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Biomedical subjects

R Michael Bagby

Publications and source records attributed to R Michael Bagby.

17 recordsLinked to original sources
PubMed2003

Depressive personality disorder: a critical overview.

Depressive personality disorder (DPD), which has a long tradition in psychiatry, currently resides in Appendix B ("Disorders for Further Study") of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. After a brief outline of this history, the authors review empirical research on DPD using the Robins and Guze criteria (discussed later) for diagnostic and clinical validity as a framework. Although DPD has unique features, the authors argue that this diagnosis can largely be subsumed under dysthymic disorder. As a result of diagnostic confusion, and of the small amount of research conducted in this area, recommendations for the assessment and treatment of DPD are necessarily speculative. The authors conclude that if personality disorders are maintained as categoric constructs, DPD may best be understood as a subtype of dysthymic disorder. A more radical solution would be to conceptualize DPD, along with the other personality disorders, as extreme positions along dimensional continua.

Depressive Disorder↗
PubMed2003

The 20-Item Toronto Alexithymia Scale. III. Reliability and factorial validity in a community population.

OBJECTIVE: Some researchers have questioned the stability of the three-factor structure of the 20-Item Toronto Alexithymia Scale (TAS-20) or the reliability of one or more factors of the scale. The aim of this study was to assess the replicability of the factor structure of the TAS-20 in a large community sample and to determine also whether the same three-factor structure can be recovered in men and women. The study also assessed the reliability of the scale and the influence of gender, age, and education on TAS-20 scores. METHOD: The TAS-20 was administered to 1933 adults (880 men and 1053 women) residing in several small cities and towns in Ontario, Canada. The factor structure of the scale was assessed using confirmatory factor analysis (CFA). RESULTS: The three-factor structure of the TAS-20 was replicable in the entire community sample and also separately in men and women. The TAS-20 and its three factors demonstrated internal reliability, and the variables of gender, age, and education accounted for relatively small or modest amounts of variability in total TAS-20 and factor scale scores. CONCLUSION: The results provide strong support for the reliability and factorial validity of the TAS-20 and indicate the importance of using CFA when assessing the replicability and theoretical integrity of the factor structure of the scale.

Adult↗
PubMed2003

The 20-Item Toronto Alexithymia Scale. IV. Reliability and factorial validity in different languages and cultures.

OBJECTIVE: The aim of this paper was to review findings from studies that have evaluated the reliability and factorial validity of the 20-item Toronto Alexithymia Scale (TAS-20) in different languages and cultures. METHOD: Data from published articles as well as unpublished data from various countries were reviewed to determine whether the three-factor structure of the TAS-20 is replicable in different cultures by the method of confirmatory factor analysis (CFA), and whether the scale and its three-factor scales show internal reliability in these cultures. RESULTS: The TAS-20 has been translated adequately into 18 different languages and evaluated by CFA in 19 different countries. There is strong support for the generalizability of the three-factor structure of the scale across languages and cultures. In addition, the full-scale TAS-20 and the first two factors show adequate to good internal reliability for most of the translations. In most cultures where English is not the primary language, however, the third factor lacks internal reliability; this might be due to cultural differences or a response bias to the several negatively keyed items on this factor. CONCLUSION: The findings support the use of the TAS-20 in cross-cultural research, and suggest that alexithymia may be a universal trait that transcends cultural differences.

Affective Symptoms↗
PubMed2003

Are there gender differences in major depression and its response to antidepressants?

BACKGROUND: The prevalence of major depression for women is about twice that for men. This gender difference in prevalence rates has led to much research addressing gender differences in the presentation and features of major depression, and, to a lesser extent, research addressing gender differences in treatment response and personality. However, studies differ considerably in the population sampled, and findings vary significantly. In the current retrospective examination of data, we investigated all of these variables in one single sample of outpatients with major depression seen in a tertiary care centre. METHODS: A sample of 139 men and 246 women with major depression receiving antidepressant treatment (SSRIs, TCAs, SNRIs, MAOIs, or RIMAs) in an outpatient setting were contrasted with regard to symptoms and severity of depression, course of illness, treatment response, and personality. RESULTS: Women were found to experience more vegetative and atypical symptoms, anxiety, and anger than men, and to report higher severity of depression on self-report measures. Regarding personality, women scored higher on conscientiousness, the extraversion facet warmth, the openness facet feelings, and sociotropy. Effect sizes were small to moderate. No differences were found in the course of the illness and treatment response. LIMITATIONS: Findings are not generalizable to inpatient or community samples, and some of the gender differences may be accounted for by gender differences in treatment seeking behaviour. CONCLUSIONS: While men and women receiving antidepressant treatment show some gender differences in the psychopathology of major depression, these differences do not appear to translate into differences in response to antidepressants. Gender differences in personality appear less profound than in the average population, indicating the potential role of a certain personality type that predisposes individuals to develop clinical depression, independent of gender. CLINICAL RELEVANCE: The current examination underscores the role gender plays in the presentation and treatment of major depression.

