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Psychopathology in 90 consecutive human immunodeficiency virus-seropositive and acquired immune deficiency syndrome patients with mostly intravenous drug use history.

This report presents systematic clinical data regarding psychiatric diagnoses, personal and family psychiatric histories, and symptomatologic aspects of 90 consecutive human immunodeficiency virus (HIV)-seropositive and acquired immune deficiency syndrome (AIDS) patients, of whom slightly less than two thirds were at risk due to intravenous drug abuse. In addition, a comparison was made between the distribution patterns of these variables at various stages of HIV illness and related at-risk behaviors. Eighty-four percent of the patients met criteria for a spectrum of DSM-III-R diagnoses (mostly affective) that were associated with high rates of affective and alcohol abuse disorders among first-degree relatives. Mood disorders did not differ significantly between the two main groups at risk (intravenous drug users [IVDUs] v others) by gender, age, or stage of illness. The overall data from the rating scales show high levels of psychic and somatic anxiety in the early stages of illness, whereas cognitive symptoms, retardation, and disorientation are dominant in later stages. A noteworthy finding in this study is that many depressed patients demonstrated current and/or past hypomanic, hyperthymic, or cyclothymic features with no evidence of brain damage detectable by computed axial tomography (CAT). These temperamental attributes, which preceded HIV infection, may have served as risk factors for both drug abuse and impulsive sexual behavior in all types of at-risk groups.

Adjustment Disorders↗

Actual versus perceived HIV status, sexual behaviors and predictors of unprotected sex among young gay and bisexual men who identify as HIV-negative, HIV-positive and untested.

OBJECTIVES: To compare the prevalence and predictors of HIV sexual risk behavior among young gay and bisexual men who perceived themselves to be HIV-negative, HIV-positive, or who were untested. DESIGN: Population-based sample of young gay and bisexual men. METHODS: Using multi-stage probability sampling, 408 gay and bisexual men aged 18-29 years in San Francisco were recruited and interviewed, and blood samples for HIV-testing from 364 participants were obtained. RESULTS: HIV prevalence was 18.7%, although 25% of the men who were HIV-positive did not know it. Thirty-seven per cent reported engaging in unprotected anal intercourse during the past year, including 59% of the men who knew they were HIV-positive, 35% of the men who perceived themselves HIV-negative and 28% of the untested men. Logistic regressions found similar predictors of unprotected intercourse for HIV-negatives and HIV-positives, including sexual impulsivity, substance use, sexual enjoyment and communication problems. CONCLUSIONS: The high rates of unprotected intercourse, particularly among the HIV-positive men, attest to the urgent need for HIV-prevention interventions for young gay and bisexual men. The findings suggest that many of the important variables to target in interventions are similar for both HIV-positive and HIV-negative men.

Adolescent↗

An experiment on the social facilitation of gambling behavior.

Research and theory regarding the social facilitation effect generates the expectation that the presence of other gamblers (or co-actors) in a gaming venue is likely to intensify individual gambling behavior and magnify losses. Fifty male and 66 female participants (116 total) played a computer-simulated electronic gaming machine with a fixed winning sequence, followed by an indefinite losing sequence. Measures of the intensity of gambling behavior included the final payout (a direct measure of losses), average bet-size, number of trials played, and the speed of play. Some participants received false feedback from the computer designed to suggest that other gamers in adjacent rooms were playing and sometimes winning at the same game. Persons who received both sight and sound information, including winning bells and instant messages regarding the wins of other (fake) players, placed more bets and lost more money compared to the other conditions with less information.

Adult↗

Hyperactivity and alcoholism: familial and behavioral correlates.

This study examined the relationship between childhood MBD/hyperactivity, familial alcoholism, and alcoholism severity, current psychopathology, and performance on three behavioral indices of impulsivity/attentional control. The subjects were 33 men VA alcoholic inpatients carefully screened to be free of complicating neurological, medical, and psychiatric problems. The findings indicated that subjects higher in MBD/hyperactivity reported considerably more psychopathology and tended to suffer more adverse effects associated with alcoholism than low MBD/hyperactivity subjects. Familial alcoholics reported significantly more childhood MBD/hyperactivity than nonfamilial alcoholics, a finding supported by higher MMPI hypomanic scores. Group differences were not found on any of the measures of impulsivity/attentional control.

