DST studies in psychotic depression: a meta-analysis

OBJECTIVE: Although hypersecretion of cortisol has frequently been reported in psychotic depression, the findings have been mixed. The authors performed a meta-analysis of the existing studies to determine the significance of differences in nonsuppression of cortisol across studies. METHOD: Fourteen studies that compared dexamethasone suppression test (DST) results in psychotic and nonpsychotic patients were examined, and a Mantel-Haenszel meta-analysis was performed. For comparison purposes, 19 studies of the DST with respect to melancholic/nonmelancholic and inpatient/outpatient distinctions were similarly reviewed. RESULTS: This analysis indicated a highly significant probability that a greater rate of cortisol nonsuppression occurs in psychotic depression. The nonsuppression rate was substantially higher in patients with psychotic depression (64%) than in nonpsychotic patients (41%). In the 19 studies of melancholia, nonsuppression was less frequent (36%), and when inpatient/outpatient status was controlled, melancholic depression was not significantly associated with nonsuppression. In nonmelancholic outpatients with major depression, the nonsuppression rate was low (12%). CONCLUSIONS: Among patients with major depression, psychotic depression is the subtype that is most closely associated with nonsuppression of cortisol on the DST. Hypercortisolemia is usually present in psychotic depression and may be important in understanding the pathophysiology of this syndrome.     

The Representation of Four Personality Disorders by the Schedule for Nonadaptive and Adaptive Personality Dimensional Model of Personality.

This study examined the relationships of the Schedule for Nonadaptive and Adaptive Personality (SNAP) model of personality to 4 targeted personality disorders (PDs) in a large multisite sample of patients. Data were examined from 529 patients, who were assigned 1 of 5 primary diagnoses: borderline, schizotypal, avoidant, and obsessive-compulsive PDs and major depression without PD. Patients were administered the SNAP questionnaire and results were compared among diagnostic groups and between patient groups and nonclinical norms. Results indicated that the dimensions of the model appear to have considerable promise in differentiating normal from abnormal personality, particularly in the propensity of individuals with PDs to manifest negative affects and interpersonal detachment. Furthermore, the model appeared to successfully distinguish specific PDs, a property that represents a particular challenge for dimensional models of personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression in Parkinson's disease: biogenic amines in CSF of "de novo" patients

INTRODUCTION: Etiology of depression in Parkinson's disease (PD) is associated with serotonergic dysfunction. Previous studies, supporting this hypothesis, were performed on patients treated with antiparkinsonian drugs. To eliminate the influence of parkinsonian drug therapy and to elucidate significance of different biochemical pathways in PD associated with depression we determined levels of biogenic amines in cerebrospinal fluid (CSF) of 26 untreated "de novo" Parkinsonian patients. MATERIAL AND METHODS: Patients were scored with the Hamilton depression scale (HD) and subdivided into groups with HD score > or = 18 and HD score < 18. Diagnosis of depression was made according to DSM III R. Both groups were matched for age and motor disability. RESULTS: In both groups no significant differences appeared between CSF levels of dopamine, noradrenaline, 3,4-dihydroxyphenylacetic acid, homovanillic acid, 3-methoxy-4-hydroxyphenylglycol and 5-hydroxyindole acetic acid, determined by high-performance liquid chromatography. DISCUSSION: In contrast to previous studies on treated Parkinsonian patients no sign of altered serotonin metabolism especially in context with severity of depression in early stages of PD was found. Due to our results, we suggest, that biochemical markers of depression in CSF of PD may be influenced by antiparkinsonian therapy and that depression in PD may respond to serotonin reuptake inhibitors mainly in later stages of PD.     

Ethnicity and mental health treatment utilization by patients with personality disorders.

The authors examined the relationship between ethnicity and treatment utilization by individuals with personality disorders (PDs). Lifetime and prospectively determined rates and amounts of mental health treatments received were compared in over 500 White, African American, and Hispanic participants with PDs in a naturalistic longitudinal study. Minority, especially Hispanic, participants were significantly less likely than White participants to receive a range of outpatient and inpatient psychosocial treatments and psychotropic medications. This pattern was especially pronounced for minority participants with more severe PDs. A positive support alliance factor significantly predicted the amount of individual psychotherapy used by African American and Hispanic but not White participants, underscoring the importance of special attention to the treatment relationship with minority patients. These treatment use differences raise complex questions about treatment assessment and delivery, cultural biases of the current diagnostic system, and possible variation in PD manifestation across racial/ethnic groups. Future studies need to assess specific barriers to adequate and appropriate treatments for minority individuals with PDs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Validity of the Five-Factor Model Prototypes for Personality Disorders in Two Clinical Samples.

