Premorbid personality aspects in mood and schizophrenic disorders

This study examines premorbid personality traits from a self-reported and family-reported perspective on a group of unipolar major depression (n = 27), bipolar (n = 21), and schizophrenic (n = 16) recovered inpatients, and a control group (n = 21). Using the Munich Personality Test (MP-T Scales) of von Zerssen for self-reporting and family-reporting personality traits, and the Kischkel scale for the measurement of “intolerance of ambiguity,” we found more “rigidity,” less “esoteric tendencies,” and more “intolerance of ambiguity” patng unipolar depressive patients. Schizophrenic patients showed more esoteric tendencies and less “extraversion.” Results confirm the hypothesis supported by many authors regarding a particular personality structure in unipolar major depression characterized by ridigity and ambiguity intolerance. This personality pattern for unipolar depressives seems to be different from the depressive personality disorder proposed by DSM-IV. Schizophrenic individuals differ by means of their self- and family-reported extraversion. Clinical and theoretical implications of these findings are discussed.     

A brief self-rating scale for PTSD after road vehicle accident

The Accident Fear Questionnaire (AFQ) is a new self-rated scale for PTSD and “accident phobia” (subsyndromal PTSD) after road vehicle accident (RVA). AFQ data from 54 RVA survivors were compared with two clinician-rated and three self-report measures of psychopathology. Diagnoses were based on the DSM-III-R structured clinical interview for PTSD and on DSM-III-R criteria for specific phobia. Diagnostic groups were similar in regards to demographic variables, duration of illness, measures of pain, self-rated physical impairment, and duration of illness. The AFQ had good internal consistency with a Crohnbach's alpha of 0.89 and yielded the largest group differences between PTSD (n = 12), “accident phobia” (n = 14), and neither diagnosis (n = 28). Subjects with PTSD tended to score highest on all self-report measures of psychopathology, followed by “accident phobics”, followed by subjects with neither diagnosis. On the AFQ, this order of severity was preserved after subjects with major depression had been removed from the analysis. Lacking effects from depression and from pain suggest that the AFQ is a specific measure of RVA-related phobic avoidance.     

Project reachout: Building social skills through art and video

A group of nine “educationally unserved” adolescents (categorically defined by PL 94-142 or “drop outs” as defined by the Providence School Department) underwent an innovative combination of treatments—art therapy, social skills training and video therapy. The outcome suggests that the combination significantly elevates feelings of self worth and esteem in the students and that such feelings are also perceived by teachers and other independent observers.     

Evaluation of two automated metrics for analyzing partner preference tests

The partner preference test (PPT) is commonly used to examine sexual and social preferences in rodents. The test offers experimental subjects a choice between two stimulus animals, and time spent with each is used to calculate a preference score. In monogamous prairie voles (Microtus ochrogaster), the PPT has been paramount to the study of pair bonding. Although powerful, use of the PPT in voles has depended primarily on human manual scoring. Manual scoring is time-consuming and is susceptible to bias and fatigue, limiting the use of the PPT in high-throughput studies. Here we compared manual scoring (real-time and 16×) and two automated scoring metrics: “social proximity” and “immobile social contact”. We hypothesized that “immobile social contact” would provide data most comparable to manually scored “huddling”, and thus be the most sensitive measure of partner preference in prairie voles. Each automated metric produced data that highly correlated with manual scoring (R > 0.90); however, “immobile social contact” more closely reflected manually scored huddling (R = 0.99; P < 0.001). “Social proximity” and “immobile social contact” were then used to detect group partner preferences in four data sets that varied by cohabitation length and sex. “Immobile social contact” revealed a significant partner preference in each data set; “social proximity” detected partner preferences in only three of the four. Our results demonstrate the utility of automated systems in high-throughput PPTs, and further confirm that automated systems capable of scoring “immobile social contact” yield results indistinguishable from manual scoring.     

