Classes Of Symptoms Research Articles

Reversal Learning as a Neuropsychological Indicator for the Neuropathology of Obsessive Compulsive Disorder? A Behavioral Study

Reversal Learning as a Neuropsychological Indicator for the Neuropathology of Obsessive Compulsive Disorder? A Behavioral Study

Reversal Learning as a Neuropsychological Indicator for the Neuropathology of Obsessive Compulsive Disorder? A Behavioral Study

A dysfunction of the fronto-striatal loop has been associated with obsessive-compulsive disorder (OCD). Functional imaging studies suggest that reversal learning is affected by deficits in fronto-striatal brain areas and thus should be impaired in patients with OCD. The authors compared patients with OCD and healthy comparison subjects on a reversal learning task. Correlation analyses and group comparisons showing prolonged reaction times of different response parameters are associated with increasing severity of compulsions. The reversal learning task has been shown to be associated with ventral fronto-striatal brain activation by functional magnetic resonance imaging (fMRI) in healthy comparison subjects. The purpose of this article is to suggest that the reversal learning task can be used as a neuropsychiatric measurement of the ventral fronto-striatal dysfunction in OCD.

Plasma homovanillic acid levels in schizophrenic patients: Correlation with negative symptoms

The relation between changes in the levels of plasma homovanillic acid (pHVA) and clinical evolution during neuroleptic treatment of schizophrenic patients has not been satisfactorily characterized, as a number of conflicting findings have been reported. Significant correlations have generally been found using the assessment of positive symptoms as an index of clinical outcome. Nevertheless, attempts to correlate pHVA concentrations with negative symptoms have yielded contradictory results. With a view to evaluating if different responses in negative symptoms are associated with distinct pHVA profiles, we examined the levels of pHVA in 46 neuroleptic-free schizophrenic patients and in these patients after neuroleptic treatment. Negative and positive symptoms were also addressed before and after treatment. Our results reveal that at least two classes of negative symptoms exist; the clinical evolution of the first class of negative symptoms parallels that of positive symptoms, and clinical improvement correlates with reduced dopaminergic activity. In contrast, in the second class, reduced dopaminergic activity is associated with a further deterioration of negative symptoms. These findings corroborate the heterogeneity of negative symptoms and may contribute to a better definition of endophenotypes in the schizophrenic syndrome.

Stress Management and Factors Related to the Deployment of Italian Peacekeepers in Afghanistan

This cross-sectional study evaluated the stress levels in Italian military personnel involved in a peacekeeping (PK) mission in Afghanistan and a homogeneous group stationed in Italy (SI group). The study was performed from April 2004 to June 2004 in a sample of 160 long-time, career volunteers of the Rossi Barracks of the Alpini di L'Aquila (Italy) (SI group, n=120; PK group, n=40). A 10-item, self-evaluation questionnaire proposed in the U.N. Stress Management Booklet was administered to each volunteer. The total item score (TIS) values for the 10 items for the two groups were calculated. These values were greater for the PK group than for the SI group for all 10 items. The TIS values were grouped into three classes of symptoms, anxiety symptoms (items 1-4), stress-induced depression (items 5-7), and posttraumatic stress (items 8-10). The class total item score (CTIS) values were then calculated as the sum of the respective TIS values. The three CTIS values for the PK group were greater than those for the SI group. In particular, the anxiety CTIS was 72 points greater in the PK group (p < 0.001). Therefore, the peacekeepers were inclined to have a greater increase in anxiety symptoms. Consequently, antipanic techniques could be used to reduce anxiety and progressive muscular relaxation training, an important preventive relaxation technique, to face stressors and to reduce clinical anxiety.

