DES Scores Research Articles

Internalized-stigma and dissociative experiences in bipolar disorder.

IntroductionDissociative symptoms have been recently related to bipolar disorder (BD) symptomatology. Moreover, the disease burden carries on a share of perceived self-stigma that amplifies the BD impairment. Internalized stigma and dissociative symptoms often seem overlapping, leading toward common outcomes, with reduced treatment seeking and poor adherence. We hypothesize a potential relationship between dissociation and self-stigma in patients suffering from BD.Materials and methodsIn this cross-sectional study we enrolled a total of 120 adult clinically stable BD outpatients. All participants completed the Internalized Stigma of Mental Illness (ISMI), Dissociative Experiences Scale-II (DES-II), and Manchester Short Assessment of Quality of Life (MANSA).ResultsAverage age and age at BD (BD-I n = 66, 55%; BD-II n = 54, 45%) onset were 46.14 (±4.23), and 27.45 (±10.35) years, with mean disease duration of 18.56 (±13.08) years. Most participants were female (n = 71; 59.2%) and 40 (33%) of them experienced lifetime abuse, with an average of 1.05 (±0.78) suicide attempts. DES scores (mean 31.8, ±21.6) correlated with ISMI total-score, with significant association with spikes in Alienation (13.1, SD±3.1) (p < 0.001) and Stereotype (13.8, SD±3.9) (p < 0.001). Linear regression analysis has shown a significant association between DES total score and alienation (p < 0.001), stereotype (p < 0.001) and MANSA total-score (p < 0.001).DiscussionFor the first time, our data suggests that self-stigma is associated to dissociative symptoms, reducing overall quality of life in BD. The early identification of at-risk patients with previous lifetime abuse and high perceived stigma could lead the way for an ever more precise tailoring of treatment management.

Dissociative Symptoms in Bipolar Disorder: Impact on Clinical Course and Treatment Response.

Background: Dissociative symptoms are under recognized and scarcely studied by clinicians and researchers in patients with bipolar disorder (BD). We examined the relationship between dissociative symptoms and the psychotic features in patients with BD and assessed clinical and socio-demographic characteristics more frequently associated with dissociative symptoms and treatment response.Methods: Participants were 100 adult outpatients with BD. They were screened with semi-structured interview to collect socio-demographic and clinical characteristics; the Dissociative Experiences Scale-II (DES-II) and the ALDA scale were used to assess dissociative psychopathologies and response to treatment with mood stabilizers, respectively.Results: DES score (mean 31.7 ± 21.7) correlated with clinical variables, BD features, and course of illness. Psychotic symptoms, mixed features, and previous suicide attempts significantly predicted DES score [F(3, 47) = 39.880, p < 0.001, R2 corrected = 0.713]. Dissociative symptoms were inversely correlated with poor response to treatment (r = −0.593; p < 0.001).Limitations: Cross-sectional design with a small sample and backward clinical assessment of psychotic symptoms.Conclusions: Dissociative phenomena are closely related to the presence of psychotic symptoms, mixed features, and previous suicide attempts in BD, especially in BD-I. Given the close association between dissociative and psychotic symptoms, this association could represent a diagnostic indicator of BD-I that may guide the clinician to plan the most appropriate treatment.

The Protective Role of Resilience in Emotional Exhaustion Among Dental Students at Clinical Levels.

PurposeThe epidemic of burnout among dental students has been repeatedly documented. This study aimed to assess burnout, specifically emotional exhaustion (EE), and examined the impact of protective and risk psychological factors for EE among clinical-level dental students in Saudi Arabia (SA).MethodsA cross-sectional study was conducted, using a convenience sample of undergraduate dental students who were recruited from five separate dental schools. A self-administered questionnaire was distributed to 500 students to obtain socio-demographic data and to assess the students’ psychological characteristics (Maslach Burnout Inventory EE subscale, Dental Environment Stress Scale [DES] and Brief Resilience Scale [BRS]). Descriptive, bivariate and multivariable logistic regression analyses were performed.ResultsOf 272 respondents, 53% reported high EE. Adjusted multivariable logistic regression modelling demonstrated that students who reported higher BRS scores were significantly less likely to report high EE (adjusted odds ratio [AOR]=0.79, 95% CI=0.70–0.89, p<0.001). However, females were more than twice as likely as males to report high EE (AOR=2.27, 95% CI=1.14–4.61, p=0.024). In addition, students who reported higher DES scores also reported high EE (AOR=1.10, 95% CI=1.07–1.12, p<0.001).ConclusionThe findings suggest that resilience is a protective factor against high EE, after adjusting for key characteristics. There is a need for a preventive programme that addresses EE, taking into consideration other unexplored underlying factors.

