Clinical presentations in combat veterans diagnosed with posttraumatic stress disorder

This article investigated subtypes of symptom patterns among male combat veterans diagnosed with posttraumatic stress disorder (PTSD) through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Graham, Ben-Porath, Tellegen, Dahlstrom, & Kaemmer, 2001) clinical and validity scales. Participants were 126 veterans seeking outpatient treatment for combat-related PTSD at a Veterans Affairs Medical Center. Two well-fitting MMPI-2 cluster solutions (a four-cluster solution and a three-cluster solution) were evaluated with several statistical methods. A four-cluster solution was determined to best fit the data. Follow-up analyses demonstrated between-cluster differences on MMPI-2 "fake bad" scales and content scales, the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986), Mississippi Combat PTSD scale (M-PTSD; Keane, Caddall, & Taylor, 1988), and Clinician-Administered PTSD Scale (CAPS-1; Blake et al., 1990). Clusters also were different in disability-seeking status, employment status, and income. Implications for research and clinical practice using the MMPI-2 with combat veterans presenting with PTSD are briefly addressed.     

MMPI-2 indices of psychological disturbance and attention and memory test performance in head injury

A number of studies have investigated the relationship between psychological disturbance and neuropsychological (NP) test performance. The current study is a replication and extension of who found that MMPI-2 indices of psychological disturbance are related to performance on NP tests of attention and memory in psychiatric and head-injured patients. In a large sample (N=381) referred for evaluation after sustaining presumed head injury, we examined the relationship between MMPI-2 indices of psychological disturbance and measures of attention and memory from the Wechsler Memory Scale-Revised (WMS-R), Wechsler Adult Intelligence Scale-Revised (WAIS-R), California Verbal Learning Test (CVLT), and the Memory Assessment Scales (MAS). Although related to other domains, MMPI-2 variables were most consistently related to measures of attention and List Learning. Even when demographic variables, injury severity, and litigation status were controlled, MMPI-2 indices significantly predicted performance on six out of eight tests. However, the correspondence between similar indices on the WMS-R and MAS were relatively low, especially for Verbal Memory and Visual Reproduction. Further, litigation was significant in predicting only 2 of 8 attention and memory indices.     

A manifest anxiety scale from the MMPI-168

An established measurement of anxiety that uses MMPI items is Taylor's Manifest Anxiety Scale (MAS). Because the items on the MAS are distributed over the entire MMPI, this measure is not available from a popular short form, the MMPI-168. A new composite anxiety scale that comprises items on the MMPI-168 is described, together with relevant normative statistics and its relationship with other MMPI scales.     

Effect of estrogen replacement therapy on symptoms of depression and anxiety in non-depressive menopausal women: a randomized double-blind, controlled study

The efficacy of estrogen replacement therapy (ERT) for mood disturbances associated with menopause has yet to be firmly established. The objective of this study was to investigate the efficacy of ERT for improving mood and anxiety of non-depressive postmenopausal women. This double-blind, randomized, placebo-controlled study involved two treatment groups: one receiving conjugated equine estrogens (CEEs; 0.625 mg/day) and the other placebo, for six cycles of 28 days each. Subjects were hysterectomized, healthy, non-depressive (according to Schedule for Affective Disorders and Schizophrenia, Life Time Version [SADS-L]) women. Depressive and anxiety symptoms were assessed with the Beck Depression Inventory (BDI), and the Hamilton Anxiety Scale (HAMA), respectively. The Profile of Mood States (POMS) and other scales were used to characterize symptoms. In both groups, BDI scores were significantly lower at cycles 1, 2, 3, and 6, compared with baseline assessments (p < 0.01). Anxiety scores for both groups significantly improved from cycle 3 to study endpoint. The only significant difference favoring the active group occurred at cycle 1. POMS scores were significantly improved at the end of cycles 1, 2, 3 and 6 among treated subjects and at the end of cycles 2, 3, and 6 among placebo subjects. ERT is not associated with improvements in mood or anxiety symptoms in non-depressive, hysterectomized, postmenopausal women.     

