Kellner Symptom Questionnaire Research Articles

The Detached Mindfulness approach to anxiety disorders in an Italian mental health service

IntroductionAnxiety disorders are one of the most common mental illnesses, and a consistent increase was observed after the COVID-19 pandemic. Mindfulness refers to a process that leads to a mental state characterized by nonjudgmental awareness of the present experience. Mindfulness can be considered both a skill and a practice. The stronger is the ability to adopt a mindful state, the less suffering one will experience. While Mindfulness-based Psychotherapies have shown efficacy in their treatment, they have not yet been thoroughly studied in Italian public mental health services. In Detached Mindfulness, negative thoughts are acknowledged and avoided by turning them into actions using a standardized, time-limited, metacognitive intervention.ObjectivesThe purpose of this study is to examine the efficacy and cost-effectiveness of Detachment Mindfulness for twelve patients with Generalized Anxiety Disorder (GAD) not being treated pharmacologically.Methods We enrolled 12 patients diagnosed with GAD according to DSM-V in an 8-session program of Detached Mindfulness Psychotherapy (once a week). The Generalized Anxiety Disorder - 7 Scale (GAD-7) and the Kellner Symptom Questionnaire (SQ) were used to assess anxiety symptoms at baseline (T0), after 4 sessions (T1), and at the end of treatment (T2). The Client Satisfaction Questionnaire (CSQ-8) was used to assess treatment satisfaction.ResultsThe GAD-7 score showed consistent reductions in generalized anxiety symptoms after Detached Mindfulness treatment (mean decrease of -42% at the end of the program). As measured by SQ, patients also reported improvement in physical well-being, relaxation, and somatic symptoms significantly respect to baseline. As for treatment satisfaction, ten out of twelve patients rated their treatment as satisfactory. As reported by patients, mindfulness can become a powerful and effective means to relate to one’s own internal experiences such as anxiety or fear, learning to recognize them, staying with them and avoiding their consequences.ConclusionsThese results showed that detached mindfulness was an effective and cost-effective intervention for GAD, given the short amount of time it requires and the ease with which it can be implemented. For its extensive use in the public mental health system to be further supported, studies on larger populations are needed.Disclosure of InterestNone Declared

Emotional, Behavioral, and Physical Health Consequences in Caregivers of Children with Cancer: A Network Analysis Differentiation in Mothers’ and Fathers’ Reactivity

Background: Pediatric cancer presents mental and physical challenges for patients and their caregivers. However, parental distress has been understudied despite its negative impact on quality of life, disability, and somatic disorders. Parents of oncopediatric patients experience high levels of suffering with their resilience tested throughout their children’s illness. Identifying at-risk parents and offering specific treatments is crucial and urgent to prevent or alleviate negative outcomes. Methods: This study used statistical and network analyses to examine symptom patterns assessed by the Kellner Symptom Questionnaire in 16 fathers and 23 mothers at different time points: diagnosis, treatment, and discharge. Results: The results indicated significantly higher distress levels in parents of oncopediatric children compared to the control reference population. Gender-specific differences in symptom profiles were observed at each time point, and symptoms showed a gradual but non-significant decrease over time. Conclusions: The network analysis yielded valuable insights that, when applied in clinical practice, can guide the implementation of timely treatments to prevent and manage parental distress, thus addressing long-term, stress-related issues in primary caregivers of children diagnosed and treated for cancer.

