Structured Clinical Interview For DSM-IV Personality Disorders Research Articles

Age-neutrality of the SCID-II: Differential Item Functioning in Younger Outpatients (Aged 20-45) and Older Outpatients (Aged 65+)

ABSTRACT Objectives Measurements are often developed for the assessment of personality disorders (PDs) in younger adults and seldom evaluated on the applicability in older adults. Remarkably, research has not yet been conducted into age-group appropriateness of the gold standard for the assessment of PDs, known as Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Therefore, the current study empirically investigated the age-neutrality of the PDs assessed by the SCID-II. Methods Age-neutrality was examined in 84 younger adults (aged 20–45 years) and 68 older adults (aged 65–85) by Differential Item Functioning (DIF). The impact of DIF on scale level was further examined using Differential Test Functioning analyzes to examine the impact of the amount of DIF variance in the items on scale level. Results Overall, the great majority, 95.8% of the categorically measured items and 87.5% of the dimensionally measured items, was endorsed in the same way by younger adults and older adults with equal scores on the PD scale. Subsequent analyzes revealed no large DTF for PD scales. Conclusions Overall the SCID-II in an outpatient population is age-neutral for both categorically and dimensionally scored PD scales. Clinical Implications The SCID-II can be used for the assessment of PDs in older adults.

Self- but not other-mentalizing moderates the association between BPD symptoms and somatic complaints in community-dwelling adolescents.

The aim of this study was to evaluate the potential moderator role of poor mentalization in the association between borderline personality disorder (BPD) traits and somatization, specifically focusing on the polarities of self- and other-mentalizing. This is a cross-sectional, general population study evaluating adolescents (n=162, 61.3% female; ages 12-18, M=14.63, SD=1.02). The relationship between BPD traits and somatization was evaluated with self-mentalization (attention to emotions and clarity of emotions) and other-mentalizing as moderator variables. One hundred sixty-two adolescents without serious mental health disorders were evaluated using self-report measures for borderline personality disorder traits (screening questionnaire for the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), somatic symptoms using the Somatic Symptoms Questionnaire (SSQ), self-mentalizing using the Trait Meta-Mood Scale-24 (TMMS) and other-mentalizing using the Adolescent Mentalizing Interview (AMI)). Linear regressions were conducted to test the moderation effects of self- and other-mentalizing in the relationship between BPD symptoms and somatic complaints, controlling for age and sex. Moderation analysis was conducted using PROCESS version 3.5. The association between BPD symptoms and somatic complaints was moderated by a self-mentalizing dimension (emotional clarity) (b=-0.019, 95% CI=-0.0379 to -0.0002, p=.0476), but not other-mentalizing (b=0.027, 95% CI=0.000 to 0.053, p=.051). The effect of BPD symptoms on somatization disappears when emotional clarity is high, regardless the level of attention to emotions. Self-mentalizing appears to be an adaptive skill as it attenuates the relationship between BPD traits and somatization. Specifically, emotional clarity rather than simple attention to emotions is the aspect of self-mentalizing attenuating this association. These results support that self-mentalization is an important function in the management of body-associated emotions even in non-clinical levels of BPD traits. Findings suggest that strengthening self-mentalizing skills across development might contribute to resilience and salutogenesis.

Obsessive\u2013compulsive personality disorder in rapid eye movement sleep behavior disorder

Rapid eye movement sleep behavior disorder (RBD) is a common prodromic non-motor symptom of Parkinson’s disease (PD). Only few studies have evaluated the personality of RBD patients with conflicting results. Aim of the study was to evaluate the frequency of Personality Disorders (PeDs)in RBD. RBD patients, PD patients and healthy controls (HC) were enrolled. All the enrolled subjects underwent a full neurological examination. Motor symptoms were evaluated with the UPDRS-Motor Examination. PeDs were assessed with the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Twenty-nine RBD patients [14 men (48.3%); mean age 55.6 ± 11.1], 30 PD patients [17 men (56.7%); mean age 65.7 ± 10.7] and 30 HC [12 men (40%); mean age 65.7 ± 5.4] were enrolled in the study. PD patients had a disease duration of 4.5 ± 4.6 and presented a mean UPDRS-ME score of 26.7 ± 9.4. The most frequent PeDs was the Obsessive–Compulsive one (OCPeD); OCPeD was significantly more frequent in RBD (55.2%) patients than HC (13.3%; p-value < 0.001). No significant differences were found comparing the frequency of OCPeD in RBD patients to that in PD. In the present study, the prevalence of OCPeD in RBD patients was close to that reported in PD patients. Our data could suggest the existence of a common disease-specific RBD-PD personality profile.

