Biomedical subjects

A Arntz

Publications and source records attributed to A Arntz.

At least 19 recordsLinked to original sources

PubMed2003

Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder.

Cognitive therapy (CT) and applied relaxation (AR) as treatments of generalized anxiety disorder (GAD) were compared in a sample of 45 patients of a community mental health center, randomly allocated to condition. Patients were assessed before and after a 12-session treatment, and at one and six months follow-ups. There was a 20% drop out from CT and 15% from AR (NS), with some drop outs being considerably improved. Both completers and intention-to-treat analyses revealed that both treatments were effective (ESs of composite and specific measures ranging from 0.53 to 1.14). At one-month follow-up AR tended to do better than CT, with CT catching up with AR at six months. Recovery rates and proportions of patients showing reliable change were comparable to other studies on AR and CT, with 55% of CT and 53.3% of AR patients recovered on the STAI-trait at six-month follow-up. These results confirm that both CT and AR are effective treatments for GAD, and also that there is still room for improvement.

Adolescent↗

PubMed2003

[Iris-claw phakic intraocular lens for high myopia correction. Visual and refractive results].

PURPOSE: To determine predictability, efficacy, complications and patient's satisfaction to phakic intraocular lens (Artisan) in highly myopic patients. METHOD: Retrospective study of 65 eyes (36 patients), with preoperative spherical equivalent (SE) between -9,75 and -25,0 diopters (D) operated on by a single surgeon (JAD) between January 1999 and August 2001. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, postoperative complications, and patient's subjective response were evaluated. RESULTS: UCVA evaluated 3 months postoperatively was 0.47 and BSCVA was 0.62. An average gain of 2.3 lines was observed with respect to the preoperative BSCVA. Refraction between +/-0.50 D from emmetropia ocurred in 49.23% of the eyes, and between +/- 1.0 D in 78.46% of the eyes. The difference between intended SE (preoperative SE minus IOL diopter) and achieved postoperative SE, showed a 0.55 D mean undercorrection. An intraocular pressure (IOP) over 30 mmHg was seen in 10% of the eyes in the immediate postoperative period. Night halos/glare perception was < > in 20% of the eyes, and in 90.77% of the cases the patient showed satisfaction with the results of the procedure. CONCLUSION: Artisan iris-claw phakic lens implantation in highly myopic eyes is a safe procedure that increases BSCVA. It was observed a tendency towards undercorrection in the postoperative refractive outcome.

Adult↗

PubMed2003

[Subclinical keratoconus diagnosis by elevation topography].

PURPOSE: To evaluate the most effective parameters of Orbscan Corneal Topography System for subclinical keratoconus screening. METHODS: The study includes corneas from patients with clinical diagnosis of keratoconus (group 1, n=35), patients with subclinical keratoconus (group 2, n=14) and a control group of myopic subjects paired in gender, age and refractive spherical equivalent (group 3, n=35). Placement of the apex, anterior and posterior corneal elevation, minimal corneal thickness, anterior chamber depth and corneal diameter were evaluated. RESULTS: The most frequent location of the apex was at the inferotemporal sector (53%). Mean anterior elevation was 56.73 S.D. 25.95 mm in group 1 and 20.35 S.D. 8.04 mm in group 2; results that are statistically significant different from the control group (p<0.001). Mean posterior elevation was 126.23 S.D. 57.7 mm in group 1 and 54.28 S.D. 19.55 mm in group 2, both showing a statistically significant difference from the control group (p<0.001). Minimal corneal thickness and anterior chamber depth also showed statistically significant differences between the three groups. No differences were found in corneal diameter values. CONCLUSIONS: Statistically significant differences were found in anterior and posterior elevation, minimal corneal thickness and anterior chamber depth parameters, as measured by the Orbscan system, between normal myopic subjects and those with clinical and sub-clinical keratoconus. These parameters should be considered in the detection of patients with increased risk for developing secondary keratectasia following corneal refractive surgery.

Adolescent↗

PubMed2002

Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout.

The present study investigated predictors of treatment outcome and dropout in two samples of PTSD-patients with mixed traumas treated using prolonged imaginal exposure. Possible predictors were analysed in both samples separately, in order to replicate in one sample findings found in the other. The only stable finding across the two groups was that patients who showed more PTSD-symptoms at pre-treatment, showed more PTSD-symptoms at post-treatment and follow-up. Indications were found that benzodiazepine use was related to both treatment outcome and dropout, and alcohol use to dropout. Demographic variables, depression and general anxiety, personality, trauma characteristics, feelings of anger, guilt, and shame and nonspecific variables regarding therapy were not related to either treatment outcome or dropout, disconfirming generally held beliefs about these factors as contra-indications for exposure therapy. It is concluded that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome or dropout. Clinically seen, it is therefore argued that exclusion of PTSD-patients from prolonged exposure treatment on the basis of pre-treatment characteristics is not justified.

