Psychopathological Processes Research Articles

Ethnic Differences in Patterns of Suicide Across the Life Cycle

The authors analyzed suicide across the life cycle of different ethnic groups in an urban population equally divided between blacks (44.6%) and whites (48.1%). Two data sets were used: 1) all suicides in Fulton County, Ga., from January 1994 through December 2002 and 2) all U.S. suicides reported by the National Center for Injury Prevention in 1999 and 2000. The population rates for suicide in Fulton County were 1.22 per 100,000 black females, 10.74 per 100,000 black males, 9.89 per 100,000 white females, and 21.04 per 100,000 white males. In Fulton County, age at completed suicide was more than a decade lower in blacks than in whites. The median age of black victims was 32 years, with an interquartile range (IQR) of 23-45, and the median for whites was 44 years (IQR=31-58); the difference was significant. The mean ages of victims who were black (mean=36.1 years, SD=17.0) and of "other" race (mean=35.7, SD=14.3) were significantly lower than the mean for whites (mean=46.2, SD=18.5). The national data were similar, but minorities accounted for an even smaller percentage of suicides. Median age at completed suicide for African Americans nationally was 34 years (IQR=24-45) compared to 44 years (IQR=32-58) for Caucasians. African Americans commit suicide at rates much lower than those for whites, but they do so when much younger and they have a narrow, age-defined window of vulnerability. Age-specific psychopathological processes and protective factors may define suicide risk for each demographic group.

Book Essays and Reviews

Fashioned as it is in the image of its creator, the intricacy and complexity and of the human psyche is staggering in scope for those of us who seek to understand and repair its maladies. Over the years, this has led workers in psychiatry and psychology to generate an enormous number of theories to explain psychopathological processes, and an equally large number of therapeutic methods designed to repair the damage. Such a wide variety of approaches has led to confusion and conflict, often resulting in a polarization of opinions that has hampered scientific progress. Given the daunting nature of the task, it has become apparent over the years that the most useful innovations in theory and therapeutic technique come from those that systematically integrate past findings with new data and fresh ways of organizing previous findings. Lorna Smith Benjamin’s book on Interpersonal Reconstructive Therapy (IRT) successfully adheres to this integrative model. For this reason, her book should prove highly useful for students, clinicians, and researchers from all sectors of the field of psychotherapy, from behaviorists to psychoanalysts. As implied by the subtitle to Dr. Benjamin’s book, the underlying theories and techniques that she presents are designed to promote recovery in patients who are not responding well to standard psychotherapeutic treatment. However, her work has a far broader application, and should be useful in helping clinicians to stay more focused on the therapeutic task and to achieve a better understanding of the often mysterious repetitive patterns of pathologic behavior manifested by our patients, even those who seem to be getting better with standard treatments. Dr. Benjamin’s IRT approach to understanding and treating psychopathology is based on her Developmental Learning and Loving theory (DLL). J. Bowlby’s (1969) studies on attachment show how early life rePsychiatry 67(2) Summer 2004 208

Intervention i præpsykotiske tilstande: En gennemgang af aktuel forskning og relaterede problemstillinger

Olsen, K.A. & Rosenbaum, B. (2004): Intervention in prepsychotic states: A review of current research. Nordisk Psykologi, 56, 3, 178–200. The article offers an account of current research and ideas on intervention in the prepsychotic state of developing schizophrenia. During the last decade this field has seen an increased activity aimed at examining the possibility of a primary prevention. Intervention in prepsychotic states calls for an interdisciplinary practice and touches on the psychological field in many ways. Thus, there are a number of areas in which psychology can gain from and contribute to a better understanding of the field; psychopathological processes, subjective experience and identity and meaningful clinical practice in the nebulous transitional stage between a nonpsychotic and psychotic interpretation of reality, to name but a few. The article describes characteristic prodromal signs as well as scales and interviews, presumed to be sensitive to the subtle prepsychotic symptoms. Issues concerning conceptual and ethical problems are mentioned.

Personality development: an introduction toward process approaches to long-term stability and change in persons.

This special issue is concerned with the systematic transformation of persons and personalities as they move through their lives. The focus is on developmental processes early in the life course that influence both long-term stability and change. Contributors represent diverse topics and viewpoints, but offer new data on classical issues of personality, including trait structure, self-regulation and internalization, self-evaluation, and self-efficacy. In addition, the issue includes empirical contributions on newer approaches to bullying, developmental processes in psychopathology, the influence of racial and ethnic discrimination on subsequent adjustment, and cultural influences on personality development. The issue also includes a special contribution addressing methodological and statistical advances in dealing with prospective longitudinal data assessing personality over time.

