Prediction of antidepressant responses to lithium

The authors studied 53 patients hospitalized for depression to evaluate possible associations between pretreatment responses to the Minnesota Multiphasic Personality Inventory and behaviorally rated responses to lithium. Patients were randomly assigned to two groups (A and B) in which responders and nonresponders were balanced for sex. For the 18 women in group A, a lithium response scale discriminated responders with 89% accuracy. For the 9 males, a separate scale discriminated responders with 100% accuracy. In a cross-validation, the two scales discriminated responders and nonresponders with 100% accuracy in group B. The empirical methodology of this study suggests an alternative to the theoretical-rational approach of predicting response to antidepressant drugs based on pretreatment depressive symptoms.     

Personality correlates of platelet monoamine oxidase (MAO) activity in female and male subjects

Associations between platelet monoamine oxidase (MAO) activity and scale scores from the Eysenck Personality Questionnaire, the Impulsiveness-Venturesomeness-Empathy inventory and the Karolinska Scales of Personality were studied in 32 female and 29 male students (age range 17-19 years). There were significant negative correlations between MAO activity and extraversion-related scales for male subjects; in the female group the correlations were also negative but nonsignificant. When comparing subgroups with low, intermediate, and high platelet MAO activity subjects, consistent trends were observed in the direction of higher scores in the impulsivity scales, the sensation seeking-related Monotony avoidance scale, and the Indirect Aggression scale for both female and male low MAO activity groups.     

Markers for vulnerability to psychopathology: temperament traits associated with platelet MAO activity

The functional linkage between platelet MAO activity and psychopathology was explored by analyzing temperamental correlates in 40 male subjects by means of scales from the Eysenck Personality Questionnaire (EPQ), the Zuckerman Sensation Seeking Inventory, and the Karolinska Scales of Personality (KSP). Linear correlations were found with two sensation seeking scales, replicating earlier findings. However, nonlinear correlations predominated. Subjects with intermediate platelet MAO activity had higher scores in conformity scales and lower scores in anxiety and hostility scales than low and high MAO subgroups. Low MAO subjects showed a pattern of higher scores in KSP Impulsiveness, EPQ Neuroticism, and KSP Somatic Anxiety and Irritability and lower scores in KSP Socialization, in line with personality profiles found in alcoholics, psychopaths, and suicide attempters who also tend to have low platelet MAO activity. High MAO subjects scored lower in sensation seeking and conformity scales and higher in KSP Psychasthenia, Muscular Tension and Suspicion scales, consistent with clinical links between high platelet MAO activity and anxiety and paranoia.     

A study of the dimensionality and measurement precision of the SCL-90-R using item response theory

We used item response theory (IRT) to (a) investigate the dimensionality of the Symptom Checklist-90-Revised (SCL-90-R) in a severely disturbed patient group, (b) improve the subscales in a meaningful way and (c) investigate the measurement precision of the improved scales. The total sample comprised 3078 patients (72% women, mean age=35±9) admitted to 14 different day hospitals participating in the Norwegian Network of Personality-focused Treatment Programmes. Mokken Scale Analysis was used to investigate the dimensionality of the SCL-90-R and improve the subscales. This analysis was theory-driven: the scales were built on two start items that reflected the content of the disorder that corresponds with the specific scale. The Graded Response Model was employed to determine measurement precision. Our theory-driven IRT approach resulted in a new seven-factor solution including 60 of the 90 items clustered in seven scales: depression, agoraphobia, physical complaints, obsessive-compulsive, hostility (unchanged), distrust and psychoticism. Most of the new scales discriminated reliably between patients with moderately low scores to moderately high scores. In conclusion, we found support for the multidimensionality of the SCL-90-R in a large sample of severely disturbed patients.     