Adolescent↗

PubMed2001

Correlates of autobiographical memory specificity: the role of depression, anxiety and childhood trauma.

The present study examined the role of childhood trauma, major depressive disorder (MDD), and anxiety disorder (AD) in overgeneral autobiographical memory. Ninety-three outpatients and 24 healthy controls completed a childhood trauma questionnaire and an autobiographical memory test (AMT). Results showed that MDD diagnosis rather than trauma history predicted AMT-performance. Memory specificity was not related to AD diagnosis, recovered MDD, or self-rated depression severity. The present findings cast doubts on theories that emphasize the role of childhood trauma in overgeneral autobiographical memory.

Adult↗

PubMed2001

Emotion- and intrusion-based reasoning in Vietnam veterans with and without chronic posttraumatic stress disorder.

Patients suffering from anxiety disorders other than posttraumatic stress disorder (PTSD) interpret anxiety responses themselves as evidence that threat is impending: "if anxiety, then threat" (Arntz, Rauner, & van den Hout, 1995, Behaviour Research and Therapy, 33, 917-925). This "emotion-based reasoning" (ER) may render a disorder self-perpetuating. Analogous to ER, danger might also be inferred from the presence of intrusions: "intrusion-based reasoning" (IR). The aims of this study were to test whether ER and IR are involved in chronic PTSD. Vietnam combat veterans with or without PTSD or other anxiety disorders rated perceived danger of brief scenarios in which information about objective danger (danger vs safety) and response (anxiety/intrusions vs non-distressing emotion) was systematically varied. Two series were administered: ER-scenarios were non-specific for PTSD and IR-scenarios were specific for PTSD. Relative to control participants, PTSD patients engaged in both ER and IR: whereas veterans without PTSD inferred the danger of scenarios from objective stimulus information, veterans with PTSD also inferred danger from the presence of anxiety or intrusions. Further analyses showed that these effects were largely mediated by perceived uncontrollability.

Anxiety↗

PubMed2001

Evaluations of others by borderline patients.

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.

Adult↗

PubMed2000

Hypervigilance in borderline disorder: a test with the emotional Stroop paradigm.

The hypothesis of cognitive theories of hypervigilance for signs of danger in Borderline Personality Disorder (BPD) was tested with the emotional Stroop task. BPD patients (n = 15), Cluster C personality disorder (PD) patients (n = 12), and nonpatient controls (n = 15) diagnosed with SCID-I and SCID-II interviews color-named emotional and nonemotional words presented in three colors on a personal computer screen, first in a subliminal condition (words presented for a very short, individually calibrated time followed by a mask to prevent conscious recognition of the word) and then in a supraliminal condition. Four classes of negative words were used, including three classes of BPD-specific words (negative views of others, sexual abuse-related words, negative self-descriptors) and one class of general negative words that was unrelated to BPD pathology. In contrast to the nonpatient controls, both BPD and Cluster C patients showed interference caused by supraliminally presented emotional words. There was no difference between the clinical groups and there was no evidence for specificity of the effect for certain stimulus classes. The subliminal Stroop failed to yield any significant effect. Results are interpreted as evidence for the presence of a relatively crude hypervigilance for any emotionally negative stimulus in both BPD and Cluster C PDs.

Adult↗

PubMed1999

No interactive effects of naltrexone and benzodiazepines on pain during phobic fear.

Animal research has shown that anxiety may inhibit pain through the release of endogenous opioids. On the other hand, anxiety is often believed to exacerbate pain in clinical situations, and anxiety reduction has been shown to attenuate the affective component of pain. In the present study phobic anxiety was induced by confronting forty-eight spider phobic subjects with a spider, after which they received two mildly painful electrical stimuli at two different current levels. The benzodiazepine alprazolam (1 mg) was administered to investigate the influence on pain of a reduction in anxiety, while the role of endogenous opioids was studied by administering the opioid antagonist naltrexone (50 mg). Alprazolam resulted in lower anxiety and pain ratings during pain stimulation, supporting the idea that (presumably pain-related) anxiety may increase the experience of pain. Naltrexone did not influence pain and anxiety ratings, nor was there a significant interaction between the two pharmacological manipulations. These findings confirm previous evidence that phobic fear does not necessarily induce an endogenous opioid-mediated analgesia.