Adult↗

[Psychopathological dynamics of suicidal behavior in childhood and puberty].

The oversimplifying and scientifically untenable separation of suicide (successful) and attempted suicide (unsuccessful) was overcome by Stengel's fundamental findings that only very few attempted suicides are failed suicides, and that the majority of attempted suicides are acts a qualitatively distinct character. Psycho(patho)dynamic analyses of suicidal acts disclosed that in a portion of the suicide attempts there is no or at least no determined suicidal intent. The definition of 'suicidal attempt' which has come into general use is therefore imprecise, because in many cases suicide is not "attempted" but the technique of suicidal behaviour is only used for a primary non-suicidal purpose. A differential typology of the entire content of the concept of 'suicide attempt' which includes vague non-homogeneous matters has become unavoidable and is being discussed here. In the suicidal behaviour of children the problems become even clearer. The 'suicide attempt' in children does not meet Stengel's criteria. The great majority of cases are not 'attempted' suicides, do not show a final determination, do not come about in a calculated manner, and are not based on an ambivalence about life and death, but are rather a potentially fatal substitution by suicidal behaviour for a demonstrative appeal for help, for a resigned escape signal or for an impulsive cry. Neither can one recognize the development of the pre-suicidal syndrome described by Ringel.

Adolescent↗

Psychosocial modifiers of response to stress.

The impact of stress upon an organism is far more complex than the simple design of most stress research implies. We offer an expanded model for studying the relation of stressors to pathological outcomes, which takes into account both the adaptive capacity of the organism before the stressor occurs and the defenses marshalled in response to the stressor. The model also distinguishes among the initial responses of alarm, sustained defensive behaviors, and the relatively irreversible endstates which remain after resistance has ended. Realizing that only a multidiscomplinary approach can begin to capture the wholeness of human experience, this research paradigm anticipates that stressors, adaptive capacities, defenses, alarm reactions, and pathologial end-states will take place at the biological, psychological, interpersonal and sociocultural levels simultaneously and successively. Data on life change stress and psychological health outcomes gathered as part of the Air Traffic Controller Health Change Study are analyzed to illustrate the use of the model in identifying psychosocial and biological modifiers of response to stress.

Adaptation, Psychological↗

History of family suicide behaviors and negative problem solving in multiple suicide attempters.

This study examined the relationship between family history of suicide, negative problem solving orientation and suicide attempt status (multiple suicide attempters versus single suicide attempters). Suicide attempters with a family history of suicide were more likely to have multiple suicide attempts when compared to suicide attempters who did not have a family history of suicide. This relationship was consistent with a model in which the relationship between family history and suicide attempt status is mediated by negative problem solving. Results of this study are discussed as they pertain to the theory and treatment of suicide attempters.

Adult↗

High-lethality status in patients with borderline personality disorder.

Recurrent suicidal behaviors in patients with Borderline Personality Disorder (BPD) are often considered communicative gestures; however, 10% complete suicide. This study seeks to identify risk factors for suicide within a BPD sample by comparing patients with High- and Low-Lethality attempts. BPD attempters (n = 113) were assessed on demographic, diagnostic, and personality variables: clinical symptoms, suicidal behaviors; childhood, family, and treatment histories; social adjustment; and recent life events. Forty-four High-Lethality attempters, defined by a score of 4 or more on Beck's Medical Lethality Scale, were compared to 69 Low-Lethality attempters. Discriminating variables were entered in a multivariate logistic regression model to define predictors of High-Lethality status. High-Lethality attempters were older, with children, less education, and lower socioeconomic class (SES) than Low-Lethality attempters. They were more likely to have Major Depressive Disorder (MDD), co-morbid Antisocial Personality Disorder (ASPD), and family histories of substance abuse. They reported greater intent to die, more lifetime attempts, hospitalizations, and time in the hospital. High-Lethality status was best predicted by low SES, co-morbid ASPD, extensive treatment histories, and greater intent to die. These characteristics resemble profiles of patients who complete suicide, are not specific for BPD, and do not include impulsivity, aggression, or severity of BPD criteria.

Adult↗

Justification for separating schizotypal and borderline personality disorders.