Volumetric analysis of the prefrontal cortex, amygdala, and hippocampus in major depression.

Magnetic resonance imaging (MRI) studies in depressed subjects report smaller volumes of amygdala, hippocampus, inferior anterior cingulate, and the orbital prefrontal cortex (OPFC), components of the limbic-cortico-thalamic circuit. Major depression occurs more commonly in women, raising the possibility of an additional psychopathological process affecting women and not men. We sought to determine whether volumetric differences related to mood disorders are dependent on sex. Eight male and 10 female depressed subjects, meeting DSM III R criteria for a major depressive episode, and eight male and 10 female healthy volunteers had MRI scans on a 1.5 T GE Signa Advantage scanner. The regions of interest included amygdala, hippocampus, inferior anterior cingulate, and OPFC. In all analyses, regional volumes were normalized for total cerebral volume. Volumetric changes in the ROIs showed a significant sex by diagnosis interaction, indicating a different pattern of volumetric changes in depressed males compared with females relative to controls. Relative to sex-matched controls, the left inferior anterior cingulate was smaller in depressed males (23%) compared with depressed females (11%). Depressed females but not depressed males had smaller amygdala compared with controls (F-value = 4.946, p = 0.033). No significant volumetric differences were noted in the hippocampus or OPFC. No volumetric correlations were noted with clinical variables, depression subtypes, or a reported history of sexual or physical abuse. Sex may affect volumetric deficits in amygdala and anterior cingulate cortex in mood disorders, but no effects were found in the hippocampus or OPFC. The biology of mood disorders in females may differ in some aspects from males, and may contribute to the higher rate of depression in women.

Processus psychopathologique, sentiment et syndrome de vulnérabilité

The aim of this paper is to show the interest of taking into account, in the psychological reflection, the feeling of vulnerability met by a patient at the beginning of the psychopathological process. The authors attempt to specify the diverse modalities of the vulnerability, the nature of the predisposition and of its factors, the differences between the deeply lived feeling and the syndrome, revealed into the identitary weakening itself. They examine the way from the feeling to the syndrome of vulnerability, being like a terrifying waiting of a internal disintegration, from extreme situations, intentional or imposed. The clinical approach of psychical weakness of the elderly people and of the inaugural experiences of the schizophrenia (particularly the case of Suzanne Urban), permits to precise the processual nature of the syndrome of vulnerability. It proposes a new reading of some syndromes of acute psychic disorganization.

Conceptual, methodological, and statistical issues in developmental psychopathology: a special issue in honor of Paul E. Meehl.

With the passing of Paul E. Meehl, Regents Professor of Psychology at the University of Minnesota, on February 14, 2003, the world lost one of the most influential clinical psychologists of the 20th century. The breadth of his interests, the preciseness and clarity of his thinking, the elegance of his writing, and his ability to integrate scientific and clinical matters of import were hallmarks of his illustrious career (see, e.g., Meehl, 1954, 1973, 1991). Yet, it is the very magnitude of his professional pursuits that defy categorization or even placement within a single field of inquiry. Whether they pertain to philosophical matters, measurement and psychodiagnostic issues, or elucidating psychopathological processes, Paul Meehl's contributions were seminal and established a base on which scholars could build their own theoretical and research perspectives. Although Paul certainly did not consider himself to be a developmental psychopathologist, his influence can be seen in the theoretical and methodological streams that have nurtured the emergence and growth of the field. Thus, it seems a fitting tribute to Paul that this Special Issue, “Conceptual, Methodological, and Statistical Issues in Developmental Psychopathology,” be dedicated in his honor.

Testing a theory of chronic pain.

Chronic pain is highly prevalent among older people with arthritis, with depression as its major outcome. The psychopathological process of chronic pain and its outcomes in older people with arthritis have not been the subject of extensive research. The purpose of this study was to test a middle-range theory of chronic pain derived from the Roy Adaptation Model, a nursing theory whose validity has not been tested in the context of chronic pain. The study used a convenience sample of 71 older people with arthritis. Two subscales of the Arthritis Impact Measurement Scales were used to measure pain and physical disability. Social support was measured by Part II of the Personal Resource Questionnaire, and the Elderly Daily Stress scale was used to measure daily stress. Participants also completed the 10-item Center for Epidemiological Studies of Depression scale. Univariate analysis, correlation, and path analysis were used to analyse the data. Overall, the data supported the hypothesized model in which pain, disability, social support, age, and gender are predictors of daily stress and daily stress further predicts depression. The direct effects of chronic pain, disability, and social support accounted for 37% of the variance of daily stress, which in turn predicted 35% of the variance of depression. Age and gender had no influence on daily stress. The chi-square index suggested a fit between the data and the model, and therefore the current model is temporarily accepted. Other fit indices also showed a good fit of the model to the data. To simplify the model, a revised version was developed. This study validated a middle-range theory to explain the effects of chronic pain in older people with arthritis and highlights the importance of chronic pain in the development of depression.