Obsessive-Compulsive Personality Symptoms Predict Poorer Response to Gamma Ventral Capsulotomy for Intractable OCD.

Gamma ventral capsulotomy (GVC) is a radiosurgical procedure which aims to create lesions in the ventral part of the anterior limb of the internal capsule (ALIC). It has been used as a treatment option for patients with intractable obsessive–compulsive disorder (OCD) who do not respond to several first-line treatments attempts. However, changes in personality disorder symptoms after GVC have not been investigated. The aims of this study are to investigate changes in personality disorder symptoms after GVC and to search for baseline personality disorder symptoms that may predict clinical response to GVC. Fourteen treatment-intractable OCD patients who underwent GVC completed the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) at baseline and one year after the procedure. Wilcoxon signed-rank test was performed to investigate personality disorder symptom changes before and after surgery. Linear regression models were utilized to predict treatment response, using baseline personality disorder symptoms as independent variables. We did not observe any quantitative changes in personality disorder symptoms after GVC, compared with baseline. Higher severity of obsessive-compulsive personality disorder symptoms at baseline was correlated with worse treatment response after GVC for OCD (β = −0.085, t-value = −2.52, p-value = 0.027). These findings advocate for the safety of the GVC procedure in this specific population of intractable OCD patients, in terms of personality disorder symptom changes. They also highlight the importance of taking into account the severity of obsessive–compulsive personality disorder symptoms when GVC is indicated for intractable OCD patients.

Significance of personality disorders in the face of drop-outs from psychiatric hospitalizations. The case of selected psychiatric units.

The World Health Organization's estimations indicate that about 50% of patients in well-developed countries may not adhere to long-term therapies. In the field of psychiatry, drop-outs from psychiatric treatment are particularly important. Personality disorders are a significant part of this sphere. The aim of this research was to empirically verify the hypothesis regarding the relation between comorbid personality disorders and drop-outs from treatment among patients of psychiatric wards. This study was a prospective cohort study. 110 patients, hospitalized in 3 different psychiatric wards, were included. Personality disorders were assessed with the Structured Clinical Interview For DSM-IV Personality Disorders (SCID-II). The research was financed by the Polish National Science Center (DEC-2011/01/N/NZ5/05364). The response rate was 89.1%. 72.56% of patients suffered from personality disorders (SCID-II) (among them the most prevalent were: personality disorder - not otherwise specified - 40.7% and borderline personality disorder - 12.38%; 22.95% of patients dropped out from treatment). However, occurrence of personality disorders was not relevant for those drop-outs. On the other hand, relationships at the level of certain criteria of borderline personality disorders and passive-aggressive personality have been revealed. These relationships became stronger when considered from the perspective of differences in the organization of treatment at individual wards. Some personality disorders may play an important role in drop-outs from psychiatric treatment. Presented results require further research.

Addiction severity and comorbidity among women with alcohol use disorders: A hospital-based study from India.