Brain-derived neurotrophic factor and mood in perimenopausal depression

BackgroundPrevious work implicates high pro-inflammatory biomarkers in mood disturbance and low brain-derived neurotrophic factor (BDNF) levels in major depression. However, in hormonally-sensitive premenstrual dysphoric disorder (PMDD), BDNF levels are higher when mood is worse. Perimenopausal depression has not been studied to date. We evaluated whether BDNF and inflammatory cytokines predict mood symptoms across the menstrual cycle in hormonally-sensitive perimenopausal depression symptoms. MethodsData from 49 time points derived from mid-to-late follicular phase [M/L-FP] and peri‑menstrual assessments of 14 perimenopausal women ages 38–52 with ovulatory menstrual cycles 24–35 days long across 1–2 cycles for mood symptoms, BDNF levels, cytokines, gonadal steroids. Depression was assessed with Montgomery-Åsberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI); irritability with Kellner Symptom Questionnaire Anger-Hostility subscale (SQ); overall psychological distress with Profile of Mood States (POMS). Mixed models were run on dependent measures of MADRS (primary endpoint) and other mood outcomes (BDI, POMS, SQ) with independent variables of interest (each biomarker, cycle phase), controlling for cycle number and participant. ResultsAfter FDR adjustment, BDNF levels showed consistent significant positive relationships to MADRS (β=0.00053; p = 0.0028), POMS (β=0.00153; p = 0.0394), SQ (β=0.00053; p = 0.0067), and BDI (β=0.00039; p = 0.0231). Cycle phase did not affect this relationship. No other biomarker consistently predicted affective symptom severity. LimitationsSmall sample size and large number of comparisons. ConclusionIn women with perimenopausal depression symptoms, BDNF is elevated in association with more severe mood symptomatology, resembling the pattern in hormonally-sensitive PMDD and suggesting a hormonally-sensitive mood disorder biomarker profile distinct from that of major depression.

Impact of Major Surgical Procedures on Quality of Life of Patients with Advanced Heart Failure

Purpose Advanced Heart Failure (A-HF) is a clinical condition which interferes with patient identity and perception. Psychological reactions depend on the nature and severity of patient disease, personality and environmental factors. Our goal was to evaluate quality of life of outpatients with left ventricular assist device (LVAD), heart transplantation (HT) and optimal medical treatment (OMT) for heart failure (HF). We additionally analyzed two cohorts of patients resulting different in terms of objective disease severity, to assess eventual perceived quality of life differences. Methods We included all consecutive adult patients presenting at our outpatient clinic for routine follow-up between January and September 2019. Including criteria were: being subjected to right heart catheterization (RHC), presence of LVAD for at least 2 months, HT for at least 2 months. Clinical severity of HF has been stratified using RHC and 6-minute walk test. Psychological parameters were measured by Kellner Symptom Questionnaire, Brief-Illness Perception Questionnaire, and WHO Quality of Life -BREF. Results Overall population consisted of 179 patients (HT=90, LVAD=15, and OMT-HF =74). OMT-HF patients were stratified into advanced and non-advanced (A-HF/NA-HF). A-HF patients walked significant less meters (p 3 (p=0.89), walked meters (p=0.32), CI (p=0.82). In psychological well-being comparison between OMT, LVAD and HT, patients who underwent advanced surgical therapy showed better results in terms of anxiety (p=0.014), depression (p=0.003), anger (p=0.04) and illness perception (p Conclusion Patients undergoing a major surgical procedure, such as LVAD implantation or Heart Transplantation, showed overall better psychological parameters than patients with chronic heart failure treated with medical therapy.

COVID-19 Related Distress in Gambling Disorder.

The COVID-19 pandemic has exerted a dramatic impact on everyday life globally. In this context, it has been reported that the lockdown and social distancing may have exerted an impact even on gambling behavior, not only by increasing gambling behavior in those affected by this disorder but even contributing to the occurrence of new cases. To explore such a possibility, we designed a cross-sectional web survey addressing a general population sample that lasted 3 weeks (March 23–April 20). Participants completed a survey including a demographic information section, a question regarding the presence of pathological gambling in the past and several questionnaires. These included the Perceived Stress Scale (PSS), the Kellner's Symptom Questionnaire (SQ), and the version of The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) that investigated the presence of gambling behaviors in the last week. The final sample was composed by 254 subjects (112 males, 44.1%; 142 females, 55.9%). According to PG-YBOCS total score, pathological gambling has been found in 23.6% (n = 60) of the sample (53 males, 88.3%; 7 females, 11.7%), which is a high frequency compared to that reported by the existing literature. Among gamblers, 20.9% (n = 53) reported both past and current problem gambling (they have been defined as “chronic gamblers”), whereas 2.8% (n = 7) did not report to use gambling platforms in the past but only in the last week (defined as “new gamblers”). Data analysis showed a statistically significant difference between gamblers and people who do not gamble in age but not in education, and higher level of perceived stress, distress, and hostility in both chronic and new gamblers compared to those who did not report gambling behavior. A consistent proportion of business owners and unemployed individuals reported problem gambling during the lockdown period.