Correlation of platelet MAO activity with introversion: A study on a German rural population

Platelet monoamine oxidase (MAO) activity and personality characteristics were correlated in a sample of 52 men (37 ± SD 13 years) and 54 women (37 ± SD 15 years) from a rural community. Personality characteristics were measured by using the Freiburger Persönlichkeitsinventar (FPI-A). In the males, weak but significant linear correlations (Pearson product-moment and Spearman rank correlations) were found between platelet MAO activity (p-tyramine and benzylamine as substrates) and the extraversion/introversion dimension. In the females, however, there were no consistent significant correlations between MAO activity and FPI test scores. Comparing the top and bottom 25% of the platelet MAO distribution resulted in a significant difference for the second order factor extraversion in the group of men but not in the group of women. The significant correlation between MAO and introversion could not be attributed to cigarette smoking, food consumption, alcohol, or drugs. In accord with previous biochemical-behavior research, it is suggested that reduced platelet MAO activity may, to some extent, reflect an impulsive personality type.     

Pentametric distribution of platelet monoamine oxidase activity

The distribution of catalytic activity of platelet monoamine oxidase (MAO) with both tryptamine and phenylethylamine as substrates was examined in 1,129 Swedish men at age 18 years. A mixture of five components was needed to describe the distribution, even when the original scale was transformed to remove skewness. The proportions of admixture were 2% for the extremely low component with a mean of -2.3 sigma, 29% for moderately low MAO (mean -0.8 sigma), 51% for intermediate MAO (mean 0.0 sigma), 15% for moderately high MAO (mean + 1.3 sigma), and 3% for extremely high MAO (mean + 3.0 sigma). Thus, the upper and lower deciles each contain contributions from two extreme components that differ from a much larger intermediate component with activity near the mean of the general population. This is compatible with a minimum of three alleles at a single major locus or with at least two polymorphic loci. The hypothesis that MAO activity is controlled by two alleles at a single locus was tested and rejected. The demonstration of at least five distinct components to the distribution of MAO warrants further research to characterize the biochemical structure and function of MAO enzyme variants as well as study of the behavioral correlates of the components.     

Obstructive sleep apnea in epilepsy patients: the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) is a useful screening instrument for obstructive sleep apnea in a disease-specific population

OBJECTIVE: To determine useful cutoffs on the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) in an epilepsy population. BACKGROUND: Epilepsy and obstructive sleep apnea (OSA) frequently coexist, and treating OSA in epilepsy patients may reduce seizure frequency and improve daytime sleepiness. The SA-SDQ, a 12-item validated measure of sleep-related breathing disorders, may be a useful tool to screen epilepsy patients for OSA, although appropriate cutoff points have not been established in this population. Previously suggested SA-SDQ cutoff points for OSA in a non-epilepsy population were 32 for women and 36 for men. PATIENTS AND METHODS: One hundred twenty-five subjects with epilepsy undergoing polysomnography completed a survey about their sleep, including the 12-item SA-SDQ scale. Receiver-operating characteristics curves were constructed to determine optimal sensitivity and specificity. RESULTS: Sixty-nine of the 125 subjects (45%) had apnea-hypopnea indices greater than five, indicating OSA. The area under the curve was 0.744 for men and 0.788 for women. For men, an SA-SDQ score of 29 provided a sensitivity of 75% and a specificity of 65%. For women, an SA-SDQ score of 26 provided a sensitivity of 80% and a specificity of 67%. CONCLUSIONS: The SA-SDQ is a useful screening instrument for OSA in an epilepsy population. Our results indicate that the previously suggested cutoffs for OSA (36 for men and 32 for women) may be too high for this specific population. We suggest screening cutoffs of 29 for men and 26 for women.     

