Individual and family correlates for cigarette smoking among Taiwanese college students

Objective

This college-based questionnaire survey aimed to explore the individual, family, and peer correlates for cigarette smoking among first-year college students.

Method

The sample included 2918 first-year college students (males, 45.5%) recruited from a national university in Taiwan (participation rate, 79.1%). The participants reported on questions about various substances, attitudes toward substances, personality characteristics, psychopathology, suicidal behaviors, parenting style, family function and use of substances, and peer substance use.

Results

There were 263 (9.0%; males, 70.6%) current smokers. Compared to nonsmokers, college smokers were more extraverted and neurotic, and showed less harm avoidance, and more novelty seeking in their personality. They had more hostile, somatic, depressive, paranoid, and psychotic symptoms in terms of psychopathology. Smokers were more likely to use other substances, and to have suicidal ideations, wishes, plans, and attempts. Smokers perceived lower family cohesion, less care from their fathers, and less overprotection from their mothers. They were more likely to have peers and family members who also smoked or used other substances. The most associated correlates were male sex, older age, other substance use, novelty seeking, suicidal ideation and attempts, sibling and peer substance use, a prosubstance attitude, and less maternal overprotection.

Conclusions

Our findings support the association of cigarette use in Taiwanese young adults with several individual, family, and peer factors identified in Western studies. Intervention in cigarette use should be multifaceted, by taking its correlates and the concurrent psychopathology, use of substances, and suicidality into consideration.     

Body image dissatisfaction as an important contributor to suicidal ideation in Korean adolescents: Gender difference and mediation of parent and peer relationships

Objectives

This study was to examine not only the contribution of body image dissatisfaction to suicidal ideation, according to gender, but the mediating role of parent and peer relationships on the association between body image dissatisfaction and suicidal ideation.

Methods

Data from the 2004 Korean Education and Employment Panel, a school-based survey administered to a nationally representative sample of Korean adolescents, are used in the study. With the exception of participants with missing data on important questions (suicidal ideation, self-evaluated body image, self-reported weight/height, risk factors related to suicide), information from 5426 students (2896 males and 2530 females) in grades 9 and 12 was separately analyzed along gender lines using multivariate logistic regression.

Results

In both genders, body image dissatisfaction contributed to suicidal ideation, after controlling for covariates (i.e., school type, perceived family economic hardship, parent-related negative life events, delinquent behaviors, unhealthy behaviors, and self-efficacy). Such association existed throughout all body mass index ranges, and underweight males and normal females were most vulnerable to suicidal ideation if they are dissatisfied with their bodies. Parent and peer relationships partially mediated the association between body image dissatisfaction and suicidal ideation in both genders, but these effects were very small.

Conclusions

How adolescents evaluate their body image may be an important indicator of suicidal ideation. Future research should further test the link between body dissatisfaction and suicidal ideation, even after controlling for other important forms of psychopathology known to be associated with these issues.     

German validation of the Conners Adult ADHD Rating Scales-self-report (CAARS-S) I: Factor structure and normative data

Background

Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood. Instruments for diagnosing ADHD in childhood are well validated and reliable, but diagnosis of ADHD in adults remains problematic. Attempts have been made to develop criteria specific for adult ADHD, resulting in the development of self-report and observer-rated questionnaires. To date, the Conners Adult ADHD Rating Scales (CAARS) are the international standard for questionnaire assessment of ADHD. The current study evaluates a German version of the CAARS self-report (CAARS-S).

Methods

Eight hundred and fifty healthy German control subjects were recruited to fill out the CAARS-S and to answer questions on sociodemographic variables. Explorative and confirmative factor analyses were conducted to obtain the factor structure for the German model and to replicate the factor structure of the original American model. Analyses on gender, age, and education level were calculated for normative data.

Results

The explorative factor analysis of the German sample results in a six-factor solution that explained 52% of the variance. A confirmative analysis that was based on the 42 items of the original American model showed a high model-fit. Analyses of normative data showed significant influences of age, gender, and education level on the emerging subscales.

