Temperament and character during the course of unipolar depression among inpatients

Cloninger has developed a novel approach concerning relationships between psychopathological syndromes and personality by his biosocial theory. Increased levels of harm avoidance (HA) were consistently found in unipolar disorders. The present study was conducted to cross-validate, in part, previous findings that high harm avoidance (HA) persisted in the course of disorder and to explore the distinct role of character dimensions. One hundred and twenty-six inpatients with an unipolar depressive disorder and 126 healthy controls, strictly matched for age and gender have been included in the study. Our findings underline that higher harm avoidance among unipolar depressives compared to healthy controls persisted after treatment even if a significant reduction could be observed. Recurrent disorders and comorbidity with anxiety disorders seem to be related to a relatively immature character in terms of consistently lower scores for the character dimensions (e.g. self-directedness and cooperativeness) of the patients classified into these groups both at admission and at discharge compared with their healthy counterparts. Received: 17 December 1998 / Accepted: 14 November 1999     

Impact of axis II comorbidity on the course of bipolar illness in men: a retrospective chart review

Objectives:  The purpose of this study was to investigate whether the presence of comorbid personality disorder influences the course of bipolar illness.
Methods:  Fifty-two euthymic male bipolar I out-patients were assessed using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID II). Bipolar patients with an axis II diagnosis were compared with those without an axis II diagnosis on retrospectively obtained demographic, clinical and course of illness variables.
Results:  Thirty-eight percent of the bipolar patients met criteria for an axis II diagnosis. Two (4%) met criteria for (only) a Cluster A disorder, four (8%) for (only) a Cluster B, and six (12%) for (only) a Cluster C disorder. One (2%) bipolar patient met criteria a disorder in both Clusters A and B, and one (2%) for a disorder in Clusters B and C. Five (10%) met criteria for at least one disorder in Clusters A and C, and one met criteria for disorders in Clusters A, B, and C. The presence of a personality disorder was significantly associated with a lower rate of current employment, a higher number of currently prescribed psychiatric medications, and a higher incidence of a history of both alcohol and substance use disorders compared with the bipolar patients without axis II pathology.
Conclusions:  Our results extend previous findings of an association between comorbid personality disorder in bipolar I patients and factors that suggest a more difficult course of bipolar illness.     

Early physical and sexual abuse associated with an adverse course of bipolar illness.

BACKGROUND: There is growing awareness of the association between physical and sexual abuse and subsequent development of psychopathology, but little is known, however, about their relationship to the longitudinal course of bipolar disorder. METHODS: We evaluated 631 outpatients with bipolar I or II disorder for general demographics, a history of physical or sexual abuse as a child or adolescent, course of illness variables, and prior suicide attempts, as well as SCID-derived Axis I and patient endorsed Axis II comorbidity. RESULTS: Those who endorsed a history of child or adolescent physical or sexual abuse, compared with those who did not, had a history of an earlier onset of bipolar illness, an increased number of Axis I, II, and III comorbid disorders, including drug and alcohol abuse, faster cycling frequencies, a higher rate of suicide attempts, and more psychosocial stressors occurring before the first and most recent affective episode. The retrospectively reported associations of early abuse with a more severe course of illness were validated prospectively. CONCLUSIONS: Greater appreciation of the association of early traumatic experiences and an adverse course of bipolar illness should lead to preventive and early intervention approaches that may lessen the associated risk of a poor outcome.     

