DSM III-R Axis Research Articles

The relation of major depression, OCD, personality disorders and affective temperaments with Temporal lobe epilepsy

BackgroundIn patients with temporal lobe epilepsy (TLE), studies demonstrate frequent comorbidity with mood disorders, personality disorders (especially obsessive-compulsive disorder) and major depression, but there are conflicting findings. This study aimed to investigate psychiatric comorbidities and affective temperament among TLE patients and to explore the relationships between obsessive compulsive disorder, other personality disorders, major depression and affective temperament in order to clarify the mediator effect of TLE in these relationships. MethodsThirty patients with TLE and 30 healthy volunteers were included. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Structured Clinical Interview for DSM III-R Axis II Disorders (SCID-II), Hamilton Anxiety (HAM-A) scale, Hamilton Depression (HAM-D) scale, Beck Suicidal Ideation Scale (BSSI) and Yale Brown Obsession Compulsion Scale (YBOCS) were applied and evaluated by a psychiatrist. Additionally, all individuals completed The Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A). ResultsPatients with temporal lobe epilepsy had higher scores in TEMPS-A, HAM-A, HAM-D, YBOCS and BSSI. Major depression, obsessive compulsive disorder and dependent and antisocial personality disorders were prevalent in patients. With respect to affective temperaments, depressive, cyclothymic and anxious temperaments were associated with obsessive compulsive disorder comorbidity; whereas, depressive and anxious temperaments were found to be associated with major depression comorbidity in patients with TLE. Furthermore, cluster A and cluster C personality disorders were associated with affective temperaments in patients with TLE. Affective temperaments had no correlation with illness duration, seizure frequency, depression severity and suicidal thoughts, but obsessions and compulsions. Suicidal thoughts were associated with obsessions and compulsions. ConclusionAffective temperaments are core personality traits with biological background and they may provide a foundation for psychiatric disorders, especially mood disorders. Considering that TLE originates from abnormalities in brain circuitry, it may form a basis for psychiatric disorders. Therefore, psychiatric evaluation to determine comorbidities may be beneficial to increase the quality of life of patients with TLE.

The relationship between childhood trauma, emotion recognition, and irritability in schizophrenia patients

This study investigated the relationship between childhood trauma, irritability, and emotion recognition, in schizophrenia patients during a psychotic break. Thirty-six schizophrenia inpatients and 36 healthy controls were assessed with the Irritability Questionnaire (IRQ) and two facial emotion recognition tasks, the Emotion Discrimination Test (EDT) and Emotion Identification Test (EIT). Patients were further assessed with the Structured Clinical Interview for DSM III-R Axis II Disorders (SCID-II), the Positive and Negative Symptom Scale (PANSS), and the Childhood Trauma Questionnaire-28 (CTQ-28). EDT and EIT performance was significantly impaired in patients compared to healthy controls. Furthermore, patients tended to misidentify sad, surprised, or angry faces as showing fear, and this misidentification correlated with the patients’ irritability. Childhood adversity increased irritability both directly and indirectly through emotion misidentification.

Biopsychosocial Aspects of Atypical Odontalgia

Background. A few studies have found somatosensory abnormalities in atypical odontalgia (AO) patients. The aim of the study is to explore the presence of specific abnormalities in facial pain patients that can be considered as psychophysical factors predisposing to AO. Materials and Methods. The AO subjects (n = 18) have been compared to pain-free (n = 14), trigeminal neuralgia (n = 16), migraine (n = 17), and temporomandibular disorder (n = 14). The neurometer current perception threshold (CPT) was used to investigate somatosensory perception. Structured clinical interviews based on the DSM-IV axis I and DSM III-R axis II criteria for psychiatric disorders and self-assessment questionnaires were used to evaluate psychopathology and aggressive behavior among subjects. Results. Subjects with AO showed a lower Aβ, Aδ, and C trigeminal fiber pain perception threshold when compared to a pain-free control group. Resentment was determined to be inversely related to Aβ (rho: 0.62, P < 0.05), Aδ (rho: 0.53, P < 0.05) and C fibers (rho: 0.54, P < 0.05), and depression was inversely related with C fiber (rho: 0.52, P < 0.05) perception threshold only in AO subjects. Conclusion. High levels of depression and resentment can be considered predictive psychophysical factors for the development of AO after dental extraction.

