Showing papers in "Journal of Nervous and Mental Disease in 2011"

Mental health service utilization among college students in the United States.

Abstract: We aimed to provide the most comprehensive picture, to date, of service utilization and help-seeking behavior for mental health problems among college students in the United States. We conducted online surveys in 2007 and 2009 of random samples of students in 26 campuses nationwide. Among students with an apparent mental health problem (32% of the weighted sample), 36% received any treatment in the previous year. The prevalence of psychotherapy and medication use was approximately equal. Treatment prevalence varied widely across campuses, with some campuses having prevalence 2 to 3 times higher than those of others. Apparent barriers to help-seeking included skepticism on treatment effectiveness and a general lack of perceived urgency. Overall, the findings indicate that help-seeking for mental health varies substantially across student characteristics and across campuses. Strategies to address the low prevalence of treatment will need to be responsive to this diversity.

Prevalence and clinical impact of childhood trauma in patients with severe mental disorders.

Abstract: A high prevalence of childhood abuse has been reported in patients with severe mental illness. We conducted a cross-sectional study of 102 patients with schizophrenia, bipolar disorder, or schizoaffective disorder. Social, demographic, and clinical data were obtained. Patients were evaluated using Brief Psychotic Relative Scale, and Traumatic Life Events and Distressing Event questionnaires. Almost half (47.5%) of these patients had suffered some kind of child abuse, and our results confirmed a relationship between a history of childhood abuse and more severe psychosis. Diagnosis of schizophrenia was determined 4.1 years earlier in victims of childhood abuse. Hospital admissions were twice as high in victims of psychological abuse. Patients with a history of sexual abuse were more than twice as likely to attempt suicide (68% vs. 28.9%).

Toxoplasma gondii Seropositivity and Suicide rates in Women

Abstract: Toxoplasma gondii (T. gondii) is an intracellular protozoan parasite that infects roughly a third of the world population. In an immunocompetent host, infection is generally chronic and asymptomatic, as the immune system keeps T. gondii confined to cysts and the intracellular space within muscle and brain. Seropositivity has been linked to schizophrenia, car accidents, changes in personality, and more recently, suicidal attempts. Very recently, seroprevalence for 20 European countries was found to be associated with increased suicide rates. Although suicide rates were age-standardized, given that T. gondii seroprevalence increases with age, and blood samples were drawn in women, we now retested in women only the association between suicide and T. gondii seropositivity, stratified by age. Simple correlations between ranked T. gondii seropositivity and suicide rate identified statistically significant relationships in women 60 and older (p<0.05); adjusting for GDP, the statistical significance expanded to include women 45 and older. The strongest association was in the 60-74 group where, after adjustment for GDP, the relationship (p=0.007) resisted Bonferroni adjustment for multiple comparisons. In conclusion, the results suggest that a positive relationship between rates of infection with T. gondii and suicide is apparent in women of postmenopausal age. Prospective studies are necessary to further confirm this association predictively and explore mechanisms mediating this relationship.

Lifetime traumatic experiences and posttraumatic stress disorder in the German population: results of a representative population survey.

Abstract: Only a few European population-based studies on the epidemiology of posttraumatic stress disorder (PTSD) are available to date. This study aims to broaden the epidemiological knowledge of traumatic experiences (TEs), PTSD, and comorbid mental conditions in a representative German sample (N = 2510). The Composite International Diagnostic Interview list of traumatic events, the Posttraumatic Diagnostic Scale, and Patient Health Questionnaire (PHQ)-9 as well as PHQ-15 were used in this survey. Main results were low frequencies of TEs (24%) and PTSD (2.9%). Older participants (>60 years) reported significantly more TEs and more posttraumatic symptoms, whereas there was no significant difference in PTSD prevalence. A third of the subjects diagnosed with PTSD were found positive for depressive syndromes, and 27% were found positive for somatization syndrome. The results show that TEs and posttraumatic symptoms are frequent in senior citizens and thus have to be considered when treating older patients with mental health conditions.

Perinatal mental health.