Clinical Psychology in School and Educational Settings: Emerging Trends

Background: First clinical services in psychology have been established for educational purposes when Witmer founded its Psychological Clinic. Over the years, the educational dimension played a significant role in the development of new evaluation methods and intervention strategies for the pursuit of positive mental health. The present review aims to capture developments that have been considered emerging applications of clinical psychology in school and educational settings. Methods: We conducted a search of the literature on Scopus, PubMed and Web of Science. The following search terms were used and combined: “clinical”, “psychology”, “educational”, and “school”. Results: A total of 18 research articles were included and analyzed in the current review. A number of studies showed that school-based positive psychology interventions were effective not only in reducing symptoms of psychological distress (somatization, depression, and anxiety) but also in increasing levels of positive mental health (a sense of individual growth, self-esteem, self-efficacy and optimism). As to studies on evaluation methods, the WHO-5 and the psychological well-being subscale from the Kellner Symptom Questionnaire were found to be clinically valid self-rating scales for the assessment of positive mental health in children and adolescents. Conclusion: Studies demonstrated that promoting positive mental health is more beneficial in the long term than simply treating symptoms of psychological distress. In clinical psychology, time has come to move from a traditional psychopathology-based perspective to a positive clinical approach to be used for innovative interventions and assessment strategies in school and educational settings.

Anxiety in adolescent epilepsy. A clinimetric analysis

Background Anxiety and depression have been considered to be neglected disorders in epilepsy. Because panic disorder is one of the most important anxiety disorders, it has been problematic to use very comprehensive anxiety questionnaires in epilepsy patients, as panic attacks and epileptic seizures, although two distinct clinical entities from a diagnostic point of view, show a significant overlap of symptoms.Aims We have focused on single items for anxiety and depression as screening candidates in adolescent epilepsy.Methods The individual panic attack item in the Screen for Children Anxiety Related Emotional Disorders Scale (SCARED) and the single depression item in the Kellner Symptom Questionnaire were tested. Our samples consisted of adolescent patients with epilepsy and a matched control group with healthy participants, as well as two numerical groups acting as controls.Results The single panic attack item identified panic anxiety in 24.1% in the group of patients with epilepsy and 0.0% in the matched control group (p = 0.01). The single depression item identified 52.2% with depression in the epilepsy group and 6.2% in the matched control group (p = 0.001).Conclusion As screening instruments, single items of panic attack and depression are sufficient to screen for these affective states in adolescent epilepsy. The clinical implications are that it is important to be quite specific when screening for depression and panic attacks in adolescent patients with epilepsy.

Positive Narrative Group Psychotherapy: the use of traditional fairy tales to enhance psychological well-being and growth.

BackgroundOral narrative strategies have rarely been applied in the positive psychology domain. Traditional folk and fairy tales are concerned with several concepts that are now scientifically investigated by research on positive psychology, such as resilience, self-realization, personal growth and meaning in life. The aim of this pilot study was to apply a new narrative approach based on fairy tales (Märchen, tales of magic, rise tales) told, discussed, and written in a group context for the purpose of promoting psychological well-being and growth.MethodsA group intervention consisting of 7 sessions was delivered to 21 women who reported adjustment disorder. The group was conducted by a folklorist and a clinical psychologist. Each session consisted of an introduction to a number of themes recurring in fairy tales as well as references to the social uses of narratives, followed by a discussion with the participants. In two concluding workshops, participants were asked to work as a group to write their own original fairy tale. Assessment pre- and post-intervention was performed with the Ryff Psychological Well-being Scale, the Kellner Symptom Questionnaire and 2 subscales of the Posttraumatic Growth Inventory (Appreciation of Life and personal strengths).ResultsParticipants reported increased personal growth, self-acceptance, and an enhanced sense of appreciation of life and personal strengths, together with decreased levels of anxiety.ConclusionsThis pilot investigation suggests the feasibility and positive effect of a group intervention based on narrative strategies for promoting well-being and growth in stressed women. Considering its promising results, clinical implications and possible further applications are discussed.