Adolescent↗

PubMed1999

Psychometric properties of the Multidimensional Pain Inventory, Dutch language version (MPI-DLV).

The purpose of this study was to investigate the psychometric properties of a Dutch translation of the Multidimensional Pain Inventory, MPI-DLV. Data was available on 733 chronic pain patients. There were three issues of special interest. The first one related to the comparability between the MPI-DLV and the American and German MPI versions with regard to the psychometric aspects. The second dealt with the construct validity of the MPI-DLV scale 'general activity'. It was predicted that patients with high scores on this scale would be in better physical condition, as measured on a working-to-tolerance bicycle ergometer test. In relation to the third issue, attention was given to the factor-invariance between fibromyalgia patients and back pain patients. From the results obtained it was concluded that (1) the factorial structure of the three MPI parts is replicated and the reliability estimates and validity indicators are similar to those from the American and German versions; (2) patients with high scores on the 'general activity' scale are in better physical condition and (3) MPI-DLVs of fibromyalgia and back pain patients do have similar factorial structures. Evidence was also obtained that the MPI-DLV is sensitive to treatment changes. Applications of the MPI-DLV are discussed.

Adult↗

PubMed1999

Assumptions in borderline personality disorder: specificity, stability and relationship with etiological factors.

The specificity and stability of a set of assumptions hypothesized to be characteristic of Borderline Personality Disorder (BPD) was investigated. BPD patients (n = 16) were compared to cluster-C personality disorder patients (n = 12) and to normal controls (n = 15). All subjects were female and diagnosed with SCID-I and -II. Subjects rated a short version of the Personality Disorder Beliefs Questionnaire (PDBQ), with six sets of 20 assumptions each, hypothesized to be characteristic of avoidant, dependent, obsessive-compulsive, paranoid, histrionic and borderline personality disorder. The BPD assumptions (Cronbach alpha = 0.95) proved to be the most specific to BPD patients. Subjects rated the shortened PDBQ again after viewing an emotional video fragment one week later. Despite increased negative emotions, the PDBQ ratings remained relatively stable. Confirming the cognitive hypothesis, regression analyses indicated that the BPD assumptions mediate the relationship between self-reported etiological factors from childhood (sexual abuse and emotional/physical abuse) and BPD pathology assessed with the SCID-II. It is suggested that a set of assumptions is characteristic of BPD, and is relatively stable despite the instability of the behaviour of people diagnosed as having BPD.

Adult↗

PubMed1999

Avoidant personality disorder and implicit schema-congruent information processing bias: a pilot study with a pragmatic inference task.

Cognitive theory of personality disorders hypothesizes that each personality disorder is characterized by typical maladaptive schemes and that these schemas direct the processing of information resulting in schema-congruent biases. With regard to the avoidant personality disorder, these hypotheses were put to an initial test in a pilot study, using a self-report questionnaire to asses DSM-III-R personality pathology, a belief questionnaire to assess avoidant schemas and a pragmatic inference task to assess schema-congruent implicit attributional bias. Participants were students (n = 57) who scored high or low on DSM-III-R avoidant personality pathology. As predicted from cognitive theory, DSM-III-R avoidant personality pathology was associated with avoidant beliefs (t(45.1) = 4.68, p < 0.001) and avoidant beliefs were associated with schema-congruent information processing bias (t(55) = 2.17, p = 0.02, one-tailed test). However, DSM-III-R avoidant personality pathology was not associated with schema-congruent information processing bias (t(55) = 0.17, p = 0.43, one-tailed test). In addition to avoidant beliefs, low self-esteem was also related to the information processing bias. Social phobia and general personality pathology, two other control variables, were not. The findings warrant further study using the pragmatic inference task in a clinical group.

Adolescent↗

PubMed1999

Treatment of childhood memories: theory and practice.

With the growing interest of cognitive behaviour therapy in early developed psychopathology like personality disorders there is an increased need for therapeutic methods for more directly treating pathogenic schemas. Exploring and reinterpreting memories of early childhood experiences that are assumed to have contributed to the pathogenesis are more and more viewed as a promising way to modify core schemas. Experiential methods seem to be the most effective. This article discusses two main forms of these methods: (i) imagery with rescripting and (ii) role play, both of childhood interactions with key figures. For both, protocols are provided as guidelines for clinicians and to stimulate standardization so that this new field can be opened for experimental research. Theoretical views are discussed as to why these methods might be so effective in treating chronic problems that originated in childhood.

Adolescent↗

PubMed1999

Do personality disorders exist? On the validity of the concept and its cognitive-behavioral formulation and treatment.