Abstract: Pregnancy is the time during which physiological and psychological preparation for motherhood takes place. It has long been considered a blessed time, free of psychiatric disorders. However, there is now strong evidence that major depressive disorder may occur not only after birth but even during the prepartum. Most often, mental illness during this period is underestimated, not assessed, therefore not diagnosed, and consequently goes untreated. Reviewing the literature on the negative impact of both maternal and infant health in case of perinatal depression, we underline that recognizing and treating prenatal depression will lead to preventive and curative treatments for mothers, enhance infant health, and therefore positively influence mother-infant relationships.

Factors associated with interest in receiving help for mental health problems in combat veterans returning from deployment to Iraq.

Abstract: Mental health problems in service members often go untreated This study focused on factors related to interest in receiving help in a survey sample of 577 combat veterans who were screened positive for posttraumatic stress disorder, depression, or generalized anxiety disorder 3 months after returning from Iraq Over three quarters of respondents recognized that they had a current problem, but only 40% were interested in receiving help Interest in receiving help was associated with recognizing a problem and receiving mental health services in the past year More negative attitudes toward mental health care were associated with lower interest in receiving help; paradoxically, more negative perceptions of unit stigma were associated with increased interest in receiving help Further studies are needed to better define the relationship between stigma perceptions, interest in receiving care, and actual care utilization and to determine whether attitudes toward mental health care can be modified through changes in how care is delivered Attitudes toward mental health care should be considered in treatment interventions

Hopelessness and suicidal ideation in Iraq and Afghanistan War Veterans reporting subthreshold and threshold posttraumatic stress disorder.

Abstract: We examined hopelessness and suicidal ideation in association with subthreshold and threshold posttraumatic stress disorder (PTSD) in a sample of Iraq and Afghanistan War Veterans (U.S., N = 275) assessed within a specialty VA postdeployment health clinic. Veterans completed paper-and-pencil questionnaires at intake. The military version of the PTSD Checklist was used to determine PTSD levels (No PTSD; subthreshold PTSD; PTSD), and endorsement of hopelessness or suicidal ideation were used as markers of elevated suicide risk. Veterans were also asked if they received mental health treatment in the prior 6 months. Veterans reporting subthreshold PTSD were 3 times more likely to endorse these markers of elevated suicide risk relative to the Veterans without PTSD. We found no significant differences in likelihood of endorsing hopelessness or suicidal ideation comparing subthreshold and threshold PTSD groups, although the subthreshold PTSD group was less likely to report prior mental health treatment. Clinicians should be attentive to suicide risk in returned Veterans reporting both subthreshold and threshold PTSD.

Psychotherapy versus second-generation antidepressants in the treatment of depression: a meta-analysis.

Abstract: Most meta-analyses have concluded that psychotherapy and pharmacotherapy yield roughly similar efficacy in the short-term treatment of depression, with psychotherapy showing some advantage at long-term follow-up. However, a recent meta-analysis found that selective serotonin reuptake inhibitors medications were superior to psychotherapy in the short-term treatment of depression. To incorporate results of several recent trials into the meta-analytic literature, we conducted a meta-analysis of trials which directly compared psychotherapy to second-generation antidepressants (SGAs). Variables potentially moderating the quality of psychotherapy or medication delivery were also examined, to allow the highest quality comparison of both types of intervention. Bona fide psychotherapies showed equivalent efficacy in the short-term and slightly better efficacy on depression rating scales at follow-up relative to SGA. Non-bona fide therapies had significantly worse short-term outcomes than medication (d = 0.58). No significant differences emerged between treatments in terms of response or remission rates, but non-bona fide therapies had significantly lower rates of study completion than medication (odds ratio = 0.55). Bona fide psychotherapy appears as effective as SGAs in the short-term treatment of depression, and likely somewhat more effective than SGAs in the longer-term management of depressive symptoms.

Stigma in America: has anything changed? Impact of perceptions of mental illness and dangerousness on the desire for social distance: 1996 and 2006.