The authors examined the validity of D. R. Lynam and T. A. Widiger's (2001) prototypes for personality disorders (PDs) derived from the facets of the 5-factor model (FFM) of personality in 2 clinical samples. In the 1st sample (N = 94), there was good agreement between the prototypes generated by experts and the profiles reported by patients. These FFM PD similarity scores also demonstrated good convergent and discriminant validity with results from a semistructured interview and a self-report measure of Axis II pathology. In the 2nd sample (N = 132), the FFM PD similarity scores demonstrated excellent longitudinal stability and good predictive validity with regard to consensus ratings of PD features. The implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The consequences of depressive affect on functioning in relation to Cluster B personality disorder features.

The authors examined the effects of depressed affect (DA) on functioning measured by behavioral tasks pertaining to abstract reasoning, social functioning, and delay of gratification in relation to Cluster B personality disorder features (PDs) in a clinical sample. Individuals were randomly assigned to either a DA induction or control condition. Consistent with clinical conceptualizations, the authors expected that Cluster B PD symptoms would be related to maladaptive responding (e.g., poorer delay of gratification) when experiencing DA. As hypothesized, many of the relations between the Cluster B PDs and functioning were moderated by DA (e.g., borderline PD was negatively related to abstract reasoning, but only in the DA condition). However, many of the Cluster B PDs symptom counts were related to more adaptive responses in the DA condition (e.g., less aggressive social functioning, better delay of gratification). The authors speculate that individuals with Cluster B PDs may be more likely to respond maladaptively to alternative negative mood states, such as anger and fear. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A depressive syndrome responsive to lithium. An analysis of 20 cases

The authors analyze a series of 20 patients seen over the past 4 years who have shown a dramatic improvement following the introduction of lithium carbonate to their therapy. The results indicate that these patients showed a consistent syndrome with the following features: a) anergic endogenous depression; b) positive family history in first degree probands; c) obsessional personality traits and symptoms; d) hypochondriasis and somatic symptoms; e) failure to respond to previous antidepressant therapy with tricyclic and MAOI compounds as well as ECT. A previous study by Gittleson showed that one third of a series of psychotic depressives admitted to the Maudsley Hospital, London, also displayed obsessional symptoms and hypochondriasis. These patients, however, seemed to do as well with standard antidepressant treatment as a control group of psychotic depressives without obsessional features. However, in this series, there was a 7 per cent residue whose obsessional symptoms worsened, even after recovery from their depression. The authors' group of patients represented approximately 3 per cent of all psychotic depressives seen over the 4-year period and could, therefore, coincide with Gittleson's residue. The mean age of onset of illness in the authors' depressive group was 45.5 years, and this finding, coupled with the high incidence of psychotic depression in first degree relatives, indicates that these patients were suffering from a psychotic depression modified by personality traits, rather than an atypical obsessional neurosis. The consistency of clinical features and specificity of response to lithium therapy appear to indicate that this is a clearly definable clinical syndrome worthy of further investigation.     

Patients' versus informants' reports of personality disorders in predicting 7 1/2-year outcome in outpatients with depressive disorders.

Concordance between patients' and informants' reports of personality disorders (PDs) is low, raising the questions of which source provides more valid data and whether both contribute unique information. This study compared patients' and informants' reports of PDs in predicting outcome in a 7 1/2-year follow-up of 85 depressed outpatients. Patients and informants were independently evaluated using structured interviews; outcome was assessed using structured interviews with patients. Both patients' and informants' reports of PD diagnoses and dimensional scores independently predicted depression symptoms and global functioning at follow-up. However, only informants' reports made a unique contribution to predicting social adjustment. This finding indicates that both patients and informants provide unique information on Axis II psychopathology and argues for the use of both sources in the assessment of PDs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative clinical study of patients with Parkinson disease and essential tremor

INTRODUCTION AND OBJECTIVE: Some studies have shown that essential tremor (ET) occurs more frequently in Parkinson disease (PD) patients and opposite, suggesting these disorders are pathogenically related. To evaluate this relationship, we have compared some clinical features between patients with ET and with PD. PATIENTS AND METHODS: PD patients (N = 134) and patients with ET (N = 46), were collected from Bajo Aragon district. A diagnosis of PD was taken according to the United Kingdom Parkinson's Disease Society Brain Bank criteria. A diagnosis of ET was confirmed on the basis of Rajput et al criteria. RESULTS: A statistically significant higher number of females with ET were founded (p < 0.05). An earlier mean age at tremor onset was observed in ET patients (p < 0.0001). More than half ET patients had a positive had a positive family history of ET (p < 0.0001). Interval period between tremor onset and first medical consulting was higher in ET patients (p < 0.01). Depression was more common in PD patients (p < 0.05). CONCLUSIONS: A statistically significant differences about mean age at tremor onset, duration of illness, positive family history of ET, one side or bilateral tremor onset and frequency of depression were observed between these two disorders. The differences found in clinical features and others described previously about necropsy findings and TEP with 18F-Dopa studies, don't support the possibility that PD and ET are pathogenically related.     

