Biomedical subjects

P R Joyce

Publications and source records attributed to P R Joyce.

At least 37 records · Page 2Linked to original sources

PubMed1999

Body weight in bulimia nervosa.

OBJECTIVES: The objectives of this study were to determine: 1) factors associated with body mass index (BMI) in women with bulimia nervosa prior to treatment; 2) changes in BMI during cognitive behavioral therapy (CBT) for bulimia nervosa; and 3) predictors of weight change during CBT treatment. METHODS: Participants were 94 women with DSM-III-R bulimia nervosa enrolled in a randomized clinical trial of CBT. Eating disorder symptomatology, past and current psychopathology, and BMI were measured prior to treatment and after twelve weeks of treatment. RESULTS: A significantly lower BMI prior to treatment was independently associated with a history of anorexia nervosa, substance use, cigarette smoking, and a high frequency of vomiting. Reductions in binge eating, purging, and food restriction after treatment did not result in significant changes in BMI. Increasing age, higher maximum lifetime body weight, and a high frequency of binge eating at baseline predicted weight gain during treatment. Weight loss during treatment was predicted by a high frequency of vomiting, and elevated levels of body dissatisfaction prior to treatment. DISCUSSION: Patients hesitant to engage in treatment for fear of weight gain upon cessation of their bulimic behaviors should be reassured that CBT is not usually accompanied by substantial weight gain. Identification of women at risk of significant weight gain or loss during CBT may enable therapists to focus on its aspects that help to prevent excessive body weight changes.

Adolescent↗

PubMed1999

Visceral protein and hematological status of women with bulimia nervosa and depressed controls.

Serum visceral protein and hematological indices and their behavioral and clinical correlates were determined in women with bulimia nervosa and depressed controls. One hundred and fifty-two women who met DSM-IV criteria for bulimia nervosa and 68 women with DSM-IV major depression completed a structured clinical interview and had blood samples drawn prior to admission to outpatient treatment programs. Albumin and prealbumin concentrations were lower in the depressed women, possibly due to recent weight loss. Elevated transferrin values suggested mild iron deficiency in nearly one-fifth of women with bulimia nervosa. Of women with bulimia nervosa, the 10.7% who had hemoglobin and 5.1% who had vitamin B12 levels below the normal range were not distinguishable on measures of body mass index, binge eating, vomiting, or restriction frequency. The 4.3% with low prealbumin levels experienced significantly more episodes of binge eating and vomiting in the prior fortnight than those with normal values. Frequency of vomiting was also inversely associated with albumin concentration. Hamilton Depression Rating Scale scores were inversely and linearly related to serum vitamin B12. Lower B12 levels in those with alcohol abuse/dependence did not explain the association between B12 and HDRS scores. No hematological indices were related to body mass index, binge eating or restriction frequency, or restriction intensity. In summary, women with bulimia nervosa do not appear to be at greater risk of visceral protein or hematological abnormalities than psychiatric controls. It is suggested that a high frequency of vomiting and alcohol abuse/dependence, increases the risk of subclinical malnutrition in women with bulimia nervosa, and that poor vitamin B12 nutriture may interfere with the functioning of the serotonergic or catecholaminergic systems and contribute to depressive symptoms in bulimia nervosa.

Adolescent↗

PubMed1999

Early deficient parenting in depressed outpatients is associated with personality dysfunction and not with depression subtypes.

BACKGROUND: We investigated the associations between recollected levels of parental care and current symptomatology, axis I and axis II comorbidity and family psychiatric history in 248 depressed outpatients. METHODS: The sample was divided into three approximately equal groups according to PBI scores. Current symptomatology was assessed with the SCL-90, SAS and HAM-17. Axis I and axis II comorbidity were assessed with the SCID-P and SCID-II respectively. RESULTS: Deficient parenting was not associated with melancholia, age of onset or severity of depression. Significant linear associations were found for recurrent depression, comorbid substance disorder, current symptomatology and, of most significance, personality disorders. CONCLUSION: Personality dysfunction may mediate the relation between early parental deprivation and adult psychopathology. LIMITATIONS: Possible limitations include retrospective recall of parental care and the state effects of depression on assessment.

Adolescent↗

PubMed1999

The relationship of dysfunctional attitudes to personality in depressed patients.

