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PubMed2001

[Stress response system and personality in rheumatoid arthritis patients]

Various factors such as immunogenetic determinants, sex, age and stress play an important role in the pathogenesis of rheumatoid arthritis (RA). The relationship between stress and RA is still unclear and undefined; however, various lines of research are developing in order to evaluate environmental, psychologic, and biologic stressors as predisposing factors. The aim of our study was to evaluate whether stress-related psychologic factors and personality disorders might be involved in the development of RA, by using a psychometric investigation-methodology in a series of patients. Twenty-three patients underwent a clinical interview and other specific psychometric tests. Macro and microstressful life-events preceded RA in 83% of the cases. Sixty percent of the patients showed a correlation between flare-ups of the disease and appearance of microevents. An obsessive-compulsive personality was found in 26% of the patients. Anxia was detected in 40% of the patients. Among the group of patients with borderline disorder's was also detected alexithymia. The high prevalence of major life-events preceding the onset of RA and the presence of personality disorders support the role of the altered stress response system as an important pathogenetic factor in the disease.

Journal Article↗
PubMed2006

Cerebral information processing in personality disorders: I. Intensity dependence of auditory evoked potentials.

Patients with personality disorders such as the histrionic type exaggerate their responses when receiving external social or environmental stimuli. We speculated that they might also show an augmenting pattern of the auditory evoked potential N1-P2 component in response to stimuli with increasing levels of intensity, a response pattern that is thought to be inversely correlated with cerebral serotonin (5-HT) activity. To test this hypothesis, we collected auditory evoked potentials in 191 patients with personality disorders (19 patients with the paranoid type, 12 schizoid, 14 schizotypal, 18 antisocial, 15 borderline, 13 histrionic, 17 narcissistic, 25 avoidant, 30 dependent and 28 obsessive-compulsive) and 26 healthy volunteers. Their personality traits were measured using the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). Compared with healthy subjects and other patient groups, the histrionic group scored higher on the basic traits Affective Instability, Stimulus Seeking, Rejection and Narcissism, and on the higher traits Emotional Dysregulation and Dissocial, than the other groups, and the schizoid group scored lower on most of the DAPP-BQ basic and higher traits. In addition, the histrionic group showed steeper amplitude/stimulus intensity function (ASF) slopes at three midline scalp electrodes than the healthy controls or the other patient groups. The ASF slopes were not correlated with any DAPP-BQ traits in the total sample of 217 subjects. However, the DAPP-BQ basic trait Rejection was positively correlated with the ASF slopes at all three electrode sites in the histrionic group. The increased intensity dependence of the auditory N1-P2 component might indicate that cerebral 5-HT neuronal activity is, on average, weak in the histrionic patients.

Adult↗
PubMed1996

Laxative abuse among women with eating disorders: an indication of psychopathology?

OBJECTIVE: The results of the scant research on laxative abuse among women with eating disorders suggest that laxative abuse is a diagnostic indicator of greater psychopathology. We further investigated the relationship of history of laxative abuse to eating and related attitudes, impulsivity, and personality pathology. METHOD: Women assessed in an outpatient clinical setting and diagnosed with anorexia nervosa, binge-eating/purging type (n = 51) or bulimia nervosa, purging type (n = 280) completed measures of laxative abuse, eating and related attitudes, and personality psychopathology at intake. RESULTS: More than one-half of both groups had abused laxatives at some point. History of laxative abuse was unrelated to eating disorder diagnostic category, current age or body weight, history of stealing, self-induced injury, having attempted suicide, interpersonal distrust, maturity fears, or compulsive or dependent personality features. Compared to nonabusers, laxative abusers demonstrated more perfectionism and avoidant personality features. Significant statistical interactions among variables revealed that bulimia nervosa patients who had abused laxatives exhibited the most pathological scores on scales measuring drive for thinness, body dissatisfaction, ineffectiveness, lack of interoceptive awareness, and passive-aggressive and borderline personality features. Anorexia nervosa patients who had abused laxatives had the highest scores on the histrionic scale. DISCUSSION: Results are discussed with regard to past research and clinical implications. We propose that laxative abuse among eating disordered women may serve different functions depending on diagnosis and underlying personality dynamics.