The effects of aripiprazole on the subscales of the Kellner Symptom Questionnaire in treatment resistant depression

We have recently examined the efficacy of low-dose aripiprazole augmentation for major depressive disorder (MDD), with modest nonsignificant benefit found. In a secondary investigation, we examined whether aripiprazole resulted in improvement in four subscales (depression, anxiety, somatic symptoms, and hostility) of the Kellner Symptom Questionnaire (KSQ). We reanalyzed data from the main outcome study on 221 MDD patients with inadequate response to selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. Patients were randomized, using the sequential parallel comparison design, into two 30-day phases, as follows: drug/drug (aripiprazole 2 mg/day in phase 1, aripiprazole 5 mg/day in phase 2), placebo/drug (placebo in phase 1, aripiprazole 2 mg/day in phase 2), or placebo/placebo (placebo in both phases). We examined changes in the KSQ score from baseline to endpoint on the basis of the subscaled Well-being and Reversal Distressed Anxiety Subscales. The score for the KSQ depression subscale improved from baseline to the end of follow-up, with a significant advantage for aripiprazole over placebo (P=0.0327). Although improvement was also observed in the anxiety and hostility scales, neither attained a significant advantage over placebo; no significant change was observed for the somatization subscale. Aripiprazole augmentation resulted in a significant improvement compared with placebo augmentation only in the depression subscale of the KSQ; however, the low dose may not have been enough to have an impact on the anxiety and hostility scales. The good tolerability of the low dose may have resulted in the absence of worsening of somatic symptoms. Prospective studies are needed to better characterize the impact of low doses of aripiprazole augmentation on different manifestations of MDD.

Italian validation of Multiple Visual Analogue Scales for Bipolarity (MVAS-BP) of Ahearn and Carroll

The aim of the present study was to validate the Italian version and to assess the clinimetric properties of Ahearn and Carroll's Visual Analogue Scales for Bipolarity (MVAS-BP), a self-rating questionnaire measuring affective state. MVAS-BP consist of 26 items: 1 item assesses overall mood, 2 items anger and 23 items are based on the Carroll model of bipolar disorder (Consummatory Reward, Incentive Reward, Central Pain, Psychomotor Regulation). MVAS-BP have been translated into Italian and administered with Kellner's Symptom Questionnaire (SQ), Ryff's Psychological Well-Being Scales (PWB), and Cloninger's Tridimensional Personality Questionnaire (TPQ) to a normative sample of 450 people. The assessment was repeated after one month. Test-retest reliability, means scores, differences according to sociodemographic variables and correlations among the scales of MVAS-BP, SQ, PWB and TPQ were performed in order to assess clinimetric properties. Test-retest coefficients were highly significant. Significant sex differences were found in the scales of consummatory reward, central pain, psychomotor regulation and anger. MVAS-BP scales were significantly related with symptom and well-being scales, but with very low correlation coefficients, and only with one personality dimension, TPQ Harm Avoidance. MVAS-BP has been found to possess clinimetric properties and to record specific and different information from those investigated by other questionnaires.

Five-year longitudinal evaluation of quality of life in a cohort of patients with differentiated thyroid carcinoma