To examine the addiction severity, comorbid psychiatric disorder and their temporal relationship among women seeking treatment for Alcohol Use Disorders (AUDs). The sample comprised of 35 women with AUDs, with or without psychiatric disorders, recruited from the outpatient and inpatient settings of a tertiary-care hospital. Their mean age was 38.51 years (S.D=7.42). Patients were assessed using Clinical Data Sheet (CDS), Mini-International Neuropsychiatric Interview (MINI), Structured Clinical Interview for DSM-IV Personality disorders (SCIDII), Addiction Severity Index (ASI)-Alcohol subscale and Fagerstrom Test for Nicotine Dependence (FTND). Findings of the study indicated that on average patients initiated alcohol use in their early twenties and developed dependence by the age of 29.66 years (S.D=7.60). The average duration of alcohol dependence was less than a decade before seeking treatment. The mean composite score on ASI was 0.71 (S.D=0.18) and on FTND was 5.16 (S.D=2.59), indicating a high level of alcohol and moderate level of nicotine dependence respectively. On MINI, 57.14% of the patients met the criteria for co-occurring Axis I psychiatric disorders such as major depression disorder and dysthymia. In the majority of the cases, comorbid Axis I disorders were secondary to AUDs. On SCID-II, 17% met the criteria for borderline personality disorder. Examining and understanding the substance use and clinical profile of patients with AUDs are crucial for planning intensity, settings and focus of treatment for women with AUDs.

Reliability and validity of a Chinese version of the Diagnostic Interview for Borderlines-Revised.

Borderline personality disorder (BPD) is the most studied of the axis II disorders. One of the most widely used diagnostic instruments is the Diagnostic Interview for Borderline Patients-Revised (DIB-R). The aim of this study was to test the reliability and validity of DIB-R for use in the Chinese culture. The reliability and validity of the DIB-R Chinese version were assessed in a sample of 236 outpatients with a probable BPD diagnosis. The Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) was used as a standard. Test-retest reliability was tested six months later with 20 patients, and inter-rater reliability was tested on 32 patients. The Chinese version of the DIB-R showed good internal global consistency (Cronbach's α of 0.916), good test-retest reliability (Pearson correlation of 0.704), good inter-rater reliability (intra-class correlation coefficient of 0.892 and kappa of 0.861). When compared with the DSM-IV diagnosis as measured by the SCID-II, the DIB-R showed relatively good sensitivity (0.768) and specificity (0.891) at the cutoff of 7, moderate diagnostic convergence (kappa of 0.631), as well as good discriminating validity. The Chinese version of the DIB-R has good psychometric properties, which renders it a valuable method for examining the presence, the severity, and component phenotypes of BPD in Chinese samples.

高校学生人格障碍问题的分布和特点&lt;br&gt;The Distributing and Characteristic of Students’ Personality Disorder Problems in an University

目的：深入了解高校学生群体中人格障碍问题的分布和特点。方法：采用人格障碍诊断问卷(PDQ-4+)对3552名高校学生(包括大学生和研究生)进行人格障碍筛查，并用人格障碍临床定式检测(SCID-II)对该群体中的边缘型人格障碍进行诊断。结果：1) 本科生PDQ-4+各分量表得分显著高于研究生(分裂性除外)；2) 男生在偏执型、分裂型、自恋型、反社会型、强迫型、被动攻击型上得分显著高于女生，在依赖型、回避型和边缘型三项上显著低于女生；3) 强迫型和边缘型在95的百分位上明显高于原量表划界分；4) 按原划分标准，强迫型阳性率最高，回避型、表演型、自恋型、边缘型等依次之，分裂性阳性率最低；5) 高校学生样本中边缘型人格障碍(BPD)的患病率大约为1.74%。结论：PDQ-4+高校样本在一些项目上存在性别和文理科的差异；PDQ-4+原划分标准不适合高校学生样本，建议在实际工作中采用新的划界分。 Objective: To achieve an in-depth knowledge of personality disorders prevalence features in the university students groups. Methods: Personality Diagnostic Questionnaire-4 + (PDQ-4+) was administered to a sample consisting of 3552 university students (including postgraduate and undergraduate) to investigate personality disorder (PD) subjects, and BPD subjects were diagnosed by Structured Clinical Interview for DSM-IV personality disorders (SCID-II). Results: 1) The undergraduates showed significantly higher than graduate students in the subscales for different types of PD (excluding schizoid) of PDQ-4+; 2) The males showed significantly higher than females in subtypes of paranoid, schizotypal, antisocial, narcissistic, compulsive-obsessive and passive-aggressive, and lower in subtypes of avoidant, borderline and dependent; 3) The results of Percentile showed that the scores of compulsive-obsessive and borderline were significantly higher at the point of 95% than cut-off scores of PDQ-4+; 4) According to the original classification, the positive rate of compulsive-obsessive was the highest, avoidant, histrionic, narcissistic, borderline followed, and schizotypal was the lowest; 5) The prevalence of BPD was 1.74% in the university students groups. Conclusion: There were differences in gender and art & science on some terms of PDQ-4+; the original classification of PDQ-4+ is not suitable for university students, it needs to be adapted when applied.