83-LB: Are Activation, Behaviors, and Attitudes to Managing Care Associated with Utilization of a Remote Diabetes Monitoring Platform (RDMP) and Improvement of A1C?

Background: Many validated patient-reported outcome measures (PROMs) evaluate activation, behaviors, and attitudes towards managing one’s own health and care. However, their association with utilization of diabetes management technology and glycemic control has not been well studied. Methods: People participating in Livongo’s RDMP for 12-18 months were surveyed using 3 validated PROMs that assessed activation (PAM), empowerment (DES), and distress (DDS). Pearson correlation was used to assess the relationship between PROMs and multivariable logistic regression was used to evaluate associations of PROM scores on RDMP usage and A1c improvement overall and by insulin use. Results: PAM and DES scores were most correlated with each other (r=0.48); neither were associated with A1c improvement. People with higher DES scores were 20% more likely to have high RDMP usage (p&amp;lt;0.05) and people with high RDMP usage were 4.4 times more likely to have A1c improvement. High distress (DDS17&amp;gt;=3) was negatively associated with A1c improvement. Conclusions: In this study, PAM was not associated with activation, behaviors, and attitudes influencing RDMP usage and outcomes, while the DES and DDS17 were associated with RDMP. Because of the impact of distress on outcomes, it should be monitored and RDMP interventions should focus on distress reduction. Disclosure M. Perez-Nieves: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. W. Lu: Employee; Self; Livongo Health. J. Poon: Employee; Self; Eli Lilly and Company. L. Fan: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. R. James: Advisory Panel; Self; AstraZeneca. Employee; Self; Livongo Health. B. Shah: Employee; Self; Livongo Health.

Patient Empowerment Using Electronic Telemonitoring With Telephone Support in the Transition to Insulin Therapy in Adults With Type 2 Diabetes: Observational, Pre-Post, Mixed Methods Study.

BackgroundInitiation of insulin therapy for the management of type 2 diabetes can be an unwelcome and distressful development for patients. Current evidence suggests that telemonitoring can help improve glycemic control in type 2 diabetes and can support empowerment to self-manage diabetes. This telemonitoring intervention was underpinned by an empowerment approach.ObjectiveThis study aimed to evaluate the clinical effectiveness and feasibility and the patients’ and health care providers’ experiences of a 12-week telemonitoring intervention with telephone support for patients commencing insulin therapy. This paper focuses on the impact on patient empowerment.MethodsAn observational, pre-post, multimethod, and triangulation design was employed to study a 12-week automated electronic telemonitoring intervention with telephone support from a diabetes clinical nurse specialist (CNS). Forty patients were recruited from the clinic as they were about to commence insulin therapy. In the quantitative arm, biometric data (hemoglobin A1c [HbA1c] and weight) and psychosocial data (diabetes empowerment scale [DES] scores and diabetes distress scale [DDS] scores) were gathered by the research team at baseline (T1), the end of the intervention (T2), and 3 months postintervention (T3). Data on hospital admission and general practitioner (GP) visits were collected for the duration of the study. In the qualitative arm, separate focus group interviews were conducted with the CNS team supporting the intervention (n=2) and patients (n=16).ResultsOf 39 patients who completed the intervention, 23 (59%) were male. The mean age of the sample was 62.4 years (range 37-80 years). The mean HbA1c (mmol/mol) decreased significantly between T1 and T2 (mean difference [MD] −17.13; P<.001) and T1 and T3 (MD −18.16; P<.001), with no significant impact on weight. In the focus groups, patients reported an increased awareness to self-manage diabetes and feelings of safety and comfort. There were 13% (5/39) of patients who had hypoglycemia on two or more occasions. A significant increase in the mean DES score occurred between T1 and T2 (MD 0.62; P=.001) and T1 and T3 (MD 0.72; P<.001). The mean DDS score decreased between T1 and T2 (MD −0.64; P=.002) and T1 and T3 (MD −0.6; P=.002). The mean patient satisfaction with the intervention was above 4 out of possible 5 on all items on the Telemedicine Satisfaction and Usefulness Questionnaire. We observed a reduction in diabetes clinic attendances and GP visits. A significant increase in workload was reported by the CNS team.ConclusionsThis intervention had an empowering effect for patients in the self-management of type 2 diabetes and has the potential to meet the need for safer and more effective care in insulin initiation in the community setting. We observed a significant increase in workload for health care staff. Telemonitoring needs to be streamlined with health care delivery and accompanied by adequate support services.