PW01-183 - Relationship of personality disorders to the symptoms of schizophrenia

IntroductionIt is well estabhished that the frequency of all types of personality disorders are increased in schizophrenia. Stable personality traits influence the progress of the illness. The aim of this study was to investigate comorbid personality disorders and their relations with positive and negative symptoms in schizophrenia patients.Materials and methodsData belonging to 27 female and 23 male schizophrenic patients (n=50) followed-up in our outpatient clinic constituted our series. Any patients having a history of mental retardation, head injury, prior neurological illness, alchohol or substance abuse were excluded. All patients were in a clinically stable phase of illness, and having no changes in medication for at least three months. Having obtained informed consent, patients were administered the Structured Clinical Interview for DSM-IV (SCID) as well as the Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), Hamilton Axiety Scale (HAM-A), Calgary Depression Scale for Schizophrenia, Global Assessment of Functioning (GAF), and The Structured Clinical Interview for DSM III-R Axis II Personality Disorders.ResultsThirty-six schizophrenia patients had at least one kind of comorbid personality disorder (72%) while 14 (28%) had not. Comparing the patients having personality disorders to the rest of our patient population, we have found no statistically significant differences in age groups, clinical variables and functioning.DiscussionWe have shown that approximately three fourths of our series accompanied by at least one type of personality disorders, a finding consolidating and concordant with some of the previous works.

Neuropsychiatric symptoms three years after subthalamic DBS in PD patients

To evaluate neuropsychiatric symptoms in PD patients submitted to bilateral deep brain stimulation of the subthalamic nucleus (DBS-STN) by comparison with a control group of PD patients not treated with DBS. 25 consecutive PD patients bilaterally implanted for DBS of STN (DBS group) were compared to a control group of 25 not operated PD patients (CT group) for mood, anxiety and personality traits. The two group were matched for age, sex, duration and severity of the illness. DBS PD patients were assessed three years after surgery. Mood was evaluated through the Beck Depression Inventory (BDI). Anxiety was measured by means of the State-Trait Anxiety Inventory (STAI X1-X2) and personality traits were evaluated with the Structured Clinical Interview for the DSM-IIIR Axis II Disorders (SCID II). Comparing the DBS group and the CT group, no significant differences were found for mood (BDI) or state and trait anxiety scores (STAI X1-X2). Obsessive-compulsive traits scores were found to be significantly lower in the DBS group (p < 0.03). The results of this case-control study suggest that STN DBS does not lead to relevant modifications of mood, anxiety and personality provided that PD patients are well selected for the surgical treatment.

A magnetic resonance spectroscopy study of antisocial behaviour disorder, psychopathy and violent crime among military conscripts.

Prefrontal and/or temporo-limbic abnormalities associated with antisocial personality disorder (APD), high psychopathy scores and violent behaviours can readily be evaluated by neuroimaging methods. In this study, we compared the brain metabolites in adult male military conscripts with APD, high psychopathy scores and serious violent crimes (n = 15) with age- and educational-level-matched healthy controls (n = 15) by means of magnetic resonance spectroscopy. All cases were diagnosed by means of the Diagnostic Statistical Manual-IV APD module of the Structured Clinical Interview for DSM III-R Axis II Disorders (SCID-II) semistructured questionnaire in Turkish. The psychopathy scores were evaluated by means of the Hare Psychopathy Checklist-Revised translated into Turkish (PCL-R). PCL-R is a 20-item, reliable and valid instrument for assessment of psychopathy, both in categorical and dimensional natures. All patients had a total score of 29 (of possible 40) or higher from PCL-R, indicating a high degree of psychopathy. Our results showed no significant differences in ratio of N-acetyl aspartate (NAA), creatine (Cr) and choline-related compounds in the right dorsolateral prefrontal cortex, anterior cingulate cortex (ACC) and amygdala-hippocampus regions of cases compared with controls. ACC NAA/Cr was significantly negatively correlated with both the PCL-R total score and the PCL-R factor I score (interpersonal/affective problems) among the cases. As ACC plays an important role in decision-making and emotional information processing, we postulate that the lower NAA/Cr ratio, suggesting impaired neural integrity, may increase the severity of interpersonal/affective problems of the psychopathy factor in male subjects exhibiting APD, high psychopathy overall scores and violent crimes.

Functional Deterioration in Individuals with Schizophrenia Spectrum Personality Symptoms

Although previous studies have noted functional deterioration in patients with severe schizotypal symptoms who meet criteria for schizotypal personality disorder, we are not aware of any study which examines level of functioning in nonpatients who experience mild schizophrenia spectrum personality (SSP) symptoms. With this issue in mind, occupational functioning was examined in non-patient subjects with mild SSP symptoms. Patients were recruited from the community by newspaper advertisements or from the first-degree relatives of patients with schizophrenia. Individuals with no DSM-IIIR Axis I diagnosis and with SSP symptoms (n = 60) and without symptoms (n = 75) participated in the study. The two groups had similar mean age and years of education. Occupational function was evaluated using the Level of Function Scale. The SSP patients with mild symptoms had significantly lower occupational scores (5.62 + 2.50) than the non-SSP patients (7.76 + 0.69; p < 0.001). A total of 39% of SSP patients, compared with 3% of non-SSP patients showed poor occupational functioning (chi 2 = 31, df = 1, p < 0.001). There was a significant deterioration in the socioeconomic status in SSP patients compared with their parents' status. Patients with mild SSP symptoms who were otherwise healthy showed severe difficulties with occupational function. Further research is needed to identify subtle deficits underlying functional deterioration and to develop targets for treatment strategies.