The phenomenology of hairpulling in a community sample

Assessment and treatment of trichotillomania (TTM) has evolved substantially over the past decade. However, standardized assessment and empirically supported treatment for TTM is still in early stages of development. We proposed that information important to the ongoing evolution of assessment and treatment could be obtained through the study of hairpulling across its range of severity. Hairpulling phenomenology was assessed in a large community sample across its range of presentation. Although the estimated prevalence rate of .6% for TTM is congruent with past studies, the 1.2% prevalence estimated for clinically significant hairpulling suggests that the current diagnostic criteria are overly restrictive. Overall, hairpulling occurred at a rate of 6.5%, while age of onset was 15.92 years. Symptoms of depression, anxiety, and history of teasing were positively associated with hairpulling, while self-esteem was negatively related to hairpulling. Cognitions most commonly associated with hairpulling were “feels coarse” (53.3%), “doesn’t feel right” (30.0%), “is curly” (26.7%), and “doesn’t look right” (23.3%). Environments most commonly associated with hairpulling included “while reading” (38.9%), “while watching television” (37.0%), and “in class” (35.25). Applications of findings to assessment and intervention formulation are suggested, and limitations and future directions are discussed.     

Interobserver reliability of ICSD–R minimal diagnostic criteria for the parasomnias

Objective To estimate the interobserver reliability (IR) of the minimal diagnostic criteria for the parasomnias provided in the International Classification of Sleep Disorders Revised (ICSD–R).Methods Fifty consecutive subjects underwent a structured interview by three doctors based on the ICSD–R minimal criteria for the diagnosis of 13 parasomnias at any time in life. IR was calculated by Kappa statistics and interpreted according to conventional categories.Results In the group of Arousal Disorders, IR was “substantial” (kappa 0.74) for confusional arousals, “slight” (kappa 0.36) for sleepwalking, “fair” (kappa –0.02) for sleep terrors. In the group of Wake–Sleep Transition Disorders, IR was “substantial” to “almost perfect”, but “moderate” for sleep starts (kappa 0.41). In the group of Parasomnias usually associated with REM Sleep, IR was “substantial” (kappa 0.69) for sleep paralysis, “moderate” (kappa 0.46) for RBD, “fair” (kappa 0.25) for nightmares. In the group of Other Parasomnias, IR was “substantial” to ”almost perfect” (kappa between 0.73 and 0.93).Conclusions When the clinical diagnosis of parasomnias is based on the ICSD–R: 1) the majority of Arousal Disorders and REM sleep parasomnias showed only a “fair” to “moderate” IR; 2) all of the other parasomnias showed a ”substantial” to “almost perfect” IR. Nosological entities with unsatisfactory IR share complex motor phenomenology associated with a mental state difficult for the patient to define. The source of disagreement probably lies in the difficulty in interpreting patients’ reports. For these parasomnias IR must be verified and possibly improved with training.     

Validation of the Hypomania Checklist (HCL-32) in a nonclinical sample of German adolescents

We tested the psychometric properties of the Hypomania Checklist (HCL-32) in a sample of nonclinical adolescents, examined the association with current psychopathology, and tested if “hypomanic” adolescents differ from other participants regarding HCL-scores and psychopathology. A total of 294 students completed the HCL-32 and the SDQ, a screening for psychopathology. In adolescence, the internal structure of hypomania seems to be represented by a triple structure. The first factor “active-elated” is an indicator of symptoms related to energy and activity. The adult factor “irritable-risk taking” is better reflected by two separate factors (“disinhibited/stimulation-seeking” and “irritable-erratic”). These factors were associated with externalizing problems. “Hypomanic” adolescents showed higher HCL total and disinhibited/stimulation-seeking scores and reported more conduct problems than “non-hypomanic” youngsters. The internal structure of the HCL in adolescents mirrors the association of juvenile bipolarity with substance use and symptoms of ADHD and conduct disorder and presents preliminary evidence for its validity.     

Associative and non-associative changes in unit activity of the rat hippocampus

Two main types of neurons of the dorsal hippocampus were recorded in chronic rats during the classical conditioning of an arousal phenomenon (neocortical EEG desynchrony). The relative importance of the associative and non-associative factors was assessed by a differentiation procedure. In naive rats, during the “acquisition” session most type-I neurons rapidly acquired an “inhibitory” response closely parallel to the EEG response. Neither of these responses showed differentiation. Some type-II neurons acquired an “excitatory” response which was independent of the EEG response and which had a significant tendency to differentiation. These data were confirmed in rats submitted to several “retention” sessions. All the type-I neurons were undifferentiated while 11 out of 41 type-II neurons were differentiated. Type-I neurons were characterized by a bursting mode of discharge. Their activity was higher during slow wave sleep (SWS) than during wakefulness (W) or paradoxical sleep (PS). Most of the differentiated type-II neurons were more active during W and/or PS than during SWS.     