Understanding the Heterogeneity of OCD

Back to table of contents Previous article Next article Letter to the EditorFull AccessUnderstanding the Heterogeneity of OCDJOHN E. CALAMARI, Ph.D., JOHN E. CALAMARISearch for more papers by this author, Ph.D., North Chicago, Ill.Published Online:1 Nov 2005https://doi.org/10.1176/appi.ajp.162.11.2193AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: I read with interest the excellent review of dimensional approaches to understanding obsessive-compulsive disorder (OCD) heterogeneity by David Mataix-Cols, Ph.D., and colleagues (1). I agree with the authors that OCD heterogeneity is an important issue and that failure to identify differences within the condition has significantly hindered advances in theory and treatment. My comments focus on the authors’ contention that a dimensional approach to understanding OCD heterogeneity is an inherently superior method.There have been three recent approaches to understanding OCD symptom heterogeneity. Some researchers have focused on patients’ dominant compulsive behavior to form symptom subgroups (e.g., washers versus checkers). This approach is limited and fails to capture most cases in which patients are seen with multiple classes of symptoms. In recent investigations, the diversity and complex patterns of symptoms seen in clinical presentations have been characterized with multivariate statistical analyses. Factor analysis has been used to identify the latent dimensions of several comprehensive OCD symptom measures. Alternatively, symptom measures have been subjected to cluster analysis to form symptom-based subgroups of individuals. In cluster analysis, individuals are assigned to groups created by maximizing between-group differences and minimizing within-group variability on a set of measures (2).Cluster analysis may offer several advantages over factor analysis in characterizing OCD heterogeneity, and this categorical approach is not limited in some of the ways Dr. Mataix-Cols et al. implied. In cluster analysis, individuals are unambiguously assigned to unique groups, whereas in factor analysis, each individual is assigned a score on all of the identified latent dimensions. Thus, the factor scores estimated for individuals may not connect the person to a specific dimension. As Dr. Mataix-Cols et al. pointed out, hoarding symptoms have emerged as a symptom dimension that predicts unresponsiveness to current pharmacotherapy and standard behavior therapy. Although there has been limited study, similar results have been reported with a cluster analysis approach in which the hoarding subgroup was less responsive to behavior treatment (3). The results of several recent cluster analyses (e.g., reference 4) suggest that complex symptom presentations can be captured with a cluster analysis approach and that resultant clusters are far from monosymptomatic.The relative merits of categorical and dimensional approaches to psychiatric classification have long been debated. The use of each of these approaches to understanding OCD heterogeneity warrants further investigation.

Information processing and cognitive behavior therapy for obsessive-compulsive disorder: Comorbidity of delusions, overvalued ideas, and schizophrenia

Schizophrenia, in conjunction with obsessive-compulsive symptoms, presents significant barriers to treatment. This is true even if the obsessive-compulsive symptoms would ordinarily be considered straightforward for cognitive-behavioral treatment. These many limitations in treatment are considered here in light of the information processing deficits that are associated with schizophrenia. Further, the demands of exposure with response prevention, used in the case of Sam, require special considerations in complex cases such as these. We highlight some of the specific approaches necessary in the clinical care of schizophrenia with obessive-compulsive symptoms in light of the information-processing deficits associated with each problem, and discuss some of the issues faced in clinical settings where there is a reliance on empirically supported treatments for conditions or classes of symptoms. The specific considerations raised here extend to cases of obsessive-compulsive disorder (OCD) that are complicated by the presence of overvalued ideas, essentially a delusional subtype of the disorder.

Familiality and heritability of subtypes of attention deficit hyperactivity disorder in a population sample of adolescent female twins.

Attention deficit hyperactivity disorder (ADHD) is a highly heritable but clinically heterogeneous syndrome. The study examined the familiality and heritability of ADHD subtypes as defined by DSM-IV and by latent-class analysis in a population sample of adolescent female twins. To determine which elements of ADHD cluster together, latent-class analysis was applied to data obtained from parents on the 18 DSM-IV ADHD symptoms in 4,036 female twins age 13-23 years in a population sample identified from the registry of all births in Missouri for the years 1968-1996. Relative risk and odds ratios were used to assess within-subtype and between-subtype familiality and heritability of both DSM-IV and latent-class ADHD subtypes. Latent-class analysis was most compatible with the existence of three mild and three severe classes of ADHD symptoms in the general population. The three severe classes showed moderate overlap with DSM-IV ADHD subtypes. The primarily inattentive and combined subtypes of DSM-IV ADHD co-clustered within families. The primarily hyperactive/impulsive DSM-IV subtype and the individual latent-class analysis subtypes did not co-cluster. Subtypes defined by both approaches were highly heritable. Unlike DSM-IV subtypes of ADHD, latent-class ADHD subtypes appear to be independently transmitted in families. These classes may be more appropriate targets for molecular genetic studies of ADHD.

Specific classes of symptoms predict readiness to change scores among dually diagnosed patients

The Transtheoretical Stages of Change model hypothesizes that disadvantages of substance abuse must outweigh advantages before change occurs. This study examined whether substance-related sequelae predicted readiness to change scores. A total of 150 dually diagnosed patients were administered the CAGE questionnaire (CAGE is an acronym for questions about substance use: Cutting down, Annoyed by criticism, feel Guilty, Early morning usage), which was scored for mood and behavior symptoms: a checklist of 12 physical, intrapersonal, and environmental symptoms; and the Brief Readiness to Change questionnaire (RTC). Regression analyses suggested that more physical and mood symptoms were predictive of higher total RTC ( R 2 = .11); physical, mood, and behavioral symptoms were predictive of higher contemplation scores ( R 2 = .17), whereas fewer physical symptoms were predictive of higher precontemplation scores ( R 2 = .05). The results suggest that the relative severity of physical, mood, and behavior symptoms may be important factors related to the contemplation of change among dually diagnosed patients.