The course and outcome of psychiatric illness in people with Prader–Willi syndrome: implications for management and treatment

Background This study is part of a larger UK‐wide study investigating psychiatric illness in people with Prader–Willi syndrome (PWS), and describes the longitudinal aspect of psychiatric illness, in particular psychotic illness, and examines the use and role of psychotropic medication. Method A total of 119 individuals with genetically confirmed PWS were included in the study. An informant‐based questionnaire was administered for each participant to screen for a history of psychopathology. Those who screened positive were visited at their homes to obtain further information. This assessment included a full psychiatric history and mental state examination using the Psychiatric Assessment Schedule for Adults with Developmental Disability and the Operational Criteria Checklist for psychotic and affective illness to collect information regarding phenomenology and course of illness, and a modified life events questionnaire. At the end of the study period, informant‐based telephone interviews were again carried out, up to 2.5 years after the initial screening. Information regarding medication usage was collected. Results The results confirm previous findings that psychiatric illness in people with PWS resembles an affective disorder. Individuals with the maternal uniparental disomy genetic subtype had a more severe course of illness than those with the deletion genetic subtype in terms of a greater risk of recurrence, more episodes, higher incidence and a possibly poorer response to medication with more side‐effects. Individuals with a recurrent episode during the follow‐up period had a poorer course of illness. Selective serotonin reuptake inhibitor medication is frequently used, and beneficial effects may reflect fundamental pathological processes in PWS. Mood‐stabilizing medication was found to be of little benefit and reasons for this are examined. Conclusion The longitudinal course of psychiatric illness and response to medication in people with PWS is fully described. Further research is needed regarding the effect of psychotropic medications, particularly mood‐stabilizing medication. These data will enable informed decisions to be made regarding management options and provide information on the possible long‐term outcome of illness.     

Prevalence of mental illness in homeless men in Munich, Germany: results from a representative sample

OBJECTIVE: The aim of the study was a reliable assessment of the prevalence of DSM-IV mental disorders in a representative sample of homeless men in the city of Munich. METHOD: A preliminary survey yielded an estimate of 1,022 single homeless men in Munich divided among three sectors (shelter users, service users and street dwellers). A random sample of 265 single homeless men was surveyed from these three sectors. An age-matched comparison group of 178 men was selected randomly from a community register. The Structured Clinical Interview for DSM-IV (SCID-IV) was used for diagnostic classification. RESULTS: The lifetime prevalence rates of mental disorders were as follows: 72.7% vs. 15.2% for alcohol dependence, 32.8% vs. 7.3% for mood disorders, 15.9% vs. 6.2% for anxiety disorders and 9.8% vs. 0.6% for psychotic disorders. Of the homeless males in Munich, 93.2% had at least one lifetime DSM-IV axis I diagnosis, while this was the case for only 38.2% of the community controls. One-month prevalence for all SCID DSM-IV axis I disorders in homeless males was 73.4%. CONCLUSION: Lifetime DSM-IV axis I mental disorders were 2.4 times more frequent among homeless individuals compared to community control. Implications for health care planning are discussed.     

Longitudinal course of panic disorder: clinical and biological considerations

The longitudinal course of panic disorder and its associated symptoms were investigated in thirty-eight patients. The temporal relationships among panic attacks, generalized anxiety, agoraphobia and depression are described. Similar and different biological alterations in the tricyclic-responsive disorders of primary depression and panic disorder are reviewed and discussed.     

Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach

OBJECTIVE: Many anti-stigma programmes use the 'mental illness is an illness like any other' approach. This review evaluates the effectiveness of this approach in relation to schizophrenia. METHOD: The academic literature was searched, via PsycINFO and MEDLINE, to identify peer-reviewed studies addressing whether public espousal of a biogenetic paradigm has increased over time, and whether biogenetic causal beliefs and diagnostic labelling are associated with less negative attitudes. RESULTS: The public, internationally, continues to prefer psychosocial to biogenetic explanations and treatments for schizophrenia. Biogenetic causal theories and diagnostic labelling as 'illness', are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance. CONCLUSION: An evidence-based approach to reducing discrimination would seek a range of alternatives to the 'mental illness is an illness like any other' approach, based on enhanced understanding, from multi-disciplinary research, of the causes of prejudice.     