Adolescent↗
PubMed2003

A comparison of antidepressant response in younger and older women.

The objective of this report is to compare antidepressant response rates and tolerability in younger and older women. One hundred fifteen female outpatients who met DSM-IV criteria for major depressive disorder were evaluated before and after 8 weeks of treatment with a selective serotonin reuptake inhibitor, nefazodone, or venlafaxine. The sample was divided into younger and older groups based on age to approximate premenopausal and postmenopausal status. Eighty-six age-matched male outpatients formed the comparison group. Younger women compared with older women had significantly lower Hamilton Rating Scale for Depression scores after 8 weeks of antidepressant treatment and achieved significant higher rates of remission. There were no differences in overall drug tolerability. This pattern was not replicated in the male patients. Younger women with depression are more responsive to serotonergic antidepressants. This may relate to changes in menstrual status. Limitations of the study and implications for the role of female sex hormones are discussed. Future investigations should include measurement of reproductive hormone levels.

Adult↗
PubMed2003

Lithium carbonate versus cognitive therapy as sequential combination treatment strategies in partial responders to antidepressant medication: an exploratory trial.

BACKGROUND: Partial antidepressant response is associated with increased rates of relapse. Despite increasing evidence that full symptomatic remission is the optimal goal of antidepressant therapy, there have been few comparisons between disparate treatment approaches to achieve this goal. METHOD: Forty-four patients with DSM-IV major depressive disorder (MDD) who had a partial response (17-item Hamilton Rating Scale for Depression [HAM-D-17] score of 8-15) during open-label antidepressant treatment for 8 to 14 weeks were randomly assigned to receive cognitive therapy (CT) or lithium augmentation (LA) for a further 8 weeks using a single-blind design. Antidepressant medication was continued throughout the study. Subjects were also reassessed 4 weeks after discontinuation of LA or CT. Patients were enrolled in this study beginning September 1996 and follow-up for all patients was completed in December 2000. RESULTS: Although LA or CT did not significantly decrease symptom severity during sequential combination therapy, there was a significant decrease in HAM-D-17 scores 4 weeks later in LA-treated subjects compared with CT-treated subjects (p =.04). This resulted in 32% of patients achieving remission status, although between-group differences were not significantly different (38% in the LA group compared with 26% in the CT group, p =.39). CONCLUSION: Despite methodological limitations, this preliminary study provides justification for both combination treatments. An adequately powered, randomized, controlled trial to evaluate the relative merits of combination psychotherapy and augmentation of pharmacotherapy in patients with partially remitted MDD is required.

Adolescent↗
PubMed2002

Obsessive-compulsive disorder and the five-factor model of personality: distinction and overlap with major depressive disorder.

Research on individual differences in obsessive-compulsive disorder (OCD) has focused largely on analogue models with participants experiencing sub-clinical obsessions and/or compulsions. Few studies have examined the association between normal, dimensional personality traits and obsessive-compulsive symptomatology in a clinical sample. The purpose of this study was to examine personality differences in patients with a primary diagnosis of OCD (n = 98) or major depression (n = 98) using the domains and facets of the five-factor model of personality (FFM). Patients completed the self-report version of the Revised NEO Personality Inventory (NEO PI-R). When contrasted with community controls (Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual, Psychological Assessment Resources, Odessa, FL, 1992), participants with OCD were found to differ across the domains (and facets) of neuroticism, extraversion, and conscientiousness and the facets of openness and agreeableness. Further, when compared to depressed participants, those with OCD were found to be more extraverted, agreeable, conscientious and less neurotic. With the exception of the conscientiousness domain (and facets), these significant differences were maintained even after controlling for depression severity. These results highlight the unique associations between trait domains and facets of the FFM and OCD.

Adult↗
PubMed2002

The detection of feigned uncoached and coached posttraumatic stress disorder with the MMPI-2 in a sample of workplace accident victims.