Burmese political dissidents in Thailand: trauma and survival among young adults in exile.

This study assessed the self-reported mental health, physical health, and social functioning of young adult political exiles and relates their psychiatric symptoms to their trauma and survival strategies. A 1992/93 survey of Burmese who fled to Bangkok, Thailand, after participating in a 1988 uprising against Burma's government elicited information on employment, education, disability, trauma, survival strategies, and depressive and posttraumatic stress symptoms. The 104 participants reported a mean of 30 trauma events, including interrogation (89%), imprisonment (78%), threats of deportation (70%), and torture (38%). Many reported poor health and lack of social supports, but few reported substantial social disability. The prevalence of elevated symptom scores was 38% for depressive symptoms and 23% for criterion symptoms of posttraumatic stress disorder. Symptoms of avoidance and of increased arousal were the most strongly related to cumulative trauma. Two survival strategies, camaraderie and a Buddhist concept of self-confidence (weria), were associated with somewhat reduced levels of both classes of symptoms. Burmese political exiles in Thailand are young adults adversely affected by severe trauma. Their psychosocial well-being may deteriorate further without legal protections to reduce the continuing stress and violence.

Positive or negative symptoms — which are more appropriate as diagnostic criteria for schizophrenia?

For over a decade there has been a consensus that the diagnosis of schizophrenia should rest upon the presence of positive symptoms. Recently it has been suggested to give negative symptoms, which have played a prominent role in research, more diagnostic importance again. This study investigated the usefulness of that suggestion. In a sample of 489 inpatients covering the whole range of psychiatric diagnoses, the frequencies and prevalences of positive and negative symptoms were determined. Analyses of variance were calculated to assess the diagnostic validity of the different classes of symptoms. The study demonstrates that positive symptoms are of much higher diagnostic value than negative symptoms. A change of diagnostic procedures giving more importance to negative symptoms is discouraged.

Self-Reported Depressive Symptoms in Association with Medication Exposures among Medical Inpatients: A Cross-Sectional Study

To evaluate associations between exposure to three classes of medications (angiotensin converting enzyme inhibitors, calcium channel blockers, and corticosteroids) and self-reported depressive symptoms. The study utilised a cross-sectional study design in a sample of medical inpatients. Associations between self-reported depressive symptoms and exposure to angiotensin converting enzyme inhibitors or calcium channel blockers were not observed. However, an association between self-reported depressive symptoms and corticosteroid exposure was identified. The association was strongest in subjects reporting a past history of depression or a family history of depression. The strength of the corticosteroid-depressive symptom association was comparable with that of associations observed for age, poverty and psychosocial stress. Depressive symptoms among medical inpatients have a biopsychosocial etiology. Corticosteroid exposure may be a biological risk factor for depressive symptoms in this population.

A microscopic study of the different classes of symptoms coded by the Vf gene in apple for resistance to scab (Venturia inaequalis)

The different symptoms of resistance coded by the VF gene were studied on glasshouse‐grown apple seedlings after inoculation with a conidial suspension of Venturia inaequalis. Scanning‐electron microscopy and histological observations defined precisely three different classes of symptoms. Class 1 corresponds to a hypersensitive reaction. Class 2 is characterized by considerable tissue modifications but no sporulation whatsoever occurs; this reaction defines resistant hybrids. In class 3 the fungus remains active and can sometimes sporulate abundantly; this class was divided into two subgroups, one comprising all the hybrids of weak resistance, the other the hybrids of weak susceptibility.

