Brain abscesses in Northern Ireland: a 30 year community review.

One hundred and seventy-two cases of intracranial abscesses, obtained from Neurosurgical and Centralised Autopsy Records for Northern Ireland for the 30 years, 1947--1976, have been reviewed. The incidence of the disease has fallen from five to three per million of population per year over the past three decades. Intracranial abscesses were three times as common in males as in females. Twenty-nine per cent of the abscesses were in the temporal lobe, 25% frontal, 10% parietal, 6% cerebellar, 3% occipital, and 7% were either subdural or in deep sites such as the thalamus; the remainder (20%) were multiple. Multiple and occipital abscesses were all fatal, temporal and parietal abscesses were associated with a 65% mortality, and 45% of patients with frontal abscesses died. Chronic suppurative otitis media was the single largest cause, and it was the only aetiological factor to have shown a progressive decline over 30 years. For those seen and treated in the neurosurgical unit the mortality was 53%, but if those obtained from the necropsy records were included the overall mortality was 70%.     

Startle reactivity and PTSD symptoms in a community sample of women

Exaggerated startle and PTSD symptoms have been investigated primarily in relation to acute or Type I stressors. The present study examined PTSD symptoms and startle eyeblink response in relation to chronic or Type II stressors. Type II stressors were operationally defined as high levels of childhood corporal punishment and high levels of current partner aggression. This study recruited a sample of 52 women from a metropolitan community and administered several questionnaires assessing experience of corporal punishment in childhood, current intimate partner aggression and level of PTSD symptoms. Following questionnaires, women were presented with eight auditory startle probes (white noise). Results showed that both childhood corporal punishment and intimate partner aggression were associated with women's PTSD symptom scores. However, only PTSD symptom scores were associated with reduced startle. Results are discussed in light of Type I and Type II stressors, and recent suggestions in the PTSD literature that a subgroup of individuals may experience physiological suppression rather than heightened physiological reactivity.     

Psychotic-like experiences and depressive symptoms in a community sample of adolescents

Purpose

Studies of psychotic-like experiences (PLEs) within community samples of adolescents have explored predominantly positive experiences. There is a paucity of research examining the prevalence and correlates of negative PLEs, and whether particular subtypes of negative PLEs can be identified among the general population of adolescents. This study examined the association of both positive and negative PLEs with depressive symptoms, including detailed analysis of subtypes of positive and negative psychosis dimensions.

Method

A community sample of 777 adolescents (50.9% girls: mean age 14.4 years) completed a questionnaire assessing positive and negative PLEs and depressive symptoms.

Results

Principal component factor analysis identified four factors of positive symptoms (persecutory ideation, grandiose thinking, first-rank/hallucinatory experiences and self-referential thinking), and three factors of negative symptoms (social withdrawal, affective flattening, and avolition). Depressive symptoms were associated positively with persecutory ideation, first-rank/hallucinatory experiences, social withdrawal, and avolition, whereas grandiose thinking related negatively with depressive symptoms. Neither self-referential thinking nor affective flattening related to self-reported depression.

Conclusions

These findings support the view that not all types of positive and negative PLEs in adolescence are associated with depression and, therefore, they may not confer the same vulnerability for psychotic disorders.     

Depressive symptoms and mental health service utilization in a community sample

Summary This study examines the utilization of health visits for mental health purposes by community respondents with depressive symptoms. Data are drawn from first wave interviews of the Epidemiologic Catchment Area (ECA) project at the Baltimore, Durham, and Los Angeles sites. The results indicate that persons with depressive symptoms, even in the absence of a recent DIS/DSM-III disorder, are at increased risk for making mental health related visits. The risk of visiting a general medical provider or mental health specialist for mental health treatment tends to increase as the number of depressive symptoms increase. Sociodemographic factors including age, racial background, and employment status also influence the risk of making a mental health related visit.     

Exposure to community violence and post-traumatic stress symptoms: mediating factors

Children's perceptions of safety and family conflict were examined as mediators of the relation between exposure to community violence and post-traumatic stress symptoms. Results indicated that exposure to community violence was related to perceptions of decreased neighborhood safety and increased family conflict, and that this, in turn, mediated the impact of violence exposure on children's post-traumatic stress symptoms. Implications for research are discussed.     