Since the introduction of personality disorders as important diagnostic categories in the DSM-III [APA (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association] the concept of personality disorder (PD) has met both skepticism and enthusiasm. This paper addresses criticisms, reviews theoretical and empirical evidence for the concept of personality disorders (PD), critically discusses widespread clinical ideas about PDs, and reviews cognitive-behavioral models and treatments of PDs. It is concluded that there is enough evidence for the usefulness of PDs as diagnostic categories. A confirmatory factor analysis for instance yielded very reasonable evidence for the categories hypothesized by the DSM. Contradicting widespread ideas, research indicates that PDs are not a contraindication for cognitive-behavioral treatments of axis-I problems, and that there are even indications that PD pathology itself can be successfully treated using modified CBT methods. In stark contrast to the generally rich empirical history of CBT, research on cognitive models and treatment of PDs is virtually absent. However, the sparse attempts indicate that cognitive models may be fruitful in this area. Future research should be directed at further developing and testing cognitive conceptualizations and treatment models.

Adult↗

PubMed1998

The impact of personality disorders on treatment outcome of anxiety disorders: best-evidence synthesis.

Thirty-five studies were traced addressing the impact of comorbid personality disorders on treatment outcome of anxiety disorders. The conclusions of this review are based on the best-evidence procedure. We used two selection criteria that studies had to meet to be included in the present review. The study design had to be prospective and a (semi)structured interview had to be used for the assessment of personality disorders. From the fifteen selected studies it cannot be concluded that, in general, personality disorders affect treatment outcome for anxiety disorders negatively. We can only suspect that some personality disorders may have an adverse impact upon treatment outcome in anxiety disorders, and they should be investigated further. For the time being, in clinical practice one has to be cautious in relating personality disorders to less well treatment outcome in axis I anxiety disorders.

Anxiety Disorders↗

PubMed1998

Underpredicted pain disrupts more than correctly predicted pain, but does not hurt more.

One of the explanations for the negative effects of underpredicted aversive experiences is that they have more impact than correctly predicted aversive experiences. In a laboratory experiment 40 normal female subjects executed an auditory discrimination task. Subjects were randomly assigned to a correct information condition and an underprediction information condition. After ten trials (baseline) subjects were informed that they would receive some painful (correct prediction) or non-painful tingling (underprediction) stimuli during the discrimination task. Starting just before five of the following 20 discrimination trials, 2 s of painful electrical stimulation was given. Subjects rated sensations and painfulness of the electrical stimulation, subjective anxiety, and degree of distraction from the task, after each pain stimulus. Reaction times of the discrimination task and heart rate were measured. Underprediction information resulted in lower pain ratings, but stronger heart rate responses and higher disruption on the discrimination task, compared to correct information. This suggests that while underpredictions of pain do not hurt more, disruption on primary tasks and physiological impact are higher. Underpredicted pain has more impact than correctly predicted pain, not because it hurts more, but because it conveys inherent danger information.

Adolescent↗

PubMed1998

Short-interval test-retest interrater reliability of the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) in outpatients.

The short-interval test-retest interrater reliability of the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) was studied in a psychotherapy outpatient group whose main complaint was mostly an Axis I anxiety disorder. Using a test-retest approach to assess interrater reliability, three sources of variance were taken into account (rater variance in the elicitation and interpretation of information and patient variance across interviews). Base rate requirements were established before calculating reliability coefficients. On the whole, interrater agreement on the SCID-II was found to be satisfactory, except for the histrionic personality traits. This is the first study that has estimated short-interval test-retest interrater reliability of the SCID-II in outpatients, and also the first that has studied single SCID-II traits and dimensional diagnoses. The results found support the use of the SCID-II as a diagnostic instrument for clinical and research purposes.

Adult↗

PubMed1998

Patient-informant concordance on the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II).

In the assessment of personality disorders, patients reports can be questioned for several reasons, such as lack of insight, shame, and acute psychiatric state. High concordance between patient-based and informant-based diagnoses would be an indication of the validity of patient reports (convergent validity). The present study examined the concordance between 42 psychotherapy outpatients and their informants (intimates) on the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Similar to prior studies, low or only modest levels of agreement were found. In comparison with evaluations of the personality of the patient by the therapist, patient interviews seemed to be more valid than informant interviews. Furthermore, couples with high intensity and intimacy in the contact generally showed higher agreement than couples with low intensity and intimacy. In conclusion, the data slightly suggest that patient reports are more valid than informant reports. However, the lack of a golden standard forces us to find more evidence before concluding that patient reports on personality result in valid diagnoses.

Adult↗