Personality disorders: model for conceptual approach and classification. Part I: General model

In this article we present data suggesting that one core deficit in personality represents a common dimension extending across most categories of personality disorders (PDs), whereas clinically discrete syndromes classified as PDs in DSM IIIR are categorical maladaptive types related orthogonally to the common borderline dimension. In a sample of 121 subjects with PDs and 67 controls, persons with PDs and without PDs manifested similar profiles on the Millon Clinical Multiaxial Inventory (MCMI) scales for various behavior styles. Conversely, the two groups consistently differed with respect to the MCMI borderline scale: in contrast to non-PD persons, those with PDs were strikingly more borderline and typically scored above 75 points (the latter has been established as the cut off for the diagnosis of Borderline PD). Likewise, persons with PDs scored significantly higher on the Diagnostic Interview for Borderlines than the control group. These results suggest that: i) most symptoms usually considered typical of the borderline personality characterize other PDs as well; ii) borderline features seem to be characteristic of persons with PDs and can be used to distinguish PDs vs. non-PDs. Therefore, symptoms widely regarded as typical of the borderline personality characterize other PDs as well. This shared dimension may explain the overlap in categorical diagnoses of individual PDs. Moreover, this shared dimension may be efficiently used as the classificatory principle for PDs. In Part II of this article, we present a model that classifies deviant behaviors in a systematic way, i.e., combines three levels of functioning (normal, neurotic, and borderline) with a limited number of categories of (mal) adaptive behavior types.     

The impact of personality disorders on behavioral treatment outcome for social phobia

The impact of personality disorders (PDs) on exposure in vivo treatment for social phobia was investigated in three groups of social phobics: social phobia without any PD (n = 30), social phobia with a single diagnosis of avoidant PD (n = 18) and social phobia with multiple PDs (n = 13). We hypothesized parallel change for social phobia with and without an avoidant PD with the latter group being more impaired before and after treatment. In order to test this hypothesis, confidence intervals for change were computed. In line with our hypothesis, social phobics in all three groups improved significantly during treatment and no interaction effects were found on the repeated MANOVAs. By using a confidence interval, parallel change was found on most measures. The impact of additional anxiety and mood disorders on treatment outcome was investigated separately. The analyses showed that an additional anxiety or mood disorder also did not predict outcome of exposure treatment.     

Neuropsychological deficits in psychotic versus nonpsychotic unipolar depression.

A broad range of neuropsychological function was compared in samples of young adult unipolar depressed inpatients with and without psychotic features. Consistent with expectations, the psychotic depressive group demonstrated a broad range of deficit and had more impaired performances than the nonpsychotic group. Relevance of these data for hypotheses concerning psychotic depression as a unique diagnostic entity is discussed. In the context of previous research, the current findings suggest that accounting for individual differences in depression may clarify discrepancies between earlier studies of neuropsychological function in depression, and our understanding of the mechanisms by which depression influences cognition may be refined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting individual change in personality disorder features by simultaneous individual change in personality dimensions linked to neurobehavioral systems: The longitudinal study of personality disorders.

Personality disorders (PDs), long thought to be immutable over time, show considerable evidence of individual change and malleability in modern prospective longitudinal studies. The factors responsible for the evident individual change in PDs over time, however, remain essentially unknown. A neurobehavioral model that posits negative emotion (NEM), nonaffective constraint (CON), communal positive emotion (PEM-C), and agentic positive emotion (PEM-A) as important systems underlying PD provides a theoretical basis for investigating predictors of change in PD features over time. Thus, in this study, the authors investigated how individual change in NEM, CON, PEM-C, and PEM-A over time predicted individual change in PD features over time, using longitudinal data on PD assessed by the International Personality Disorders Examination (A. W. Loranger, 1999), as well as data on normal personality features gathered within a 4-year prospective multiwave longitudinal study (N = 250). The authors used the method of latent growth modeling to conduct their analyses. Lower initial levels of PEM-C predicted initial levels of the growth trajectories for those with elevated Cluster A PD features. Elevated NEM, lower CON, and elevated PEM-A initial levels were found to characterize the initial levels of growth trajectories for those with increased Cluster B PD features. Interestingly, subjects with higher initial levels of PEM-A revealed a more rapid rate of change (declining) in Cluster B PD features over time. Elevated NEM and decreased PEM-C initial levels were found to characterize the growth trajectories for subjects with increased Cluster C PD features. The substantive meaning of these results is discussed, and the methodological advantages offered by this statistical approach are also highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Axis II psychopathology as a function of Axis I disorders in childhood and adolescence

