Validation of the Hebrew Version of the Dissociative Experiences Scale (H-DES) in Israel

Abstract

Ob jec tives : The pur pose of this re search was to ex plore the va lid ity of the con cept of dis so ci a tion as mea sured by a He brew version of the Dissociative Ex pe ri ences Scale (H-DES) in Is rael.

De sign: The first study ex am ined the re li abil ity and va lid ity of the H-DES by as sess ing 340 con sec u tive ad mis sions to an Is raeli out pa tient clinic, and 290 nonclin i cal sub jects. The sec ond study ex plored the construct va lid ity of the con cept of dis so ci a tion by study ing re la tion ships be tween re ported past traumatization and cur rent lev els of dis so ci a tion among a dif fer ent co hort of 70 women Is raeli out pa tients.

Re sults: The H-DES has good testre test and split-half re li abil ity in clin i cal and nonclin i cal sub jects, and is in ter nally con sis tent. Its con vergent va lid ity with the MMPI 2 Philips Dis so ci a tion Scale is good, and it has good cri te rionre lated va lid ity with DSM-IV dissociative dis or der di ag no ses. The con cept of dis so ci a tion as mea sured in Is rael by the H-DES has high re li abil ity and va lid ity.

Con clu sions : The re li able iden ti fi ca tion of dis sociative ex pe ri ences in Is rael as well as in sev eral cul tures out side North Amer ica sup ports dis soci a tion as a valid psy cho log i cal con struct with wide spread cross cul tural ap pli ca bil ity. This study con tra dicts claims that dis so ci a tion is merely a pass ing North Amer i can pro fes sional fash ion.     

Symptoms of Acute Stress Disorder and Posttraumatic Stress Disorder Following Exposure to Disastrous Flooding

Abstract

This lon gi tu di nal study ex am ined symp toms of acute stress dis or der (ASD) and posttraumatic stress dis or der (PTSD) fol low ing ex po sure to threat and loss dur ing a ma jor flood. One hun dred and thirtyone per sons com pleted an ini tial sur vey from one to three months postflood as sess ing ASD symp toms and ex po sure to floodre lated threat and losses; 74 of these per sons com pleted a one-year fol low-up as sessing PTSD symp toms. Re sults showed that threat and loss were both sig nif i cantly re lated to ASD symp toms. Ex po sure to losses and ASD symp toms, but not threat, pre dicted the de vel op ment of PTSD symp toms. These re sults sug gest that stressor char ac ter is tics, such as loss and threat, may be dif fer en tially re lated to shorter and lon gerterm trauma responses. These re sults ex tend pre vi ous re search by show ing that ASD symp toms pre dict those of PTSD among di sas ter sur vi vors and that stressor char ac ter is tics to gether with acute symp toms pre dict longterm dis tress.     

HMPAO SPECT Study of Regional Cerebral Blood Flow in Dissociative Identity Disorder

Abstract

The aim of the study was to in ves ti gate if there were any char ac ter is tics of re gional c e re bral blood flow (rCBF) in dissociative iden tity dis or der. Fif teen pa tients with dissociative iden tity dis or der and eight healthy vol un teers par tic i pated in the study. The clin i cal di ag no sis of dissociative iden tity dis or der was con firmed us ing the Struc tured Clin i cal In ter view for DSM-IV Dissociative Dis or ders. The Struc tured Clin i cal In ter view for DSM-III-R was also ad min is tered to all pa tients in or der to screen comorbid psy chi at ric con di tions. Re gional ce re bral blood flow was stud ied us ing a SPECT sys tem with Tc99m-hexamethyl -propylenamine (HMPAO) as a tracer. The rCBF ra tio was de creased in orbito-fron tal re gion bi lat er ally and in creased in left (dom i nant hemisphere) lat eral tem po ral re gion among pa tients with dissociative iden tity dis or der when com pared to the con trol group. The struc tured in ter view di ag no ses of con cur rent or life time ma jor de pres sion, PTSD, psy chotic dis or der, or on go ing drug treat ment were not sig nif i cantly re lated to perfu sion in these re gions. There was no sta tis ti cally mean ing ful dif fer ence in rCBF ra tios be tween host and al ter per son al ity states. Our find ings sug gest that orbitofron tal and left (dom i nant hemi sphere) lat eral tem poral re gions are af fected in dissociative iden tity dis or der. A rep li ca tion of this study on a larger group of drugfree dissociative pa tients and var i ous psy chi at ric con trol groups would lead to more de fin i tive find ings.     