Conclusion

Even though the explorative factor analysis yields a solution different from the American original, the confirmative factor analysis results in such a high model-fit that use of the American version is justified with respect to international multicenter studies, for which this instrument will be highly valuable.     

Axis I comorbidity and psychopathologic correlates of autodestructive syndromes

Objective

Nonsuicidal deliberate self-harm and factitious disorders have been proposed as subtypes within the autodestructive behavior spectrum, basically differing in the issue of concealment. Aims are to determine Axis I diagnoses and psychopathologic correlates of open self-harmers and patients diagnosed with factitious disorders.

Methods

One hundred ninety-four psychosomatic medicine inpatients participated. Assessment included the structured World Health Organization Composite International Diagnostic Interview (computerized version) and self-report questionnaires for anxiety, depression, perceived stress, and personal coping resources.

Results

Thirty-seven patients identified with self-destructive behavior were matched with 37 patients without such behavior. Overt self-harmers (n = 18) were more frequently diagnosed with anxiety, depressive, substance abuse/dependence, or eating disorders and reported more stress than factitious disorder patients (n = 19) or those without self-destructive behavior. Patients with factitious disorder exhibited lower Axis I comorbidity and less psychopathology than patients without self-harm behavior.

Conclusions

Regarding psychopathologic assessment, contrary to open self-harmers, factitious disorder patients appear strikingly inconspicuous.     

Sociodemographic predictors of transitions across stages of alcohol use, disorders, and remission in the National Comorbidity Survey Replication

Background

Although much is known about risk factors for the initiation of alcohol use, abuse, and dependence, few population-based studies have examined the predictors of transitions across these stages.

Aim

The aim of this study is to examine the sociodemographic predictors of transitions across 6 stages of alcohol use in the National Comorbidity Survey Replication, a nationally representative household survey of the US population.

Methods

A lifetime history of alcohol use, regular use (at least 12 drinks in a year), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol abuse and dependence with abuse was collected in 5692 National Comorbidity Survey Replication respondents using the World Health Organization Composite International Diagnostic Interview, Version 3.0.

Results

Lifetime prevalence estimates were 91.7% for lifetime alcohol use, 72.9% for regular use, 13.2% for abuse, and 5.4% for dependence with abuse. Male sex, young age, non-Hispanic white race/ethnicity, low education, student status, and never being married predicted the onset of alcohol use, the transition from use to regular use, and from regular use to abuse. An early age of onset of alcohol use also predicted the latter transition. The transition from abuse to dependence was associated with an early age of onset of regular alcohol use, being previously married, and student status. Remission was predicted by young age and a later age of onset of alcohol abuse.

Conclusion

The reduced number and magnitude of factors associated with transitions to dependence and remission suggest qualitatively different risk factors at these stages relative to other stages of progression. Further knowledge is needed concerning the mechanisms underlying these differences to guide selective and indicated prevention programs.     

Executive control in chronic schizophrenia: A perspective from manual stimulus-response compatibility task performance

Background

Antisaccade deficits are a well-documented pathophysiological characteristic in schizophrenia. However, it is yet unclear whether these findings reflect a specific oculomotor deficit, general psychomotor impairment or disturbance in executive control mechanisms.

Methods

Performance in a manual stimulus-response compatibility (SRC) task and a neuropsychological test-battery covering different cognitive and motor domains were obtained in 28 patients with chronic schizophrenia. It was compared with a normative cohort of healthy subjects and validated by comparison with a sub-sample of that cohort consisting of 28 age, gender and education matched controls.

Results

Patients showed significantly worse performance than controls in tests requiring maintenance or manipulating of multiple components but were unimpaired in simple motor, memory or executive tasks. In the SRC task patients had a significantly worse performance in the congruent condition and also a significantly higher increase in error rate from the congruent to the incongruent condition. There were, however, neither a group difference nor a group-by-condition interaction with respect to reaction times.