Differentiated thyroid carcinoma (DTC) generally has a favorable outcome. Thyroid disease, treatments, stress, and comorbidity can compromise health-related quality of life (QoL) and indirectly weigh upon the outcome. From 2004 to 2008, we evaluated QoL longitudinally in 128 DTC subjects. During scheduled examinations, subjects were asked to undergo a semi-structured psychiatric interview and five rated inventories. The same examination was conducted in 219 subjects after surgery for benign thyroid pathology. Low scores represent a better QoL. DTC and control subjects were similar in terms of age, male/female ratio, concomitant psychopharmacological treatments, and frequency of psychiatric diseases. In DTC subjects, Billewicz scale (BS) scores showed an increasing trend over time, especially among females. The ad hoc thyroid questionnaire (TQ) scores were similar in both groups and did not change over time, but at the end of the study ad hoc TQ and BS were significantly related. Ad hoc TQ scores were also related to age on entry to the study. In both male and female DTC subjects, Hamilton's tests for anxiety (HAM-A), but not for depression (HAM-D), showed an improving trend. At the end of the study, HAM-A and HAM-D scores were comparable to those of the control group. HAM-A and HAM-D were both positively correlated with the stage of cancer and the time between diagnosis and treatment. Only HAM-D correlated with age on entry to the study. Kellner symptom questionnaire (KSQ) item scores were higher in DTC subjects than in controls. The change over time in the items including anxiety, somatization, depression, and hostility was significant. Somatization and hostility were more significantly reduced in DTC females than in DTC males. Hostility scores were significantly lower in DTC subjects than in controls at the end of the study. Somatization and depression were significantly related to staging on diagnosis and age on entry to the study. Our study confirms a wide variation of illness perception in DTC subjects, which is generally unrelated to the favorable clinical follow-up of the disease. Psychological evaluation during long-term follow-up improved QoL scores, which reached the same levels noted in subjects with a history of thyroid surgery for benign thyroid pathology. Our data indicate that special attention should be paid to QoL in older DTC subjects and those with more severe staging on diagnosis.

Psychological Characterization of Demoralization in the Setting of Heart Transplantation

The aims of this study were to examine the psychological features of demoralization and its overlap with major depressive disorder in a sample of cardiac transplant recipients, with special reference to psychological well-being, quality of life, and psychological distress. We also tested whether demoralization was significantly associated with demographic characteristics and clinical parameters, including survival status at a 6-year follow-up. From May to December 2002, 95 heart transplanted patients were administered the Structured Clinical Interview for DSM-IV and the Diagnostic Criteria for Psychosomatic Research, leading to the identification of major depressive disorder and demoralization, respectively. Patients also completed Ryff's Scales of Psychological Well-Being, Kellner's Symptom Questionnaire, and the World Health Organization Quality of Life-Brief Version scale. Demoralization was related to impairments in physical, psychological, social, and environmental quality of life and in psychological well-being, especially self-acceptance and environmental mastery (all P ≤ .05). It was also associated with higher levels of psychological distress, and it was more frequent in women (P = .027) and in single patients (P = .038). The co-occurrence of a major depressive episode did not alter this pattern of associations. The addition of demoralization to major depressive disorder resulted in decreased Scales of Psychological Well-Being autonomy, positive relations, and self-acceptance (all P ≤ .05). Demoralization and major depressive disorder were identified in 31 (32.6%) and 14 (14.7%) patients, respectively. Among depressed subjects, 5 (35.7%) were not demoralized, and 22 (71%) of those with demoralization did not satisfy the criteria for major depressive disorder. Nine patients were both depressed and demoralized. Diagnostic Criteria for Psychosomatic Research-defined demoralization has some distinctive features that confirm previous phenomenological observations.

Hurtful Words: Association of Exposure to Peer Verbal Abuse With Elevated Psychiatric Symptom Scores and Corpus Callosum Abnormalities

Previous studies have shown that exposure to parental verbal abuse in childhood is associated with higher rates of adult psychopathology and alterations in brain structure. In this study the authors sought to examine the symptomatic and neuroanatomic effects, in young adulthood, of exposure to peer verbal abuse during childhood. A total of 848 young adults (ages 18-25 years) with no history of exposure to domestic violence, sexual abuse, or parental physical abuse rated their childhood exposure to parental and peer verbal abuse and completed a self-report packet that included the Kellner Symptom Questionnaire, the Limbic Symptom Checklist-33, and the Dissociative Experiences Scale. Diffusion tensor images were collected for a subset of 63 young adults with no history of abuse or exposure to parental verbal abuse selected for varying degrees of exposure to peer verbal abuse. Images were analyzed using tract-based spatial statistics. Analysis of covariance revealed dose-dependent effects of peer verbal abuse on anxiety, depression, anger-hostility, dissociation, "limbic irritability," and drug use. Peer and parental verbal abuse were essentially equivalent in effect size on these ratings. Path analysis indicated that peer verbal abuse during the middle school years had the most significant effect on symptom scores. Degree of exposure to peer verbal abuse correlated with increased mean and radial diffusivity and decreased fractional anisotropy in the corpus callosum and the corona radiata. These findings parallel results of previous reports of psychopathology associated with childhood exposure to parental verbal abuse and support the hypothesis that exposure to peer verbal abuse is an aversive stimulus associated with greater symptom ratings and meaningful alterations in brain structure.