Severe and persistent mental illness: a useful definition for prioritizing community-based mental health service interventions

OBJECTIVE: There is a lack of consensus on the identification of seriously mentally ill patients (SMI). This study investigates the external and predictive validity of an operationalized definition for the severity and persistency of mental illness applied to a sample of service users attending a community mental health service. METHOD: The definition is based on the fulfilment of dysfunction (GAF < or = 50) and illness duration (> or = 2 yrs) criteria. The study was conducted with a two-year longitudinal design. External and predictive validity of the SMI definition were assessed against the diagnosis of psychosis. RESULTS: Our data show evidence for an overall high predictive and external validity of the SMI definition and high sensitivity in predicting those with high burden of mental illness. CONCLUSIONS: In order to identify people with high levels of psychiatric burden, the SMI working definition seems to be more useful than that simply based on diagnostic criteria.     

Congenital supratentorial arachnoidal and giant cysts in children: a clinical study with arguments for a conservative approach

Little is known about the natural course of arachnoidal cysts (AC) and the incidence of complications. This poses a problem in selection of patients for surgical interventions. The present authors report on 19 children with supratentorial AC of varying location and size. The mean follow-up time is 6 years. The evolution of presenting symptoms, the developmental course, the occurrence of complications, the surgical intervention performed and its outcome are described. Associated neurological disorders cannot always be attributed to the cyst. If surgery is being considered, a causal relationship between the symptom and the cyst should be plausible. Received: 17 April 1996 Revised: 17 July 1996     

Physical illness and depression: the effects of acute physical illness on the mental state of psychiatric inpatients

A patient is described with a severe agitated depression who made a dramatic recovery following an acute myocardial infarction. A retrospective case notes study was conducted to investigate the effects of a sudden physical illness on the mental state of a group of psychiatric inpatients. Seven patients were identified with agitated depression who improved considerably following an acute life-threatening physical event. Patients with other forms of depression, schizophrenia and schizoaffective disorder showed either no change or underwent a deterioration in mental state.     

A comparison of the course of burnout and prolonged fatigue: a 4-year prospective cohort study

OBJECTIVE: Outcomes in burnout and prolonged fatigue have hardly been compared in longitudinal research, despite several similarities such as the importance of fatigue symptoms in both conditions. This study aims to assess and compare the course of burnout and prolonged fatigue in the working population. METHODS: Prospective data from the Maastricht Cohort Study on Fatigue at Work were used. The course was determined in terms of complaints and absenteeism. Participants who completed questionnaires at baseline and at the 12-, 24-, and 48-month follow-ups were divided into three subgroups: "pure fatigue" (n=485), "pure burnout" (n=296), and "burnout & fatigue" (n=426). RESULTS: The "burnout & fatigue" group had the highest proportion (29%) of the chronic course type compared to the "pure burnout" (2%) and "pure fatigue" (9%) groups, in addition to more absenteeism over time compared to the "pure fatigue" group. Recovery from all conditions was highest in the "pure burnout" group (40%). The course of burnout and prolonged fatigue is characterized by its dynamic nature. DISCUSSION: Differences emerged in the course of burnout and prolonged fatigue. The differential diagnosis of employees presenting with fatigue complaints could be important in estimating the outcome of complaints and need for therapy.     

The sense of coherence as a predictor of the scope and impact of stigma experiences among people with mental illness

This study explored the role of the sense of coherence (SOC) in predicting the scope and impact of stigma experiences in 229 patients with schizophrenia or affective disorders. Findings revealed that SOC significantly predicted lower levels of stigma, accounting for 13% of the variance in stigma experiences and 4% of the variance in stigma impact, over and above that explained by background characteristics, diagnosis and the psychiatric symptoms of the participants.     