Platelet monoamine oxidase activity and evoked response as predictors of anxiety and depression derived from the content analysis of speech

Platelet MAO activity has been reported by several investigators to differentiate schizophrenia, schizophrenia related depressive disorders, alcoholism, unipolar and bipolar depression from normal controls. Evoked potentials likewise have differentiated schizophrenic and affective patients. However, the precise relationship between MAO activity, evoked potentials (EP), and psychiatric illness has not been clarified. A possible association between psychopathology and high MAO activity/EP reducing and low MAO activity/EP augmenting has been reported. Such a bidirectionality further confounds results. This study was undertaken to determine the association of psychopathological dimensions found in a group of subjects whose platelet MAO activity and evoked responses were obtained two years earlier. Utilizing the Gottschalk-Gleser verbal behavior scales of Anxiety, Depression, Social Alienation-Personal Disorganization and Cognitive Impairment a significant correlation was revealed between low platelet MAO activity and high Total Anxiety scale and Shame Anxiety subscale scores. Additionally, a significant correlation was demonstrated between reducing evoked potentials and elevated Death Anxiety, Somatic Concerns, and Total Death and Mutilation Depression subscales scores, combined and separately. Furthermore, a significant positive correlation was found between augmenting evoked potentials and Overt Hostility Outward scores. No significant correlations were demonstrated between platelet MAO activity or evoked potentials and Social Alienation-Personal Disorganization or Cognitive Impairment scores. These findings lend support to the position that biological markers may predict predispositions to anxiety and depression.     

Platelet monoamine oxidase in alcoholism

We studied platelet monamine oxidase (MAO) activity using 14C-tyramine as substrate in hospitalized alcoholic patients in the early phases of abstinence and in nonhospitalized normal control volunteers. Platelet MAO was determined in 75 patients (67 men, 8 women) with alcoholism and 123 normal control volunteers (52 men, 71 women). The platelet MAO activity in alcoholic patients was significantly lower than in normal control volunteers. We also observed that the mean platelet MAO activity in male alcoholics was significantly lower than in normal males. The analysis of platelet MAO in alcoholics revealed a mixture of two normal distributions. Alcoholic patients falling into the low MAO component were younger in age, with a lower age of onset of alcoholism, and had higher frequencies of family history of alcoholism. They thus resembled type II alcoholics described by other investigators. Platelet MAO may thus serve as a useful biological marker for subtyping alcoholism and identifying high-risk groups at an early stage. The findings of this study are consistent with previous reports of low platelet MAO activity in alcoholic patients.     

Prevalence of mental disorders in a 70-year-old urban population

The prevalence of mental diseases and abnormalities in a representative, systematic sample of 70-year-olds in Gothenburg, Sweden, is presented. Out of 460 selected subjects, 392 (85.2 %) took part and the responders and non-responders were similar in several respects. A case was defined by cut-off points on symptom and/or sign rating scales and diagnoses were defined operationally but as closely as possible to the ICD-classification. The total psychiatric morbidity, excluding personality deviations, was 16.9% in men and 26.1% in women, and excluding also mild neuroses 12.7% in men and 15.5% in women. The prevalence of psychoses was 3.0% in men and 3.5% in women, of neuroses of moderate-severe degree 6.6% in men and 11.5% in women, of neuroses of mild degree 4.2% in men and 10.6% in women, of alcoholism 3.0% in men and 0.0% in women and of oligophrenia 0.0% in men and 0.4% in women. The prevalence of demential syndromes of a psychotic degree was 2.4% in men and 1.3% in women, of a neurotic degree 4.2% in men and 1.8% in women and the total prevalence of demential syndromes was thus 6.6% in men and 3.1% in women. Indications of previous alcohol problems and no or a low current consumption of alcohol were noted among 18.1% of the men.     

Alexithymia in the German general population

The Toronto-Alexithymia-Scale (TAS-20) is used worldwide as a valid measurement of alexithymia. Until now, population-based standardization and cut-off values of the German TAS-20 version have not been available. This study provides these by means of a representative German sample and by investigating the factorial structure of the TAS-20. Data were generated from a representative random sample of the German general population (1,859 subjects aged between 20 and 69). The TAS-20 sum score was normally distributed. The mean value was 49.5 (SD = 9.3) in men and 48.2 (SD = 9.2) in women. Divorce, single and low social status were associated with enhanced sum scores. Ten percent of the population exceeded the TAS-20 sum score threshold of ≥61. The 66th percentile reached 53 for men and 52 for women. Factor analysis identified three factors that match the scales of the English original version. An additional fourth factor (“importance of emotional introspection”) was extracted. Total explanation of variance by these four factors was 52.27%. The sum score of the German TAS-20 version is suited for the standardized measure of alexithymia. For selecting alexithymic individuals in experimental studies, the cut-off ≥61 is possibly too restrictive. Therefore, we propose the 66th percentile for the identification of high alexithymics. The TAS-20 sum score is associated with important socio-demographic variables. The factorial structure is reliable; the fourth factor (“importance of emotional introspection”) provides differentiation of content and allows for enhanced explanation of variance.     