Why the Diagnostic Criteria for Dissociative Identity Disorder Should Be Changed

Abstract

This paper examines the psy chi at ricdiagnosis of dissociative identity disorder (DID)inlightofthedevelopmentsinpsychi at ricclassification that have guided the last four re vi sions of the Diagnostic and Sta tis ti calMan ualforMen talDis or ders (DSM) (Amer i can Psychiatric Association, 1980, 1987, 1994, 2000). The author argues that multiple per son al ity 's pas sage from DSM-III, through DSM-III-R, to its current form as DID in DSM-IV-TR has left the di ag no sis out of step with the state of the art of psy chi atric classification. Ten dis advantages of the Diagnostic and Sta tis ti calMan ual of Men talDis or ders, Fourth Edi tion- Text Revision (DSM-IV-TR) cri te riafor DID are iden ti fied. The DSM-IV-TR cri te ria for DID: (1) are out of step with the state of the art of psy chi at ric clas si fi cation; (2) are not based on taxometric anal y sis of the symp toms of DID; (3) in correctly im ply that DID is a closed con cept; (4) have poor con tent valid ity; (5) throw away im portantinformation; (6) dis courage taxonomic research; (7) have poor reliability and cause frequent misdiagnoses; (8) are not “user-friendly”; (9) are un nee es sar ily con tro versial; and (10) along with pre vi ous ver sions of the DSM, have pro duced an artifactually low base-rate of DID for the past 20 years. In an effort to remedy these disadvantages, a re liable, user-friendly, polythetic set of diagnostic criteria for “Major Dissociative Disorder” is proposed for DSM-V. Using these polythetic cri te ria, the dissociative dis or ders (presently con cep tu al ized as Dissociative Am ne sia, Dissociative Fugue, DID, Depersonalization Disorder, and Dissociative Disorder Not Otherwise Spec ified) can be re struc tured into an eas ily un der stood and more re liable set of di ag nos tic en ti ties. This al ter nate nosology of the dissociative disorders consists of Sim pie Dissociative Dis or der (with at least three). sub types), Gen er al ized Dissociative Dis or der, Major Dissociative Disorder (with two subtypes), and Dissociative Disorder Not Otherwise Specified.     

Dissociation and Sexual Trauma in Prostitutes

Abstract

This in ves ti ga tion fo cuses on dis so ci a tion in a sam ple of pros ti tutes. As part of a larger ex plor atory study in ves ti gat ing the im pact of trauma on mem ory, 33 pros ti tutes were in ter viewed re gard ing the frequency of their past sex ual as sault ex pe ri ences (both be fore and dur ing their in volve ment in pros ti tu tion) and cur rent dissociative ex pe ri ences. Ex treme vari abil ity was ev i dent re gard ing the par tic i pants' dissociative ex pe ri ences and their re ported num ber of sex ual as saults. Im pli ca tions con cern ing the re la tion be tween a his tory of ear lier trauma and adult disso ci a tion are dis cussed.     

Memory and Dissociative Tendencies

Abstract

Con cep tual and meth od olog i cal ap proaches from cog nitive sci ence have in creas ingly been ap plied to re search ex am in ing the rela tion be tween trauma, dis so ci a tion and ba sic cog ni tive func tion ing. The cur rent study rep li cates and ex tends re cent re search that ex am ined perfor mance in a di rected for get ting task us ing PTSD and trauma his tory as the group ing vari ables (McNally, Metzger, Lasko, Clancy, & Pitman, 1998) to col lege stu dents who were clas si fied as high or low dissociators based on their per for mance on the Dissociative Ex pe ri ences Scale (DES: Bernstein & Putnam, 1986). High and low DES par tic i pants' per formance was ex am ined un der two attentional con texts: a se lec tive at ten tion con di tion and two new di vided at ten tion con di tions (based on DePrince & Freyd, 1999). Dif fer ences be tween the groups were re vealed when a di vided at ten tion ver sion of the task was em ployed. Con sis tent with DePrince and Freyd (1999), when di vided at ten tion was re quired, high DES par tic i pants re called fewer trauma and more neu tral w o r d s than did low DES par tic i pants, who showed the op po site pat tern.     

新疆维吾尔族与汉族广泛性焦虑患者人格特征研究

目的 探讨维、汉族广泛性焦虑临床特征及人格特征的差异.方法 采用汉密尔顿焦虑量表（HAMA）和明尼苏达多项人格调查表（MMPI）对维族56例、汉族83例广泛性焦虑患者进行测试.结果 维族组HAMA睡眠障碍因子分、认知障碍因子分明显高于汉族组（t=1.873,P＜0.05;t=3.245,P＜0.01）.MMH测试两组有8个量表T分同时高于70分,6个量表T分同时低于70分,且维族组校正分量表分值（K）低于汉族组（t=2.126,P＜0.05）,轻躁狂量表分值高于汉族组（t=2.366,P＜0.05）.结论 民族文化对广泛性焦虑发病规律、临床特征有影响,对人格特征影响很小,不同民族广泛性焦虑具有共同的人格特征.     