Developmental perspectives in child and adolescent depressive symptoms in a community sample

This developmental study provides some normative data on the distribution of depressive symptoms in 210 children and adolescents in three different age groups (8, 12, and 17 years) from a nonclinically referred sample. The Child Assessment Schedule and other instruments were used. Studying depression from a dimensional point of view, the authors found withdrawal, pessimism, horrible dreams, and suicidal ideation and tendency in the different age groups to be closely related to depressive symptoms.     

ADHD and depressive symptoms in adolescents: the role of community violence exposure

Social Psychiatry and Psychiatric Epidemiology - Comorbid depression is common in adolescents with attention-deficit/hyperactivity disorder (ADHD). As yet, however, little is known about the...     

Hardiness, type A behavior, and physical symptoms in a Japanese sample

This study examined the possible mediating effects of hardiness and Type A behavior on the relationship between stressful life events and physical and psychological well-being in a Japanese male sample (N = 78). The ANOVA showed the main effects of hardiness on both physical symptoms and depression. It is indicated that hardiness protects individuals from both physical symptoms and depression. There was a significant stressful life events x Type A interaction, indicating that the Type As tended to possess physical symptoms even when stressful life events decreased. No three-way interaction among hardiness, Type A behavior, and stressful life events was found. The results suggested that hardiness and Type A were independently related to physical and psychological well-being. Implications for the influence of Japanese culture on hardiness and Type A behavior are discussed.     

Neuropsychiatric and behavioral symptoms in a community sample of Hispanics with Alzheimer's disease

The purpose of this study was to characterize and compare neuropsychiatric symptoms in a sample of 367 community-dwelling subjects: 70 Hispanics and 230 non-Hispanic white patients with Alzheimer's disease, and 22 Hispanics and 45 non-Hispanic white healthy age-matched controls. Neuropsychiatric symptoms were common among all patients with Alzheimer's disease. In the Alzheimer's disease groups, Hispanic subjects presented to the initial assessment with more symptoms than non-Hispanic white subjects did. In comparison to the non-Hispanic white population, the proportion of Hispanics with neuropsychiatric and behavioral symptoms was higher. These findings have implications for differential sociocultural presentations of Alzheimer's disease among ethnic/racial groups.     

Trajectory classes of depressive symptoms in a community sample of older adults

Kuchibhatla MN, Fillenbaum GG, Hybels CF, Blazer DG. Trajectory classes of depressive symptoms in a community sample of older adults. Objective: To identify trajectories of depressive symptoms in older community residents. Method: Depressive symptomatology, based on a modified Center for Epidemiological Studies–Depression scale, was obtained at years 0, 3, 6, and 10, in the Duke Established Populations for Epidemiologic Studies of the Elderly (n = 4162). Generalized growth mixture models identified the latent class trajectories present. Baseline demographic, health, and social characteristics distinguishing the classes were identified using multinomial logistic regression. Results: Four latent class trajectories were identified. Class 1 – stable low depressive symptomatology (76.6% of the sample); class 2 – initially low depressive symptomatology, increasing to the subsyndromal level (10.0%); class 3 – stable high depressive symptomatology (5.4%); class 4 – high depressive symptomatology improving over 6 years before reverting somewhat (8.0%). Class 1 was younger, male gender, with better education, health, and social resources, in contrast to class 3. Class 2 had poorer cognitive functioning and higher death rate. Class 4 had better health and social resources. Conclusion: Reduction in high depressive symptomatology is associated with more education, better health, fewer stressful events, and a larger social network. Increasing depressive symptomatology is accompanied by poorer physical and cognitive health, more stressful life events, and greater risk of death.     