AIM: To examine the relationship between dysfunctional attitudes and personality in depressed patients. METHOD: One hundred depressed patients completed both the Dysfunctional Attitudes Scale (DAS) and the Temperament and Character Inventory (TCI). RESULTS: Scores on the DAS correlated with duration of depression, age of onset of depression, age, harm avoidance and self-directedness. In a multiple regression analysis three measures explained 45% of the DAS score. These were duration of depression, reward dependence and self-directedness. In both the univariate analyses and multiple regression the strongest predictor of dysfunctional attitudes was the character dimension of self-directedness. CONCLUSION: The character dimension of self-directedness in the TCI which assesses an individuals' self-concept, relates highly with the dysfunctional attitudes score on the DAS. Given that the TCI assesses personality within a broader framework of a psychobiologic and developmental model, self-directedness may have a wider application as a measure of self-concept than the DAS.

Adult↗

PubMed1999

Prevalence of suicide ideation and suicide attempts in nine countries.

BACKGROUND: There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data. METHODS: Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand. RESULTS: The lifetime prevalence rates/100 for suicide ideation ranged from 2.09 (Beirut) to 18.51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0.72 (Beirut) to 5.93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married. CONCLUSIONS: While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

Adolescent↗

PubMed1999

The relationship among three models of personality psychopathology: DSM-III-R personality disorder, TCI scores and DSQ defences.

BACKGROUND: Current systems of describing personality pathology have significant shortcomings. A polydiagnostic approach is used to study the relationship between psychological, psychoanalytical and psychopathological models of personality. METHODS: The subjects were 256 patients enrolled in treatment studies of major depression and bulimia nervosa. Subjects were assessed using the Temperament and Character Inventory (TCI), the Defense Style Questionnaire (DSQ) and the Structured Clinical Interview for DMS-III-R personality disorders (SCID-II). RESULTS: Subjects had high rates of DSM-III-R personality disorders with 52% having at least one personality disorder. Cluster A personality disorders were correlated with low reward dependence, high harm avoidance and low self-directedness and cooperativeness. Cluster B personality disorders were related to high novelty seeking and low self-directedness and cooperativeness. Cluster C personality disorders were correlated with high harm avoidance and low novelty seeking and low self-directedness. Immature defences were related to DSM-III-R personality symptoms, but individual defences were not related to personality clusters in a predictable way. Immature defences were strongly related to low self-directedness and cooperativeness. Both TCI self-directedness scores and immature defence scores were moderately predictive of the presence and number of personality disorders. CONCLUSION: A widely accepted clinical nosology (DSM-III-R personality disorders) rated using a clinical interview correlates reasonably predictably with two theoretical models derived from different paradigms and rated using self-reports. This might be seen as providing concurrent validity for all three models. However, serious methodological shortcomings confront studies of this type, including sample selection and measurement of personality dysfunction. One way to begin to resolve these problems is to study which personality measures are best related to treatment response and prognosis.

Adolescent↗

PubMed1999

Susceptibility genes for nicotine dependence: a genome scan and followup in an independent sample suggest that regions on chromosomes 2, 4, 10, 16, 17 and 18 merit further study.

Cigarette smoking is associated with considerable morbidity, mortality, and public health costs. Genetic factors influence both smoking initiation and nicotine dependence, but none of the genes involved have been identified. A genome scan using 451 markers was conducted to identify chromosomal regions linked to nicotine dependence in a collection of 130 families containing 343 genotyped individuals (308 nicotine-dependent) from Christchurch, New Zealand. By pairwise analysis, the best result was with marker D2S1326 which gave a lod score under heterogeneity (H-LOD) of 2.63 (P=0.0012) and a nonparametric linkage (NPL, Zall) score of 2.65 (P=0.0011). To identify regions that warranted further study, rather than comparing the pairwise scores from the scan to theoretical thresholds, we compared them to an empirical baseline, found here to be H-LOD scores of 0.5 and Zall scores of 1.0. We also found a number of large (31-88 cM) regions where many (8-16) consecutive markers yielded small but positive Zall scores. Selected regions of chromosomes 2, 4, 10, 16, 17 and 18 were investigated further by additional genotyping of the Christchurch sample and an independent sample from Richmond, Virginia (91 families with 264 genotyped individuals, 211 nicotine-dependent). Multipoint nonparametric analysis showed the following maximums for the Christchurch sample: Chr. 2 (Zlr=2.61, P=0.005), Chr. 4 (Zlr=1.36, P=0.09), Chr. 10 (Zlr=2.43, P=0.008), Chr. 16 (Zlr=0.85, P=0.19), Chr. 17 (Zlr=1.64, P=0.05), Chr. 18 (Zlr=1.54, P=0.06). Analysis of the Richmond sample showed the following maximums: Chr. 2 (Zlr=1.00, P=0.15), Chr. 4 (Zlr=0.39, P=0.34), Chr. 10 (Zlr=1.21, P=0.11), Chr. 16 (Zlr=1.11, P=0.13), Chr. 17 (Zlr=1.60, P=0.05), Chr. 18 (Zlr=1.33, P=0.09). It is probable that the small samples used here provided only limited power to detect linkage. It may have been difficult therefore to detect genes of small effect, or those that are influencing risk in only a small proportion of the families. When simply judged against the usual standards of linkage significance, none of the individual regions yielded strong evidence in either sample. Some or all of the most positive results in the genome scan of the Christchurch sample, therefore, could be due to chance. However, the presence in the Christchurch scan of multiple large regions containing many consecutive positive markers, coupled with the relatively positive results in these same regions in the Richmond sample, suggests that some of these regions may contain genes influencing nicotine dependence and therefore deserve further study.