Interpretation

: Our results provide evidence against an isolated oculomotor deficit but also against an undifferentiated psychomotor dysfunction in chronic schizophrenia. Rather, in synopsis with previous reports on antisaccade performance, it becomes evident that the degree of impairment follows closely the amount of executive control required in a task, which in turn may relate to dysfunctional top-down bias of the prefrontal cortex arising from unstable task instructions.     

Genetics for understanding and predicting clinical progression in multiple sclerosis

Introduction

Multiple sclerosis (MS) is a dys-immune disease of the central nervous system with highly variable and unpredictable long-term outcome.

State of the art

In the early 1970s association between HLA alleles and MS was established. Very recently, the power of Genome Wide Association Studies (GWAS) enabled the identification of several loci involved in immune functions as genetic risk factors in MS. Recent data suggest that common genetic variations might modulate the clinical phenotype of MS through a regulation of key pathophysiological pathways.

Perspectives

Identification of modifier genes might offer an opportunity to explore new relevant therapeutic targets and early prognostic markers. To date, studies of modifier genes in MS are numerous but results are still unclear. This research field may now benefit from large cohorts of patients available for association studies.

Conclusion

In this context, we propose a review of epidemiological and association studies of genetic modifying effect in MS.     

Relations of internalized stigma with temperament and character in patients with schizophrenia

Objective

The aim of the study was to assess the associations between self-stigma and temperament and character dimensions.

Methods

One hundred twenty outpatients with diagnosis of schizophrenia, established with Mini International Neuropsychiatric Interview were consecutively included in the study. Self-stigma was assessed with Internalized Stigma of Mental Illness (ISMI), personality dimensions with Temperament and Character Inventory, and psychopathology with Positive and Negative Symptom Scale.

Results

The results showed that higher level of harm avoidance, lower self-directedness, and persistence correlated with ISMI and all its subscales. Self-transcendence correlated with ISMI subscales alienation, discrimination, and stigma resistance. Regression analyses controlling for psychopathology, age, length of illness, and number of hospitalizations revealed that higher level of harm avoidance and low self-directedness predicted internalized stigma.

Conclusion

The finding suggests that the experience of self-stigma is related to personality dimensions. Interpretations of these findings include the possibility that, irrespective of patients' psychopathology or functional characteristics, experience of self-stigma and its consequences might depend on personality dimensions. Further studies are needed.     

The epidemiology of major depression and ethnicity in the United States

Objectives

To determine the prevalence, age of onset, severity, associated disability, and treatment of major depression among United States ethnic groups, national survey data were analyzed.

Methods

National probability samples of US household residents aged 18-years and older (n = 14,710) participated. The main outcomes were past-year and lifetime major depression (World Mental Health Composite International Diagnostic Interview). Major depression prevalence estimates, age of onset, severity, associated disability, and disaggregated treatment use (pharmacotherapy and psychotherapy) and treatment guideline concordant use were examined by ethnicity.

Results

The prevalence of major depression was higher among US-born ethnic groups compared to foreign-born groups, but not among older adults. African Americans and Mexicans had significantly higher depression chronicity and significantly lower depression care use and guideline concordant use than Whites.

Discussion

We provide concise and detailed guidance for better understanding the distribution of major depression and related mental healthcare inequalities and related morbidity. Inequalities in depression care primarily affecting Mexican Americans and African Americans may relate to excesses in major depression disease burden.     

Gender differences in trait aggression in young adults with drug and alcohol dependence compared to the general population

Objective

Data in gender differences in aggression among alcohol and drug dependent subjects are lacking, and no published data are available about gender differences among various subtypes of substance using populations. The goal of this cross-sectional study was to investigate gender differences with regard to types of trait aggression in substance dependent young populations (age: 20-35 years) compared to the general population.

Methods

Subjects were selected from two clinical samples with a diagnosis of alcohol and drug dependence as well as from a representative sample of the general population. Trait aggression was measured by the four individual subscales of the Buss Perry Aggression Questionnaire (physical-PA, verbal aggression-VA, hostility-H and anger AN) whereas alcohol and drug use were characterized by the AUDIT and EuroADAD scales, respectively.