Abstract: Data from the 1996 and 2006 General Social Survey were analyzed to examine the relationship between the desire for social distance from individuals with mental illness and a number of factors that were thought to contribute to it, including perceptions of mental illness and dangerousness. Ra

A Controlled Comparison of the Effectiveness and Efficiency of Two Psychological Therapies for Posttraumatic Stress Disorder: Eye Movement Desensitization and Reprocessing vs. Emotional Freedom Techniques

Abstract: The present study reports on the first ever controlled comparison between eye movement desensitization and reprocessing (EMDR) and emotional freedom techniques (EFT) for posttraumatic stress disorder. A total of 46 participants were randomized to either EMDR (n = 23) or EFT (n = 23). The participants were assessed at baseline and then reassessed after an 8-week waiting period. Two further blind assessments were conducted at posttreatment and 3-months follow-up. Overall, the results indicated that both interventions produced significant therapeutic gains at posttreatment and follow-up in an equal number of sessions. Similar treatment effect sizes were observed in both treatment groups. Regarding clinical significant changes, a slightly higher proportion of patients in the EMDR group produced substantial clinical changes compared with the EFT group. Given the speculative nature of the theoretical basis of EFT, a dismantling study on the active ingredients of EFT should be subject to future research.

Distinctive clinical characteristics and suicidal tendencies of patients with anxious depression

Abstract: This study evaluated clinical characteristics and suicidality of patients with anxious depression in a large cohort of samples. Data were collected from 1003 patients who were depressed. A total of 461 patients were diagnosed with anxious depression and 542 were diagnosed with nonanxious depression. After adjusting for the severity of depression, those in the anxious depression group had significantly younger onset age, had been suffering from depression for a longer period, were more likely to experience a recurrence, and obtained lower scores on a scale assessing quality of life. The anxious depression group was characterized by a significantly higher proportion of individuals reporting significant suicidal ideation and previous suicide attempts, and those in this group tended to obtain higher scores on the Scale for Suicide Ideation. The present findings that were drawn from detailed evaluation of suicidality strongly support previous results assessed only with the help of clinical reports. More attention should be paid to assess suicide risk in these patients.

Mental Health Service Use After the World Trade Center Disaster: Utilization Trends and Comparative Effectiveness

Abstract: Previous research suggested that community-level mental health service use was low following the World Trade Center Disaster (WTCD) and that brief interventions were effective. In the current study, we assess service use during a longer follow-up period and compare the effectiveness of brief versus multisession interventions. To assess these, we conducted baseline diagnostic interviews among New York City residents 1 year after the WTCD (N = 2368) and follow-up interviews 2 years afterward (N = 1681). At follow-up, there was an increase in mental health utilization, especially for psychotropic medication use, and a decrease in use of physicians for mental health treatment. The best predictor of service use at follow-up was higher WTCD exposure. Using propensity score matching to control for selection bias, brief mental health interventions appeared more effective than multisession interventions. These intervention findings held even after matching on demographic, stress exposure, mental health history, treatment history, access to care, other key variables. Our study suggested that community-level mental health service use increased in the follow-up period and that brief interventions were more effective than conventional multisession interventions. Since this study was designed to assess treatment outcomes, our findings raise clinical questions.

Religious involvement and suicidal behavior among African Americans and black Caribbeans

Abstract: This study explores the relationship between religious denomination, four dimensions of religious involvement, and suicidality (lifetime prevalence of suicide ideation and attempts) within a nationally representative sample of African American and Black Caribbean adults. The relationship between religious involvement and suicide for African Americans and Black Caribbeans indicated both similarities and differences. For both groups, religious involvement was largely protective against suicidal ideation and attempts, although, in some instances, specific measures were associated with higher suicidality. Looking to God for strength, comfort, and guidance was protective against suicidal attempts and ideation, whereas stating that prayer is important in stressful situations was associated with higher levels of ideation for both groups and higher attempts among Black Caribbeans. For African Americans, reading religious materials was positively associated with suicidal ideation. Among Black Caribbeans, subjective religiosity was negatively associated with ideation, and being Catholic was inversely associated with attempts, whereas being Pentecostal was inversely associated with ideation. These findings are discussed in relation to previous research and current conceptual frameworks that specify multiple (e.g., prevention and resource mobilization) and often divergent pathways of religious effects on physical and mental health outcomes.

Interaction between alliance and technique in predicting patient outcome during psychodynamic psychotherapy.