Flash Technique Group Protocol for Highly Dissociative Clients in a Homeless Shelter: A Clinical Report

The Flash Technique is a new protocol for use in the preparation phase of eye movement desensitization and reprocessing (EMDR) to quickly reduce the emotional intensity of traumatic memories, prior to full processing with EMDR. This report presents results from a Flash Technique group for five highly dissociative, currently sober addicts in a men's shelter. This group was an attempt to provide an affordable, trauma-focused intervention for the homeless. As part of the intake, each client met individually with the therapist for 30 minutes, to learn to use the flash technique to process a traumatic memory. Three inventories were used to measure treatment outcome: the Short PTSD Rating Interview (SPRINT), the Dissociative Experience Survey (DES-II), and the Beck Depression Inventory-II (BDI-II). Clients filled out the surveys 3 weeks before the start of the group and had their individual sessions 2 weeks before the start of the group. The DES and BDI-II were repeated at the beginning of the eighth session of the group. Clients' surveys showed a decline in scores after seven sessions of therapy: the DES scores dropped from 39.07 (standard deviation [SD] = 23.01) to 20.48 (SD = 10.02) with d = 0.81 and the BDI-II scores dropped from 32.4 (SD = 11.01) to 13.2 (SD = 8.4) with d = 1.74. Pre- and 2-week posttreatment SPRINT surveys showed scores dropping from 28 [SD = 2.05] pretreatment to 15.75 [SD = 5.19] 2 weeks posttreatment, with d = 6.07.

S231. THE ROLE OF DOPAMINERGIC AND GLUTAMATERGIC NEUROTRANSMISSION IN DELUSIONAL IDEATION AND SENSORY INFORMATION PROCESSING OF PATIENTS WITH SCHIZOPHRENIA IN COMPARISON TO HEALTHY HUMAN PARTICIPANTS

BackgroundThe primary aim of this study was to generate neurobiological evidence regarding the impact of dopaminergic and glutamatergic neurotransmission on reasoning biases related to delusional ideation in patients with schizophrenia associated with impaired processing of sensory information. The proposed respective roles of these neurotransmitter systems have been encapsulated in the so-called dopamine- and glutamate-hypotheses of schizophrenia. From a behavioural perspective both reduced glutamate and enhanced dopamine levels are currently discussed as critical contributing factors to generate aberrant beliefs (glutamate) during information sampling and to generate confidence or expected precision (dopamine) during action selection. Hence, by modulating levels of glutamate and dopamine in the brain we hypothesized to induce reported impairments of patients with schizophrenia related todelusional ideation.MethodsThe study consisted of three aligned experiments: In the first two experiments a prospective interventional drug study was conducted with n=192 participants employing a randomized, placebo-controlled, double-blinded design on two parallel testing-groups, receiving either dopaminergic or glutamatergic neuromodulators: Experiment I: either 2.5mg haloperidol (D1/D2-receptor antagonist; HAL), 2.5mg bromocriptine (D2-receptor agonist; BRO), or placebo (PLC-1). Experiment II: either 120mg Dextromethorphan (NMDA-receptor antagonist, DXM), 250mg D-Cycloserine (NMDA-receptor agonist, CYC), or placebo (PLC-2). In the third experiment n=45 patients with schizophrenia (SZ) and n=45 healthy control participants (HC) matched for gender, age and IQ were investigated. All experiments employed a computerized (Matlab, Cogent) version of the Beadstask (Huq, Garety et al. 1988). In total participants processes 60 Beadstask trials subdivided into three levels of difficulty: (I) easy trials with a bias of 80–90% for one predominant bead color in a sequence, (II) difficult trials (60–70% bias), and (III) ambiguous trials (no bias, 50% likelihood). Additionally, the task consisted of three parts that were presented in a fixed order: an easy draws-to-decision condition, an easy probability estimates condition, and a difficult draws-to-decision condition.ResultsIn accordance with foregoing studies, SZ patients showed significantly less draws to decision compared to HC (all p≤0.038). Explorative analysis across experimental conditions further revealed no significant differences for participants receiving DXM (NMDA-receptor antagonist) compared SZ patients (all p≥0.090), but obtained less draws to decision in the DXM group than all other groups. Whereas following HAL intervention the number of draws increased significantly compared to any other experimental group (all p≤0.048). Analyzing the probability estimates condition we quantified changes of probability estimates on an individual subject level whenever there was a change of bead color in a sequence (so called disconfirmatory evidence score, DES). In case of easy and difficult trial types we observed significantly higher DES scores in participants with SZ compared to HC (p≤0.003) and again obtained no differences between SZ and DXM (p=0.037).DiscussionOur findings are supportive for a hypothesized relationship between neurotransmitter state alterations of glutamate and dopamine in patients with schizophrenia and the delusional ideation. Future analysis will focus on developing a computational behavioral model of cognitive processing of the Beadstask, implementing our neurobiological findings in order to further disentangle the neurobiological underpinnings of delusional ideation in patients with schizophrenia.