Adult↗

PubMed1999

Cannabis abuse and serious suicide attempts.

AIMS: To compare the relationship between cannabis abuse/dependence and risk of medically serious suicide attempts in individuals making serious suicide attempts and randomly selected comparison subjects. DESIGN: Case-control comparison. SETTING: Cases, a general hospital; controls, the local community. PARTICIPANTS: Cases were 302 consecutive individuals making medically serious suicide attempts; 1028 randomly selected control subjects. MEASUREMENTS: DSM-III-R mental disorder diagnoses; measures of socio-demographic characteristics and childhood and family experiences. FINDINGS: Of those making serious suicide attempts, 16.2% met DSM-III-R criteria for cannabis abuse/dependence at the time of the attempt, compared with 1.9% of comparison subjects (OR = 10.3; 95%CI, 5.95-17.8, p < 0.0001). Risks of serious suicide attempt were significantly related to a series of socio-demographic and childhood characteristics, and to mental disorders that were co-morbid with cannabis abuse/dependence. When the association between cannabis abuse/dependence and suicide attempt risk was controlled for socio-demographic factors, childhood factors and concurrent psychiatric morbidity, there was a marginally significant association (OR = 2.0; 95%CI, 0.97-5.3, p < 0.06) between cannabis abuse/dependence and serious suicide attempt risk. CONCLUSIONS: These results suggested that much of the association between cannabis abuse/dependence and suicide attempt risk arose because: (a) individuals who develop cannabis abuse/dependency tend to come from disadvantaged socio-demographic and childhood backgrounds which, independently of cannabis abuse, are associated with higher risk of suicide attempt, or (b) because cannabis abuse/dependence is co-morbid with other mental disorders which are independently associated with suicidal behaviour. Nevertheless, the possibility remains that cannabis abuse/dependence may make an independent contribution to risk of serious suicide attempt, both directly and through the possible effects of cannabis abuse on risk of other mental disorders.

Adolescent↗

PubMed1999

Personality disorder and the Temperament and Character Inventory in the elderly.

OBJECTIVE: The aim of this study was to determine the prevalence of personality disorders in a group of elderly patients without an organic mental disorder and to examine the relationship between the Temperament and Character Inventory (TCI) and personality disorder symptoms in psychogeriatric clinical practice. METHOD: A total of 91 subjects completed the Structured Clinical Interview for DSM-III-R personality questionnaire and the 125-item TCI. RESULTS: Of the 91 subjects, 34 individuals (31%) had at least one DSM-III-R personality disorder diagnosis, with avoidant, dependent and paranoid personality disorder being the most common. The trends and correlations between the temperament and character dimensions and the correlations between individual personality disorder symptoms and the dimensions were similar to those in the original model. The most significant findings were the strong negative correlations of the character scores of self-directedness and co-operativeness with the total number of personality disorder symptoms, and the fact that the self-directedness scores predicted the number of personality disorder diagnoses. CONCLUSION: The reported prevalence rate is comparable to studies of both younger and older patient populations using similar methodology. The TCI provides a useful framework for further research on personality disorders in the elderly.

Aged↗

PubMed1999

Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression.

OBJECTIVE: We examined the relation between personality traits as measured by the Temperament and Character Inventory (TCI) and a reported history of suicide attempts in women with anorexia nervosa, bulimia nervosa and major depression. METHOD: We compared the prevalence and severity of suicide attempts in women with anorexia nervosa (n = 68), bulimia nervosa (n = 152) and major depression with no history of an eating disorder (n = 59), and we examined the relation between the TCI scales and suicide attempts. RESULTS: Comparable numbers of women across the three groups had attempted suicide. The temperament dimension of high persistence and the character dimensions of low self-directedness and high self-transcendence were associated with a reported history of suicide attempts. CONCLUSION: Suicide attempts are equally common in women with eating disorders and women with depression. Whether the observed association between temperament and suicide attempts reflects correlates, causal factors or sequelae of suicide attempts is unknown.

