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PubMed1996

Attentional bias in obsessional compulsive disorder.

To date, studies of information processing in anxiety disorders have suggested that the latter are characterised by vigilance for threatening stimuli, possibly specific to personally relevant threat content. The present study represents an attempt to establish whether patients suffering from Obsessional Compulsive Disorder (OCD), generally classified as an anxiety disorder, show a similar cognitive bias. Thus, a replication of MacLeod, Mathews and Tata's (1986) study [Journal of Abnormal Psychology, 95, 15-20] is reported, employing modified materials of direct concern to the OCD subjects i.e. Contamination-related words. The results did indeed reveal content specific vigilance, whereby the OCD group were more vigilant for contamination content than mood-matched High Trait Anxious (HTA) controls, but the reverse was true for Social Anxiety words. Additionally, while a general threat interference effect was identified for both OCD and HTA subjects this was not content specific. A second experiment employing Low Trait Anxious subjects revealed no vigilance for threat nor any threat interference in this sample. The clinical implications and possible mechanism underlying these results are discussed.

Adult↗
PubMed2001

Psychosocial and endocrine features of chronic first-episode major depression in 8-16 year olds.

BACKGROUND: Psychoendocrine processes may have a role in explaining individual differences in the outcome of major depression in 8-16-year-old school children. METHODS: Salivary cortisol and dehydroepiandrosterone (DHEA) levels at 8:00 AM and 8:00 PM, life events, and comorbidity were assessed at presentation, 36, and 72 weeks in 47 (60%) of 78 clinically referred subjects with a first episode of major depression. Comparisons were made between chronic and nonchronic major depression. RESULTS: Chronic depression was characterized by being older, cortisol hypersecretion at 8:00 PM at all three assessments, increasing depression-dependent life events over the follow-up period, and comorbid obsessive-compulsive disorder (OCD) at presentation and at 36 weeks. Chronicity may be best predicted by increasing depression-dependent events over the 72-week period. Such events are more likely in cases with evening cortisol hypersecretion at entry and persistent OCD. Variations in DHEA levels were not associated with chronicity or increasing life events. CONCLUSIONS: During adolescence, but not childhood, the persistence of major depression may occur through an increase of risk for further and particular types of depression-dependent undesirable life events (personal disappointments and/or dangers to the self), that are more likely in those subjects with persisting cortisol hypersecretion and unresolved comorbid OCD.

Adolescent↗
PubMed1988

Compensation and non-compensation chronic pain patients compared for DSM-III operational diagnoses.

Two hundred and eighty-three mixed chronic pain patients, consecutive admissions, were diagnostically evaluated as per DSM-III, Axis I, Axis II or personality type psychiatric operational criteria. Controlling for primary organic treatment diagnosis, age and race, statistical comparisons were made between male compensation patients (n = 93) and male non-compensation patients (n = 23) and between female compensation patients (n = 38) and female non-compensation patients (n = 28) for all DSM-III diagnoses. Male compensation patients were significantly overrepresented for these diagnostic groups: conversion disorder (somatosensory type); combined personality disorders; and passive-aggressive personality disorder. Male non-compensation patients were significantly overrepresented for these diagnostic groups: no diagnosis on Axis I; combined personality types; and compulsive personality type. Female compensation patients were significantly overrepresented for conversion disorder (somatosensory) only. Female non-compensation patients were significantly overrepresented for generalized anxiety disorder and combined anxiety syndromes. Compensation chronic pain patients may be at risk for some psychiatric disorders not previously identified: conversion disorder (somatosensory), and personality disorders.

Adult↗
PubMed2000

A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder.

BACKGROUND: To date, only 1 controlled study has found a drug (haloperidol) to be efficacious in augmenting response in patients with obsessive-compulsive disorder (OCD) refractory to serotonin reuptake inhibitor (SRI) monotherapy; patients with comorbid chronic tic disorders showed a preferential response. This report describes the first controlled study of risperidone addition in patients with OCD refractory to treatment with SRI alone. METHODS: Seventy adult patients with a primary DSM-IV diagnosis of OCD received 12 weeks of treatment with an SRI. Thirty-six patients were refractory to the SRI and were randomized in a double-blind manner to 6 weeks of risperidone (n = 20) or placebo (n = 16) addition. Behavioral ratings, including the Yale-Brown Obsessive Compulsive Scale, were obtained at baseline and throughout the trial. Placebo-treated patients subsequently received an identical open-label trial of risperidone addition. RESULTS: For study completers, 9 (50%) of 18 risperidone-treated patients were responders (mean daily dose, 2.2 +/-0.7 mg/d) compared with 0 of 15 in the placebo addition group (P<. 005). Seven (50%) of 14 patients who received open-label risperidone addition responded. Risperidone addition was superior to placebo in reducing OCD (P<.001), depressive (P<.001), and anxiety (P =.003) symptoms. There was no difference in response between OCD patients with and without comorbid diagnoses of chronic tic disorder or schizotypal personalty disorder. Other than mild, transient sedation, risperidone was well tolerated. CONCLUSION: These results suggest that OCD patients with and without comorbid chronic tic disorders or schizotypal personality disorder may respond to the addition of low-dose risperidone to ongoing SRI therapy.