Autoradiographic analyses of 5-HT 1A and 5-HT 2A receptors after social isolation in mice

Social isolation of rodents is used to model human psychopathological processes. In the present study, the effects of intermediate and long term isolation housing on postsynaptic 5-HT 1A and 5-HT 2A receptors were analyzed in male mice housed in groups or isolation for 4 and 12 weeks. [ 3H]8-OH-DPAT and [ 3H]ketanserin were used to label 5-HT 1A and 5-HT 2A receptors. Four representative sagittal sections (planes 1–4) were scored by in vitro autoradiography. Whereas after 4 weeks of housing both receptor densities were lowered significantly in isolated mice, after 12 weeks of housing only marginal isolation effects were seen. Intermediate isolation reduced 5-HT 1A receptors especially in the lateral frontal, parietal and entorhinal cortex (−63%), in the lateral CA1–3 and dentate gyrus region of the hippocampus (−68%), in the basolateral, basomedial, central and medial amygdaloid nuclei (between −38 and −66%), and in the hypothalamus (−28%). 5-HT 2A receptors were strongly reduced in the frontal cortex (between −47 and −74%), in the hippocampus (between −47 and −95%), in the striatum (between −66 and −76%), and in the accumbens nucleus (between −59 and −73%) in comparison to group housed control mice. After 12 weeks of isolation in the hippocampus continuously decreased 5-HT 1A receptor densities were demonstrated (between −24 and −61%). But increased 5-HT 2A receptor densities were seen in the lateral striatum (+86%) compared to control mice. Age-dependent effects were also found. After 12 weeks of group housing the 5-HT 1A and 5-HT 2A receptor densities were decreased (between −28 and −54%) in all analyzed brain regions in comparison to 4 weeks of group housing. Isolated animals showed diminished 5-HT 1A receptor densities in the cortex (−14%) and hippocampus (−15%), but increased 5-HT 1A receptor densities in the amygdala (+33%) after 12 weeks. The 5-HT 2A receptor densities were increased in all analyzed regions (between +31 and +96%) after 12 weeks of isolation compared to 4 weeks. To explain these dynamic, time-dependent pattern of isolation-induced changes different regulation processes are supposed regarding 5-HT 1A and 5-HT 2A receptors. Besides metabolism-related adaptation processes also neurotransmitter and hormonal (e.g., glucocorticoid) interactions especially in limbic regions have to be considered.

Parent-child conflict and the comorbidity among childhood externalizing disorders.

Previous research has suggested that substantial comorbidity exists among childhood externalizing disorders, specifically attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). Moreover, parent-child conflict predicts each of these disorders. Our goals were to determine whether parent-child conflict was associated with the comorbidity among ADHD, CD, and ODD, and to explicitly examine the etiology of this association via a genetically informative design. We compared the fit of the following 2 biometric models: the 2-factor common-pathway model, which examined genetic and environmental contributions to the relationship between conflict and the covariation among the 3 disorders, and the Cholesky model, which examined the relationship between conflict and each disorder individually. The sample consisted of 808 same-sex 11-year-old twin pairs from the Minnesota Twin Family Study, a population-based sample of Minnesota twins and their families. Main outcome measures included symptom counts for ADHD, CD, and ODD, obtained from structured interviews administered to twins and their mothers. Parent-child conflict was assessed via mother and twin reports of the Parental Environment Questionnaire. The 2-factor model provided a better fit to the data. These results indicated that conflict accounted for 33% of the covariation among the disorders, via genetic and environmental factors. Parent-child conflict appears to act as a common vulnerability that increases risk for multiple childhood disorders. Furthermore, this association is mediated via common genetic and environmental factors. These findings support the idea that the comorbidity among these disorders partially reflects core psychopathological processes in the family environment that link putatively separate psychiatric disorders.

Les poèmes français de Michel Mitsakis : néologies d’aède ou néologismes de phrénopathe ?

The Greek writer Michel Mitsakis (1863–1916) rapidly became known for the dynamic nature of his work, but also for his most singular behavior. His text on a village idiot and on the psychiatric hospital in Corfu are major literary works. After a first hospitalization for “dementia praecox” in 1896, after that date he hardly ever wrote in his native language. On the contrary, between 1900 and 1911, he wrote several poems in French scribbled in the margins of a volume of the Iliad, or on pieces of paper which he left on journalists’ desks. These poems are of great literary importance. The implication of the psychopathological process in Michel Mitsakis’s work is also of major interest.

Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.

Excessive exercise in anorexia nervosa and bulimia nervosa: relation to eating characteristics and general psychopathology.

Excessive exercise is a well-known phenomenon in anorexia nervosa, but less is known about its role in bulimia nervosa. In addition, there is little evidence regarding the psychopathological processes that might act as predisposing, triggering, or maintaining factors for such exercise. The present study examined the presence of excessive exercise in different women with eating disorders, and its psychopathological correlates. Case notes from 63 anorexia nervosa and 61 bulimia nervosa patients were examined. Two-way multivariate analyses of variance (diagnosis x use of excessive exercise) were used to determine the impact of the two factors upon eating characteristics (EAT-40 and BITE) and psychopathological symptoms (SCL-90-R). While high levels of depression were more likely among all patients who used excessive exercise, levels of anxiety and somatization were particularly high only among those anorexics who exercised excessively. Possible explanatory models are advanced to account for this pattern of findings, focusing on the possible use of exercise as an affect regulation strategy among anorexia nervosa patients. Further research is suggested to test and develop this model, and possible clinical implications are outlined.

Grundsätzliches zur Konzeption einer evolutionären Psychiatrie

Phenomenological, biological and aspects of psychiatric disorders lack an integrative metatheoretical framework. This paper reviews the foundations of evolutionary psychiatry. Many aspects of evolutionary psychiatry are largely based on the fitness theory. Since many biologists argue that the unit of selection is the gene rather than the single organism or a group of organisms, the of inclusive fitness embraces the fitness of an individual plus the fitness of his or her close relatives with whom the individual on average shares a calculable proportion of genes, depending on how close the relationship actually is. Reciprocal altruism, parental investment in relation to sexual selection, and parent-offspring conflict constitute specific problems that guide the evolution of psychological mechanisms and strategies of an organism especially in terms of its behaviour. Such problems have probably contributed to the evolution of the human social brain that developed in the environment of evolutionary adaptedness to solve problems of adaptive significance of ancestral conditions. Despite this seemingly gene-centred view, evolutionary psychiatry may be understood as a metatheory to integrate genetic understanding and causal explanation of psychopathological processes, including neurobiological and psychological findings, because it takes both, the ultimate and the proximate level of evolved cognitive capacities, emotion and behaviour, into account. Many psychiatric disorders may therefore be considered as dysfunctions of the social brain. This could be exemplified by disorders that are characterised by a compromised capacity for inferring the mental states of other individuals, referred to as theory of mind. In real-life situations mental state attribution usually interferes with affective cues which is, for instance, crucial for experience and behaving empathetically. In many severe psychiatric disorders the lack of empathy may therefore at least in part explain why the competence of patients suffering from schizophrenia, for example, is reduced. Although gender-specific differences in prevalence rates and symptomatology of psychiatric disorders are mentioned in the diagnostic manuals of psychiatric disorders to some extent, it is widely underrecognised that some of these differences emerged due to divergent problems of adaptation for men and women. Likewise, some concepts of psychoanalytic such as the Oedipus complex are inconsistent with evolutionary psychiatry. From an evolutionary point of view there is no such conflict between offspring and same-sex parent, however, parents and offspring disagree over the amount of parental investment, e.g. in terms of resource allocation and investment in potential other offspring. Many insights from evolutionary psychology and psychiatry are therefore also therapeutically neglected but may open new opportunities for empirical research.

Experimental psychopathology, clinical science, and practice: An irrelevant or indispensable alliance?

Psychopathology research is the scientific foundation for legitimate and credible forms of clinical practice and the ethical delivery of mental health services. Experimental psychopathology is a subfield of psychopathology research; its aims are to elucidate variables and processes that contribute, either in whole or in part, to the etiology, exacerbation, or maintenance of abnormal behavior. To date, experimental psychopathology has been poorly understood with regard to its identity, aims, history, and relevance for clinical practice. In this article, we critically review and address the role of experimental psychopathology in the contemporary field of clinical science and practice. Overall, we suggest that experimental psychopathology can maintain its important contributions to the field, and perhaps more important, adapt to the current health care context to have an even larger impact on directing conceptual and empirical analyses of core psychopathology processes.