Perceived Stress among Undergraduate Dental Students in Relation to Gender, Clinical Training and Academic Performance.

AimThis study aimed at evaluating the perceived stress and its sources among undergraduate dental students at Jazan University, Saudi Arabia.Materials and MethodsIn this cross-sectional study, the data were collected using the DES questionnaire. The overall score of stress and scores by individual domains were described and analyzed by different grouping factors: gender, study level, marital status and GPA.ResultsA total of 366 dental students agreed to take a part in this study. Up to 57% of the participants were females. The overall DES score was 1.67 ± 0.45. Female students and married students scored higher stress levels than their counterparts. Stress increased significantly among students as their educational level increased. Inversely, the stress levels were lower in participants with high GPA. Multiple linear regression analyses revealed that “Study level” and “Gender” were significant independent determinants of overall DES and, also, most of the stress domains. Forty one percent of the variability in DES score can be explained by these determinants.ConclusionDES among dental students in Jazan University is moderate and slightly higher. It is higher among females and increases significantly with study progression. However, students who had higher GPA showed lower levels of stress.Clinical significanceReduction and/or relief of stress among dental students will reflect positively on persistence and academic achievement, which will lead to better management and care of patients.

Prevalence of Dissociative Experiences in Those Referred to Emergency Psychiatric Centers After Attempting Suicide

Background: Dissociation is a symptom that can be related to traumatic childhood events. Dissociation in some cases is categorized in a distinct subgroup from other psychiatric disorders. Objective: The purpose of this study was to investigate the prevalence of dissociative experiences in patients who have attempted suicide and who have referred to an emergency psychiatric center. Methods: This was a cross-sectional epidemiological study in which dissociative experiences were evaluated in 98 patients who referred to Ibn Sina and Hafez hospitals after attempting suicide. In addition to determining the prevalence of these experiences, the relation between the symptoms and variables such as sex, age, marital status, education and suicide risk was determined. Results: There was a significant difference in the level of disappointment between married and single patients (P = 0.047). The mean disappointment score for the overall population was 11.92, which is in the normal range. There was no significant relationship between the dissociation score and level of disappointment (P = 0.933). The prevalence of dissociative experiences was found to decrease as the age of the patients increased (P = 0.006). There was no significant difference between the rate of suicide as reflected in the measurement of disappointment and dissociative symptoms. There was no significant relationship between DES score and other variables. Conclusion: One cause of psychological pressure in deciding to attempt suicide is family conflict. Many individuals who attempt suicide did not have a thought-out desire to take their lives, but attempted it impulsively in response to a periodic stressor.

Schémas précoces inadaptés et dimensions de la personnalité chez des adolescents consommateurs abusifs d’alcool