Psychiatric disorders and outcome following cardiac transplantation

Background Psychosocial factors are frequently included in determining candidacy for cardiac transplantation. Although there are some data demonstrating a link between preoperative psychosocial status and postoperative outcome, a definitive answer has yet to be reached. Methods We studied 107 consecutive patients, transplanted from January 1990 to September 1991, with a retrospective review of pretransplant psychiatric evaluations to define a DSM III-R Axis I diagnosis. The medical outcome data included 1-year survival, rehospitalizations, infections, and rejection episodes, gathered from the transplant database. Results There were no discernable differences between the groups with ( n = 25) and without ( n = 82) a DSM III-R Axis I psychiatric disorder prior to transplant in the evaluation of demographic data and medical outcome variables. Conclusion These data demonstrate that individuals with a history of psychiatric disorder who are carefully selected for compliance with medical care display no inherent difference from individuals without psychiatric disorder in medical outcome and survival at 1 year after cardiac transplantation.

Brain glucose metabolism in borderline personality disorder

We searched for regional cerebral metabolic disturbances in patients with borderline personality disorder (BPD). Ten inpatients with BPD, no current DSM-IIIR Axis I diagnosis and free of any psychotropic substances, were compared with 15 age-matched control subjects using positron emission tomography with 2-deoxy-2-[ 18F]fluoro- d-glucose and semiquantitative analysis of regional glucose metabolic activity. We found relative hypometabolism in patients with borderline personality disorder at the level of the premotor and prefrontal cortical areas, the anterior part of the cingulate cortex and the thalamic, caudate and lenticular nuclei. This study shows significant cerebral metabolic disturbances in patients with borderline personality disorder. These metabolic disturbances, which are similar to some of those described in other psychiatric entities, may help to understand the characteristic clinical aspects of this disorder.

Comorbidity of drug dependence and other mental disorders: a two-phase study of prevalence at outpatient treatment centres in Italy

A cross-sectional multicentre study aimed at evaluating the prevalence of DSM III-R Axis I morbidity among drug addicts seeking treatment. Consecutive outpatients of the National Health Service's treatment units (aged 18–60 years, fulfilling criteria for drug dependence and without primary diagnosis of alcohol dependence) were enrolled at intake. In the first phase of the study, professional staff members evaluated current psychiatric morbidity of 317 clients clinically. In the second phase, trained interviewers administered the Composite International Diagnostic Interview and a European adaptation of the Addiction Severity Index to 65 probands. Some current psychiatric morbidity was found in 26.2% of subjects recruited during the first phase and in 22.2% during the second; lifetime comorbidity was ascertained in 32.3% of probands recruited in the second phase. Unfortunately, remarkable rates of undetermined diagnostic assessment during the second phase are due to refusers. The distribution of categorical diagnoses is somewhat different between the two samples, but the most frequent are Anxiety and Mood disorders in both. Primary versus secondary psychiatric diagnoses were also distingushed when evaluated over a lifetime. The rates of psychiatric comorbidity are low in this study as compared with previous investigations, but suffer from a poor compliance with structured diagnostic procedures by unselected probands. Other methodological factors may also affect this kind of research. Prospective studies are needed to evaluate the validity of comorbid diagnostic constructs and their prognostic significance. Also, a concurrent assessment of Axis II disorders may be helpful to explain symptomatic polymorphism in case of multiple Axis I comorbidity.

Personality disorder symptoms, gender, and age as predictors of adolescent disgust sensitivity

Disgust reactions are believed to result from a defensive, physiological, human emotion that is present from birth with the purpose of protecting individuals from harm (e.g. poisoning). Yet, disgusteliciting stimuli eventually expand to include socio-moral stimuli like sex acts (e.g. incest) and socio-cultural stimuli like social status (e.g. Hindu caste system). Inevitably, personal traits become important variables determining what is deemed disgusting. This study expanded on previous research that investigated the association between personality traits (i.e. neuroticism and psychoticism) and disgust sensitivity by examining the possible relationship between DSM III-R Axis II personality types and disgust sensitivity in a non-clinical sample of 149 college undergraduates. The current findings revealed that the degree to which respondents could be seen as having certain personality types—;Schizoid, Obsessive Compulsive, and Dependent—;was significantly related to disgust sensitivity as were participants' gender and age.