Mentalization and autobiographical memory as clinical components of the self and identity

Psychoanalysts have suggested that a mentalization process is required for the transformation of drives and affects into mental representations of self and others. Meanwhile, neuroscientists suggest that episodic memory, through autonoetic consciousness, is crucially involved in the elaboration of the Self and subjective experience. This research empirically investigates the relationship between the quality of mentalization and the efficacy of autobiographical recall, and considers childhood trauma and psychopathology as possible related factors. Thirty participants presenting with either high or low mentalization profiles according to the Mental States Rating Systems (MSRS) were submitted to the TEMPau, a semi-structured interview designed to assess the quality of autobiographical recall from several criteria (episodicity, self-perspective and consciousness). Childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). The Symptom Checklist (SCL- 90-R) and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) were used to assess global symptomatology and Axis-II disorders respectively. As expected, levels of mentalization are related to higher levels of childhood abuse (emotional, physical and sexual) and symptomatology (SCL-90-R Global Severity Index). However, contrary to our expectation, better autobiographical memory is associated with poor mentalization profiles, although spontaneity of recall is less efficient in those subjects. No significant relation was found between Axis-II disorders and traits, and other clinical variables.

2758 – Personality and treatment dropout in depressed outpatients

Introduction Premature termination is common among patients treated for depression with either pharmacotherapy or psychotherapy. Yet little is known about factors associated with premature treatment termination among depressed patients. In other hand, there is conflicting evidence about the influence of personality disorder on outcome in depressive disorders. Aims The present study assesses whether personality may predict the dropout of a psychotherapy group for patients with depressive disorder. Methods A personality disorders (PDs) self-report questionnaire based on the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) was completed by 39 depressed outpatients. All patients attended a group-based CBT program for depression consisted of 10 weekly 90 minutes sessions. Patients were categorized in groups as completers vs. dropouts. Dropout was defined as attendance at less than 7 sessions. Differences between groups were tested using Student's t -test and in order to measure the specific contribution of personality on dropout a logistic regression analyses were performed. Results Comparing treatment completers (67%) vs. dropouts (33%), groups differed significantly on number of items in schizotypal, narcissistic and borderline PDs. The dropout group scored significantly higher on these PDs than the completer group. Scores on borderline personality disorder emerged as a significant predictor of dropout. Conclusions Depressed outpatients with comorbid borderline traits are at higher risk of premature termination and may require modified treatment strategies.

Personality disorders, common mental disorders and receipt of disability benefits: evidence from the British National Survey of Psychiatric Morbidity

Common mental disorders (CMDs) are associated with occupational impairment and the receipt of disability benefits (DBs). Little is known about the relationship between personality disorders (PDs) and work disability, and whether the association between CMDs and work disability is affected by the presence of co-morbid PDs. The aim of this study was to examine the association between DB and individual categories of PDs, with special attention to the effect of co-morbid CMDs on this association. The association between DB and PD was examined using data from the 2000 British National Survey of Psychiatric Morbidity. Probable PD caseness was identified using the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) screening questionnaire. The impact of CMDs, assessed with the revised version of the Clinical Interview Schedule (CIS-R), was examined as a covariate and in a stratified analysis of co-morbidity. Other covariates included sociodemographic factors, long-standing illnesses and substance use. Probable PD was associated with DB, with the strongest associations found for borderline, dependent and schizotypal PD. Antisocial PD was not associated with DB. The relationship between PD and DB was strongly modified by CMD, reducing the association from an odds ratio (OR) of 2.84 to 1.34 [95% confidence interval (CI) 1.00-1.79)]. In the stratified analysis, co-morbid PD and CMD showed a stronger association with DB than PD without CMD but, when fully adjusted, this effect was not significantly different from the association between CMD without PD. Individuals screening positive for PD are more likely to experience severe occupational outcomes, especially in the presence of co-morbid CMD.