OBJECTIVE: To examine the occurrence of elevated personality disorder (PD) dimensional scores in a community sample of young adults as a function of the occurrence of Axis I disorders through age 18 years. METHOD: 299 individuals who had been interviewed regarding Axis I disorders twice while in adolescence (first when 14 through 18 years of age) were carefully assessed regarding Axis I and II psychopathology at age 24. RESULTS: The prevalence of PD diagnoses was relatively low (3.8% in participants with a history of Axis I versus 1.7% in participants with no Axis I history). The occurrence of all four Axis I diagnostic categories (major depression, anxiety disorders, disruptive behavior disorders, substance use disorders) in childhood and adolescence was associated with elevated PD dimensional scores. The likelihood of elevated PD dimensional scores increased as a function of the number of Axis I disorders. Elevated PD scores were significantly associated with a negative course of major depression. CONCLUSIONS: Although the rates of PDs were low, the findings suggest a substantial degree of association between early-onset Axis I disorders and Axis II psychopathology in young adulthood. More research is needed to develop assessment and treatment recommendations addressing the early manifestations of PDs.     

Rare clinical syndromes occurring with diarrhea (a lecture)

Study of psychopathological structure of melancholic depressions in 75 patients suffered with schizophrenia and schizoaffective psychosis revealed 4 their types exactly pure melancholic depression, melancholic depression with anxious disorders, melancholic depression with anesthetic disorders, melancholic depression with apathetic-adynamic disorders. One patient may have different types of melancholic depressions. The transfer of one type in another during the attack of disease was picked out.     

Salivary duct carcinoma: clinicopathological and immunohistochemical studies

The SCID-II Personality Questionnaire, modified for DSM-IV and ICD-10 Diagnostic Criteria for Research (ICD-10-DCR), was administered to 58 consecutive patients with agoraphobia with panic disorder in order to screen for personality disorders (PDs) and assess diagnostic agreement between DSM-IV and ICD-10-DCR. The diagnostic agreement, as expressed by kappa values, was 0.78 for the presence of any personality disorder (PD), but it ranged from 0.51 for schizoid PD to 0.83 for dependent PD. There was a tendency for ICD-10-DCR to overdiagnose PDs, except for borderline and dependent PDs. The sources of disagreement can be traced to differences in the conceptualization of some PDs and differences in diagnostic criteria and diagnostic thresholds; these are further examined in an effort to improve diagnostic criteria and attain greater compatibility between the two diagnostic systems.     

Two-Year Prospective Naturalistic Study of Remission From Major Depressive Disorder as a Function of Personality Disorder Comorbidity.

In this study, the authors examined prospectively the 24-month natural course of remission from major depressive disorder (MDD) as a function of personality disorder (PD) comorbidity. In 302 participants (196 women, 106 men), psychiatric and PDs were assessed at baseline with diagnostic interviews, and the course of MDD was assessed with the Longitudinal Interval Follow-Up Evaluation at 6-, 12-, and 24-month follow-ups. Survival analyses revealed an overall 24-month remission rate of 73.5% for MDD that differed little by gender. Participants with MDD who had certain forms of coexisting PD psychopathology (schizotypal, borderline, or avoidant) as their primary PD diagnoses had a significantly longer time to remission from MDD than did patients with MDD without any PD. These PDs emerged as robust predictors of slowed remission from MDD even when controlling for other negative prognostic predictors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prediction of suicidal intent in depressed patients

The aim of the present study was to examine the relationships between suicidal ideation or suicidal attempts and severity of depression, presence of personality disorders, and sociodemographic factors in a population of depressed in-patients. A total of 338 adult depressed psychiatric in-patients were examined and classified according to DSM-III criteria as having major depression with or without melancholic or psychotic features, adjustment disorder with depressed mood or dysthymic disorder. Scores on the Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI) and Zung Self-Rating Depression and Anxiety Scales (SDS and SAS) were measured. We found that suicidal ideation was significantly related to severity of depression (according to the HDRS and all self-rating scales), a lower global assessment of functioning the year before hospitalization, and previous psychiatric hospitalizations. The items with the strongest predictive value for suicidal ideation were hopelessness, depressed mood, feelings of guilt, loss of interest and low self-esteem. These symptoms predicted 43% of the variance in suicidal ideation. None of the above predictors of suicidal ideation was related to suicidal attempts. Depressed patients with a personality disorder attempted significantly more suicidal attempts and showed more suicidal ideation than depressed patients without personality disorder. No significant correlations were found between suicidal ideation or suicide attempts and gender, marital status, employment status or psychosocial stressors during the previous 6 months.