Prepubertal Psychosis: A Case Control Study

Psychotic symptoms, hallucinations, delusions, or a thought disorder, are very rarely observed in children. This holds true not only for the community at large, but even in high risk groups such as the offspring of schizophrenic mothers. This study was undertaken to describe the frequency, syndromes, demographics, and neurodevelopmental and medical correlates of prepubertal psychosis. A chart review was conducted at nine child psychiatry inpatient units in the New York metropolitan area of all children admitted over a two year period who received a discharge diagnosis of a DSM III-R axis I “nonorganic” psychotic disorder. The next age and sex matched admission was used as a control subject. One hundred prepubertal psychotic children were identified, of which 55 were given a diagnosis of psychotic disorder NOS (atypical psychosis). Psychotic children were overwhelmingly male and from the lower social classes. In both cases and matched controls, disorders of higher cognitive functioning were frequent, while neurologic and medical disorders were rarely diagnosed. Psychotic symptoms occur prior to the onset of puberty, but the syndromal presentation and demographics differ from adult onset psychotic disorders. These results support the hypothesis of a neurodevelopmental influence upon psychotic symptomatology and suggest an alternative explanation of the schizophrenic progress.

Psychiatric Morbidity in Adults with Hypopituitarism

Forty-one adults with established hypopituitarism and deficiency of growth hormone (GHD) were compared to an age and sex-matched group with another chronic metabolic disorder (diabetes mellitus) using standardized psychiatric rating and diagnostic measures. Nineteen (46%) of the GHD group were identified as definite psychiatric cases compared with 10 (24%) of the diabetics (odds ratio 1:9:1). The most frequent DSM III-R axis I psychiatric diagnoses were major depression (32% GHD patients and 10% of diabetic patients) and dysthymia. The risk of being a psychiatric case showed an association with duration of illness in the diabetic group, but not in the GHD group. Biochemical indices were not related to the risk of being a case in either group. Hypopituitarism is associated with a higher prevalence of psychiatric disturbance than can be attributed solely to the presence of a chronic disorder.

Psychiatric comorbidity of bulimia nervosa inpatients: relationship to clinical variables and treatment outcome

SummaryExperimental evidence suggesting that psychiatric comorbidity has important clinical and prognostic implications in bulimia nervosa has mostly been based on outpatient studies investigating a selection of co-existing psychopathological features with rather unstructured and not standardized diagnostic instruments. Using structured instruments (SCID-P, MDCL) for the diagnoses of DSM III-R axis I disorders and clinical interviews for the diagnosis of DSM III-R axis II disorders in 24 hospitalized bulimics, the present study demonstrated that more than half of the patients had two or three axis I disorders in addition to bulimia nervosa and almost half of the patients met criteria of at least one personality disorder. Subgroups of patients classified according to the type of psychiatric comorbidity did not differ significantly with respect to clinical features; regarding measures of hospital behavior therapy outcome. However, the findings provided evidence for a negative impact of anxiety disorder in addition to bulimia nervosa on the improvement of bulimic behavior and possibly also on self-rated depression.

Sensory gating deficits in psychiatric impatients: Relation to catecholamine metabolites in different diagnostic groups

Acutely ill psychiatric inpatients were examined for a deficit in sensory gating, measured as failure to suppress the P50 wave of the auditory-evoked response to the second of paired stimuli. Previously, we had found that in mania, this sensory gating deficit is correlated with increased plasma-free levels of the noradrenergic metabolite 3-methoxy, 4-hydroxyphenylglycol (pMHPG), whereas in schizophrenia, there is no correlation with catecholamine metabolism. To assess the generalizability of these findings, we examined inpatients with a broader range of diagnoses, including those with multiple DSM III-R Axis I, II, and III diagnoses. The patients were grouped into three diagnostic spectra for analysis: schizophrenic, manic, and depressive. In the schizophrenic patients, there was no relationship between pMHPG or other catecholamine metabolites and the sensory gating deficit. In manic patients, however, a positive correlation between pMHPG level and the sensory gating deficit was again observed. This relationship did not extend to the depressive patients, who uniquely showed sensory gating deficits that correlated negatively with the severity of their illness. The data suggest that sensory gating deficits are common to these three diagnostic spectra, but the deficits in each group have different relationships to catecholamine metabolism and symptom severity that may reflect differences in the underlying neuronal pathophysiology of these illness.