Abstract: The current study examined whether alliance interacted with psychodynamic interventions to predict patients' psychotherapy outcomes. A prospective study of psychodynamic psychotherapy with 68 outpatients who were treated by 23 therapists was used. The patients rated the alliance with their therapist early in treatment. Therapist use of psychodynamic techniques was reliably rated by independent clinicians for the same sessions. The therapy outcomes were measured at the end of treatment based on the patients' global symptomatology as well as estimate of improvement across a broad range of functioning. In all models, we controlled for the patients' pretherapy psychiatric severity. Analyses were conducted using multilevel modeling to account for therapist effects. Results revealed that patient rated alliance was significantly related to improvement on a measure of broad band functioning. In addition, alliance and psychodynamic interventions interacted to predict this scale of multidimensional therapy outcome. Further, results showed that several individual psychodynamic techniques interacted with alliance that were meaningfully related to this measure of broad band outcome including (1) linking current feelings or perceptions to the past; (2) focusing attention on similarities among patient's relationships repeated over time, settings, or people; and (3) identifying recurrent patterns in patient's actions, feelings, and experiences. In this sample of outpatient psychodynamic treatments, the dynamic techniques were most effective when provided in the context of strong alliances.

Suicidal ideation among National Guard troops deployed to Iraq: the association with postdeployment readjustment problems.

Abstract: Despite well-documented postdeployment readjustment problems affecting veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF), few studies have explored the possible relationship of readjustment stressors to the recent increase in military suicide. This study examined associations between suicidal ideation and postdeployment readjustment problems using cross-sectional population-based survey data from 1665 National Guard members who recently returned from Iraq. The findings suggested that readjustment problems are widespread, with 45% of veterans endorsing one or more financial or family problems 3 months postdeployment. After adjusting for mental health and combat exposure, veterans with the highest number of readjustment stressors were at 5½ times greater risk of suicidal ideation than those with no stressors. In a psychiatrically impaired subsample, the high stressor group experienced a fourfold risk of suicide ideation compared with those with no stressors. The findings argue for suicide prevention efforts that more directly target readjustment problems in returning OEF/OIF veterans.

Alexithymia is common among adolescents with severe disruptive behavior.

Abstract: This study aimed to examine alexithymic features and associations between alexithymia and psychiatric symptoms among adolescents living in a closed institution because of severe behavioral problems. Forty-seven adolescents (29 boys and 18 girls) aged 15 to 18 years completed the 20-item Toronto Alexithymia Scale (TAS-20) Questionnaire and the Youth Self-Report, whereas their foster parents completed the Child Behavior Checklist. The TAS-20 scores of the participants were compared with those of an extensive population sample (N = 6000) matched by age and birth year. Reform school adolescents are significantly more alexithymic than the control group, and the TAS-20 scores are correlated with numerous psychiatric problems, mainly in the internalizing spectrum, but also with thought problems and self-reported aggression. Promoting abilities in identifying and describing feelings is important when treating delinquent adolescents.

Intrinsic motivation as a predictor of work outcome after vocational rehabilitation in schizophrenia.

Abstract: Intrinsic motivation is a construct commonly used in explaining goal-directed behavior. In people with schizophrenia, intrinsic motivation is usually subsumed as a feature of negative symptoms or underlying neurocognitive dysfunction. A growing literature reflects an interest in defining and measuring motivational impairment in schizophrenia and in delineating the specific role of intrinsic motivation as both an independent predictor and a mediator of psychosocial functioning. This cross-sectional study examined intrinsic motivation as a predictor of vocational outcomes for 145 individuals with schizophrenia and schizoaffective disorder participating in a 6-month work rehabilitation trial. Correlation and mediation analyses examined baseline intrinsic motivation and negative symptoms in relation to work hours and work performance. Data support a significant relationship between intrinsic motivation and negative symptoms and significant correlations with outcome variables, such that lower negative symptoms and greater intrinsic motivation were associated with better work functioning. Moreover, in this sample, intrinsic motivation fully mediated the relationships between negative symptoms, work productivity, and work performance. These results have significant implications on the design of work rehabilitation interventions for people with schizophrenia and support a role for targeting intrinsic motivation directly to influence vocational functioning. Future directions for research and intervention are discussed.