Adult↗
PubMedDate not supplied

Proposal of a dimensional model of personality disorders.

During recent years there has been a growing interest on several aspects regarding psychopathology in general and particularly with personality disorders, such as dual psychopathology, comorbidity and dimensional models. Going from the Eysenck's three-factor model to the Fiske's five-factor one, from the Cloninger's psychobiological model to the Millon's biosocial one, a wide variety of personality analysis models, as well as dimensions to which the different personality disorders should be anchored, have been proposed. Here, we propose a dimensional model for personality disorders based on DSM-IV criteria, which are cognitive style (field dependence-independence), prevalent emotion (anger-fear), interpersonal style (submissiveness-dominance), and impulse control (impulsiveness-compulsiveness). We consider that these dimensions are related to different levels of cerebral complexity, assuming that evolution operates under the redundancy principle. Based on these dimensions, a bimodal model in which antisocial personality (high field dependence, anger, dominance, and impulsiveness) and schizotypal personality (low field dependence, fear, submissiveness, and compulsiveness) would be anchored in each extreme is proposed. Between these two extremes, the rest of personality disorders, such as borderline, paranoid, narcissist, histrionic, dependent, passive-aggressive, avoidant, obsessive-compulsive, paranoid, and schizoid, would be anchored.

Humans↗
PubMedDate not supplied

Ethnicity and four personality disorders.

The current study examined the relationship between ethnicity and DSM-IV personality disorders. The distribution of four personality disorders--borderline (BPD), schizotypal (STPD), avoidant (AVPD), and obsessive-compulsive (OCPD)--along with their criteria sets, were compared across three ethnic groups (Caucasians, African Americans, and Hispanics) using both a clinician-administered diagnostic interview and a self-report instrument. Participants were 554 patients drawn from the Collaborative Longitudinal Personality Disorders Study (CLPS) who comprised these three ethnic groups and met personality disorder criteria based on reliably administered semistructured interviews. Chi-square analyses revealed disproportionately higher rates of BPD in Hispanic than in Caucasian and African American participants and higher rates of STPD among African Americans when compared to Caucasians. Self-report data reflected similar patterns. The findings suggest that in treatment-seeking samples, Caucasians, Hispanics, and African Americans may present with different patterns of personality pathology. The factors contributing to these differences warrant further investigation.

Adolescent↗
PubMed1989

New antidepressants and 5-HT uptake inhibitors.

The efficacy of 5-HT uptake inhibitors, including paroxetine, as antidepressants is compared with that of the reference tricyclic antidepressants. It is suggested that some of the older tricyclic antidepressants might not have been released for general clinical use if tested by today's rigorous standards. Placebo-controlled, multicentre studies indicate that 5-HT uptake inhibitors are both effective as antidepressants and well tolerated by depressed patients. They also appear to have a role in the treatment of depression when associated with personality disorders, in the treatment of obsessive-compulsive disorder and bulimia, and in resistant depression. Moreover, the evidence for efficacy in the prophylaxis of depression is better established for 5-HT uptake inhibitors than for reference antidepressants.

Antidepressive Agents↗
PubMed1995

Personality patterns in subjects at risk for affective disorders.

The main conclusions of this study on the familial links between personality patterns and affective disorders are: (1) The personality features with the greatest degree of symptomatic overlap with unipolar depression were more common among the first-degree relatives of probands with this diagnosis: thus dysthymic temperament and neuroticism are enhanced in this group of relatives compared to controls. Likewise personality features with a high degree of symptomatic overlap with bipolar affective disorder were more common among the first-degree relatives of probands with this diagnosis. Thus levels of dysthymic and cyclothymic temperament were elevated in this group of relatives compared to controls, whereas a familial link between neuroticism and bipolar disorder was not observed. (2) In addition, personality traits with only limited similarity with the syndromes of depression and mania were also found to be linked with affective disorders (obsessive-compulsive PD to bipolar disorders, rigidity to both subtypes of affective disorders). These associations have different implications regarding the association between personality/temperament conditions and disorders depending on the degree of overlap between symptoms and the personality trait. Those with substantial overlap may indicate the presence of a unitary disease process in which the enhancement of subthreshold affective traits may result in aggravation of behavior characteristics fulfilling the criteria of fullblown episodes of the disease. This relationship was particularly stressed by Kraepelin, Kretschmer, Clayton et al. and Akiskal. In this view personality and temperament patterns represent minor variants of the associate acute disorders. On the other hand, the relationship between dissimilar conditions may indicate the presence of a risk of underlying vulnerability factors which led to affective disorder only in the presence of additional risk factors. An example of the latter relationship in the present study is the aggregation of obsessive-compulsive and anancastic traits in families with affective disorders. Tellenbach focussed on this particular constellation. Epidemiological and family studies including these personality traits are too rare to fully appreciate the relevance of this particular relationship. Future prospective studies and family genetic studies which investigate the relationship between temperament, personality traits and disorders and affective syndromes are clearly indicated by the results presented herein.