汶川地震后某医学院护理新生心理状况研究

目的对汶川大地震后处于一般灾区的某医学院校大一护理新生的心理状况进行调查,并进行相关影响因素的研究,为该群体的心理健康教育与干预提供依据。方法以某医学院180名护理新生为调查对象,采用一般情况问卷、事件影响量表（IES）、贝克抑郁自评问卷（BDI）、焦虑自评量表（SAS）、特质应对方式问卷（TCSQ）对样本进行调查。结果 132名大学生IES总分≥20分,占总数的17.8%;有抑郁症状者占47.3%（轻度抑郁占20%,中度抑郁占26.7%,严重抑郁占0.6%）,有焦虑症状者占20%;2PTSD症状与暴露因素相关,与焦虑分和抑郁分呈显著正相关（P〈0.01）,与消极应对方式呈显著负相关（P〈0.01）。结论汶川大地震半年后处于一般灾区的某医学院校护理新生仍存在一定的心理问题,应该对他们开展适当的心理健康教育和心理干预工作。     

Utility of the Response Bias Scale (RBS) and other MMPI-2 validity scales in predicting TOMM performance

The present study represents a replication and extension of the original Response Bias Scale (RBS) validation study. In addition to examining the relationship between the Test of Memory Malingering (TOMM), RBS, and several other well-researched Minnesota Multiphasic Personality Inventory 2 (MMPI-2) validity scales (i.e., F, Fb, Fp, and the Fake Bad Scale), the present study also included the recently developed Infrequency Post-Traumatic Stress Disorder Scale and the Henry–Heilbronner Index (HHI) of the MMPI-2. Findings from this retrospective data analysis (N = 46) demonstrated the superiority of the RBS, and to a certain extent the HHI, over other MMPI-2 validity scales in predicting TOMM failure within the outpatient Veterans Affairs population. Results of the current study confirm the clinical utility of the RBS and suggest that, particularly if the MMPI-2 is an existing part of the neuropsychological assessment, examination of RBS scores is an efficient means of detecting negative response bias.     

Affective state and EEG sleep profile in response to rapid tryptophan depletion in recently recovered nonmedicated depressed individuals

BACKGROUND: The current study examines whether a tryptophan-free amino acid drink (TFD) causes a transient mood relapse in unmedicated patients recently recovered from major depression. TFD is thought to reduce cerebral serotonin, a neurotransmitter implicated in depression. Some studies report that TFD reverses the antidepressant and REM-suppression effects of selective serotonin reuptake inhibitors (SSRIs). METHODS: Following an average of 10 weeks of Cognitive Behavioral Therapy (CBT), 13 recovered patients who achieved 50% or greater reduction on the initial Hamilton Rating Scale of Depression (HRSD) underwent a double-blind challenge with the TFD and a control drink. In order to demonstrate the central physiological effects of the TFD on REM sleep in these patients, all night polygraphic sleep recordings were obtained before and after the TFD and control drink. RESULTS: Relative to the control drink, TFD decreased REM latency and plasma concentrations of tryptophan but had no statistically significant effect on mood symptoms as measured by the HRSD, Beck Depression Inventory (BDI), and Profile of Mood States (POMS). LIMITATIONS: High participant attrition, a physiologically active control drink, physical side effects in response to both drinks, and low statistical power may be methodological considerations that limit interpretation of findings. CONCLUSIONS: The failure to find a transient mood relapse after the TFD may suggest that: (a) nonpharmacological recovery from depression does not occur via serotonergic mechanisms, (b) participant variables may be operating, or (c) CBT alters psychological responses to unfavorable biological states.     

Emotional correlates of fluency test and Maze performance

This study tested the hypothesis that depression, anxiety, and bizarre thought content, as measured by MMPI-2 scales, would show a negative relationship with performance on widely used measures of executive functioning. Subjects were 70 male psychiatric patients who were ostensibly free of any neurologic disease or history of substance abuse. Correlational analyses were performed between age and education-corrected scores on the Controlled Oral Word Association Test (FAS), Design Fluency, and WISC-R Mazes, and scores on MMPI-2 scales D, PT , Anxiety, Fears, Obsessional Thinking, Depression, and Bizarre Mentation. The findings suggest that fluency and maze performance is (1) largely independent of measures of depression (D, DEP) and bizarre mentation (BIZ); (2) mildly associated with a measure of generalized anxiety (ANX); and (3) strongly related to an MMPI-2 measure of fearfulness (FRS).     

