A Study of Borderline Personality Disorder from the Viewpoint of Ego Functions

Abstract: Twenty-eight Borderline Personality Disorder patients (BPD) (by DSM-III-R) were compared with 19 neurotic patients by consulting clinical charts and an interview. The clinical features and ego functions were examined. The results brought this conclusion: (1) Disorders of ego functions of BPD covered a wide range, and were especially noted in object relations. Brief psychotic experiences, depressive experiences, and impulsiveness were the characteristics of the clinical features of BPD. An examination chiefly from the viewpoint of ego functions brought two more conclusions: (2) BPD could be partly included in the schizophrenia spectrum and the affective disorder spectrum, (3) BPD can be divided into two: (a) A Core Group with impulsiveness, (b) A Serious Group with impulsiveness, and brief psychotic experiences and/or depressive experiences.     

Characterizing Mood States in Individuals Diagnosed with Bipolar Disorder and Intellectual Disability

Introduction: The purpose of this study was to gain additional insight on patterns of behavior of three individuals dually diagnosed with intellectual disability (ID) and bipolar disorder as they cycled between elevated and depressed mood states. Methods: Data were collected from weekly, one-hour observations across a period of several months. The total duration of time spent engaged in target responses (pacing, rocking, and talking), in addition to indirect measures of activity (Irritability and Hyperactivity subscale of the Aberrant Behavior Checklist–Community; ABC-C), were assessed to characterize and monitor changes in overall state. Results: While observable behavior seemed to be a good indicator of overall state, ABC-C Irritability and Hyperactivity subscales were not. Additional analyses included lag sequential analyses of environmental stimuli and conditions potentially correlated with observed behavior. Conclusions: Our findings suggest that observable behavior may be one way to monitor the progression of bipolar disorder in those with ID; however, further research needs to be conducted.     

Mood disorders and influenza epidemics in Japan

The finding that influenza epidemics are associated with an increased risk of adult mood disorder has been controversial. In this study, data were collected from governmental statistics, the Patient Survey in Japan, in 1996. Index years were defined as 1957/58, 1962, and 1965, and comparison years were defined as 2 years before and 2 years after the index year. The subjects were 361 patients with mood disorders who were born in the index years of influenza epidemics. In order to isolate patients exposed to an influenza epidemic during their second prenatal trimester, the months of birth 5 months after the influenza epidemics were defined as risk exposure months. The proportions of patients born during the exposure period in the index years were compared with those of patients born in the corresponding months in the comparison years. The same procedures were conducted for the periods 2 and 8 months after the epidemics. For female inpatients only, the proportion of patients born in the A2 influenza-exposure months in 1965 with second-trimester exposure was smaller than that of patients born in the corresponding months in the comparison years; the same phenomenon was observed for third-trimester exposure in 1957-58. However, no differences were observed in other comparisons. These findings suggest that prenatal exposure to influenza might decrease the risk for adult mood disorders in females. However, whether there is a causal relationship is still unproven.     

Psychological Variables Associated With Outcome of Spinal Cord Stimulation Trials

Study Design. This is a prospective study designed to identify psychological factors associated with response to spinal cord stimulation (SCS) trial. Summary of Background Data. In most centers, implantation of a permanent SCS system is preceded by a trial of a temporary stimulating electrode. Yet, even among those who report greater than 50% pain reduction during trial, a significant number of these patients fail to receive long-term pain relief from the permanent system. Because mood disorders can alter pain report, we hypothesized that refined definition of the psychological factors associated with SCS success could result in improved selection of candidates for SCS trial. Methods. The study sample consisted of 43 chronic pain patients (72% failed back surgery syndrome, 77% with radiating low back pain) who were referred for implantable pain management. Following psychological evaluation, patients were admitted for a three-day inpatient trial of SCS. Report of at least 50% pain relief during trial was considered a success and resulted in implantation of the permanent stimulator. Patients were retrospectively divided into two groups: those whose pretrial pain was relieved by at least 50% (“success”) and those whose pain was relieved by less than 50% (“failure”). Results. Univariate t-test or chi-square analyzes of group means of an extensive psychological battery followed by a global, stepwise logistic regression model of trial outcome was used to analyze between group results of a psychological test battery. MMPI depression and mania subscores were found to be significantly elevated among the two outcome groups (p = 0.007 and 0.025, respectively). Conclusions. Patient mood state is an important predictor of trial outcome. Specific indicators of SCS trial outcome are the MMPI depression and mania subscale scores with successful trials being associated with individuals who are less depressed and have higher energy levels.     

Oppositional Defiant and Conduct Disorder Behaviors in Boys With Autism Spectrum Disorder With and Without Attention-Deficit Hyperactivity Disorder Versus Several Comparison Samples

We compared disruptive behaviors in boys with either autism spectrum disorder (ASD) plus ADHD (n = 74), chronic multiple tic disorder plus ADHD (n = 47), ADHD Only (n = 59), or ASD Only (n = 107). Children were evaluated with parent and teacher versions of the Child Symptom Inventory-4 including parent- (n = 168) and teacher-rated (n = 173) community controls. Parents rated children in the three ADHD groups comparably for each symptom of oppositional defiant disorder (ODD) and conduct disorder. Teacher ratings indicated that the ASD + ADHD group evidenced a unique pattern of ODD symptom severity, differentiating them from the other ADHD groups, and from the ASD Only group. The clinical features of ASD appear to influence co-morbid, DSM-IV-defined ODD, with implications for nosology.     