Changing Physician Attitudes Toward the Ketogenic Diet: A "Parent-Centered" Approach to Physician Education about a Medication Alternative

Alternative medical therapies such as the ketogenic diet are often dismissed by the medical community. We used a “parent-centered” approach to make physicians aware of the ketogenic diet, an alternative therapy for difficult-to control seizures in children. Parents became aware of the diet through national TV and film. Written and video information was made available to them and they were encouraged to ask their physicians about the potential usefulness of the ketogenic diet for their child. Between 1994 and 1999 we assessed the success of this approach with three surveys of all U.S. child neurologists. This “parent-centered” approach increased physician knowledge about the diet, but had little effect on its use. Despite evidence of its effectiveness, physicians continued to reserve its use until children had failed most new anticonvulsants. Physicians say they would use it more often if “it worked better” and if they “had a dietitian with more experience.”     

Comparison of two types of dissociation in epileptic and nonepileptic seizures

Dissociation is regarded as a possible psychological mechanism in nonepileptic seizures (NES), although existing evidence for this is equivocal. It has been suggested that the contradictory findings in this area reflect the use of measures that conflate qualitatively distinct types of dissociation, and provide inadequate coverage of the aspects of dissociation most closely related to NES. The study described here addressed this shortcoming by measuring the occurrence of two different types of dissociation, “detachment” (measured using the Cambridge Depersonalisation Scale) and “compartmentalization” (measured using the Somatoform Dissociation Questionnaire), in patients with NES (n = 32) and epilepsy controls (n = 37). As predicted, patients with NES scored significantly higher on the measure of compartmentalization only; contrary to prediction, however, this difference was no longer significant when anxiety and depression were controlled for. The conceptual and methodological implications of the study are discussed.     

Rapid cycling manic depressive patients

Chronic administration of lithium carbonate to bipolar manic depressive patients has been shown to prevent or reduce the frequency and severity of subsequent episodes of depression and particularly those of mania.^1–4 Those patients who continue to have affective attacks in spite of lithium carbonate prophylactic treatment have been studied by our group and others in order to determine if any clinical factors might be predictive of the lithium failure group.^5–6 In a prior report from our clinic we noted that a group of patients with a high frequency of affective attacks predictably had a poor prophylactic outcome with lithium treatment. These patients were termed “rapid cyclers” and were characterized by having four or more episodes of depression and/or mania per year prior to the initiation of lithium prophylactic therapy.The purpose of this paper is to describe such patients in greater clinical detail and to illustrate the effect of lithium prophylactic treatment on their clinical courses. Based on our clinical experience with such patients, an approach to the treatment of rapid cycling manic-depressive patients is presented.     

Assessment of Trait and State Aspects of Depression in Schizophrenia

Depression and negative symptoms can be difficult to distinguish in schizophrenia. Assessments for negative symptoms usually account for the longitudinal nature of these symptoms, whereas instruments available to measure depression mainly assess current or recent symptoms. This construct difference may confound comparison of depressive and negative symptoms in schizophrenia because both domains may have trait-like aspects. We developed an instrument to measure both longitudinal “trait” as well as recent “state” symptoms of depression and tested this instrument (Maryland Trait and State Depression [MTSD] scale) in a sample of 98 individuals with schizophrenia or schizoaffective disorder and 115 community participants without psychotic illness. Exploratory factor analysis of the MTSD revealed 2 factors accounting for 73.4% of the variance; these 2 factors corresponded with “trait” and “state” depression inventory items. Neither MTSD-state nor MTSD-trait was correlated with negative symptoms as measured with the Brief Negative Symptom Scale (r = .07 and −.06, respectively) in schizophrenia patients. MTSD state and trait scores were significantly correlated with the Brief Psychiatric Rating Scale depression subscale (r = .58 and .53, respectively) as well as the Profile of Mood States depression subscale (r = .57 and .44). Persons with schizophrenia had significantly greater trait depressive symptoms than controls (P = .031). Individuals with schizoaffective disorder had significantly higher trait depression (P = .001), but not state depression (P = .146), compared with schizophrenia patients. Trait depressive symptoms are prominent in schizophrenia and are distinct from negative symptoms.Key words: BNSS, schizoaffective disorder, symptom domain     