Rumination and Avoidance as Predictors of Prolonged Grief, Depression, and Posttraumatic Stress in Female Widowed Survivors of War

Abstract: This study examined independent contributions of rumination and experiential avoidance in predicting symptoms of psychological distress among female widowed survivors of war. A decade after the war in Kosovo, 100 widowed survivors of war completed measures of rumination, experiential avoidance, depression, posttraumatic stress, and prolonged grief. Results showed that both rumination and experiential avoidance significantly predicted the symptom severity of prolonged grief, depression, and posttraumatic stress. Furthermore, rumination accounted for additional variance above and beyond experiential avoidance and vice versa. Finally, the interaction of rumination and experiential avoidance did not provide significant explanatory power over and above the individual main effects. These findings suggest that rumination and experiential avoidance may be significant factors in understanding and treating psychological distress following exposure to potentially traumatic events and loss due to violence.

An experience-sampling study of depressive symptoms and their social context.

Abstract: Both clinical and subclinical depression are associated with social impairment; however, few studies have examined the impact of social contact in the daily lives of people with depressive symptoms. The current study used the experience-sampling methodology to examine associations between depressive symptoms, social contact, and daily life impairment in 197 young adults. Depressive symptoms were associated with increased isolation, negative affect, anhedonia, and physical symptoms, decreased positive affect, and social and cognitive impairment in daily life. For people with more depressive symptoms, being with social partners who were perceived as close was associated with greater decreases in negative affect, as well as increases in positive affect. Ironically, participants with depressive symptoms reported spending less time with people whom they perceived as close, minimizing the protective effects of socializing. These results suggest that people experiencing depressive symptoms may be especially sensitive to the nature of social interactions.

Evidence-based psychotherapy for schizophrenia: 2011 update.

Abstract: Many patients with schizophrenia have psychological distress and receive some form of psychotherapy. Several different psychotherapeutic approaches for schizophrenia have been developed and studied. Of these approaches, cognitive behavior therapy (CBT) has the strongest evidence base and has shown benefit for symptom reduction in outpatients with residual symptoms. In addition to CBT, other approaches include compliance therapy, personal therapy, acceptance and commitment therapy, and supportive therapy. Although usually studied as distinct approaches, these therapies overlap with each other in their therapeutic elements. Psychotherapy for schizophrenia continues to evolve with the recent advent of such approaches as metacognitive therapy, narrative therapies, and mindfulness therapy. Future research may also consider three different goals of psychotherapy in this patient population: to provide emotional support, to enhance functional recovery, and to alter the underlying illness process.

Understanding the Roles of Shame and Neuroticism in a Patient Sample of Hypersexual Men

Abstract: Although shame and facets of neuroticism have independently been linked to hypersexuality, the present study extends these findings by exploring pathways among these variables, using structural equation modeling in a patient sample of hypersexual adult men (N = 95). Results suggested that the domain of neuroticism, as represented by the NEO Personality Inventory—Revised, was a significant direct predictor of hypersexuality, with specific variance from the facet of impulsivity adding additional predictive power. Shame's bivariate association with hypersexuality was also significant, but in a predictive path model the effect of shame on hypersexuality was indirectly mediated through neuroticism and was not an independently significant predictor. Implications for treatment suggest that clinicians working with this population should evaluate precipitating risk factors to consider whether shame is activating neurotic coping or if other stressors might be influencing emotional instability that can trigger hypersexuality. Independent of the general distress associated with neuroticism, the literature on impulsivity might provide other valuable insights and direction for working with hypersexual men.

Are mobile phones and handheld computers being used to enhance delivery of psychiatric treatment? A systematic review.

Abstract: The rapid diffusion of communication technology has provided opportunities to enhance the delivery of mental health care. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a qualitative review of randomized controlled trials that reported on the efficacy of mobile phones or handheld computers used to enhance the treatment of psychiatric disorders. We identified eight randomized controlled trials. Five studies used mobile phones to target smoking cessation. Those receiving the smoking cessation intervention were significantly more likely to achieve abstinence compared with those under the control condition. Three studies used non-personal digital assistant (PDA) handheld computers targeting anxiety. Compared with those in the control condition, those who received the non-PDA handheld computer intervention had significant improvement in anxiety outcomes in only one of the three studies. The limited number of rigorous evaluations of mobile phone, PDA, or smartphone interventions for mental health problems underscores the opportunities to enhance our interventions using the available tools of contemporary technology.

Measurement of well-being in the workplace: the development of the work well-being questionnaire.