Siever and Gunderson (1979) have questioned the decision to separate Schizotypal Personality Disorder from Borderline Personality Disorder in DSM-III. The justification for this separation rests not on genetic evidence, but rather on the relative independence of the behavioral characteristics of two dimensions that up to now have both been referred to with the appellation "borderline." We believe that this separation provides the tools with which investigators may usefully study the interaction of genetic and environmental factors as they relate to personality and the major psychiatric disorders. The benefits of this separation are already apparent in that research investigators are now using two terms to describe different phenomena, when previously they were using the single term borderline. Proposed diagnostic criteria for Schizotypal Personality Disorder and Borderline Personality Disorder are appended.

Chronic Disease↗

Alcohol norms and expectations as predictors of alcohol use and problems in a college student sample.

Two-hundred thirty-one alcohol-using college students completed a questionnaire on their levels of alcohol use, moderate to severe problems with alcohol use, expectations of the effects of alcohol on their own and others' moods and behaviors, the desirability of these effects, norms of significant others for levels of alcohol use and the subject's desire to comply with these norms, reasons for drinking and not drinking alcohol, and a personality measure. Expectations of alcohol effects, norms of significant others, and reasons for drinking and not drinking alcohol were all significant independent predictors of alcohol use and problems with alcohol use. Expectation x desirability of effects formulations and norms x desire to comply with norms formulations did not improve the predictive power of the expectations and norms scales.

Adult↗

A comparison of objective classroom measures and teacher ratings of Attention Deficit Disorder.

Children identified as Attention Deficit Disorder (ADD) on the basis of teacher ratings using the SNAP Rating Scale were compared to non-ADD children on objective classroom measures including observations of classroom behavior, examination of the organization of children's desks, and scoring of daily academic work. Analyses provided some support for the ability of the objective measures to differentiate between teacher-identified ADD and non-ADD children, though there was considerable overlap on the distributions of most variables between groups. Six measures chosen by a discriminant analysis combined to predict teacher ratings in 83% of the cases. The inclusion of academic, observational, and desk measures in the discriminant function indicates the importance of a multivariate assessment of this construct.

Attention↗

Cerebrospinal fluid monoamine metabolites in boys with attention-deficit hyperactivity disorder.

Cerebrospinal fluid (CSF), plasma, and urinary monoamine metabolites were determined for 29 boys, aged 6-12, with attention-deficit hyperactivity disorder (ADHD). Levels of CSF 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG), the metabolites of serotonin, dopamine, and norepinephrine, respectively, correlated significantly with behavioral measures of aggression and impulsivity/hyperactivity. However, these correlations were in the unexpected direction; for example, CSF 5-HIAA correlated positively with the Brown-Goodwin Lifetime History of Aggression Scale. HVA in CSF was positively correlated with several measures of hyperactivity. The replicability of these findings, as well as possible socioenvironmental effects, and the predictive value of CSF monoamines in prepubertal hyperactivity are the subjects of ongoing study.

Aggression↗

Motor inhibition in trichotillomania and obsessive-compulsive disorder.

We investigated motor inhibition abilities in trichotillomania (TTM) and obsessive-compulsive disorder (OCD), two disorders characterized by repetitive, intentionally performed behaviors. Performance in a GoNogo experiment of 25 TTM and 21 OCD participants was compared to the performance of 26 HC participants. In contrast to OCD and HC participants, TTM participants tended to perform either 'fast and inaccurate' (indicating poor motor inhibition) or 'slow and accurate'. TTM participants with poor motor inhibition reported a significantly earlier age of TTM onset than those TTM participants who performed well. There was no evidence for motor inhibition deficits in OCD. Based on our data, a subgroup of TTM sufferers seems to be characterized by motor inhibition deficits.

Adult↗

Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria.

Children with attention deficit disorder with hyperactivity (ADD+H; N = 48) were compared with those without hyperactivity (ADD-H; N = 42), as well as with learning disabled and control children, on an extensive battery of interviews, behavior ratings, tests, and direct observations. ADD+H children had more externalizing and internalizing symptoms by parent and teacher report, were more off task during vigilance testing, and had more substance abuse, ADD+H, and aggression among their relatives than did the other groups. ADD-H children were more day-dreamy and lethargic by teacher report, more impaired in perceptual-motor speed, and had more anxiety disorders among their relatives than did ADD+H children. Results indicate that these 2 types of ADD may be separate, distinct childhood disorders rather than subtypes of a common attention deficit.