Neonatal lipopolysaccharide and adult stress exposure predisposes rats to anxiety-like behaviour and blunted corticosterone responses: Implications for the double-hit hypothesis

The double-hit hypothesis posits that an early life genetic or environmental insult sets up a neural predisposition to psychopathology, which may emerge in the presence of a subsequent insult, or ‘second hit’ in later life. The current study assessed the effect of neonatal lipopolysaccharide (LPS) exposure on anxiety-like behaviours in the adult Wistar rat. Rats were administered either LPS (Salmonella enterica, serotype enteritidis, 0.05 mg/kg, ip) or saline (equivolume) on days 3 and 5 of life (birth = day 1). In adulthood (85 days), subjects were allocated to either “stress” or “no stress” treatment groups. For the “stress” group, subjects were exposed to a three-day stress protocol consisting of a 30 min period of restraint and isolation. The “no stress” group was left unperturbed but were handled during this period to control for handling effects between adult “stress” and “no stress” conditions. All animals then underwent behavioural testing using standardised tests of anxiety-like behaviour, including either the Hide Box/Open Field, Elevated Plus Maze (EPM) or Acoustic Startle Response (ASR). Time and event measures for restraint and isolation, the Hide Box/Open Field and EPM were recorded using automated tracking software. Startle amplitude and habituation across time was measured in the ASR test. Prior to and following behavioural test sessions, peripheral blood was collected to assess serum corticosterone and ACTH levels. Data analysis indicated that LPS-treated animals exposed to stress in adulthood exhibited increased anxiety-like behaviour across all behavioural tests compared to controls. Sexually dimorphic effects were observed with males exhibiting increased anxiety-related behaviours compared to females (p < .05). Neonatal LPS exposure induced a significant increase in corticosterone compared to controls (p < .05), whereas corticosterone responses to stress in adulthood were associated with a significantly blunted HPA axis response (p < .05). No differences in ACTH were observed. These results lend support to the double-hit hypothesis of anxiety-related behaviour, demonstrating that neonatal immune activation produces an enhanced propensity toward anxiety-related behaviour following stress in adulthood, and that this susceptibility is associated with alterations to HPA axis ontogeny.     

Electrophysiological studies of d-lysergic acid diethylamide in the visual system

Experiments involving the use of LSD and observing its effects on neurons involved in the processing of visual information are reviewed. These studies typically involved either intravenous or iontophoretic application of the compound. Both modes of application appeared to block the optic afferent synapse at the level of the dorsal lateral geniculate nucleus and to alter the evoked activity of visual cortical neurons. Increasing the dose of LSD regardless of the manner in which it was applied tended to produce depression of both spontaneous and visually driven activity. The receptive field properties of the neurons at all levels of the visual system appear to remain intact after LSD despite changes in spontaneous activity. The effect of LSD on non-specific afferents to the dorsal lateral geniculate nucleus is depicted in relationship to two of the different kind of relay cells located in this structure. Data on LSD interaction with the effects of midbrain stimulation on “X” and “Y” neurons is presented.     

Recurrent nightmares and disorders of arousal in temporal lobe epilepsy

Sleep is known to be severely altered in temporal lobe epilepsy (TLE). Furthermore, sleep deprivation is one of the key factors contributing to cognitive deficits and drug resistance in TLE. In the past, “non-ictal” parasomnias, as well as parasomnia-like nocturnal episodes ultimately diagnosed as seizures, have been documented in epileptic patients. However, recurrence of possibly “ictal” parasomnias in TLE has not been adequately appreciated. Through questionnaires and diaries distributed to TLE patients and their families in a tertiary center for epilepsy, 20 out of 168 patients seen in the last 2 years have been identified as, probands and extensively recorded during sleep. Patients presented with confusional arousals were 16, 14 with nightmares, and 2 with sleep walking episodes. Episodes (25) corresponding to clinical or subclinical seizures have been video-polygraphically recorded in 10/20 patients. Therapy optimization, pharmacological or surgical, resolved the episodes in 17/20 patients. A better seizure control with improved quality of life can be achieved by increasing and extending the practice of nocturnal recording in TLE patients.     