La présente étude vise à évaluer les schémas précoces inadaptés et les dimensions de la personnalité du modèle à cinq facteurs dans la consommation abusive d’alcool à l’adolescence. Pour mesurer les dimensions de la personnalité, nous avons utilisé le Big Five Inventory français (BFI-Fr), la version abrégée du questionnaire de Young (YSQ-S2) pour évaluer les schémas précoces inadaptés, ainsi que l’Alcohol Use Disorders Identification Test (AUDIT) pour la consommation d’alcool. Deux cents adolescents ayant préalablement complété ces questionnaires ont ensuite été répartis en trois groupes selon que leur consommation d’alcool était nulle (n = 33), occasionnelle (n = 78) ou abusive (n = 89). Les résultats montrent que les consommateurs abusifs obtiennent des scores significativement plus élevés que les consommateurs occasionnels et que les non-consommateurs sur le score global d’activation des schémas précoces inadaptés, ainsi que sur six schémas spécifiques (abandon, imperfection, vulnérabilité, contrôle émotionnel à outrance, grandeur, manque d’autocontrôle). Nos résultats montrent également des scores de Névrosisme significativement plus élevés chez les consommateurs abusifs, en comparaison aux consommateurs occasionnels et aux non-consommateurs. Les implications théoriques et pratiques de ces résultats sont discutées. Alcohol is the most widely consumed drug amongst adolescents and its misuse is a great public health concern. In France, regular alcohol consumption in this population has increased over the past decade (Spilka et al., 2015). This disturbing trend makes research on risk factors for alcohol misuse among adolescents particularly important. In the literature, early maladaptive schemas are considered as a possible risk factor in the onset and maintenance of psychopathology (Young, 1994; Ball, 1998). They are defined as broad pervasive patterns that are comprised of memories, emotions and cognitions regarding oneself and one's relationships with others, and are dysfunctional to a significant degree (Young et al., 2005). Theoretically, early maladaptive schemas begin to develop during early childhood from toxic experiences (Young, 1994). Although research has demonstrated that adult alcohol abusers report greater early maladaptive schema endorsement than a non-clinical comparison group (Decouvelaere et al., 2002; Roper et al., 2010), we are unaware of any research that has examined whether early maladaptive schemas are prevalent among adolescents alcohol abusers. Similarly, relationships between alcohol misuse and personality domains of the Five Factor Model (Costa and McCrae, 1992) have been widely examined in samples of adults (Kotov et al., 2010; Ruiz et al., 2008), yet only one study has raised this question among adolescents (Merenäkk et al., 2003). For these reasons, the present study aims to examine early maladaptive schemas and personality domains of the Five Factor Model in adolescent alcohol abusers. This research involved 286 adolescents recruited in high schools. Each participant completed five self-report questionnaires assessing (1) alcohol consumption [Alcohol Use Disorders Identification Test (AUDIT)], (2) cannabis consumption [Mini International Neuropsychiatric Interview (MINI)], (3) early maladaptive schemas [Young Schemas Questionnaire (YSQ-S2)], (4) personality domains [Big Five Inventory français (BFI-Fr)] and (5) depression [Beck Depression Inventory - Second Edition (BDI-II)]. Fifty-seven participants were excluded from this study due to the following criteria: suffering from depression (n = 13), excessive consumption of cannabis (n = 41) or use of a drug other than alcohol, tobacco or cannabis (n = 3). Twenty-nine adolescents were also excluded because their questionnaires were incomplete. Finally, 200 adolescents (124 boys and 76 girls) were divided into three groups according to their alcohol consumption: absent (n = 33), occasional (n = 78) or abuse (n = 89). An analysis of covariance (ANCOVA) was conducted on early maladaptive schemas and personality domains with age as covariate to explore the relationship between these dimensions and alcohol consumption among adolescents. The results indicated that alcohol abusers are significantly different from occasional users and non-users by (a) a global hyperactivation of early maladaptive schemas, (b) a hyperactivation of six specific schemas (abandonment, defectiveness, vulnerability, emotional inhibition, grandiosity, insufficient selfcontrol) and (c) significantly higher scores of Neuroticism. The data is coherent with the literature suggesting that early maladaptive schema could be a risk factor for the initiation and maintenance of substance abuse (Ball, 1998, 2007). In addition, this study suggests that Young's schema theory might constitute a valuable framework to understand alcohol abuse in adolescence. The results also show that alcohol abusers present low emotional stability and difficulties in feeling positive emotions, which is consistent with earlier studies among young adults (Mezquita et al., 2010; Ruiz et al., 2003). However, more research is needed to further understand the relationship between early maladaptive schemas, personality and alcohol abuse in adolescence. This could confirm the relevance of therapeutic programs targeting early maladaptive schemas and personality traits in this population.