In this study research participants completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) under standard instructions and then were asked to fake posttraumatic stress disorder (PTSD) when completing the MMPI-2 for a 2nd time in 1 of 4 conditions with different instructions on how to fake PTSD: (a) uncoached, (b) coached about PTSD symptom information, (c) coached about MMPI-2 validity scales, or (d) coached about both symptoms and validity scales. These MMPI-2 protocols were then compared with protocols of claimants with workplace accident-related PTSD. Participants given information about the validity scales were the most successful in avoiding detection as faking. The family of F scales (i.e., F, FB, FP), particularly FP, produced consistently high rates of positive and negative predictive power.

Accidents, Occupational↗
PubMed2002

Antidepressant side effects in depression patients treated in a naturalistic setting: a study of bupropion, moclobemide, paroxetine, sertraline, and venlafaxine.

OBJECTIVE: There is no commonly accepted standard for comparing antidepressant-induced side effects. This study evaluates a clinician-administered scale, the Toronto Side Effect Scale (TSES), in a natural practice clinic. METHOD: We used the TSES to assess side effects in 193 depression patients who completed 8 weeks of treatment with either bupropion, moclobemide, paroxetine, sertraline, or venlafaxine. RESULTS: Rates of remission (Hamilton Rating Scale for Depression [HRSD] < 7) did not differ across drugs after 8 weeks of treatment. Paired drug comparisons yielded significant differences in 16 of the 32 side effects. We present differences between pairs of the 5 antidepressants in Central Nervous System (CNS), gastrointestinal (GI), and sexual side effects. A measure of side-effect intensity distinguished paroxetine from the other antidepressants on a measure of sexual dysfunction. CONCLUSIONS: These results confirm the clinical utility of the TSES as a simple, clinician-administered antidepressant side-effect scale.

Adult↗
PubMed2002

The predictive capacity of the MMPI-2 and PAI validity scales and indexes to detect coached and uncoached feigning.

The objective of this study was to examine the relative effectiveness of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Personality Assessment Inventory (PAI) validity scales and indexes to detect malingering. Research participants were either informed (coached) or not informed (uncoached) about the presence and operating characteristics of the validity scales and instructed to fake bad on both the MMPI-2 and PAI. The validity scale and index scores produced by these research participants were then compared to those scores from a bona fide sample of psychiatric patients (n = 75). Coaching had no effect on the ability of the research participants to feign more successfully than those participants who received no coaching. For the MMPI-2, the Psychopathology F scale, or F(p), proved to be the best at distinguishing psychiatric patients from research participants instructed to malinger, although the other F scales (i.e., F and Fb) were also effective. For the PAI, the Rogers Discriminant Function index (RDF) was clearly superior to the other PAI fake-bad validity indicators; neither the Negative Impression Management scale nor Malingering Index were effective at detecting malingered profiles in this study. Overall, RDF proved to be marginally superior to F and F(p) in distinguishing MMPI-2 and PAI protocols produced by research participants asked to malinger and psychiatric patients. Both the RDF and the F and F(p) scales, however, were able to increase the predictive capability of one another.

Adult↗
PubMed2002

Validation of the dimensional factor structure of the personality psychopathology five in clinical and nonclinical samples.

Confirmatory factor analysis (CFA) was used to determine whether the latent structure underlying the items composing the MMPI-2 Personality Psychopathology Five scales (PSY-5; Harkness, McNulty, & Ben-Porath, 1995) is representative of the theoretical model that informed their construction. Results from the CFA revealed a good fit between the hypothesized five-factor model and the obtained latent factor structure in both clinical (n = 284) and nonclinical (n = 351) samples. Moreover, the PSY-5 model proved to be a better fit than a random five-factor model and a one-factor model. Correlations between the PSY-5 scales and a set of MMPI-2 (DSM-IV) personality disorder scales provided additional evidence of convergent and discriminant validity.

Adult↗
PubMed2002

Assessing the DSM-IV structure of personality disorder with a sample of Chinese psychiatric patients.

The validity of the three-cluster system of personality disorders (PDs) in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; APA, 1994) was examined in a sample of Chinese psychiatric patients (n = 227), who completed the self-report Personality Disorders Questionnaire for DSM-IV (PDQ-4; Hyler, 1994) and who were also administered the clinician-rated Personality Disorders Interview-IV (PDI-IV; Widiger, Mangine, Corbit, Ellis, & Thomas,). Using confirmatory factor analysis, a three-factor model corresponding to the DSM-IV clusters was tested and compared statistically to a one-factor model and a set of random, three-factor models. Only the clinician-rated instrument supported the DSM-IV three-cluster model, and then only when the factors were allowed to correlate. Results from the theoretically more rigorous uncorrelated model testing did not support the DSM-IV model for either assessment modality.