Platelet monoaminooxidase activity and behavioural characteristics in humans

We investigated the possible relationship between platelet MAO activity and behavioural characteristics, measured by MMPI, in a group of 19 healthy volunteers. The results showed that high MAO activity tended to be typical of subjects with inhibitory characteristics and that low MAO activity was more typical of uninhibited subjects.     

Type A behaviour, education and psychosocial work characteristics in relation to ischemic heart disease—A case control study of young survivors of myocardial infarction

The interaction of Type A behaviour, psychosocial work environment and education in relation to medical risk factors for IHD was analyzed in a case-control study of male and female post-MI-patients under age 45. In multivariate analysis LDL/HDL-cholesterol ratio and smoking (explaining 27 and 6% of the variance) emerged as the two most important discriminators of patients from control subjects. The third factor, variety of work tasks, explained 5% of the variance. Type A behaviour ranked as factor no.7, explaining only 2% of the variance and educational level did not reach statistical significance as an independent explanatory factor. When the sample was divided into men and women with high and low education, most of the patient-control difference in Type A and psychosocial work characteristics was found among highly educated men on one hand and women with a low level of education on the other. Thus Type A behaviour seems to be less important and psychosocial work environment more important in adding psychosocial risk to the medically established risk of IHD.     

Clinical utility of the premenstrual assessment form as an instrument auxiliary to the diagnosis of premenstrual dysphoric disorder

The Premenstrual Assessment Form (PAF) is a retrospective self-report questionnaire, yielding classification into syndromal categories and severity assessment (unipolar summary scales) of behavioral, psychological and physical premenstrual changes. However, the PAF has been criticized due to an overlap of its syndromal categories and the unipolar summary scores from symptomatic and asymptomatic women. PAF data from women seeking treatment for premenstrual symptoms and meeting a provisional diagnosis of premenstrual dysphoric disorder (PMDD; n=30) were compared to a control group (n=16). Results showed that 97% of the symptomatic group met the PAF depressive premenstrual syndrome criteria vs. only 12% of the control subjects (chi(2)=29.9, P<0.001). The symptomatic group also reported more severe premenstrual symptoms in all unipolar scales than the control subjects. Sixteen symptomatic women completed two menstrual cycles of prospective daily ratings, and half of them had their provisional diagnosis of PMDD confirmed. There were no significant differences in the scores of the PAF unipolar summary scales between the subgroups with or without the diagnosis confirmation. Most of the PAF scales displayed high sensitivity, but low specificity. These findings suggest that the PAF can be useful to differentiate clinical population and control samples, but it does not provide information to make a more definite diagnosis of PMDD.     

The assessment of depression inventory (ADI): a new instrument used to measure depression and to detect honesty of response

We examined the psychometric properties of the Assessment of Depression Inventory (ADI). This instrument assesses depression and also has validity scales that address response honesty. Three studies were conducted. The first describes the development of the ADI. The second compared the concurrent validity of the ADI Depression (Dep) scale with the BDI-II, and the ADI Feigning (Fg) scale responses of psychiatric inpatients with those of a sample of community volunteers asked to feign depression. The third study was used to cross-validate the results with a separate sample of participants. The ADI Dep scale correlated highly with the BDI-II. Significant differences were also found between the honest patient responders and the non-patient feigners on the Fg scale. The data supports the ADI validity scales as measures of response style and the Dep scale as a measure of depression.     