A longitudinal study of psychological stress among undergraduate dental students at the University of Jordan

BackgroundThe purpose of this study was to identify whether psychological stress increased as undergraduate dental students progressed through their studies from first to fifth year. Another objective was to determine if the perceived sources of stress have changed along the years.MethodsTo achieve these aims, a cohort of students at the University of Jordan were followed from first to fifth year of dental school. Fifth year students completed both the General Health Questionnaire ‘GHQ-12’ which was used to assess psychological stress and the Dental Environment Stress questionnaire ‘DES’ which was used to examine the perceived sources of stress. The same cohort of students had completed similar questionnaires during their first year of study. Chi-square analysis and independent t-test analysis were performed to compare GHQ-12 and DES scores between first and fifth year.ResultsResults showed that psychological stress increased from first to fifth year of study. Eighty- nine percent of fifth year students scored over the cut-off point of three in the GHQ-12 compared to 58 % in the first year. The difference between the years was statistically significant at p = 0.05. Mean score for DES also increased between first and fifth year of study and the difference was statistically significant at p = 0.05.ConclusionsResults of this study demonstrated that stress in dental students at the University of Jordan increased along the years. Fifth year students showed a high level of psychological stress and methods to reduce that stress should be further investigated and utilized.

Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study

To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care.

The Effects of Individual Biological Rhythm Differences On Sleep Quality, Daytime Sleepiness and Correlations with Dissociative Experiences

Objective Individuals who differ markedly by chronotype, i.e., morning-type or evening-type, differ on a number of psychological, behavioral, and biological variables. Disruption in the usually integrated functions of consciousness, memory, identity and perception is definitional to dissociation, particularly pathological forms of dissociation. Dissociative experiences possess dream-like properties, which might be fueled by a labile sleep-wake cycle. Our study aimed to investigate the effects of individual biological rhythm differences on sleep quality and daytime sleepiness in conjunction with dissociative experiences. Method Participants were 372 undergraduates, ranged between 18 and 26 years of age, 61.6 % were females. The volunteers completed a package of psychological instruments including the Morningness–Eveningness Questionnaire, Dissociative Experiences Scale, Insomnia Severity Index, and Epworth Sleepiness Scale. Results We performed mediation regression analysis of relations between dissociative symptomatology and chronobiological features mediated by insomnia and sleepiness. We run a multiple mediator model utilizing from the SPSS script in which we bootstrapped 5000 times. We found direct effect of the MEQ scores on the DES scores was not substantial. Direct effect of the MEQ on the ESS was not significant; whilst the direct association between the ESS and the DES was significant (β=0.79; p Discussion We found significant associations of pathological dissociation in terms of DES-taxon with insomnia and sleepiness.

Psychotherapeutic treatment of eating disorders improve dissociative experiences and impulse regulation but not alexithymia. A case series report.

Eating disorders (EDs) are complex conditions associated with disability and a high rate of mortality. Typical characteristics of these diseases are dissociation, alexithymia and impulse dysregulation, all strategies dealing with negative emotions and regulate negative affect and anxiety. Our study aimed to assess the effectiveness of intensive psychological treatment for EDs, with particular reference to the above mentioned clinical characteristics. Eight outpatients with eating disorders in psychotherapeutic treatment were evaluated in two stages after one year (T1 and T2), using the Eating Disorder Inventory II, the Toronto Alexithymia Scale 20, and the Dissociative Experiences Scale. Wilcoxon test showed significant reductions in DES score as well as in two subscales of the EDI-2, Impulse Regulation and Body Dissatisfaction (I-EDI2 and BD-EDI2), while alexithymia levels did not show any difference. We can confirm the effectiveness of psychotherapy in people with EDs as regards dissociative moments, impulsivity and body dissatisfaction. However, alexithymia remains unchanged, possibly because of its deep emotional nature.

Dissociative experiences in epilepsy — A neuropathological and sociodemographic study in a Chinese population

BackgroundIt is well known that dissociative experiences coexist with various epilepsy syndromes. However, the prevalence of dissociative experiences in different subtypes of epilepsy remains unknown. This is especially important because of the current prevalent view that the etiology of dissociation in seizures is neurobiological rather than psychosocial. The amygdala especially has been implicated in such dissociative features of epilepsy. This would indirectly imply that the patients with CPS have higher prevalence of dissociative symptoms compared with those with GTCS. MethodologyWe studied and compared the dissociative experiences as well as the depression and anxiety levels between 24 patients suffering from temporal lobe epilepsy and 26 patients suffering from generalized tonic–clonic seizures. We used the Dissociative Experiences Scale to evaluate the dissociative experiences. A third group of healthy individuals was included as the control group. The statistical significance was fixed at 0.05. ResultsThere were significant differences between the scores of DES-II of the healthy individuals and those of patients with epilepsy. However, there were no significant differences between the DES scores of different patients with epilepsy categorized according to neuropathology. There were also no significant differences between HAM-A and HAM-D scores between groups with epilepsy, but the scores were higher than those of the healthy individuals. There were significant differences between the DES scores in different sociodemographic groups such that higher scores were observed in groups with lower education (p<0.05). In addition, the scores on DES were higher in individuals with low socioeconomic status than in those with high socioeconomic status. ConclusionThe patients with temporal lobe epilepsy and those with generalized tonic–clonic seizures have similar dissociative experiences which are both more than those found in individuals without epilepsy. However, these dissociative experiences may not be related to the neuropathological parameters as much as they are to the sociodemographic parameters like education, age, socioeconomic status, and sex. This shows that the psychopathology of dissociation in epilepsy is similar to that of the general population.