Axis I and II psychiatric disorders in patients with traumatic brain injury: A 12-month follow-up study

Objective: To evaluate the occurrence of axis I and II psychiatric disorders among patients with traumatic brain injury (TBI).Design: Prospective observational study. Forty-five adult patients, who had attended an emergency unit because of TBI, were recruited. At 12 months, 38 patients were interviewed.Measures: Psychiatric disorders were evaluated using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II).Results: Before TBI, the 12-month rate of axis I psychiatric disorders was relatively high (39.5%) and the rate of alcohol dependence was especially elevated (18.4%). During the 12 months after TBI, axis I disorders were found in 47.4% of subjects. Six patients (15.8%) were found to have a disorder with an onset after TBI. Of these, five patients had depressive disorders (13.2%). Almost one third of the subjects (29.0%) had personality disorders. Antisocial and obsessive-compulsive personality disorders were the most frequent (10.5%).Conclusions: Both axis I and II psychiatric disorders are common among patients with TBI. Alcohol dependence and personality disorders are prevalent in individuals prone to TBI, whereas depressive disorders typically develop after injury. Psychiatric disorders should be addressed in rehabilitation, as otherwise they will hinder the recovery after TBI.

Screening for personality disorder in probationers: Validation of the Standardised Assessment of Personality—Abbreviated Scale (SAPAS)

ABSTRACTPersonality disorder (PD) is an important indicator of future recidivism, and a brief assessment of PD would be of great value to those working in the criminal justice system. There is insufficient research on PD among probation populations. We examined the concurrent validity of a mini‐interview for PD, the Standardised Assessment of Personality—Abbreviated Scale (SAPAS), by comparing its performance with that of the Structured Clinical Interview for DSM‐IV Personality Disorders (SCID‐II) in a sample of 40 individuals on probation in Lincolnshire, UK. The SCID‐II identified 30/40 (75%) of the sample as having a PD. The most common category was antisocial PD, for which 20/40 (50%) were positive. A cut score of 3 on the SAPAS produced a good balance of sensitivity (0.73) and specificity (0.9) for case identification. We conclude that the SAPAS is a valid screening tool for PD among those on probation and is of potential value to those working in the criminal justice system. Copyright © 2011 John Wiley &amp; Sons, Ltd.

The Impact of ADHD and Autism Spectrum Disorders on Temperament, Character, and Personality Development

Objective:The authors describe personality development and disorders in relation to symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders. Method:Consecutive adults referred for neuropsychiatric investigation (N=240) were assessed for current and lifetime ADHD and autism spectrum disorders and completed the Temperament and Character Inventory. In a subgroup of subjects (N=174), presence of axis II personality disorders was also assessed with the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Results:Patients with ADHD reported high novelty seeking and high harm avoidance. Patients with autism spectrum disorders reported low novelty seeking, low reward dependence, and high harm avoidance. Character scores (self-directedness and cooperativeness) were extremely low among subjects with neuropsychiatric disorders, indicating a high overall prevalence of personality disorders, which was confirmed with the SCID-II. Cluster B personality disorders wer...

Diagnostic efficiency among psychiatric outpatients of a self-report version of a subset of screen items of the Structured Clinical Interview for DSM–IV–TR Personality Disorders (SCID-II).

This article describes the identification of a 10-item set of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) items, which proved to be effective as a self-report assessment instrument in screening personality disorders. The item selection was based on the retrospective analyses of 495 SCID-II interviews. The psychometric properties were studied in a prospective validation study in a random sample of Dutch adult psychiatric outpatients, using the SCID-II interview as the gold standard. First, all patients completed the short questionnaire. One week later, they were interviewed with the full SCID-II. After another week, the short questionnaire was readministered. According to the scores obtained with the full SCID-II, 97 patients (50%) had a personality disorder. The set of 10 SCID-II items correctly classified 78% of all participants. The sensitivity, specificity, and positive and negative power were 0.78, 0.78, 0.78, and 0.78, respectively. The results based on the retrospectively obtained data were rather similar to those obtained in the prospective validation study. Therefore, it is concluded that the set of 10 SCID-II items can be useful as a quick self-report personality disorder screen in a population of psychiatric outpatients.