青少年自我伤害行为的常用评估方法

本文综述了国外评估青少年自我伤害行为的6种工具,分别是自杀观念问卷(SIQ)、筛查问卷(SQ)、贝克自杀观念量表(BSI)、自我毁损的功能评估(FASM)、自我伤害想法和行为访谈表(SITBI)和自我伤害的内隐联想测验(I-AT),对它们的各自的评估范围、功能、内容和不足进行了逐一的介绍。     

Concurrent validity of the clinical symptom syndrome scales of the millon clinical multiaxial inventory

This study examined relationships between the clinical symptom syndrome scales of the Millon Clinical Multiaxial Inventory (MCMI) and the various clinically meaningful mood or symptom states measured by the six Profile of Mood States (POMS) scales (N = 243). The MCMI symptom scale—POMS symptom/mood scale relationships found in this study were compared with MCMI symptom scale—MMPI and SCL-90 symptom/mood scale relationships reported in the MCMI manual (Millon, 1983). Results of the present investigation, when combined with results of the previous analyses reported in the MCMI manual, reveal a number of consistent associations of moderate strength between MCMI symptom scales and selected mood or symptom scales from the MMPI and Symptom Checklist-90 as well as from the POMS. Although most relationships between the MCMI symptom scales and the symptom/mood scales of the POMS, MMPI and SCL-90 were consistent with expectation, the Anxiety, Dsythymia and Psychotic Depression scales of the MCMI show limited ability to discriminate appropriately between anxiety and depression in several of the concurrent validity analyses considered herein.     

Severity of insomnia correlates with cognitive impairment

INTRODUCTION AND METHODS: Cognitive deficits in insomnia have been already reported (5), however, a correlation between cognitive impairment and severity of insomnia was not as yet studied. Sixteen not medicated patients with primary insomnia according to DSM-IV (4), 7 men an 9 women, of mean age 40.8 year, were compared to 16 controls, matched according to age, sex and education. Standard polysomnographic data (PSG) were recorded. The next day all the subjects completed Athens Insomnia Scale (AIS) (7), Hyperarousal Scale (HS) (6), Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI), Multiple Sleep Latency Test (MSLT) (3), Continuous Attention Test (CAT) with simple reaction time (RT) (8) and Selective Reminding Test (SRT) (2). RESULTS AND DISCUSSION: The psychophysiological differences between patients and controls are shown in Table I. HAM-D and BDI scores were elevated in patients, although none of the patients met clinical criteria of depression. Insomniacs did not differ in the immediate recall, but the number of repetitions necessary to learn all the items of SRT was greater in patients. Insomniacs usually complain of poor performance, however, learning impairment has not been documented in insomnia. Degree of the learning impairment correlated with insomnia score (Fig. 1). Cognitive deficit cannot be due to a daytime sleepiness because sleep latency in all MSLT sessions was not shorter in insomniacs. No correlations between results of SRT and standard PSG parameters were found, in accordance with the thesis that subjective feeling of nonrestorative sleep and other accompanying deficits are only symptoms of an underlying 24-hour disorder (1).     

Suicidal ideation and the subjective aspects of depression

BackgroundSuicidal ideation is common in depression, but only moderately related to depression severity — in part because certain clusters of symptoms, such as those related to core mood disturbance, have a differential relationship to suicidal thinking.Methods400 medication free participants with current major depression were assessed with either or both the Hamilton Depression Rating Scale (HDRS, n = 396) and Beck Depression Inventory (BDI, n = 366), and the Scale for Suicide Ideation (SSI). Depression rating scales were decomposed into symptoms clusters previously reported (Grunebaum et al., 2005), in order to evaluate their association to suicidal thinking.ResultsCorrelations between overall depression severity ratings and the measure of suicidal ideation were modest, and reduced when specific items assessing suicidal thinking on these depression scales were removed. Symptom clusters assessing Psychic Depression (HDRS), Subjective Depression (BDI), and Self-Blame (BDI) were the strongest correlates of suicidal ideation; other somatic and vegetative symptoms had little or no association to suicidal ideation. Severity of these symptom clusters effectively discriminated those with (SSI > 0) and without (SSI = 0) ideation; severity of these symptom clusters was less strongly associated with the severity of ideation once ideation was present.LimitationsThis is a cross-sectional study, and the dynamic relationship between changes in the severity of various depressive symptoms and change in suicidal thinking remains to be explored.ConclusionsDepression severity is moderately associated with suicidal ideation, and accounted for primarily by core mood disturbance symptoms and self-punitive thinking. These associations may explain why suicide risk might remain high during treatment even though somatic and vegetative symptoms improve.     