职业康复对住院精神分裂症患者康复作用

目的:探讨职业康复对社区精神分裂症病人康复的作用。方法:将69名住院精神分裂症患者随机分为干预组和对照组,对干预组患者实施职业康复干预,经过6个月的观察,每3个月用自制一般情况调查表、阳性和阴性症状量表(PANSS)、现有能力及康复效果评估表对两组进行比较。结果:干预6个月后两组间PANSS中的阳性和阴性症状量表有显著性差异(t=-3.593,-2.216;P均0.05);现有能力及康复效果评估表中,第6个月时讲究卫生能力、生活能力、工作情况及总评有显著差异(t=-2.798,-2.178,-2.474,-2.398;P均0.05)。结论:对慢性精神分裂症患者实行职业康复训练,有利于促进患者康复及阴性症状的改善。     

职业康复对住院精神分裂症生存质量的影响

目的:探讨职业康复对住院精神分裂症病人病情及生存质量的影响。方法:将69名住院精神分裂症患者随机分为干预组和对照组,对干预组患者实施职业康复干预,经过6个月的观察,每3个月用自制一般情况调查表、阳性和阴性症状量表(PANSS)、社会功能缺陷筛选量表(SDSS)、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)对两组进行比较。结果:干预6个月后两组间PANSS中的阳性和阴性症状量表有显著性差异(t=-3.593,-2.216;P0.05);SDSS第6个月时两组间差异有统计学意义(t=-2.112,P0.05);生存质量简表中生理领域在第3个月有显著差异(t=2.608,P0.05),第6个月时生理及社会关系领域有显著差异(t=2.563,2.502;P0.05)。结论:对慢性精神分裂症患者实行职业康复训练,有利于促进患者康复及阴性症状的改善,及社会功能的恢复,对生存质量中的生理及社会关系领域有明显作用。     

社区干预对高血压患者生活方式和行为习惯的影响

目的:探讨社区干预对高血压患者生活方式和行为习惯的影响。方法:将200例社区高血压患者随机分为试验组和对照组,每组100例。对照组门诊随诊,试验组在此基础上给予社区干预,时间1年。观察比较两组干预前、后生活方式和行为习惯的变化和血压控制效果。结果:两组干预1年后健康促进生活方式量表Ⅱ各维度分和总分均较干预前显著增高(F=695.414,599.960,199.360,566.346,276.237,289.369,415.927,3648.129;P0.001),但试验组增高幅度显著大于对照组(t=11.546,13.316,12.246,13.313,5.523,6.654,10.856,31.795;P0.001);在干预后第3、6、9、12个月末,两组血压均较干预前显著降低(F=828.999,659.796;P0.001),但试验组降压幅度显著大于同期对照组(t=5.771,5.572,4.284,3.672,4.479,4.937,4.172,3.049;P0.01)。结论:社区干预能显著改善高血压患者生活方式和行为方式,有利于血压控制。     

Familial Mediterranean fever in the Syrian population: gene mutation frequencies, carrier rates and phenotype-genotype correlation

BACKGROUND: Familial Mediterranean fever (FMF) is an autosomal recessive disease mainly affecting particularly Arabs, Non-Ashkenazi Jews, Armenians, and Turks. It is an autoinflammatory periodic disorder characterized by febrile and painful attacks due to inflammation involving the serosal membranes in the abdomen, chest or joints. Over 50 mutations have been identified in the MEFV gene responsible for FMF. OBJECTIVE: To identify the distribution and the frequency of the MEFV gene mutations in Syrian FMF patients and population and perform a genotype/phenotype correlation in the patients' cohort. PATIENTS AND METHODS: The study was carried out on 83 clinically diagnosed Syrian FMF patients and 242 healthy subjects. The tested individuals were screened for the most common five MEFV mutations (M694V, M694I, M680I, V726A and E148Q) by restriction fragment length polymorphism. Sequencing of exon 10 was performed only for the patients' DNA where just one or no mutation was detected. RESULTS AND DISCUSSION: Of the 83 patients studied, 74 (89%) were positive either for one, two or three mutations and nine (11%) had no mutations detected. Of those positive for mutations, 25 were homozygous, 30 were compound heterozygotes, three had complex alleles, and 16 patients had only one mutation. The M694V, V726A, M694I, M680I and E148Q mutations accounted for 45.8%, 26%, 13.9%, 4.8% and 6% of the alleles, respectively. The carrier rate in the Syrian population for the tested mutations was 17.5%, E148Q being the most common mutation, followed by V726A and M694V. The severity of the disease and development of amyloidosis seem to have an association with M694V, the most common mutation in Syrian FMF patients.