Persönlichkeitsstörungen bei jugendlichen Patientinnen mit Anorexia und Bulimia nervosa

The present study aimed to ascertain the occurrence of personality disorders (PD) in adolescent patients with anorexia (AN) and bulimia nervosa (BN) by means of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). 99 female adolescent patients (57 AN - restrictive type, 17 AN - binge-purging type, 25 BN; M(age) = 16.3 +/- 1.6) were consecutively assessed by means of SCID-II. Furthermore, the influence of age, axis-I-comorbidities, and type of treatment according to PD were examined. 30.3% of the patients met the criteria for PD according to SCID-II. AN patients of the binge-purging type showed higher prevalences of PD and higher dimensional scores than the other eating disorder groups. Moreover, our findings indicate that age and axis-I-comorbidities are associated with the development of PD. Significant differences in the occurrence of PD in the three eating disorder groups were found. Patients of the AN binge-purging type are more often affected than restricting AN or BN patients are. This, and also the influence of age and axis-I-comorbidities, should be taken into account in the treatment of patients with eating disorders.

The Danish DAPP-BQ: Reliability, Factor Structure, and Convergence With SCID-II and IIP-C

The psychometric properties of the Danish version of the Dimensional Assessment of Personality Pathology-Basic questionnaire (DAPP-BQ) were assessed in both a clinical (N = 76) and a nonclinical sample (N = 168). Internal consistencies of all scales were adequate in both samples. The four factors labeled Emotional Dysregulation (ED), Dissocial behavior (DB), Inhibition (IH), and Compulsivity (CO) were fully replicated in the clinical sample but only partially replicated in the nonclinical sample. Congruency coefficients between samples ranged from .98 to .80. Convergent validity of the DAPP-BQ was tested by correlation analysis with the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) and Inventory of Interpersonal Problems-Circumplex (IPP-C) scores. Relationship to the SCID-II was largely as predicted and in accordance with previous research. Correlations between DAPP-BQ higher order dimensions and IPP-C were also largely as hypothesized but also called attention to important conceptual issues including the fact that the higher-order term Emotional Dysregulation may not be an adequate label for a domain of behaviors that are highly interpersonal. Overall, the results indicate a successful translation of the DAPP-BQ and the strong association with interpersonal problems is regarded as an additional support for the content validity of the model.

Persönlichkeitsentwicklung im Kindes- und Jugendalter

The diagnosis of a personality disorder is defined by the fact that personality traits are formed by early childhood, but German clinicians very rarely diagnose children and adolescents with personality disorders. Opponents of diagnosing personality disorders in childhood want to avoid labeling and refer to the developmental aspect of the personality. Supporters argue that children and adolescents already possess a describable personality and the developmental process continues into adulthood. By recognizing the pathological personality tendencies early enough allows an early therapy which can prevent an acute progression. The aim of the present study was to ascertain whether the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) is applicable for use with adolescents. This empirical study indicated that one-third of the adolescents investigated were still diagnosed with a personality disorder 1 year after the primary assessment. However, the present categorizing diagnosis system proved to be insensible for childhood and adolescence. This supports the notion that dimensional systems are needed to diagnose personality traits in childhood in adolescence.

Phenomenology of Obsessive Compulsive Disorder in Patients with Temporal Lobe Epilepsy or Tourette Syndrome

Phenomenology of Obsessive Compulsive Disorder in Patients with Temporal Lobe Epilepsy or Tourette Syndrome

Phenomenology of Obsessive Compulsive Disorder in Patients with Temporal Lobe Epilepsy or Tourette Syndrome

Phenomenology of comorbid obsessive-compulsive disorder was compared in nine patients with temporal lobe epilepsy and 15 with Tourette syndrome. Content of obsessive-compulsive themes focuses on sexuality and impulsiveness in Tourette syndrome and existential thoughts in temporal lobe epilepsy.