Adolescent↗
PubMed2003

Preliminary examination of the relationship between anxiety disorders in adults and self-reported history of teasing or bullying experiences.

This preliminary study examined the relationship between anxiety disorders and self-reported history of teasing or bullying experiences, comparing individuals with social phobia, obsessive compulsive disorder, and panic disorder with or without agoraphobia. Given that aversive conditioning experiences, such as severe teasing, have been proposed to play a role in the development of social phobia and that the core feature of social phobia is a fear of social situations in which a person may be embarrassed or humiliated, we hypothesized that the social phobia group would have a higher rate of self-reported teasing history than would the obsessive compulsive disorder or panic disorder groups. Consistent with this hypothesis, a relationship between reported history of teasing and diagnosis was found. A significantly greater percentage of participants in the social phobia group (92%) reported a history of severe teasing experiences compared with the obsessive compulsive disorder (50%) and panic disorder (35%) groups. History of teasing experiences was also significantly related to an earlier age of onset for all 3 anxiety disorders, and to a greater number of self-reported additional problems in childhood. These findings suggest further directions for research in this area and highlight the significant link between perceptions of teasing in childhood and social phobia.

Journal Article↗
PubMed1999

Association of methylphenidate-induced craving with changes in right striato-orbitofrontal metabolism in cocaine abusers: implications in addiction.

OBJECTIVE: The authors have shown that decreases in dopamine D2 receptors in cocaine abusers were associated with decreased metabolism in the cingulate and prefrontal and orbitofrontal cortices. To assess whether increasing dopamine would reverse these metabolic decrements, they measured the effects of methylphenidate, a drug that increases dopamine, on brain glucose metabolism in 20 cocaine abusers. METHOD: The subjects underwent two [18F]fluorodeoxyglucose positron emission tomography scans, one after two sequential placebo injections and one after two intravenous doses of methylphenidate. D2 receptors were measured with [11C]raclopride to evaluate their relation to methylphenidate-induced metabolic changes. RESULTS: Methylphenidate induced variable changes in brain metabolism: subjects with the higher D2 measures tended to increase metabolism, whereas those with the lower D2 measures tended to decrease metabolism. Methylphenidate's effects were significant for increases in metabolism in the superior cingulate, right thalamus, and cerebellum. Methylphenidate-induced changes in the right orbitofrontal cortex and right striatum were associated with craving, and those in the prefrontal cortex were associated with mood. CONCLUSIONS: Although methylphenidate increased metabolism in the superior cingulate, it only increased metabolism in orbitofrontal or prefrontal cortices in the subjects in whom it enhanced craving and mood, respectively. This indicates that dopamine enhancement is not sufficient per se to increase metabolism in these frontal regions. Activation of the right orbitofrontal cortex and right striatum (brain regions found to be abnormal in compulsive disorders) in the subjects reporting craving may be one of the mechanisms underlying compulsive drug administration in addicted persons. The predominant correlation of craving with right but not left brain regions suggests laterality of reinforcing and/or conditioned responses.

Adult↗
PubMed1985

Clomipramine treatment of childhood obsessive-compulsive disorder. A double-blind controlled study.

Nineteen children (mean [+/- SD] age, 14.5 +/- 2.3 years) with severe, primary obsessive-compulsive disorder completed a ten-week, double-blind, controlled trial of clomipramine hydrochloride (mean dosage, 141 mg/day) or placebo, each of which was administered for five weeks. Half of the subjects had not responded to previous treatment with other tricyclic antidepressants. There was a significant improvement in observed and self-reported obsessions and compulsions that was independent of the presence of depressive symptoms at baseline. Improvement in obsessive-compulsive symptoms did not correlate significantly with plasma concentrations of the drug or its metabolites. Clomipramine appears to be effective in the treatment of children with obsessive-compulsive disorder and the treatment seems to be independent of an antidepressant effect.

Adolescent↗
PubMed1994

Obsessions, overvalued ideas, and delusions in obsessive-compulsive disorder.