Results

Alcohol and drug dependent subjects showed higher severity on all four subscales of trait aggression compared to the general population. The male-female difference was the highest in the cannabis group. General Linear Model analysis for PA indicated a significant main effect of gender (higher PA for males, p = 0.034) with no interaction between substance dependence and gender. For VA, no main effect or interaction for gender was found. Effect sizes for gender difference indicated that while males and females were similar in the control group in the severity in H and A, the level of H and AN was substantially higher in females than in males in the clinical group. These differences between the two genders reached statistical significance in the marijuana group, where female subjects showed a significantly higher severity in these two domains.

Conclusions

Compared to the normal sample chronic substance use is associated with higher scores on certain factors of trait aggression, including hostility and anger, in females than in males. Our data suggest that aggression in substance dependent females is more provocable by chronic use of alcohol and drugs than in males.     

Parental eating disorder symptoms and observations of mealtime interactions with children

Objective

To examine relationships between parental eating disorder symptomatology and observed feeding interactions with children.

Method

Twenty-three mother-father pairs of children between 18 months and 5 years completed a self-report measure of eating disorders and were observed during a family mealtime.

Results

Parental reports of eating disorder symptoms were related to observations of greater pressurizing by both parents, maternal restriction of children's food intake and use of incentives to eat, more mouthfuls of food eaten by the child, and less food refusal.

Discussion

Observed controlling feeding practices are related to symptoms of eating disorders in nonclinical groups of mothers and fathers, highlighting one mechanism by which eating distress may be transmitted within families.     

Pioglitazone inhibits platelet function and potentiates the effects of aspirin: a prospective observation study

Background

Thiazolidinediones (TZDs) are agonists of PPARγ and exert beneficial metabolic effects in patients with diabetes. They may also affect platelet function.

Objectives

To characterize potential platelet inhibitory effect of pioglitazone alone and in the presence of aspirin.

Methods

20 normal and 20 diabetic subjects were enrolled in a prospective study. On day 1, a blood sample was obtained at baseline and a second one after ingestion of 30 mg of pioglitazone. PRP was prepared and platelet aggregation and release were evaluated using ADP, collagen and arachidonic acid as agonists. Subjects returned at 6-9 days later after ingesting a single 81 mg dose of aspirin and a third blood sample was obtained. The subjects then again ingested 30 mg of pioglitazone and a fourth and final blood sample was obtained. Platelet aggregation and release were measured. PRP was incubated with thrombin to activate platelets, and the serum was separated and assayed for thromboxane B2, TGFβ and CD40L

Results

Pioglitazone alone did not affect aggregation with arachidonic acid. However, following ingestion of both aspirin and pioglitazone aggregation was significantly decreased compared to aspirin alone (P < 0.0001). Pioglitazone also potentiated aspirin-induced inhibition of ATP release using either arachidonic acid or collagen. Following pioglitazone alone, TXB₂ release was 32,719 ± 3,585 pg/ml which was significantly reduced compared to baseline (42,075 ± 4,479, P = 0.0004). Pioglitazone also potentiated the inhibition of TXB₂ release by aspirin.

Conclusion

Pioglitazone inhibits platelet function and potentiates the inhibitory effects of aspirin.     

Aggression and psychopharmacological treatments in major psychosis and personality disorders during hospitalisation

Background

A number of large-scale studies have shown that there is a relationship between many psychiatric disorders and aggression or violence. As no medication is currently approved for the treatment of aggression, pharmacotherapy (often involving drug combinations) is used on a trial-and-error basis with various degrees of response.

Method

The study involved 244 in-patients aged 19-83 years (mean 41.9 ± 11.3 SD). The Modified Overt Aggression Scale (MOAS) was used to assess any aggressive or violent behaviors occurring in the week before admission and upon discharge.Psychopathology was assessed using the Brief Psychiatric Rating Scales (BPRS).