突发群体事件受伤者创伤后应激障碍与暴露时间及社会支持的关系

目的:探讨突发群体事件受伤者创伤后应激障碍(PTSD)急性期检出率与暴露时间及社会支持的关系。方法:对乌鲁木齐市5家医院突发群体事件受伤住院的161名伤员在受伤第3、4周用自编一般情况调查问卷、心理健康自评问卷(SRQ20)、事件影响量表(IES)和领悟社会支持量表(PSSS)进行测查,完成测查155例。突发群体事件2个月后用美国精神疾病诊断与统计手册第4版修订本(DSM-Ⅳ-TR)轴I障碍临床定式检查病人版(SCID-I/P)对128名伤员(失访27名)进行检查和精神科诊断。结果:样本中PTSD检出率为41.4%(53/128),男性与女性检出率差异无统计学意义(38.7%vs.48.6%,P0.05)。男性暴露时间1 h者的SRQ20、IES得分低于暴露时间≤1 h者,女性暴露时间不同者SRQ20、IES得分无明显差异。男性暴露时间1 h者的PTSD检出率低于暴露时间≤1 h者[32.7%(16/49)vs.54.1%(20/37),P0.05],女性暴露时间不同者PTSD检出率无明显差异。领悟社会支持量表中社会总支持、内支持、外支持得分与SRQ20、IES测评结果均不相关(r=-0.26～0.24,均P0.05)。PTSD伤员与非PTSD伤员的社会支持量表得分无明显差异(P0.05)。结论:本研究显示,突发群体事件男性受伤者中暴露时间1 h有较低的PTSD检出率和较好的心理健康状况,社会支持与PTSD的发生可能无关,值得进一步研究。     

MMPI-2评估应激障碍的效果

目的:采用MMPI-2评估应激障碍(SD)患者的病理心理特征,并探讨其辅助诊断的应用价值。方法:实验组为入院治疗的29名急性应激障碍(ASD)患者及14名创伤后应激障碍(PTSD)患者,对照组为44名适应良好的应激创伤幸存者,在不影响测验症状的情况下完成MMPI-2测试。结果:ASD患者MMPI-2的F、Fb、Fp、Pa、Pt、Sc和Ma的因子得分高于对照组,K和S低于对照组,差异有统计学显著性(P<0.05-0.001);PTSD患者F、Fb、Fp、Hs、D、Hy、Pa、Pt和Sc高于对照组,S低于对照组,差异有统计学显著性(P<0.05-0.001);ASD患者Hs、D和Hy低于PTSD患者,差异有统计学显著性(P<0.05-0.001)。两组患者剖面图均呈M678型。Pa和Sc进入判别函数,该函数在训练样本和验证样本中的预测符合率分别为83.9%和72.0%。结论:SD患者和适应良好的创伤幸存者的心理病理表现明显不同,ASD患者和PTSD患者的症状特征也有所差异;MMPI-2对应激失常症状比较敏感,Pa和Sc具有较好的鉴别能力。     

Depression and demoralization among Russian-Jewish immigrants in primary care

The purpose of this study was to examine the levels and nature of psychological distress and depression among Russian-Jewish émigrés in primary care. Fifty-seven consecutive patients at the primary care clinic were assessed with the Hamilton Depression Scale (Ham-D). The subjects completed self-rating scales, including the Beck Depression Inventory (BDI), Life Orientation Test, Beck Hopelessness Scale, Attributional Style Questionnaire, and Snaith-Hamilton Pleasure Scale. Data on demographics and physical complaints were collected and analyzed. Of the patients studied, 82.5% experienced psychological distress (BDI > or = 10), and 43.9% had clinically significant depressive symptoms (Ham-D > or = 17). BDI and Ham-D scores were significantly correlated with the number of psychosomatic complaints, hopelessness, lack of optimism, anhedonia, and dysfunctional attributional style. The distressed, but not depressed, patients had preservation of hedonic capacity. The authors found a high rate of depression based upon Ham-D scores among the Russian-Jewish émigrés in primary care. The authors suggest that this high rate is attributable to a culturally specific tendency to express distress in somatic terms. The nature of distress was phenomenologically similar to demoralization.     