Adult↗
PubMed2002

Assessing full remission.

The 17-item Hamilton Rating Scale for Depression (HAM-D17) has been used for 4 decades as the "gold standard" instrument to assess the severity of depression and response to therapy in clinical research. The clinical utility of the HAM-D17 is hampered, in part, by the length of time required to administer the interview and by concern about a lack of inter-rater reliability. Several groups have developed shorter versions of the HAM-D17 for use in clinical practice. However, despite extensive research highlighting the importance of achieving full remission in minimizing the risk of relapse and recurrence, these shortened questionnaires have not been validated for the task of distinguishing between remission and response. A shortened form of the HAM-D17 with cut-off scores for full remission would offer a useful tool that physicians could readily employ in clinical practice. On the basis of the responses of a sample of 292 patients with major depression who received standard clinical treatment at a tertiary university affiliated hospital (Depression Clinic, Centre for Addiction and Mental Health, Toronto Ont.) we derived a shortened version of the HAM-D. Seven items with the greatest frequency of occurrence and sensitivity to change with treatment were identified and designated as the Toronto HAM-D7. A score of 3 or less on the Toronto HAM-D7 was found to correlate with the 17-item HAM-D definition of full remission (i.e., score of 7 or less).

Adult↗
PubMed2002

Psychosocial and clinical predictors of response to pharmacotherapy for depression.

A more complete understanding of the psychosocial and clinical predictors of response to pharmacotherapy would be of great value to both patients and physicians. Most demographic and clinical factors have not been found to be useful predictors of response. Although comorbid illness affects quality of life, there is confounding evidence about its importance when predicting response to antidepressant therapy. Some social support factors appear to be positive predictors of outcome in most trials. There is evidence to suggest that comorbid anxiety disorders and panic-agoraphobic spectrum symptoms are negative predictors of response to treatment. Substance abuse has been associated with a poorer response to antidepressant therapy, and recovery from substance abuse problems has been shown to be poorer among patients with comorbid depression. Assessment of personality dimensions may be a useful predictor of clinical course and outcome, but personality disorders present a complicated picture, with significant interaction among variables. A number of variables are significantly related to clinical course, but few factors have been clearly linked to treatment response. The challenge is to determine if any of these factors are indeed independent predictors of response and whether it is possible to match choice of antidepressant therapy and patient type.

Antidepressive Agents↗
PubMed2001

Antidepressants in clinical practice: limitations of assessment methods and drug response.

There is a recognized gap between knowledge derived from 'efficacy' data - based on usually brief randomized controlled trials and findings in natural practice 'effectiveness' studies. In considering the limitations of current antidepressants in clinical practice, we have selected three clinically important issues to examine in a natural practice data base that has been in existence for several years. These relate to: (1) Diagnostic heterogeneity and potential advances using functional brain imaging; (2) Variability of outcome measures during treatment and (3) Time to response and prediction of outcome. Copyright 2001 John Wiley & Sons, Ltd.

Journal Article↗
PubMedDate not supplied

The overlap of depressive personality disorder and dysthymia: a categorical problem with a dimensional solution.

In this paper we review the research literature on depressive personality. We begin with a brief discussion of the historical antecedents of the current debate, noting the long-standing uncertainty about the relation of this construct to both major mood disorders and normal temperament. Then we examine the DSM-IV Appendix B construct of depressive personality disorder, in particular its controversial overlap with dysthymic disorder. This overlap is discussed within the construct validation criteria proposed by Robins and Guze (1970), highlighting recent developments and responding to criticisms of our previous theoretical review. Finally, we examine dimensional alternatives to the current proposed depressive personality disorder construct using the framework of the five-factor model. We conclude that, despite persuasive evidence for the existence of depressive personality traits, support is insufficient for the inclusion of depressive personality disorder as currently defined. Instead, we propose that depressive traits are best conceptualized dimensionally, and as part of an overarching model of personality structure, rather than as a discrete diagnostic entity. Since this conclusion could also be drawn for many existing personality disorders, the issues raised here are relevant to the construction of DSM-V.

Depressive Disorder↗