acculturation, among female Korean immigrants in California. Telephone interviews were conducted with female adults of Korean descent (N = 592) from a probability sample from 2006 to 2007. Sixty-five percent of attempted interviews were completed, of which over 90% were conducted in Korean. Analyses include descriptive reports, bivariate correlations, and structural equation modeling. Findings suggest that acculturation did not have a direct impact on depression and was not associated with social support. However, acculturation was associated with reduced immigrant stress which, in turn, was related to decreased levels of depression. Immigrant stress and social support were the principal direct influences on depression, mediating the effect for most other predictors. Stressful experiences associated with immigration may induce depressive feelings. Interventions should facilitate acculturation thereby reducing immigrant stress and expand peer networks to increase social support to assuage depression.

The Psychotomimetic Effects of Short-Term Sensory Deprivation

Abstract: People experiencing sensory deprivation often report perceptual disturbances such as hallucinations, especially over extended periods of time. However, there is little evidence concerning short-term sensory deprivation and whether its effects differ depending on the individual concerned, and in particular their proneness to psychosis. This study explored whether perceptual disturbances could be elicited by a brief period of complete isolation from sound and vision in both highly hallucination prone and nonhallucination prone groups. Greater psychotomimetic experiences taking the form of perceptual disturbances, paranoia, and anhedonia were found across both groups when under sensory deprivation. In addition, hallucination-prone individuals experienced more perceptual disturbances when placed in short-term sensory deprivation than nonprone individuals. This result is discussed in terms of difficulties in source monitoring as a possible mechanism involved in proneness to hallucinations.

Early adverse experiences in schizophrenia and unipolar depression.

Abstract: To study the prevalence of early adversities in schizophrenia and unipolar depression, 2 groups of consecutive adult-onset inpatients with DSM-IV diagnoses of schizophrenia (n = 173) and unipolar depression (n = 305) were compared with an unscreened control group of volunteers from the general population (n = 310), with respect to their association with 4 types of childhood abuse and with early parental adversities (discord, separation, death, psychiatric caseness). Compared with general population, most types of early adversities (except sexual abuse and parental death) were significantly associated with both clinical groups. Compared with depression, all early adversities with the same 2 exceptions were significantly associated with schizophrenia; both frequency of abuse and number of types of abuse increased the risk of schizophrenia in a dose-response pattern, suggesting causality. These findings stress the role of social developmental factors in the etiology of schizophrenia.

Shame, Guilt, and Posttraumatic Stress Disorder in Adult Survivors of Childhood Sexual Abuse at Risk for Human Immunodeficiency Virus Outcomes of a Randomized Clinical Trial of Group Psychotherapy Treatment

Abstract: This study evaluated the effectiveness of group psychotherapy in reducing levels of shame and guilt in adult survivors of childhood sexual abuse at risk for HIV, and whether such reductions would mediate the effects of treatment on posttraumatic stress disorder (PTSD) symptoms. One hundred sixty-six women were randomized into 3 conditions: a trauma-focused group, a present-focused group, and a waitlist group. Women received 6 months of treatment and were assessed at pretreatment (T1), immediately posttreatment (T2), and 6 months posttreatment (T3). Both treatment conditions resulted in reduced shame and guilt. The treatment effect on PTSD symptoms was mediated by changes in shame, but it was not associated with changes in guilt. These findings suggest that, when treating childhood sexual abuse survivors' PTSD, it is important to address the negative self-appraisals, such as shame, that commonly accompany such symptoms.

Emotional reactions to standardized stimuli in women with borderline personality disorder: stronger negative affect, but no differences in reactivity.

Abstract: Emotional dysregulation is hypothesized to be a core feature of borderline personality disorder (BPD). In this study, we investigated the course of emotions in response to standardized emotion inductions in BPD. A total of 26 female BPD patients, 28 matched healthy control subjects, and 15 female patients with major depressive disorder listened to short stories inducing an angry, joyful, or neutral mood. Before and immediately after each story as well as 3 and 6 minutes later, participants rated their current anger, joy, anxiety, shame, and sadness. All 3 groups showed the same increase and decrease of emotions. However, strong group differences in the general level of all negative emotions occurred. While sadness was stronger both in BPD and major depressive disorder as compared with healthy controls, all other negative emotions were significantly increased in BPD only independent of comorbid depression. Extreme negative affectivity may be a more appropriate description of BPD-related emotional problems than emotional hyperreactivity.