Persecutory symptoms and perceptual disturbance in a community sample of older people: the Islington study

BACKGROUND: While there are extensive studies of paranoid symptoms and perceptual disturbance (PPD) in younger adults, relatively little is known about older adults with similar symptoms. METHOD: This study took place in Islington, an inner London borough. Enumeration Districts were randomised to provide a sampling frame. Residents aged 65 or over were interviewed at home. The Short-CARE was used to elicit psychiatric symptoms and diagnosis. Sociodemographic particulars were elicited using the Client Sociodemographic and Service Receipt Inventory. Questions were asked regarding sight and hearing. We used subsections of the geriatric mental scale to identify people who had PPD symptoms. Medications taken were recorded. We asked 'Do you have any health problems?' as a screening question for subjective health problems. RESULTS: We interviewed 720 people. Twenty-eight (3.9%) participants scored positively on the PPD sub-scales of the GMS. A forward logistic regression analysis for independent predictors of PPD found the significant independent predictors were dementia (p = 0.0000; odds ratio 6.8), drinking alcohol in last 6 months (p < 0.03; odds ratio 0.3), drinking alcohol to help sleep (p < 0.005; odds ratio 9.6), subjective memory loss (p < 0.007; odds ratio 3.3) and uncorrected visual impairment (p < 0.02; odds ratio 2.8). CONCLUSION: There is a relatively high prevalence of PPD in older people living in the community. This is not associated with higher use of services despite the increased needs. Further studies should consider interventions to meet this unmet need.     

Comorbidity of conduct disorder symptoms and internalising problems in children: investigating a community and a clinical sample

Previous studies have demonstrated that many children with conduct problems (CP) also show internalising psychopathology (IP). However, it remains unclear whether the presence of IP serves as a protective or risk factor for the severity and development of CP. The aim of the present study was to assess the prevalence and associations of comorbid IP in children with CP in a community and a clinical sample. Data from boys as well as girls with CP in the clinical range were obtained from a community sample (n = 1,160) and a clinical sample diagnosed with disruptive behaviour disorder (n = 193) from two European countries. In the community sample, information was obtained using the strengths and difficulties questionnaire, whereas in the clinical sample, the child behaviour checklist was used. Internalising disorders, according to ICD-10, were also assessed in the clinical sample. For both samples, age, gender, and impact of comorbid IP in the clinical range (above 90th percentile) for CP were explored. Results revealed that in both samples, participants with CP showed a high rate of comorbid IP (community sample: 35%; clinical sample: 78%). Participants with comorbid IP were more likely to experience social problems with peers. In the clinical sample, comorbid IP rated by the parents was more prevalent than internalising disorders according to ICD-10. Boys with CP and comorbid IP demonstrated a higher severity of externalising behaviour than boys without comorbid IP in the clinical sample. We concluded that in both samples, we found a high co-occurrence of CP and IP. Based on the idea that the co-occurrence of IP and CP in children and adolescents may potentially lead to increased antisocial behaviour, internalising psychopathology should be carefully investigated. Effective strategies and specific risk factors must be evaluated to treat comorbidity as early as possible in children with CP and IP.     

The relationship of fatigue to mental and physical health in a community sample

BACKGROUND: Previous studies have shown fatigue and depression/anxiety to be highly associated with each other. The present study seeks to differentiate between fatigue and depression/anxiety and to investigate the familiality/heritability of fatigue using sib-pairs. METHOD: The GENESiS study is a questionnaire study based in the United Kingdom that includes a five-item fatigue scale and four mental health measures (GHQ-12, EPQ-N, MASQ-AA, MASQ-HPA). Fatigue data from 10,444 sibling pairs were analysed using multivariate methods and model fitting techniques to investigate the familiality/heritability of fatigue and its relationship with the other mental health measures and physical health items. RESULTS: Fatigue correlated highly with GHQ-12 (r=0.62, p<0.001). A principal components analysis of the fatigue scale and the GHQ-12 revealed one main component which correlated highly with mental health items, and a smaller second component which correlated modestly with physical health items. Fatigue showed a modest sibling correlation (0.09, p<0.001), and multivariate modelling revealed evidence for familial effects on fatigue that were independent of the mental health measures. CONCLUSIONS: Fatigue showed a strong relationship with both physical illness and mental health measures. Fatigue is modestly familial and at least part of this familial factor is not shared with mental health measures.     

Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample

OBJECTIVE: Previous research has shown high prevalence rates of depression in multiple sclerosis patients seen in specialty clinics. The relationships among depressive symptoms and severity, duration, and course of multiple sclerosis are controversial. METHOD: A survey was mailed to members of the Multiple Sclerosis Association of King County (Wash.). Of the 1,374 eligible participants, 739 returned the survey, a response rate of 53.8%. Data about demographic characteristics, employment, and duration and course of multiple sclerosis were collected. Severity of multiple sclerosis was determined by the Expanded Disability Status Scale, self-report version. Severity of depressive symptoms was evaluated with the Center for Epidemiologic Studies Depression Scale (CES-D Scale). Analysis of covariance was used to compare mean CES-D Scale scores across categories of multiple sclerosis, and logistic regression was used to identify variables associated with clinically significant depression. RESULTS: Clinically significant depressive symptoms (CES-D Scale score > or =16) were found in 41.8% of the subjects, and 29.1% of the subjects had moderate to severe depression (score > or =21). Subjects with advanced multiple sclerosis were much more likely to experience clinically significant depressive symptoms than subjects with minimal disease. Shorter duration of multiple sclerosis was associated with a greater likelihood of significant depressive symptoms, but the pattern of illness progression was not. CONCLUSIONS: In this large community sample, the severity of multiple sclerosis was more strongly associated with depressive symptoms than was pattern of illness. Clinicians should evaluate depression in patients with recent diagnoses of multiple sclerosis, major changes in functioning, or limited social support.     

Pretrauma and posttrauma neurocognitive functioning and PTSD symptoms in a community sample of young adults

OBJECTIVE: The authors sought to assess whether neurocognitive deficits in people with the posttraumatic stress disorder (PTSD) symptoms of reexperiencing and arousal are a consequence of these symptoms or represent a preexisting vulnerability factor for developing these symptoms after exposure to a traumatic event. METHOD: A random sample of 2,097 young adults who participated in a longitudinal epidemiological study in 1999 and 2000 were reinterviewed in 2003 and 2004 after a major natural disaster (a widespread fire) had occurred in the region. At both interviews, participants completed a number of neurocognitive tests covering immediate and delayed word recall, digit span, coding speed, and vocabulary. Five pre- and posttrauma neurocognitive measures for 1,599 participants who were exposed to the fire were examined to assess the extent to which development of the PTSD symptoms of reexperiencing and arousal was associated with change in neurocognitive skills. Analyses adjusted for a number of potential confounding factors. RESULTS: Higher levels of fire-related reexperiencing and arousal symptoms were associated with less improvement in word recall ability at the second interview. However, levels of these symptoms were more consistently associated with having poorer pretrauma scores on all five neurocognitive measures available for this study. CONCLUSIONS: The presence of the PTSD symptoms of reexperiencing and arousal may result in a relative decline in some measures of verbal memory over time. The more robust finding from this study is that poorer performance on some neurocognitive tests may be a vulnerability factor for developing symptoms of PTSD, not only an outcome of PTSD symptoms.     

Maternal ratings of ODD symptoms: Subtypes versus severity in a general community sample of children

Background and aimsOppositional Defiant Disorder (ODD) is a common childhood disorder (American Psychiatric Association [APA], 2000; APA, 2013). The aim of the present study was to ascertain the optimal structure for the ODD symptoms by identifying whether ODD is a qualitatively distinct entity (categorical) or is a continuum, with high levels on this continuum reflecting ODD (quantitative or dimensional view).MethodsMothers' ratings of the ODD symptoms of 457 children, aged 3 to 15 years, as presented in the disruptive behavior rating scale were obtained. Confirmatory factor analysis (CFA), latent class analysis (LCA), and factor mixture modelling (FMM) were applied to determine the best model for oppositional defiant disorder (ODD) symptoms in children.ResultsThe findings provided most support for a FMM with 3 classes (unaffected odd class, at risk class, and affected class) and 3 factors (oppositional, antagonistic, and negative affect).ConclusionThe findings are discussed in relation to dimensional, categorical, and hybrid (categorical/dimensional) models of ODD symptoms.