Validity of the Chinese version Mood Disorder Questionnaire (MDQ) and the optimal cutoff screening bipolar disorders

To investigate the validity of the Chinese version of Mood Disorder Questionnaire (C-MDQ) in China. Patients with bipolar disorders (BP, N=284) and patients with unipolar depressive disorder (UP, N=134) were assessed with the C-MDQ. The Eigenvalues of the first two factors were 3.15 and 2.09, respectively. The Cronbach’s alpha of the C-MDQ was 0.79. The frequency of positive responses of UP patients was significantly lower than those of BP patients for 12 items except the seventh item. A C-MDQ screening score of seven or more was the best cutoff between BP and UP. The C-MDQ could distinguish between bipolar II disorder (BP-II) and UP, and the best cutoff was five. A cutoff of five had a sensitivity of 0.80 and a specificity of 0.54 between BP and UP. This study demonstrated the good validity of C-MDQ in China. The best cutoff between BP-II and UP can be regarded as the optimal cutoff between BP and UP to improve the sensitivity of screening for BP-II. Five should be the optimal cutoff between the BP and UP when only the 13 items of the questionnaire are used in China.     

心境障碍患者的非匹配负波研究

目的了解心境障碍患者非匹配负波(MMN)的特点。方法应用美国脑诱发电位仪,对34例心境障碍患者和30名正常成人进行了MMN检测。结果与正常对照组相比,心境障碍患者MMN潜伏期延迟,同时波幅降低。结论MMN可反映心境障碍患者诱发脑电波的自动加工过程,可用于精神科临床应用。     

中文版心境障碍问卷的效度与信度

目的 评估中文版心境障碍问卷(MDQ)在双相障碍(BP)患者中的信度和效度以及与重性抑郁障碍(单相抑郁障碍,UP)患者区分的最佳划界分及相应的敏感性和特异性等结果.方法 对根据美国精神障碍诊断与统计手册第4版为诊断标准确诊的284例双相障碍患者(BP组)和134例单相抑郁障碍患者(UP组),使用中文版MDQ进行测评,其中147例双相障碍患者(51.8%)在8～14 d重测.结果 中文版MDQ对BP组评定结果的因子分析显示,选取2因子的方法最佳(因子Ⅰ、因子Ⅱ的特征根值分别为2.98、2.14),2个因子对总方差的累积贡献率为39.4%;中文版MDQ内部因子一致性分析克隆巴赫系数(Cronbach's alpha)为0.77,MDQ重测相关系数为0.63(P＜0.01);13项条目的 阳性回答率为32.4%～78.2%;经ROC曲线法评价,MDQ区分BP组与UP组的最佳划界分为7分,相应敏感性、特异性为0.64、0.80.结论 中文版MDQ的信效度指标满足心理测量学要求,并且对于临床上的心境障碍患者,可以选择7分作为区分BP与UP的最佳划界分.     

Dehydroepiandrosterone for depressive symptoms: A systematic review and meta-analysis of randomized controlled trials

Depression is a mental disorder that affects millions of people around the world. However, depressive symptoms can be seen in other psychiatric and medical conditions. Here, we investigate the effect of DHEA treatment on depressive symptoms in individuals with depression and/or other clinical conditions in which depressive symptoms are present. An electronic search was performed until October 2019, with no restrictions on language or year of publication in the following databases: Medline, EMBASE, LILACS, and Cochrane Library. Randomized controlled trials comparing DHEA versus placebo were included if the depressive symptoms were assessed. Fifteen studies with 853 female and male individuals were included in this review. To conduct the meta-analysis, data were extracted from 14 studies. In comparison with placebo, DHEA improved depressive symptoms (standardized mean difference [SMD] −0.28, 95% (CI) −0.45 to −0.11, p =.001, 12 studies, 742 individuals (375 in the experimental group and 367 in the placebo group), I² = 24%), very low quality of evidence, 2 of 14 studies reporting this outcome were removed in a sensitivity analysis as they were strongly influencing heterogeneity between studies. No hormonal changes that indicated any risk to the participants' health were seen. Side effects observed were uncommon, mild, and transient, but commonly related to androgyny. In conclusion, DHEA was associated with a beneficial effect on depressive symptoms compared to placebo. However, these results should be viewed with caution, since the quality of evidence for this outcome was considered very low according to the GRADE criteria.     

Antisocial Patients: A Comparison of Those with and Those Without Childhood Conduct Disorder

The purpose of this study was to compare persons with antisocial personality disorder (ASP) with those who meet the adult criteria for ASP but fail to meet the criteria for childhood conduct disorder. Sociodemographic data, medical history, and psychiatric symptoms exhibited during a recent hospital admission were compared in the two groups by chart review. The two groups were virtually indistinguishable, except that patients without childhood conduct disorder were less likely to smoke or consume alcohol, were less likely to have spent time in a training school/boot camp as a child or adolescent, were less likely to have been admitted for a recent suicide attempt, and were less likely to have conned others. We conclude that persons meeting the adult criteria for ASP but not the childhood conduct disorder criteria essentially suffer the same disorder as those who meet full ASP criteria but are less severely affected.     

Impulsivity and dyscontrol in bulimia nervosa: is impulsivity an independent phenomenon or a marker of severity?

Fifty-eight normal-weight DSM-III-R bulimia nervosa patients were compared with 27 normal controls on measures of bulimia nervosa, depression, impulsivity, obsessionality and impulse control (dyscontrol) behaviours. Patients scored higher than controls on all these measures. Almost half the patient cohort met Lacey's multi-impulsive bulimia criteria. When bulimic symptoms were controlled for in an analysis of covariance, multi-impulsive bulimics did not score significantly differently to non-impulsive bulimics on psychometric measures of impulsivity, obsessionality and depression. The concept of impulsivity is critically reviewed and newer concepts linking obsessionality and impulsivity are explored.