Clinical Correlates of Childhood Trauma and Dissociative Phenomena in Patients with Severe Psychiatric Disorders

In this present study, we aim to investigate the possibility of a link between psychotic disorders and traumatic experiences in a group of female patients diagnosed with psychotic disorders by comparing childhood trauma exposure with a group of non-psychotic psychiatric disorder attending the same pschiatric clinic. Secondary purpose of this study is to examine the clinical correlates of trauma exposure, dissociative phenomena and psychiatric symptomatology between these two group of patients. Two psychiatric sample groups, those with psychotic disorders-mostly schizophrenic-(n = 54), and those with a non-psychotic severe psychiatric disorders (n = 24), were recruited. Data were collected for demographic, psychiatric and trauma histories and psychiatric symptomatology for all patients. In this study, high prevalance rates of childhood traumatic experiences and dissociative phenomena were found in both groups. Total scores of childhood trauma questionnaire in favor of the non-psychotic group were found to be close to significance (p = 0.052). DES scores of non-psychotic group were also higher although not statistically significant. 54.2 % of nonpsychotic cases had DES scores >20 on the other hand, that percentage of psychotic cases were found to be as 38.9 %. Furthermore, psychiatric patients who have suffered childhood traumatic experiences are far more likely to try to kill themselves than psychiatric patients who have not experienced such abuse. The high rates of childhood traumatic events in our present samples of both schizophrenia-spectrum patients and nonpsychotic patients confirm the need for clinicans to take trauma histories routinely.

Overlap between dissociation and other psychological characteristics in patients with psychogenic nonepileptic seizures

Patients with psychogenic nonepileptic seizures (PNES) often report symptoms of dissociation. However, it is unclear how these symptoms relate to psychotherapeutic treatment, for example, with cognitive-behavioral therapy (CBT). Here, we investigated the degree of overlap between symptoms of dissociation and other psychiatric features that are more traditional targets for CBT. We used a hierarchical linear regression to measure the variance associated with dissociative symptoms (as assessed by the Dissociative Experiences Scale — DES) among 46 individuals with PNESs. The regression predictor variables are indices of participants' self-rated mood, self-efficacy, quality of life, locus of control, and life outlook (e.g., optimism). Results revealed that 70.2% of the variance associated with DES score was explained by psychological distress and locus of control. The other factors examined did not make a significant contribution to the regression model. These results suggest that traditional CBT targets – mood symptoms, mood distress, and dysfunctional beliefs about locus of control – overlap substantially with self-reported dissociative symptoms.

Chronic myelomonocytic leukemia: 2013 update on diagnosis, risk stratification, and management

Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell disorder that is classified as a myelodysplastic/myeloproliferative neoplasm by the 2008 World Health Organization classification of hematopoietic tumors. It is characterized by absolute monocytosis (>1 × 10⁹/L) in the peripheral blood that persists for at least 3 months. The diagnosis of CMML rests on a combination of morphologic, histopathologic and chromosomal abnormalities in the bone marrow. It is important to exclude other myeloproliferative neoplasms and infectious/autoimmune conditions that can cause monocytosis. Several CMML-specific prognostic models incorporating novel mutations have been recently reported. The Mayo prognostic model classified CMML patients into three risk groups based on: increased absolute monocyte count, presence of circulating blasts, hemoglobin <10 gm/dL and platelets <100 × 10⁹/L. The median survival was 32 months, 18.5 months and 10 months in the low, intermediate, and high-risk groups, respectively. The Groupe Francophone des (GFM) score segregated CMML patients into three risk groups based on: age >65 years, WBC >15 × 10⁹/L, anemia, platelets <100 × 10⁹/L, and ASXL1 mutation status. After a median follow-up of 2.5 years, survival ranged from not reached in the low-risk group to 14.4 months in the high-risk group. The Food and Drug Administration has approved azacitidine and decitabine for the treatment of patients with CMML. An allogeneic stem cell transplant can potentially offer a curative option to a subset of CMML patients. It is hoped that with the discovery of several novel mutations, targeted therapies will become available in the near future.