Course, Co-Occurrence, and Longitudinal Associations of Emotional Disturbance and Delinquency from Adolescence to Young Adulthood: A Six-Year Three-Wave Study

Three questions were examined in this study: (a) What is the course of emotional disturbance and delinquency during adolescence and young adulthood? (b) To what extent do emotional disturbance and delinquency co-occur during adolescence and young adulthood? and (c) What are the longitudinal associations between emotional disturbance and delinquency in different age and gender categories during adolescence and young adulthood? Data were used from a national sample of 1,302 adolescents and young adults, who participated in a 6-year 3-wave longitudinal study. Findings showed an increase of emotional disturbance and delinquency from early to midadolescence, after which emotional disturbance stabilized and delinquency declined into young adulthood. A significant but relatively weak co-occurrence of emotional disturbance and delinquency was found. Multigroup LISREL analyses demonstrated that a stability model with no cross-lagged relations fit best for the total sample, and across age and gender categories. Thus, co-occurrence of emotional disturbance and delinquency during adolescence and young adulthood seems to result from associated but separate psychopathological processes. The strong stability of internalizing and externalizing behavior suggests that prevention efforts should be aimed at children and young adolescents.

The structure and stability of common mental disorders: the NEMESIS study.

We analyzed the underlying latent structure of 12-month DSM-III-R diagnoses of 9 common disorders for the general population in the Netherlands. In addition, we sought to establish (1) the stability of the latent structure underlying mental disorders across a 1-year period (structural stability) and (2) the stability of individual differences in mental disorders at the level of the latent dimensions (differential stability). Data were obtained from the first and second measurement of the Netherlands Mental Health Survey and Incidence Study (NEMESIS) (response rate at baseline: 69.7%, n = 7076; 1 year later, 79.4%, n = 5618). Nine common DSM-III-R diagnoses were assessed twice with the Composite International Diagnostic Interview with a time lapse of 1 year. Using structural equation modeling, the number of latent dimensions underlying these diagnoses was determined, and the structural and differential stability were assessed. A 3-dimensional model was established as having the best fit: a first dimension underlying substance use disorders (alcohol dependence, drug dependence); a second dimension for mood disorders (major depression, dysthymia), including generalized anxiety disorder; and a third dimension underlying anxiety disorders (simple phobia, social phobia, agoraphobia, and panic disorder). The structural stability of this model during a 1-year period was substantial, and the differential stability of the 3 latent dimensions was considerable. Our results confirm the 3-dimensional model for 12-month prevalence of mental disorders. Results underline the argument for focusing on core psychopathological processes rather than on their manifestation as distinguished disorders in future population studies on common mental disorders.

L'enfant face à la maladie mentale de ses parents. Impact et traitement en placement familial

Disturbances of the parental function (dysparentality) in mentally ill parents can endanger their children psychically or physically. Separation with admission of the child in a therapeutic foster care center may be decided by the judge, so as to allow a treatment for the child and the parent child relation. In this account of a foster care center practice, we analyze the psychopathological processes distorting the parental function, their impact on the child psychic development and the working through of the object relation during mediatized parent and child encounters supported in a specific way by therapeutic accompaniment.

Animal models for schizophrenia

Over the years a variety of animal models for schizophrenia have been developed. Initially, these models were predominantly pharmacological in nature, based on the effects of drugs used in the treatment of the disease. With increasing knowledge of the disturbances in the schizophrenic brain, and better methodologies to perform research in both patients and animals, animal models with face, predictive and construct validity have been set up. The present paper reviews a number of animal models that have been and still are used to uncover the mechanisms underlying the psychopathological processes leading to schizophrenia.

Polarity of the first episode, clinical characteristics, and course of manic depressive illness: A systematic retrospective investigation of 320 bipolar I patients

In 320 patients with established bipolar I disorder, we examined the past course on the basis of polarity at onset (depressive, mixed, and manic). Despite the obvious limitations of retrospective methodology, information on course parameters in a large sample of affective disorders is most practically obtained by such methodology. We believe that our systematic interview of patients and their relatives-as well as the systematic study of their records-minimized potential biases. Depressive onsets were the most common, accounting for 50%, followed by mixed and manic onsets in about equal proportion. In general, the polarity of episodes over time reflected polarity at onset. Those with depressive onset had significantly higher levels of rapid cycling, as well as suicide attempts, but were significantly less likely to develop psychotic symptoms. Mixed onsets, too, had high rates of suicide attempts, but differed from depressive onsets in having significantly more chronicity yet negligible rates of rapid cycling at follow-up evaluation. Because cases with depressive onset had received significantly higher rates of psychopharmacologic treatment, our data are compatible with the hypothesis that antidepressants may play a role in the induction of rapid cycling. Overall, our data support the existence of distinct longitudinal patterns within bipolar I disorder, which in turn appear correlated with the polarity at onset. In particular, rapid cycling and mixed states emerge as distinct psychopathologic processes.