Achievement↗

Personality characteristics of three sub-groups of children with reading disabilities.

It has been demonstrated that three subgroups of poor readers have a number of unique behavioral characteristics on intelligence, psycholinguistics, and achievement. The present research explored whether further unique behavioral patterns could be delineated between the groups when considering the dimension of personality. The subjects were 64 children between the ages of 7 and 14 yr. who had been referred to a public school summer reading remediation clinic. Four tests were administered: Peabody Picture Vocabulary Test, Durrell Analysis of Reading Difficulty, Minnesota Percepto-Diagnostic Test, and the Rorschach. The subjects were grouped on the Minnesota test cut-off scores into one of three groups and then compared on the dimension of personality. There were significant differences on certain personality variables allowing different group profiles to be established. These personality profiles were discussed.

Acting Out↗

Gray's model of personality and addiction.

It has been suggested that high levels of behavioral approach system (BAS) sensitivity predispose psychopathological conditions that are characterized by a pathological engagement in approach behaviors, such as alcohol and drug abuse. The present study examined differences in scores on the BIS/BAS scales between clinically referred drug addicts and alcoholics and healthy control subjects. Results showed that drug addicts had higher BAS scores than controls and this was particularly true for BAS drive and BAS fun seeking. No differences were observed between the alcoholics and the other two groups. This is the first time that a relation between heightened BAS and drug addicts is observed in a clinical sample. These findings provide partial support for Gray's personality theory, which predicts a relation between BAS and substance abuse.

Adult↗

Psychological, autonomic, and serotonergic correlates of parasuicide among adolescent girls.

Although parasuicidal behavior in adolescence is poorly understood, evidence suggests that it may be a developmental precursor of borderline personality disorder (BPD). Current theories of both parasuicide and BPD suggest that emotion dysregulation is the primary precipitant of self-injury, which serves to dampen overwhelmingly negative affect. To date, however, no studies have assessed endophenotypic markers of emotional responding among parasuicidal adolescents. In the present study, we compare parasuicidal adolescent girls (n=23) with age-matched controls (n=23) on both psychological and physiological measures of emotion regulation and psychopathology. Adolescents, parents, and teachers completed questionnaires assessing internalizing and externalizing psychopathology, substance use, trait affectivity, and histories of parasuicide. Psychophysiological measures including electrodermal responding (EDR), respiratory sinus arrhythmia, and cardiac pre-ejection period (PEP) were collected at baseline, during negative mood induction, and during recovery. Compared with controls, parasuicidal adolescents exhibited reduced respiratory sinus arrhythmia (RSA) at baseline, greater RSA reactivity during negative mood induction, and attenuated peripheral serotonin levels. No between-group differences on measures of PEP or EDR were found. These results lend further support to theories of emotion dysregulation and impulsivity in parasuicidal teenage girls.

Adolescent↗

Anticonvulsants in the treatment of aggression.

A significant number of violent acts are committed by individuals in whom central nervous system instability can be demonstrated by special electroencephalographic (EEG) activation procedures utilizing alpha-chloralose as the activating agent. Furthermore, subcortical electrograms suggest that this instability is related to a circumscribed ictal phenomenon in the limbic system. The abruptness of the aggressive act, the fact that the behavior is so often out of character for the individual and inappropriate for the situation, as well as the confusion and partial amnesia which accompany these episodes lend clinical support for the ictal hypothesis. Some anticonvulsants not only block the activated abnormalities on the EEG but also lead to dramatic clinical improvement in those individuals showing repeated and frequent aggressive behavior. For instance, in one study 46.7 percent and 53.3 per cent of the patients demonstrated activated abnormalities on no drug and placebo, respectively. When these same patients were receiving chlorpormazine or trifluoperazine, the activation rates were 60.0 per cent and 73.3 per cent, respectively. On the other hand, when these same patients were placed on a regimen of chlordiazepoxide the activation rate was reduced to 20 per cent (p smaller than or equal to .01). Another study involved severely distrubed chronically hospitalized psychotic patients whose aggressive uncontrolled outbursts relegated then not only to a locked ward, but often to isolation rooms despite high doses of phenothiazines. A regimen of chlordiazepoxide and

Adult↗