Bio-aerosols and the Sick Building Syndrome

Sick building syndrome is the name given to a set of varied symptoms experienced by a number of people working predominantly in hermetically sealed and air-conditioned buildings. The syndrome, which is probably multifactorial, can be diagnosed only after eliminating all other building-related-illnesses since it is not, as a rule, accompanied by any organic lesion or discernible physical sign. The symptomatology includes different classes of symptoms: - Respiratory manifestations - Ocular manifestations - Cutaneous manifestations - Odour and taste complaints - Neuropsychic manifestations Diagnosis of sick building syndrome (SBS) should be confirmed once all other building related illnesses have been eliminated: infectious disease, allergic manifestations, humidifier fever or allergic rhinitis. A considerable number of factors are supposed to provoke SBS: physical factors, chemical factors, psychological factors. But the most important are biological factors. They include dusts and various particles such as actinomycetes, other germs or moulds. To conduct building-associated investigations, it is necessary to appreciate the qualitative assessment of the disorders by questionnaires, interviews and parameters of the building and the air-conditioning system. Then the quantitative assessment must be determined by the tests of respiratory function and the effectiveness of the ventilation. The treatment of SBS is not specific because it is a multifactorial syndrome. "The sick building syndrome" (SBS) is the name given to a set of very varied but chiefly respiratory symptoms felt by a number of people, predominantly women, working in large, hermetically sealed and often air-conditioned buildings. The syndrome, which is probably multifactorial, is mainly diagnosed by exclusion, since it is not as a rule accompanied by any organic lesion or discernible physical sign. It is currently the subject of numerous research projects because it is often found in the major cities of the Western world, particularly in very high buildings (skyscrapers) among office staff who work in an artificial atmosphere for several hours a day. SBS can therefore be diagnosed only after eliminating all other building-related illnesses, that can be contracted by staying in this type of building for prolonged periods.

Clinical predictors of course and outcome in delusional psychosis.

The purpose of the study was to examine whether clinical variables of first-admitted patients with delusional psychosis were of predictive importance of course and outcome illuminated through the dimensions: psychotic symptoms, impairment, remission, and relapse at 2-year follow-up. Male, sex, age below 30 years, unmarried, long duration of psychosis, and absence of psychosocial stress prior to first admission were all statistically predictive of poor outcome. Concerning nonspecific psychological distress high mean values on the subscales of helplessness-hopelessness, dread and antisocial history were correlated to poor outcome as was low mean value of active expression of hostility. Concerning psychopathology assessed by PSE individual items as lost emotions, thought insertion, thought broadcast, primary delusions and certain auditory hallucinations (voices discussing/commenting subject in third person) predicted poor outcome. Further classes of PSE symptoms as perceptual disorder, thought disorder, and delusions of influence predicted poor outcome too. Other prognostic unfavourable variables were systematisation of delusions, severe preoccupation with present delusions and no suspicion of attempt at concealment of delusions and hallucinations.

Trichloroethylene occupational exposure: elements for better prevention.

One hundred and eighty-eight workers occupationally exposed to trichloroethylene (TRI) were studied by physical examination, exposure parameters (measure of atmospheric TRI and urinary trichloroacetic acid (CA) and evaluation of personal factors (age, alcoholic and tobacco consumption). A statistical comparison (chi 2 test) of the frequency of the symptoms observed in the high- and low-exposure populations with an analysis of nonprofessional factors allowed us to distinguish different classes of symptoms. Those more likely linked with TRI exposure are trigeminal and optic nerve impairment, asthenia, headache and dizziness. An interaction between TRI exposure and alcohol intake on the occurrence of clinical liver impairment and degreaser flush is suggested.

An interpersonal approach to hysteria

The author defines hysteria in terms of specific observable classes of interpersonal behaviors and examines the impact of these behaviors on the receiver. The hysteric communicates frailty and helplessness, thus structuring the interpersonal environment to ensure attention and inhibit aggression. The development of these roles is shown in histories of female hysterics, who were selectively reinforced for frailty, seductiveness, and passivity as children. The major classes of symptoms shown by adult hysterics--conversion symptoms and dissociative reactions--reflect these interpersonal roles. The author concludes that hysteria is a relatively specific interpersonal style that results from cultural, social, and interpersonal influences.

Drug-induced extrapyramidal symptoms and their relations to clinical efficacy.

Various theories have been proposed relating classes of drug-induced extrapyramidal symptoms to the therapeutic actions of these drugs. But contradictory conclusions have been drawn from basically similar sets of observations; the literature on the topic is fraught with confusion and equivocal results. The authors suggest reasons for the past confusion and urge that future studies be designed with adequate controls and methodological sophistication.

TUMORS OF THE PINEAL BODY

Tumors of the pineal body are rare, and their symptoms often vague. Like hypophyseal tumors, pineal (or epiphyseal) tumors, may give the general symptoms of brain tumor, with certain focal signs, and in addition, by interfering with physiological function, may bring about distinct and characteristic disturbances in nutrition. When these two separate and distinct classes of symptoms, namely, the neurological and metabolic, are present, the diagnosis becomes reasonably certain and operative removal becomes a possibility. The pineal body arises from a diverticulum of the roof of the third ventricle. As seen in the 3 to 4 months' embryo, it is a pear-shaped body, which in section shows a number of radiating compartments (lobuli), containing the parenchyma of the gland, irregularly separated by connective-tissue and vessels, which sink in from a connective-tissue capsule. Its connections with the rest of the mid-brain are extremely difficult to trace out, especially the