The prevailing view is that individuals with obsessive-compulsive disorder (OCD) are able to think rationally about their obsessive concerns and are thus able to recognize them as senseless. However, clinical observations indicate that at least some obsessive-compulsives do not regard their symptoms as unreasonable or excessive, and their ideas have been characterized as overvalued or delusional. In the present paper the concepts of obsessions, overvalued ideas, and delusions are discussed and compared, and the available studies of insight among obsessive-compulsives are reviewed. It is concluded that obsessive-compulsive ideas can not satisfactorily be dichotomized according to patients' insight, and that the notion of a continuum of strength of obsessive-compulsive beliefs is more appropriate. The relationship between degree of obsessive-compulsive conviction and outcome of therapy remains unclear. Methodological issues that complicate our understanding of OCD are considered, and theories of delusions are examined in relation to their development in OCD.

Attention↗
PubMed1987

Psychiatric diagnosis of patients with substance abuse problems: a comparison of two procedures, the DIS and the SADS-L. Alcoholism, drug abuse/dependence, anxiety disorders and antisocial personality disorder.

We compared DSM-III and RDC diagnoses from the DIS to RDC diagnoses from the SADS-L for alcohol and drug use disorders, anxiety disorders and Antisocial Personality Disorder in a group of patients with substance abuse problems. Kappa values for substance use disorders were fairly good. The instruments did not agree well on anxiety disorders, or on Antisocial Personality Disorder. Criterion differences gave rise to some of the disagreement between the instruments on Antisocial Personality Disorder, but the causes of disagreement for the anxiety disorders were not so clear. The implications of these findings are discussed.

Adult↗
PubMed2006

Symptom correlates of posttraumatic stress disorder in clients with borderline personality disorder.

Limited research has examined the clinical and functional impact of concurrent posttraumatic stress disorder (PTSD) in people with borderline personality disorder (BPD). Such information is particularly lacking for BPD clients with the most disabling symptoms: those who meet criteria for severe and persistent mental illness. We evaluated individuals with severe mental illness to assess whether PTSD in individuals with BPD was associated with more severe symptoms and impaired functioning than BPD alone and replicated these findings in an independent sample. In both the studies, the clients with PTSD and BPD reported significantly higher levels of general distress, physical illness, anxiety, and depression than those with BPD alone. Because individuals with both of these disorders are likely to require more intensive clinical services to reduce distress and improve functioning, work is needed to develop and evaluate interventions designed to address these comorbid conditions.

Adult↗
PubMed2001

Danger Ideation Reduction Therapy (DIRT) for treatment-resistant compulsive washing.

Five intractable cases of obsessive-compulsive disorder were treated with the Danger Ideation Reduction Therapy (DIRT) program. All five cases: (1) had displayed excessive washing/cleaning behaviour for at least 10 years; (2) had failed to respond to a minimum of two separate, 12-week drug trials with serotonergic agents; (3) failed to respond to at least 15 sessions of exposure and response prevention at the beginning of the present trial, and; (4) satisfied the DSM-IV criteria for OCD with Poor Insight. DIRT was conducted in 14, weekly, individual sessions or until, in the judgement of the treating clinician: (1) clinically significant gains were apparent with minimal symptomatology remaining, and (2) clients displayed a sound grasp of the cognitive model underpinning DIRT procedures. At post-treatment, substantial reductions in scores on the Padua Inventory (PI), Maudsley Obsessional-Compulsive Inventory (MOCI), Beck Depression Inventory-II (BDI-II) and two global rating scales were apparent for four of the five subjects. These improvements were maintained at 4-to-6 month follow-up, with four of the five cases meeting Jacobson and Truax's (1991) criteria for 'recovery' on the MOCI and the PI by this assessment stage. While one subject remained non-responsive, the present findings suggest that DIRT may be a viable option for treatment-resistant cases of compulsive washing. The theoretical implications of the findings are discussed.

Adult↗
PubMedDate not supplied

Group and multifamily behavioral treatment for obsessive compulsive disorder: a pilot study.