Relations between psychometric profiles and cardiovascular autonomic regulation in physical education students

This study was designed to investigate physical education (PE) students the link between mood disturbances, caused by psychological or physical stressors associated with studying, and the autonomic nervous system modifications. PE students completed the profile of mood state (POMS) questionnaire at the end of the university year. Heart rate variability (HRV) was then measured during a head-up tilt test (HUT) in those with the highest and lowest total mood disturbance (TMD) scores on three successive POMS. Among the 218 students who completed the POMS (85 female and 137 male), 65 had high TMD scores, suggesting mood disturbances and fatigue. The final sample included 12 subjects in the potentially overtrained (POT) group and 16 subjects in the control (CTL) group. A greater decrease of two indices of the autonomic system (SD1 and RMSSD) was observed during the HUT in the POT than in the CTL group (P < 0.05). The depression (Dep) and vigor (Vig) subscales of POMS were correlated with several HRV indices. More specifically, in the POT group, the Vig score was correlated with autonomous activity in the supine position, and the Dep score with percentages of change of sympatho-vagal activity during the HUT. This suggests that (1) POT students could present a weaker autonomic response to HUT, (2) Dep and Vig subscales of the POMS questionnaire may indicate autonomic dysregulations.     

Endocrine levels at the start of treatment are associated with subsequent psychological adjustment in cancer patients with metastatic disease.

OBJECTIVE: This study examined the association between hormonal profiles at the start of cancer treatment and subsequent psychological symptomatology. METHODS: Twenty-seven patients with metastatic renal cell carcinoma and 18 patients with metastatic melanoma completed three assessments during the course of treatment: at the start of treatment (baseline), at the end of treatment (3 weeks after baseline), and at a follow-up appointment 1 month later. Cortisol, norepinephrine, and epinephrine levels were measured at baseline using 15-hour urine samples. At each assessment, patients completed the Impact of Event Scale (IES) and the Brief Symptom Inventory (BSI). RESULTS: Patients reported moderate levels of distress throughout treatment as measured by the IES and BSI. Norepinephrine levels at the start of treatment were positively associated with IES total scores at the end of treatment and at follow-up, and cortisol levels were positively associated with IES total scores at follow-up after adjusting for baseline IES and overall distress scores. Norepinephrine levels were also positively associated with depression scores at follow-up, and cortisol levels were positively associated with depression scores at the end of treatment and at follow-up after adjusting for baseline depression and overall distress scores. CONCLUSIONS: Hormonal profiles at the start of cancer treatment are associated with subsequent psychological adjustment.     

Age specificity of the relationship between serum cholesterol and mood in obese women

Despite increasing evidence of an association between lower cholesterol levels and negative mood, no study has specifically investigated this relationship in obese people, a population at high risk for both dyslipidaemia and depression. Data on serum cholesterol and mood were collected in a group of 73 healthy women, aged 16 to 76 years, with different degrees of obesity and widely varying total cholesterol concentrations. Mood was assessed using three self-rated scales: the Toronto Alexithymia Scale (TAS-20), the State-Trait Anger Scale (STAS), and the Beck Depression Inventory (BDI). The association between lower total cholesterol levels and negative mood was age-dependent. No significant association was found in the younger age group (<50 years). In contrast, in the subgroup of older women, serum cholesterol was negatively and significantly correlated with the TAS-20 and the STAS. The negative correlation between serum cholesterol and the BDI was nearly statistically significant. Restricting analysis to the subjects in the highest quartile of the age distribution (>60 years) yielded stronger correlations between cholesterol and mood. In this sample of obese women, the relationship between lower cholesterol levels and negative mood was age-specific and limited to the older age group. The results of this study suggest that preventive programs or drug treatments for reducing cholesterol levels in elderly obese women should include a careful evaluation of mood state.     

Efficacy of MMPI-2 validity scales and MCMI-II modifier scales for detecting spurious PTSD claims: F, F-K, Fake Bad Scale, ego strength, subtle-obvious subscales, DIS, and DEB.

This study compared 119 personal injury claimants' scores on MMPI-2 and MCMI-II malingering scales. Data from 55 pseudo-PTSD patients and 64 controls confirm the utility of the scales examined. The following cut-offs were most effective for identifying spurious PTSD: F greater than 62, F-K = greater than -4, Es = greater than 30, FBS = greater than 24 (men), FBS = greater than 26 (women), total obvious minus subtle = greater than 90, DIS = greater than 60, and DEB = greater than 60. Pseudo-PTSD patients were those who (1) claimed to be suffering a psychological injury (2) that was so severe that it was disabling (3) due to an experience that was entirely implausible as a candidate for PTSD criterion A in DSM-III-R and (4) scored T = 65 or higher on both PK and PS, the post-traumatic stress disorder subscales of the MMPI-2.