Verbal Abuse Can Seriously Harm Far More Than Self-Esteem

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessVerbal Abuse Can Seriously Harm Far More Than Self-EsteemJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:2 Jul 2010https://doi.org/10.1176/pn.45.13.psychnews_45_13_031AbstractThe nasty things that their peers say to them can not only hurt adolescents emotionally, but may also damage their brains and set the stage for psychiatric illness later, a new study suggests.The study was headed by Martin Teicher, M.D., Ph.D., director of the Developmental Biopsychiatry Research Program at McLean Hospital in Belmont, Mass. The report was tentatively scheduled for publication July 1 on the American Journal of Psychiatry's AJP in Advance Web site.Teicher and his colleagues selected 707 late teens or young adults (aged 18 to 25) to participate in their study. None of the subjects reported having experienced domestic violence, sexual abuse, parental physical abuse, parental verbal abuse, or physical bullying by peers during childhood. So the researchers could examine peer verbal abuse independently of these other adverse experiences.Teicher and his colleagues administered the Verbal Abuse Questionnaire, which contains 15 items and addresses various types of verbal abuse such as criticizing, belittling, blaming, insulting, demeaning, or ridiculing, to determine how many of their subjects had experienced peer verbal abuse during childhood or adolescence.Nine percent had, they found. Furthermore, the bulk of peer verbal abuse transpired during the middle-school years, which generally includes youngsters aged 11 to 14. Males tended to have experienced verbal abuse from male peers, and females from female peers.Teicher and his colleagues also had their subjects fill out several questionnaires—the Kellner Symptom Questionnaire, the Limbic Symptom Checklist-33, and the Dissociative Experiences Scale—to assess the participants' current psychological health. Then they looked to see whether there were links between having experienced peer verbal abuse during childhood or adolescence and current psychological problems.The researchers found that the more exposure to peer verbal abuse subjects reported, the more likely they were to be experiencing anxiety, depression, angerhostility, dissociation, or drug use at the time of the study. Peer verbal abuse during the middle-school years was found to be especially noxious in this regard.Finally, the researchers obtained neuroimaging scans of a subset of their sample—63 young adults who had been exposed to varying degrees of peer verbal abuse. They wanted to see if they could find a significant link between subjects' exposure to peer verbal abuse during childhood or adolescence and damage to the corpus callosum.They looked for damage in the corpus callosum because it connects the left and right hemispheres of the brain, it contains nerves that carry nearly all the neural traffic to and from the cerebral cortex, and types of maltreatment other than verbal abuse had already been linked with corpus callosum damage. In other words, the researchers believed that if they could document corpus callosum damage in subjects who had experienced peer verbal abuse, it might explain why these subjects subsequently experienced psychological problems such as anxiety, depression, anger-hostility, dissociation, or drug use.Indeed they did find evidence of corpus callosum damage in their verbal-abuse subjects. So it looks as if peer verbal abuse can lead to damage in the corpus callosum, and corpus callosum damage in turn can increase the risk that young people will experience psychological problems.The study was funded by the National Institutes of Health, NARSAD, and donations from the Simches and Rosenberg families.“Hurtful Words: Exposure to Peer Verbal Aggression Is Associated With Elevated Psychiatric Symptom Scores and Corpus Callosum Abnormalities” is posted at <http://ajp.psychiatryonline.org> under “AJP in Advance.” ISSUES NewArchived