Comparison of four statistical approaches to score child development: a study of Malawian children

Assessment of child development often results in a multitude of binary outcome data. There is no agreed way to use them to score the developmental status of children. Conventional methods include age-standardized Z-scores and simple sum of number of passes. Recently two approaches based on the Rasch model and the concept of 'developmental age' have been proposed. This study aims to compare the performance of the four approaches. In a longitudinal study, 473 Malawian children were measured for growth status at age 36 months and administered a new test of developmental milestones between age 3 and 6 years. The test consisted of four domains: gross motor (GM), fine motor (FM), social and language development. The four approaches were used to score the developmental level of each child in each domain, and the results compared. In this sample, the approach based on the Rasch model provided development scores that were more normally distributed than the other approaches did. The four sets of scores were highly correlated with each other. They gave similar estimates of the effect of height-for-age on GM, social and language development. In FM development, the maximum difference in the effect size estimates was only 0.04 standard deviation despite its statistical significance (P = 0.009). The four approaches were practically equivalent in the context of the estimation of an intervention effect or association. Their relative advantages and disadvantages are discussed. None of them can be universally recommended.

Dissociative experiences differentiate bipolar-II from unipolar depressed patients: The mediating role of cyclothymia and the Type A behaviour speed and impatience subscale

Background Dissociative symptoms are often seen in patients with mood disorders, but there is little information on possible association with subgroups and temperamental features of these disorders. Methods The Dissociative Experience Scale was administered to 85 patients with a DSM-IV Major Depressive Disorder (MDD) or Bipolar-II Disorder (BP-II). Both broad-spectrum dissociation (DES total score) and clearly pathological forms of dissociation (DES-Taxon) were assessed. Temperament was assessed using Akiskal and Mallya`s criteria of Affective Temperaments and the Jenkins Activity Survey (JAS) for Type A Behaviour. Results Sixty-five patients gave valid answers to DES. The mean DES and DES-T scores were higher in BP-II (16.8 and 12.7 respectively) compared to MDD (9.0 and 5.7); DES odds ratio (OR) = 1.58 (95% CI 1.15–2.18) and DES-T OR = 1.60 (95% CI 1.14–2.25) using univariate logistic regression analyses. There was no significant difference in DES score in patients with ( n = 30) and without an affective temperament ( n = 35): mean (95% CI), 13.5 vs. 10.5 (− 7.8 to 1.9), p = 0.224. However the subgroup with a cyclothymic temperament ( n = 18) had higher DES scores (mean (95% CI): 17.8 vs. 9.7 (2.9–13.3), p = 0.003), compared to patients without such a temperament. There was no significant difference in DES scores for patients with ( n = 35) or without ( n = 28) a Type A behaviour pattern (JAS > 0): mean (95% CI) 12. 7 vs. 10.9 (− 6.8 to 3.3), p = 0.491), but a positive JAS factor S score (speed and impatience subscale) was associated with significantly higher DES scores than a negative S-score: mean (95% CI) 14.9 vs. 9.0 (1.1–10.7), p = 0.017), and this was still significant ( p = 0.005) using multiple linear regression of DES scores vs. the JAS subscale scores. DES-T scores were significantly higher in patients with OCD ( n = 9) (mean (95% CI) 18.4 vs. 6.6 (6.0–17.7), p < 0.001); eating disorder ( n = 13) (14.0 vs. 6.8 (1.8–12.6), p = 0.009), psychotic symptoms during depressions ( n = 9) (16.6 vs. 6.9 (3.7–15.8), p = 0.002), and in those with a history of suicide attempt ( n = 28) (11.9 vs. 5.4 (2.2–10.8), p = 0.003), but only OCD was an independent predictor after multiple linear regression of DES-T scores vs. all co-morbid disorders ( p = 0.043). Limitations The major limitation of the present study is a non-blind evaluation of affective diagnosis and temperaments, and assessment in a non-remission clinical status. Conclusions Dissociative symptoms measured with the Dissociative Experience Scale are associated with bipolar features, using formal DSM-IV criteria, cyclothymic temperament and the speed and impatience subscale of the JAS.