Humans↗
PubMed1997

Feeling unreal: 30 cases of DSM-III-R depersonalization disorder.

OBJECTIVE: In contrast to the recent surge of interest in other dissociative disorders, DSM-III-R depersonalization disorder has not been thoroughly investigated and characterized. The authors systematically elucidated its phenomenology, comorbidity, traumatic antecedents, and treatment history. METHOD: Thirty adult subjects (19 women and 11 men) were consecutively recruited and administered various structured and semistructured interviews as well as the self-rated Dissociative Experiences Scale. An age- and sex-matched normal comparison group was also recruited. RESULTS: The mean age at onset of depersonalization disorder was 16.1 years (SD = 5.2). The illness had a chronic course that was usually continuous but sometimes episodic. Severe distress and high levels of interpersonal impairment were characteristic. Unipolar mood and anxiety disorders were common, but none emerged as specifically related to the depersonalization. A wide variety of personality disorders was manifested; avoidant, borderline, and obsessive-compulsive were most common. Although not highly traumatized, the subjects with depersonalization disorder reported significantly more childhood trauma than the normal comparison subjects. Depersonalization had been typically treatment refractory; only serotonin reuptake inhibitors and, to a lesser extent, benzodiazepines had been of any therapeutic benefit. CONCLUSIONS: This study supports the conceptualization of depersonalization disorder as a distinct disorder with a characteristic course that is independent of mood, anxiety, and personality symptoms. A subtle relationship may exist between childhood trauma and depersonalization disorder that merits further investigation. The disorder appears to be highly treatment refractory, and prospective treatment trials are warranted.

Adolescent↗
PubMed1988

[Basic motor pattern in 4 neurotic structures].

This article discusses an experimental study in which 10 schizoid, 10 depressive, 10 obsessive-compulsive and 10 hysterical patients were filmed in five planned actions. On the basis of a questionnaire, the nature of the motoric process in each case was then evaluated by 11 people who knew nothing of the patients' personality structures. There were highly significant correlations between certain items and individual structures, allowing for the formulation of four basic patterns of movement for the individual structures. In the framework of the psychology of drives, these results confirm on the one hand the working hypothesis that motoric patterns develop in accordance with particular neurotic structures. On the other hand, the results can also be regarded as an indication of the value of defining these ordering principles.

Adult↗
PubMed1978

The Middlesex Hospital Questionnaire: a validity study.

The MHQ is a brief self-rating inventory purporting to measure aspects of six distinct categories of psychoneurosis and affective status. It has been found to be a reliable instrument and also valid as a profile measure. Two individual scales have also previously been explored in respect of validity. The present report describes a further attempt to examine the validity of individual scales in relation to pertinent single clinical diagnostic entities in a study involving 800 patients. The phobic and obsessional scales are found to be particularly accurate and differentiating in this respect. Patients variously diagnosed as suffering from anxiety states, depressive states and personality disorder tend to score very highly on several scales. The instrument serves overall to distinguish satisfactorily between such populations and others suffering from schizophrenia and anorexia nervosa. It also markedly differentiates them from 'normal' populations.

Anorexia Nervosa↗
PubMed1999

[Exposing obsessive-compulsive patients: often only 3 simple questions are enough. The family physician as "facilitator of self-disclosure"].

For numerous patients with obsessive-compulsive disorder, the family doctor is the first contact person. Many of these patients have concealed their problem for years. This paper summarizes the forms of the disorder and their indirect manifestations in the doctor's office, discusses the reasons for concealment on the part of the patient and/or his relatives, and describes the family doctor's help in three areas: aiding the "birth of revelation"; initiating pharmacotherapy and supporting behavior therapy-related self-help for patient and relatives; motivating patient and relatives to seek expert psychiatric and psychotherapeutic aid. In the second part of the paper, the family doctor is given model explanations designed as answers to common questions asked by sufferers from obsessive-compulsive disorder.

Behavior Therapy↗
PubMed2004

Early maladaptive schemas in personality disordered individuals.

The present study aimed to examine the specificity of schema domains in three personality disorder (PD) groups, namely borderline (BPD), obsessive-compulsive (OCPD), and avoidant PD (AvPD), and to correctly identify the three PD groups on the basis of these schemas. The sample consisted of 48 clinical participants diagnosed with PDs and assigned to 1 of 3 groups on the basis of their Axis II diagnoses (BPD: n = 13; OCPD: n = 13; AvPD: n = 22). High scores on Dependence/Incompetence, Defectiveness/ Shame and Abandonment were found for the BPD group. Such pattern appears to be most consistent with Young's theory of BPD. Consistent with the theory and empirical findings of Beck et al. (1990, 2001), OCPD was associated with elevations on the Unrelenting Standards schema domain, but not on Emotional Inhibition, which was found to be elevated for AvPD. In conclusion, the present study suggests that there are different patterns of schema domains across different PDs and that the Schema Questionnaire (SQ) is potentially useful in differentiating between these PDs.

Adaptation, Psychological↗