Abstract: Because there has been a lack of a single comprehensive measure for assessing workplace well-being, we elected to develop such a self-report measure. Provisional items were extracted from the literature on "positive psychology" and were adapted to capture their workplace application. The provisional 50-item set was completed by a nonclinical sample of 150 adults. A second and third sample was recruited to examine its reliability and any impact of depressed mood and sociodemographic and work-related variables, respectively. Factor analysis identified four domains, "Work Satisfaction," "Organizational Respect for the Employee," "Employer Care," and a negative construct-"Intrusion of Work into Private Life." High test-retest reliability was demonstrated for the final 31-item measure, whereas there was no distinct impact of depressed mood on the scale scores. Work Satisfaction scale scores were influenced by job type. Gender effects were found for two of the four scales, whereas a longer period of employment inversely linked to Organizational Respect for the Employee and Employer Care scores and was conversely associated with higher Intrusion of Work into Private Life scores. The refined measure should enable individuals and employers to quantify the levels of support and well-being provided by employing organizations.

Stigma, help-seeking attitudes, and use of psychotherapy in veterans with diagnoses of posttraumatic stress disorder.

Abstract: Survey and medical record data from 482 Veterans Affairs (VA) patients who recently received diagnoses of posttraumatic stress disorder (PTSD) were examined to determine need and predisposing factors associated with utilization of psychotherapy and counseling. More than half (58%) of participants initiated VA psychotherapy for PTSD within a year of diagnosis. Of those, one third completed eight or more sessions. Roughly two thirds of participants initiated counseling at a Vet Center. Initiating PTSD psychotherapy was associated with greater impairment but not with stigma, concerns about fitting in, or satisfaction with care. The use of Vet Center counseling was associated with desire for help, concerns about fitting in, and satisfaction with care. Unexpectedly, veterans with greater stigma concerns completed more psychotherapy visits and Vet Center counseling. Negative attitudes about mental health treatment did not seem to be substantial barriers to engaging in psychotherapy among these VA patients. Future research should consider enabling treatment system factors in addition to predisposing patient characteristics.

Effect of relocation and parental psychopathology on earthquake survivor-children's mental health.

Abstract: Earthquakes may increase the risk for psychopathology in children because the disaster may disrupt family functioning through causing psychopathology in the parents or disrupting social network through migration, school changes, or socioeconomic status changes caused by the job losses of the parents. This study aimed to investigate the effects of parental psychopathology on the traumatic stress and depression of earthquake survivor-children 4 years after the earthquake. A convenience sample of 104 earthquake survivor-children (43 boys, 61 girls) and their parents were assessed at their homes for earthquake experience and traumatic stress symptoms. The outcome variables were the factor scores of a child/adolescent traumatic stress questionnaire (Traumatic Stress Symptom Checklist for Children and Adolescents). The predictors of child's factor scores were examined using linear regression analyses. The traumatic stress factor score of the children was predicted two variables: the child's reported fear during the earthquake and the father's traumatic stress factor score. The depression factor score, on the other hand, was predicted using the depression factor score of the mother only. Demographic variables or relocation status were not predictive for either of children's factor scores. The results of the present study show that maternal and paternal psychopathologies have differential effects on the psychological status of earthquake survivor-children. Traumatic stress in the child is predicted using the traumatic stress of father, whereas depression in the child is predicted by mother's depression levels. Social network disruption does not seem to have a negative effect on children once parental psychopathology is taken into account.

Childhood sexual abuse severity and disclosure as predictors of depression among adult African-American and Latina women

Abstract: A history of childhood sexual abuse (CSA) has been associated with adult depression, but data on abuse severity and disclosure are scant, particularly among low-income ethnic minorities. CSA often co-occurs with other adversities, which also increase the risk of depression. This study examined the peritrauma variable of abuse severity and the posttrauma variables of disclosure and self-blame as predictors of current depression symptoms in 94 low-income African-American and Latina women with histories of CSA. After controlling for nonsexual childhood adversity and adult burden (i.e., chronic stress), severe CSA overall was associated with higher depression scores, especially among Latinas who disclosed their abuse. Depression symptoms among African-American women were highest in those who disclosed and reported high levels of self-blame at the time of the incident. The link between depression and specific peri- and post-CSA factors in minority women may help guide future interventions.