Results

All of the patients showed a significant improvement (p < 0.001) in mean weighted total MOAS scores at the end of the study, with no significant differences between the various drugs or combination therapies. The patients who received combination treatments including antidepressants showed a worsening in the weighted total MOAS score (18.46% ± 114.31% SD); the patients who did not receive antidepressants had an improvement (13.61% ± 257.36% SD) (p = 0.0069).

Conclusions

Multivariate testing of the variables age, gender, substance/alcohol abuse, the duration of hospitalisation, the administration of mood stabilisers, and the use of typical or atipical antipsychotics showed that the severity of the psychopathological picture correlated significantly with the presence of violence, whereas the effect of combined antidepressant treatment on violent behavior was only relative.     

The influence of television and video game use on attention and school problems: a multivariate analysis with other risk factors controlled

Background

Research on youth mental health has increasingly indicated the importance of multivariate analyses of multiple risk factors for negative outcomes. Television and video game use have often been posited as potential contributors to attention problems, but previous studies have not always been well-controlled or used well-validated outcome measures. The current study examines the multivariate nature of risk factors for attention problems symptomatic of attention deficit hyperactivity disorder and poor school performance.

Method

A predominantly Hispanic population of 603 children (ages 10-14) and their parents/guardians responded to multiple behavioral measures. Outcome measures included parent and child reported attention problem behaviors on the Child Behavior Checklist (CBCL) as well as poor school performance as measured by grade point average (GPA).

Results

Results found that internal factors such as male gender, antisocial traits, family environment and anxiety best predicted attention problems. School performance was best predicted by family income. Television and video game use, whether total time spent using, or exposure to violent content specifically, did not predict attention problems or GPA.

Interpretation

Television and video game use do not appear to be significant predictors of childhood attention problems. Intervention and prevention efforts may be better spent on other risk factors.     

Early retirement from work among employees with a diagnosis of personality disorder compared to anxiety and depressive disorders

Objective

Risk of retirement from work before statutory retirement age among employees with personality disorders is unknown.

Method

We used diagnoses of awarded medical rehabilitations and hospitalisations to select two clinical cohorts from a population of 151,618 employees: participants in rehabilitation (total N = 1942, 233 personality disorder, 419 anxiety disorder and 1290 depression cases) and hospitalised patients (N = 1333, 354, 126 and 853, respectively). Early retirement from work was tracked through national registers during a period of 5 years. Cox proportional hazard models were used to examine the association of diagnostic groups with risk of early retirement.

Results

In models adjusted for age, sex and socioeconomic position, the relative risk of early retirement for patients with personality disorders was 3.5-fold (95% CI 2.1 to 5.8) in the rehabilitation cohort and 2.3-fold (95% CI 1.6 to 3.5) in the hospital cohort compared with anxiety disorders. The corresponding hazard ratios of early retirement for personality disorders compared with depressive disorders were 1.1 (95% CI 0.8-1.5) and 1.7 (95% CI 1.4-2.1), respectively.

Conclusions

Personality disorders increase the risk of early retirement at least to an equal extent as depression and more than twice that of anxiety disorders.     

Predictors of persistent ADHD: An 11-year follow-up study

Objective

Despite the existence of several follow-up studies of children with ADHD followed up into adulthood, there is limited information on whether patterns of persistence and remission in ADHD can be predicted over the long term. The main aim of this study was to evaluate predictors of persistence of ADHD in a large sample of boys with and without ADHD followed prospectively for 11 years into young adulthood.

Method

Subjects were Caucasian, non-Hispanic boys with (N = 110) and without (N = 105) ADHD who were 6-17 years old at the baseline assessment (mean age 11 years) and 15 to 31 years old at the follow-up assessment (mean age 22 years). Subjects were comprehensively and blindly assessed with structured diagnostic interviews and assessments of cognitive, social, school, and family functioning.

Results

At the 11-year follow-up, 78% of children with ADHD continued to have a full (35%) or a partial persistence (subsyndromal (22%), impaired functioning (15%), or remitted but treated (6%)). Predictors of persistence were severe impairment of ADHD, psychiatric comorbidity, and exposure to maternal psychopathology at baseline.