Validation of a Women's Sexual Interest Diagnostic Interview—Short Form (WSID-SF) and a Daily Log of Sexual Activities (DLSA) in Postmenopausal Women with Hypoactive Sexual Desire Disorder

Currently, there is no clear standard assessment tool for the diagnosis and daily monitoring of hypoactive sexual desire disorder (HSDD) in postmenopausal women. The aim of the study was to validate (i) the Women's Sexual Interest Diagnostic Interview-Short Form (WSID-SF) which is a structured tool to identify HSDD; and (ii) the Daily Log of Sexual Activities (DLSA) which is a diary to monitor daily HSDD status in postmenopausal women. Both assessments were collected as self-reports by an interactive voice response system (IVRS). At the initial study visit, 629 postmenopausal women, age 39-66, were evaluated for HSDD by the WSID-SF. In addition, in a subgroup of 175 subjects at five study sites, HSDD was assessed by physicians who were blinded to the WSID-SF diagnosis. During the 58-day study period, patients completed the DLSA daily through self-reported IVRS. All women also completed the Female Sexual Function Index (FSFI), Menopause Sexual Interest Questionnaire (MSIQ), Female Sexual Distress Scale (FSDS), Dyadic Adjustment Scale (DAS), and Kellner Symptom Questionnaire (KSQ) at both the initial study visit and at the end of the study. The WSID-SF-based identifications were compared with clinical diagnoses made based on physicians' clinical experience. Construct validity of the WSID-SF and DLSA were assessed based on comparisons with questionnaire results. Internal consistency and test-retest reliability of the DLSA were also evaluated. Main outcome measures include the agreement between WSID-SF diagnosis and clinician diagnosis, convergent and divergent validity of the WSID-SF and DLSA, and reliability of the DLSA. Results. Enrolled subjects were classified into HSDD (N = 468) and non-HSDD (N = 161) groups by WSID-SF. When compared with physician's diagnosis, WSID-SF-based diagnosis had a specificity of 89% and a sensitivity of 70% (kappa = 0.46, P < 0.001). WSID-SF showed significant correlation with each domain of the FSFI, MSIQ, and FSDS (all P < 0.001). As anticipated, WSID-SF had low or nonsignificant correlations with all domains of the DAS and the KSQ. Four different algorithms were piloted to calculate DLSA scores. Data on the detailed analysis conducted to evaluate the four scoring strategies is on file (not presented in this article). Ultimately, the weekly DLSA total score calculated by algorithm #4 was selected to validate the DLSA. In the test-retest reliability evaluation, the intraclass correlation coefficient was 0.80 for women with HSDD and 0.84 for women without HSDD (P < 0.001 for all analysis). In the known-group validity comparison, the weekly DLSA total score was significantly different (P < 0.001) among the HSDD and the no HSDD groups, with an effect size of 0.89-0.92 based on Cohen's d. The DLSA also showed convergent validity with moderate to high correlations with each domain of the FSFI, MSIQ, and FSDS (P < 0.001 for all correlations). As anticipated, the DLSA had weak correlations with the DAS and KSQ demonstrating divergent validity. The WSID-SF had good specificity and sensitivity (i.e., discriminative validity) in identifying HSDD in postmenopausal women. In addition, the DLSA is a reliable and valid patient-reported outcomes tool that can be utilized to assess effectiveness of treatments in postmenopausal women with HSDD. Further, the WSID-SF and DLSA both demonstrated good convergent and divergent validity.

Preliminary Evidence for Sensitive Periods in the Effect of Childhood Sexual Abuse on Regional Brain Development

Preliminary Evidence for Sensitive Periods in the Effect of Childhood Sexual Abuse on Regional Brain Development