Adolescent↗

PubMed1999

Gender differences in the frequency of personality disorders in depressed outpatients.

We examined gender differences in the frequency of DSM-III-R personality disorder diagnoses and symptomatology in a sample of 225 depressed outpatients. This research partially replicates and extends one of the first studies in this area by Golomb et al. (1995). Males were significantly more likely than females to meet diagnoses for schizotypal, paranoid, narcissistic, antisocial, obsessive compulsive, and borderline personality disorder. Compared to females, males were also significantly more likely to have schizoid, schizotypal, narcissistic, antisocial, and obsessive-compulsive personality disorder symptomatology. Females did not predominate in any personality disorder symptomatology or diagnoses. A possible explanation for these findings is discussed. The results of this study challenge traditional assumptions about gender differences in the frequency of personality disorders, and confirm the need for future studies to investigate the relation between gender and personality disorders in specific Axis I samples.

Adult↗

PubMed1999

Personality traits and cognitive styles as risk factors for serious suicide attempts among young people.

The contribution of a series of measures of personality and/or cognitive style to serious suicide attempt risk in young people was examined in a case-control study. Individuals making suicide attempts had elevated odds of hopelessness, neuroticism, introversion, low self-esteem, impulsiveness, and external locus of control. When allowance was made for intercorrelations between these measures, hopelessness, neuroticism, and external locus of control remained significant risk factors for serious suicide attempt; self-esteem, extraversion, and impulsiveness were not significantly associated with suicide attempt risk. Nonsignificant findings were explained by the presence of substantial correlations between these measures and measures of hopelessness, neuroticism, and external locus of control.

Adolescent↗

PubMed1998

Psychiatric illness in a New Zealand sample of young people making serious suicide attempts.

AIM: To examine the extent of psychiatric illness amongst young people making medically serious suicide attempts and control subjects. METHOD: Using a case control design, 129 young people making serious suicide attempts were contrasted with 153 randomly selected community controls on a series of measures of current and lifetime DSM-III-R diagnoses of mental disorders. RESULTS: Individuals making suicide attempts were characterised by high rates of current mental disorder (89.5%), current comorbidity (54.3%), lifetime histories of psychiatric disorder (90.7%) and previous suicide attempts (52.7%). At the time of the suicide attempt, those making serious attempts had elevated rates of the following disorders: affective disorders (70.5%), substance use disorders (38.8%), anxiety disorders (14.7%), eating disorders (8.5%) and antisocial disorders (34.9%). CONCLUSIONS: Young people who made medically serious suicide attempts had high rates of a range of mental disorders, and of comorbid disorders, at the time of the suicide attempt. They had high rates of lifetime histories of mental disorders and previous suicide attempts. The implications of these findings for the development of strategies to manage, treat and prevent suicidal behaviours in young people are discussed.

Adolescent↗

PubMed1998

Food cravers: characteristics of those who binge.

OBJECTIVE: Food cravings are a frequently described antecedent to binge eating, yet not all of those who report food cravings also binge eat. The present study sought to determine the factors that distinguish cravers who binge versus those whose cravings are satisfied by a relatively "normal" amount of food. METHOD: A food craving questionnaire, a psychiatric diagnostic interview containing questions on binge eating, and a self-report booklet were completed by a group of cravers recruited by advertisement and a group of cravers from a randomly selected sample. RESULTS: In both groups, the cravers who binged were differentiated from those who did not binge by higher measures of body mass index (BMI), more frequent diagnoses of bulimia nervosa, a higher level of dietary restraint, and a by a temperament characterized by low self-directedness. In the recruited cravers, those who binged were also more likely to have had an episode of major depression, social phobia, to be cognitively controlled and harm avoidant. A comparison of recruited cravers with randomly selected cravers and control women suggests that greater rates of psychopathology and eating-related disturbances and lower levels of parental care may be found in recruited samples. DISCUSSION: In addition to elucidating factors associated with binge eating in cravers, this study highlights important differences between recruited and random samples.

Adolescent↗

PubMed1998

Elevated total cholesterol in bulimia nervosa.