Conclusions

These findings prospectively confirm that persistence of ADHD over the long term is predictable from psychosocial adversity and psychiatric comorbidity ascertained 11 years earlier.     

Peripheral blood mono-nuclear cells derived from Alzheimer's disease patients show elevated baseline levels of secreted cytokines but resist stimulation with β-amyloid peptide

Objectives

Among several other factors, the neuro-toxic β-amyloid peptide (βAP)-induced inflammatory mechanisms have also been implicated in the pathogenesis of Alzheimer's dementia (AD). Cytokines have recently emerged as prime candidates underlying this immune reaction. The purpose of this study was to evaluate the inflammatory response of peripheral blood mono-nuclear cells (PBMC) in AD.

Design

Cross-sectional (observational) study.

Setting

Behavioral and cognitive neurology clinic of the Universidade Federal de Minas Gerais in Belo Horizonte, Brazil.

Participants

AD patients (n = 19), healthy elderly (n = 19) and young (n = 14) individuals.

Measurements

Cytokine levels were assessed by enzyme-linked immuno-sorbent assay (ELISA) after exposing cells to a broad range of βAP concentrations (10^− 4-10^− 10 M) as a stimulus. AD samples were weighed against leukocytes harvested from non-demented young and elderly subjects.

Results

Cytokine production of PBMCs in the youth was characterized by low baseline levels when compared to cells from the older generation. In the aging population, AD cells were distinguished from the healthy elderly sub-group by an even higher basal cytokine secretion. The low resting concentration in young individuals was markedly increased after treatment with βAP, however cells from the elderly, irrespective of their disease status, showed unchanged cytokine release following βAP administration. Non-specific activation of PBMCs with anti-CD3/CD28 antibodies resulted in elevated interleukin (IL)-1β concentrations in AD.

Conclusions

These results demonstrate a general over-production of cytokines and resistance to βAP in the old comparison group, with a more pronounced disruption/boosted pattern in AD. Our findings are in line with the hypothesis of “inflammaging”, i.e. an enhanced inflammatory profile with normal aging and a further perturbed environment in AD. The observed cytokine profiles may serve as diagnostic biomarkers in dementia.     

L’enfance des schizophrènes : revue de la littérature

Introduction

Pre-morbid antecedents in schizophrenia have been studied for some time now more particularly as potential markers of vulnerability. What are the tell-tale signs in some of the patient's childhood? The authors suggest a non-exhaustive review of the literature on this subject.

Method

The authors reviewed the literature (English and French) of prospective and retrospective studies.

Results

Many fields appear to be impaired during the childhood of some schizophrenic patients, fields such as: developmental abnormalities, speech impairments, social interactions, behaviour, cognitive functioning. The authors also noticed the presence of neurological soft signs and para-clinical abnormalities.

Discussion

The authors suggest a critical and synthetic review of existing data: what can be retained of this data? The authors also discuss the evolution of these signs and their interaction with the evolution of the disease itself.

Conclusion

Many of these signs were noticed in several children who later developed schizophrenia. For many authors, the more important these signs are, the more severe the disease will be. These pre-morbid antecedents give rise to theoretical questions and open perspectives concerning an early diagnosis of schizophrenia.     

Measuring fatigue in clinical and community settings

Objective

The Chalder Fatigue Scale (CFQ) is a widely used instrument to assess fatigue in both clinical and nonclinical settings. Psychometric properties of the scale and discriminative abilities were examined.

Methods

A total of 361 patients with CFS and 1615 individuals in the community were assessed with the CFQ. Principal component analysis (PCA) was used to explore the structure of the scale. Receiver-operating characteristic curve (ROC) was used to investigate the discriminative properties.

Results

Two components, physical and mental fatigue, were identified in the CFS patient group and in the general population samples. Area under the curve for ROC was .91. The fatigue scale effectively discriminates, at high scores, between CFS patients and the general population.

Conclusion

Physical and mental fatigue are clearly separable components of fatigue. The CFQ can discriminate reliably between clinical and nonclinical conditions.