Recent trends toward managed care in mental health settings require investigation of the efficacy and cost-effectiveness of treatments conducted over shorter time frames or with less therapist involvement. Findings are presented in an uncontrolled trial of two types of group behavioral treatments of OCD: group (GBT) and multifamily (MFBT). Seventeen patients (10 women and 7 men) diagnosed with OCD received a partially manualized GBT delivered by co-therapy teams in three groups of ten 2-hr sessions. Mean interview-based YBOCS scores reduced significantly at posttest and at 1-year follow-up, as did measures of overall functioning on the Sheehan Disability Scale at posttest and follow-up. A second cohort of 19 patients (14 women and 5 men) was treated with MFBT that included spouses/partners and parents in three co-therapy groups. Two groups received ten 2-hr sessions and one received twelve 2-hr sessions. YBOCS scores reduced significantly at posttest and at 1-year follow-up, with corresponding gains in disability scores. Both group treatments showed large effects comparable to those reported for a more intensive individual behavioral treatment. Comparisons of treatments indicated that similar proportions of subjects were reliably changed at posttest and follow-up respectively, but more MFBT than GBT participants were clinically significantly improved. These promising cost effective group treatments remain to be tested in a controlled trial.

Adolescent↗
PubMed1987

Type A coronary-prone behaviour pattern and pathological narcissism.

Type A coronary-prone behaviour pattern exhibits many of the features of neurotic repetition compulsion. Thus, it is often maladaptive and tends to be compulsive, inflexible, irrational and ultimately non-satisfying. There is a notable similarity between the descriptions of Type A individuals in the behavioural literature and narcissistic individuals in the psychoanalytic literature. It is postulated that Type A individuals may have a deficient self-representation. This psychodynamic formulation of Type A as a variant of pathological narcissism has implications for assessment, prevention and management. In particular, it may help discriminate a sub-group of high achievers who are neurotically motivated and have abnormally high arousal. Only this sub-group may be at increased risk of coronary pathology.

Compulsive Behavior↗
PubMed1998

Behavior therapy versus clomipramine for the treatment of obsessive-compulsive disorder in children and adolescents.

OBJECTIVE: To compare, via a pilot study, the effectiveness of behavior therapy and of drug treatment in children and adolescents with obsessive-compulsive disorder. METHOD: Twenty-two children aged between 8 and 18 years were randomly assigned to behavior therapy (n = 12) or open clomipramine (n = 10) in a parallel design lasting 12 weeks. Behavior therapy included exposure and response prevention administered in weekly sessions. The mean dosage of clomipramine was 2.5 mg/kg (range = 1.4-3.3 mg/kg). The main outcome variables were the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and the Leyton Obsessional Inventory-Child Version (LOI-CV). RESULTS: Significant improvement was obtained in both treatment conditions. Behavior therapy produced stronger therapeutic changes than clomipramine on the CY-BOCS (p < .05), whereas on the LOI-CV no significant differences between the results of the two treatments were found. Five of the nine initial nonresponders showed significant changes after extension of treatment for another 12 weeks. CONCLUSION: Behavior therapy is shown to be a good alternative for drug treatment and deserves further study in larger samples of children with obsessive-compulsive disorder.

Behavior Therapy↗
PubMed1988

Cybernetics, activation, and drug effects.

Patients present unique combinations of familial relationships, developmental idiosyncrasies, social aberrations, affective states, cognitive abilities, symptoms, defects, and maladaptations. Psychopharmacological treatments form a useful approach to cutting through this complexity to the core pathophysiology. Focusing on disorders that can be brought to complete remission by medication suggests that retarded and agitated depressions, manic and angry hyperactive paranoid states, panic disorder, emotionally unstable character disorders and schizophrenias are governed by the degree of derangement of an affective-activation control system. Defects in this control system are best conceptualized in cybernetic terms rather than in terms of the current rheostat models. Conceptualization of cybernetic defects allows for understanding of psychopathological developments as well as give a framework for pharmacological benefits. One aspect of the activation-affective disorders, are disorders of two types of pleasure regulatory mechanism, here referred to as appetitive and consummatory. The relationship of disorders of these hedonic control mechanisms to affective states and those of drug abuse are considered. This schema also affirms a close relationship between the bipolar affective disorders and the schizophrenias.

Arousal↗