Lifetime patterns of social phobia: A retrospective study of the course of social phobia in a nonclinical population

This study describes the natural course of social phobia as recalled by a sample of nonclinical subjects and explores, using qualitative research methods, perceived risk factors and factors that may cause changes in its course. Thirty-nine respondents with a lifetime diagnosis of social phobia were interviewed using a semistructured interview schedule based on DSM-IV criteria. Four main lifetime patterns emerged: a slight worsening of social phobic symptoms over time, no change, slight improvement and complete remission. Thirty-eight percent of the sample was in remission at the time of interview. The mean age of onset was 12.8 ± 4.1 years. The average duration of illness was 29.0 ± 12.7 years. Factors perceived by respondents to precipitate social phobia, using content analysis, were family and school environment, onset of adolescence, low self-esteem, temperament and poverty. Factors perceived to improve symptoms were building self-esteem, exposure, determination, maturity and counseling. Factors perceived to worsen symptoms were avoidance, exposure to negative attention and comorbid disorders. Depression and Anxiety 7:113–121, 1998. © 1998 Wiley-Liss, Inc.     

Perceived parental rearing behaviour in patients with a schizophrenic disorder and its relationship to aspects of the course of the illness

Skagerlind L, Perris C, Eisemann M. Perceived parental rearing behaviour in patients with a schizophrenic disorder and its relationship to aspects of the course of the illness. Acta Psychiatr Scand 1996: 93: 403–406. © Munksgaard 1996. A total of 57 patients of both sexes (27 women and 30 men) with a definite diagnosis of a schizophrenic disorder completed the EMBU, a Swedish instrument designed to assess the experience of parental behaviour, that has been extensively used in cross-national studies. As in previous studies in different patient populations, three factors, ‘rejection’, ‘emotional warmth’ and ‘overprotection’, have been taken into account. The results obtained in the patient group were compared with those obtained in a control sample of healthy Swedish subjects. Schizophrenic patients rated both parents higher than controls on the factor ‘rejection’, and rated their mothers lower on the factor ‘emotional warmth’. No correlation was found between EMBU score and age at the first hospitalization, or number of rehospitalizations within 1 year after discharge at the index episode. The present results cross-validate those obtained by other authors in other cultural settings, and suggest that negative experiences of parental rearing might be an important factor contributing to the development of ‘vulnerability’ in a person who will subsequently develop a schizophrenic disorder.     

Cost‐of‐illness studies of dementia: a systematic review focusing on stage dependency of costs

Quentin W, Riedel‐Heller SG, Luppa M, Rudolph A, König H‐H. Cost‐of‐illness studies of dementia: a systematic review focusing on stage dependency of costs. Objective: To review cost‐of‐illness (COI) studies of dementia from Europe and North America which report costs per patient by disease stage. Method: A systematic literature search was performed in electronic databases. Studies were classified according to important determinants of costs. Results were converted into year 2006 USD‐PPP, and summarized as costs for formal and informal care in mild, moderate and severe dementia. Results: 28 studies were evaluated. They used a wide range of methods. Costs more than doubled from mild to severe dementia. Patterns and size of estimated costs depended primarily on study objectives (estimation of total costs–net costs), living arrangements of patients (community‐dwelling–institutionalized) and inclusion of informal care. Conclusion: This review is the first to have focused on costs in different stages of dementia. The stage is an important determinant of costs. However, characteristics of individual studies need to be considered, when making use of their results.     

Mental illness,physical abuse and burden of care on relatives: a study of acute psychiatric admission patients

As mental health care policies increasingly emphasize treatment and care in community settings, there has been concern over the burden that families of mentally ill people might suffer as a result. We conducted a study of the prevalence of abuse faced by relatives of patients admitted during a 6-month period to the acute psychiatric unit of a busy general hospital, who had previously been living with a relative. Patients and their relatives were assessed using semi-structured interview schedules. The experience of burden and the specific experiences of abuse since the onset of their relative's illness were recorded. In total, 32 (32%) of the 101 relatives had been struck on at least one or two occasions. Verbal abuse, threats and temper outbursts were reported by over 50% of the relatives. Principal correlates of abuse were diagnosis, concurrent drug misuse and a poor pre-morbid relationship between carer and patient.