An Initial Psychometric Evaluation of the CBCL 6-18 in a Sample of Youth with Autism Spectrum Disorders

Individuals with an autism spectrum disorder (ASD) often present with co-occurring emotional and behavioral disorders (EBD). The Child Behavior Checklist 6-18 (CBCL; Achenbach & Rescorla, 2001) is an EBD measure that contains several norm-referenced scales derived through factor analysis of data from the general pediatric population. The psychometric properties of this widely used and well-researched measure have not been evaluated in samples of youth with ASD. This study evaluated the CBCL's internal structure, scale reliability, criterion-related validity, and diagnostic accuracy using archival data from a well-characterized sample of youth with ASD (N = 122). Confirmatory factor analyses supported the unidimensionality of the CBCL's syndrome scales and its internalizing-externalizing factor structure. Significance tests indicated that many scales discriminated between two subgroups: a group of individuals with ASD + EBD and a group with ASD alone. Diagnostic accuracy analyses indicated that the CBCL had good sensitivity but low specificity for detecting co-occurring disorders. Results supported the use of the CBCL in conjunction with other clinical data when assessing for EBD in youth with ASD.     

Small head size is related to low Mini-Mental State Examination scores in a community sample of nondemented older adults.

The objective of this analysis was to determine the relationship, if any, of head size to performance on a cognitive screening test among elderly nondemented adults participating in a community-based survey. The study sample included 825 subjects (533 women, 292 men), age 70 to 95 years. Multivariate analyses, with adjustment for age and education, revealed that smaller head size was associated with low Mini-Mental State Examination (MMSE) scores (i.e., below the 10th percentile) in both men and women. For every 1-centimeter increment in head size, there was a corresponding reduction of approximately 20% in the probability of a low MMSE score.     

Rationality, emotional expression and control: Psychometric characteristics of a questionnaire for research in psycho-oncology

In some studies rationality, anti-emotionality and the control of (negative) emotions were found to be psychological risk factors for cancer. In the present study instruments were developed in order to cross-validate the role of the ‘rationality/anti-emotionality (RAE)’-concept and the ‘emotional expression and control (EEC)’-concept. The psychometric characteristics of a RAE-scale and EEC-scales were investigated in 4302 healthy women attending a breast cancer screening programme in The Netherlands. Principal components analysis revealed three factors for the RAE-scale: (1) Rationality; (2) Emotionality; and (3) Understanding. The EEC-scales consist of three factors that indicate: (1) expression of emotions to oneself; (2) expression of emotions towards others; and (3) control of emotions. These RAE and EEC scales can be of importance in psycho-oncological research, especially when: (1) the more refined subscales are used; and (2) age of the subjects is taken into account.     

High and Low Perceived Self-Control of Epileptic Seizures

PURPOSE: To define behaviours and to identify psychological, demographic, and epilepsy-related variables associated with high as opposed to low perceived self-control of seizures. METHOD: In a semistructured interview, 100 adults with intractable seizures were asked about their seizure precipitants and attempts at self-control of seizures. They also completed four psychological questionnaires. Latent Class Analysis was used to analyse the interview data to create two groups, High Controllers and Low Controllers, who were then compared on demographic, epilepsy, and psychological characteristics. RESULTS: Being able to identify and seeking out low-risk-for-seizure situations, avoiding high-risk-for-seizure situations, and making attempts at seizure inhibition were seizure behaviours that discriminated High from Low Controllers. The general probability of being a High Controller was greater than that of being a Low Controller. Perceived high self-control of seizures was associated with low chance-health locus of control. For Low Controllers, current age, age at onset of seizures, and duration of epilepsy history were related to psychological variables. A significantly higher proportion of the Low Controllers than High Controllers were women. CONCLUSIONS: Many people with intractable seizures do not accept their epilepsy as a condition over which they have no control. Perceived self-control of seizures, however, involves a complex interaction between epilepsy and psychological factors, with health locus of control an apparently important discriminator between High and Low Controllers.