Anxiety Worsens Prognosis in Patients With Coronary Artery Disease

This study examined the effect of anxiety on mortality and nonfatal myocardial infarction (MI) in patients with coronary artery disease (CAD). Inconsistent data exist regarding the impact of anxiety on the prognosis of patients with CAD. The authors conducted a prospective cohort study at an outpatient cardiology clinic of 516 patients with CAD (mean age 68 years at entry, 82% male) by administering the Kellner Symptom Questionnaire annually. The primary outcome was the composite of nonfatal MI or all-cause mortality. During an average follow-up of 3.4 years, we documented 44 nonfatal MIs and 19 deaths. A high cumulative anxiety score was associated with an increased risk of nonfatal MI or death. Comparing the highest to lowest tertile of anxiety score, the age-adjusted hazard ratio was 1.97 (95% confidence interval 1.03 to 3.78, p = 0.04). In a multivariate Cox model after adjusting for age, gender, education, marital status, smoking, hypertension, diabetes mellitus, previous MI, body mass index, and total cholesterol, each unit increase in the cumulative mean anxiety score was associated with increased risk of nonfatal MI or total mortality; the hazard ratio was 1.06 (95% confidence interval 1.01 to 1.12, p = 0.02). A high level of anxiety maintained after CAD diagnosis constitutes a strong risk of MI or death among patients with CAD.

Serum cholesterol concentration and distress in the initial days after childbirth

The link between mood disorders and cholesterol is characterized by some contradictory data. In particular, it is not clear whether health factors are responsible for lowered cholesterol levels and mood swings. The present study tests the association between serum cholesterol level and psychological distress in women in two different post-delivery hospital settings: rooming-in (RI) and no rooming-in (no-RI). On day 3 after childbirth, 147 RI and 209 no-RI women completed the Kellner Symptom Questionnaire (SQ), which evaluates anxiety, depression, somatic symptoms and hostility. Plasma cholesterol concentration was measured on the same day. There was a significant negative correlation between cholesterol and depressive symptoms in no-RI women, but not in the RI group. However, this correlation is characterized by an extremely small effect size (− 0.15). The findings of this study cast further doubt on the hypothesis of a possible association between cholesterol and depression in the general population and in mothers who have just given birth.

Venlafaxine in the Treatment of Postpartum Depression

Although postpartum depression is a highly prevalent illness, antidepressant treatment studies of postpartum depression are sparse. Incomplete recognition and treatment of puerperal illness place women at risk for chronic depression and may have adverse effects on child development. An 8-week, flexible-dose, open study of venlafaxine (immediate release; mean dose = 162.5 mg/day) was performed in a group of 15 women who met DSM-III-R criteria for major depressive disorder with onset within the first 3 months postpartum. Patients were assessed at baseline and every 2 weeks across the study. Measurements of outcome included the 17-item Hamilton Rating Scale for Depression (HAM-D), the Kellner Symptom Questionnaire, and the Clinical Global Impressions scale (CGI). Despite baseline scores of depression that were particularly high, response to treatment was robust. Twelve of 15 patients experienced remission of major depression (HAM-D score < or = 7 or CGI score < or = 2). Dramatic decrease in anxiety paralleled the decrease in depression across the sample. Venlafaxine is effective in the treatment of postpartum major depression. Early identification of women who suffer from postpartum mood disturbance is critical to minimize the morbidity associated with untreated mood disturbance and the effect of depression on children and families.

Rating well-being and distress

There is insufficient research on rating psychological well-being and distress in clinical populations. The aim of this study was to evaluate the differential characteristics of instruments assessing well-being and distress in 20 remitted patients with affective (mood and anxiety) disorders and 20 healthy control subjects matched for sociodemographic variables. Remitted patients displayed significantly higher levels of psychological distress—as measured by Paykel's Clinical Interview for Depression (CID), Van Praag's Scale for Personality Disturbances and Kellner's Symptom Questionnaire (SQ)—and significantly less well-being—as measured by Ryff's Scales of Psychological Well-Being (PWB) and the SQ—than control subjects. The correlations between scales of psychological distress and well-being were found to be complex in both patients and controls. Psychotherapeutic treatment of residual symptomatology in patients disclosed a differential sensitivity of the scales to changes. The results thus suggest that well-being cannot be equated to lack of distress (as implicitly endorsed by current psychiatric paradigms), and the need for a multidimensional assessment in stress medicine. Copyright © 2000 John Wiley & Sons, Ltd.