OBJECTIVE: It has been suggested that total serum cholesterol concentrations are elevated in bulimia nervosa. The objectives of this study were to compare cholesterol concentrations in women with bulimia nervosa with those of depressed women and population norms and to determine the dietary correlates of elevated cholesterol concentrations. METHODS: 126 women with bulimia nervosa and 57 women with major depression participating in clinical trials were studied. Total serum cholesterol concentrations were available for all participants. Prospective 2-week dietary intake analysis was examined for 49 of the bulimic women. RESULTS: Bulimic women had markedly higher total cholesterol concentrations than depressed women and in comparison to consensus recommendations and population norms. This finding remained highly statistically significant after taking into account an array of potential physical and psychopathological covariates. Dietary analysis suggested that increased total cholesterol concentrations were related to cholesterol and fat intake during binge eating, but not during normal eating. DISCUSSION: Bulimic women have higher total cholesterol concentrations that are related to excess cholesterol and fat intake during binge eating.

Adolescent↗

PubMed1998

Personality and dimensions of dietary restraint.

OBJECTIVE: Given that dietary restraint and associated dietary behavior may predispose individuals to frank eating disorders, and that differences in personality profiles have been observed across subtypes of eating disorders, we sought to address whether aspects of restrained eating (cognitive restraint, disinhibition, and susceptibility to hunger) could be distinguished using the Temperament and Character Inventory (TCI). METHOD: One hundred and one women aged 18-45 selected at random from the community completed the Diagnostic Interview for Genetic Studies (DIGS), the TCI, and the Three Factor Eating Questionnaire (TFEQ). RESULTS: Novelty seeking (NS) was significantly positively correlated with disinhibition. Self-directedness (SD) was negatively correlated with the total TFEQ score, disinhibition, and susceptibility to hunger. Self-transcendence (ST) correlated positively with total TFEQ score and cognitive restraint. DISCUSSION: These findings suggest that individuals with character traits denoting low SD and high ST may be particularly reactive and susceptible to societal messages pertaining to the ideology of slenderness.

Adolescent↗

PubMed1998

Unemployment and serious suicide attempts.

BACKGROUND: This study used a case-control design to examine the association between unemployment and risk of medically serious suicide attempt. METHOD: A sample of 302 individuals who made serious suicide attempts was contrasted with 1028 randomly selected community control subjects. RESULTS: Individuals who made serious suicide attempts reported higher rates of current unemployment (OR = 4.2) than control subjects. This association was similar for males and females. However, even before adjustment for confounding factors it was evident that exposure to unemployment made only a small contribution to suicide attempt risk. The population attributable risk for exposure to unemployment was 7.3%. After adjustment for antecedent childhood, family and educational factors the association between unemployment and risk of serious suicide attempt was reduced but remained significant (OR = 2.1), suggesting that common antecedent factors made a large contribution to risks of both unemployment and serious suicide attempt. When both antecedent family and childhood factors, and psychiatric morbidity were taken into account, unemployment was not significantly related to risks of serious suicide attempt. CONCLUSION: The results of this study provide support for the contention that much of the association between unemployment and suicidal behaviour is non-causal, and reflects common or correlated factors that contribute to risks of both unemployment and suicidal behaviour. Any remaining association between unemployment and suicide attempt risk appears to arise from the correlation that exists between unemployment and psychiatric disorder.

Adolescent↗

PubMed1998

The role of exposure with response prevention in the cognitive-behavioural therapy for bulimia nervosa.

BACKGROUND: One hundred and thirty-five women with bulimia nervosa participated in a randomized clinical trial designed to determine whether the addition of exposure with response prevention to a core of cognitive-behavioural therapy (CBT) leads to greater clinical improvement and lower risk of relapse. We present results from the end of treatment and 6- and 12-month follow-up. METHODS: Participants received eight sessions of CBT and were then randomized to either exposure to pre-binge cues (B-ERP), exposure to pre-purge cues (P-ERP), or a relaxation training control condition (RELAX). RESULTS: CBT produced significant clinical change. At the end of the behavioural treatments, there were no significant differences across the three groups on abstinence (66% in B-ERP, 45% in P-ERP and 47% in RELAX), or frequency of bingeing and purging. B-ERP, but not P-ERP, significantly reduced anxiety on the cue reactivity assessment, food restriction, body dissatisfaction and depression. These differences were not maintained at 6-month follow-up. At 12-months, B-ERP was independently associated with lower food restriction and better global functioning. CONCLUSIONS: CBT is a highly effective treatment for bulimia nervosa. B-ERP was modestly superior to P-ERP at post-treatment; however, the advantage did not remain throughout the follow-up interval. ERP for bulimia nervosa is an expensive and logistically complicated treatment that does not appear to offer any significant additive benefits that are proportional to the amount of effort required to implement the treatment.

Adolescent↗