Mental disorders among frequent attenders in primary care: a comparison with routine attenders.

Abstract: Frequent attenders account for a large proportion of primary care (PC) contacts, referrals, and prescriptions. Psychosocial and emotional distress is related to the high use of health services. Few studies have focused on the association between mental disorders assessed using structured interviews and frequent use of PC services.The aim of this study was to determine the factors associated with frequent attendance at primary healthcare units, focusing specifically on mental disorders. A two-phase screening epidemiological study comparing frequent attenders and routine attenders in five primary health care units was designed. Three hundred eighteen frequent attenders and 203 patients who attended the same units on a routine basis were compared. Sociodemographic and clinical data were obtained from statistical records and medical charts. Patients with a total score equal or higher than 7 points on the General Health Questionnaire-28 (GHQ-28) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. All the scores obtained on the GHQ were statistically different in the two populations. Frequency of mental disorders also differed significantly between both groups, with somatoform and affective disorders being the most prevalent ICD-10 categories among frequent attenders. The presence of depressive disorders and somatoform disorders is the most powerful predictive factor for frequent attendance. High comorbidity was found among frequent attenders with somatoform disorder. Frequent attendance at primary healthcare units is associated with depressive and somatoform disorders. Psychiatric comorbidity could be a confounder, particularly because affective and somatoform disorders often overlap in PC patients.

Identifying schizophrenia and other psychoses with psychological scales in the general population.

Abstract: We study the predictive power and associations of several psychopathology and temperament scales with respect to schizophrenia and other psychotic disorders. Measures of psychopathology (Physical and Social Anhedonia Scales, Perceptual Aberration Scale, Hypomanic Personality Scale, Bipolar II Scale, and Schizoidia Scale) and the Temperament and Character Inventory were included in the 31-year follow-up of the prospective Northern Finland 1966 birth cohort (N = 4926). The Perceptual Aberration Scale was the best scale for concurrent validity in psychoses, and also the best psychopathology scale in terms of discriminant validity. Participants scoring high in hypomanic personality were at the highest risk for developing psychosis during the 11-year follow-up. Harm avoidance was a dominant temperament dimension in individuals with psychosis compared with participants without psychiatric diagnoses. These scales are useful as vulnerability markers in studying psychoses.

Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified.

Abstract: The aim of this study was to investigate axis-I comorbidity in patients with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). Using the Diagnostic Interview for Psychiatric Disorders, results from patients with DID (n = 44) and DDNOS (n = 22) were compared with those of patients with posttraumatic stress disorder (PTSD) (n = 13), other anxiety disorders (n = 14), depression (n = 17), and nonclinical controls (n = 30). No comorbid disorders were found in nonclinical controls. The average number of comorbid disorders in patients with depression or anxiety was 0 to 2. Patients with dissociative disorders averagely suffered from 5 comorbid disorders. The most prevalent comorbidity in DDNOS and DID was PTSD. Comorbidity profiles of patients with DID and DDNOS were very similar to those in PTSD (high prevalence of anxiety, somatoform disorders, and depression), but differed significantly from those of patients with depression and anxiety disorders. These findings confirm the hypothesis that PTSD, DID, and DDNOS are phenomenologically related syndromes that should be summarized within a new diagnostic category.

Neurocognitive impairments and their relationship with psychosocial functioning in euthymic bipolar II disorder.

Abstract: The aim of this study was to compare neurocognitive functioning between euthymic patients with bipolar I disorder (BDI), bipolar II disorder (BDII), and healthy controls. An additional aim was to estimate the relationship between neurocognitive impairments and psychosocial functioning. Eighty-seven patients with BDI (n = 48) or BDII (n = 39) and 39 healthy controls were included. All subjects completed an extensive neurocognitive battery. Psychosocial functioning was assessed using the General Assessment of Functioning. Patients with BDII performed more poorly than did the controls in measures of psychomotor speed, verbal memory, and executive functioning. Patient groups did not show differences in any of the cognitive measures assessed. The performance in trail-making test B was the only independent predictor of psychosocial functioning in both patient groups. Patients with BDII have cognitive impairments, and this has a negative influence on their functional outcome. Our results bring additional support to the notion that BDII disorder is not a merely mild type of BDI.