Changes in social exploration of a lipopolysaccharides-treated conspecific in mice: role of environmental cues

Despite the many advantages offered by sociality in animals, one of its main drawbacks is the increased propensity to be exposed to parasites and pathogens. In infection (bacteria and viruses), one of the common symptoms used to describe an animal experiencing an acute inflammation is a “social disinterest”. According to the literature, this reduction in social behaviors would be an adaptive feature preventing further contamination. However, if the case of parasitic infection has been extensively studied, concerning inflammatory processes, no direct evidence of a proper isolation of sick animals by healthy conspecifics has been provided. The present study aimed to investigate the effects of endotoxin-induced inflammation (LPS, lipopolysaccharides) on the behavior of healthy conspecifics to verify a possible active social isolation of the immune-challenged animal. In addition, we applied variations to the functional significance of the situation by pre-exposing healthy subjects to unsanitary olfactory cues (i.e., 1,5-diaminopentane, odor of decaying flesh). Observations revealed several results: (1) no agonistic behavior was observed during dyadic encounter, whatever the immune status of the conspecifics or the olfactory stimulation; (2) endotoxin-induced inflammation triggered several behavioral changes in healthy conspecifics: increased inter-individual distance, decreased physical contacts, and changes in the modalities of social exploration (increased proportion of muzzle sniffing and decreased proportion of ano-genital sniffing); (3) these effects were more salient after olfactory priming with 1-,5-diaminopentane. Our data reveal that mice are able to discriminate the “state of sickness” in conspecifics use this information to support pertinent behavioral changes. Moreover, these results support the idea that mice would switch from a “controlled exposure” strategy under standard condition to a “pathogen avoidance” strategy under a specific unsanitary context.     

Alcoholism as a medical disorder

This report is based upon a long-term study from the Washington University Psychiatry Clinic. The study began with a systematic clinical evaluation of 500 patients, which was followed by a “blind” study of first-degree relatives and a “blind” follow-up of the index subjects. The present report deals with the diagnosis of alcoholism at index, at follow-up, and among the first-degree relatives. The results indicate that the criteria used for the diagnosis of alcoholism select patients who show a satisfactory degree of diagnostic consistency over many years. Furthermore, the diagnostic criteria select cases associated with a significant increase in the familial risk of alcoholism.Alcoholism was the only psychiatric disorder found to be increased among first-degree relatives of alcoholic probands. On the other hand, alcoholism in the probands was found to be associated with secondary depression, secondary mania, antisocial personality, Briquet's Syndrome, and drug dependence. None of these disorders, however, was found at an increased prevalence among the first-degree relatives of the alcoholics, suggesting that these associated disorders may play a significant role in the seeking of psychiatric care by patients with alcoholism.     

Non-superior disembedding performance in children with high-functioning autism and its cognitive style account

Some early studies showed a superior disembedding performance in autistic people while other studies found no difference between autistic and controls. The present study aimed to assess such disembedding ability in 14 boys with high-functioning autism (HFA) and 14 chronological age and non-verbal IQ matched typically developed boys using an Informatized Kohs’ Cube Test (“Samuel”) and a modified Children's embedded figures test (CEFT). No statistically significant group difference was found between paired subjects (although more control subjects succeeded in the Samuel Test) and the HFA subjects showed in the Samuel Test as much “flexibility” in strategy adoption as the control subjects, which is not in accordance with some early reports of superior visuo-spatial performance nor with the classical weak coherence theory. Results in the present study, the discrepancies in early findings as well as the symptomatic and cognitive heterogeneity of autism are discussed in the light of cognitive style account.     

Reaching and grasping movements in infants at risk: A review

Although the influence of intrinsic and extrinsic factors on the development of reaching and grasping skills in typical infants has been extensively described in the literature, the effect of such factors on at-risk infants is still poorly understood. Therefore, the aims of the present study were to analyze the scientific publications, from 1980 to 2008, about factors influencing reaching and grasping movements in infants at risk and to describe methodological procedures used in the studies under review. A bibliographical review on empirical studies indexed on Medline, Lilacs and Science Direct data bases was done, using as keywords the terms: “reaching movements”, “grasping”, “catching”, “prehension”, “infants”, “children”, “risk”, “deficit”, “impairment” and “delay”. 127 articles were identified, and 11 were selected. The following risk conditions were assessed in the papers: prematurity, cerebral palsy, Down syndrome, intrauterine cocaine exposure and agenesis of corpus callosum. Methodological issues as well as the intrinsic and extrinsic factors manipulated in the experiments are discussed in the light of changes in theoretical approach to motor behavior.