Relation among personality and symptoms in nonulcer dyspepsia and the irritable bowel syndrome

The importance of personality traits in nonulcer dyspepsia and irritable bowel syndrome is a controversial issue. We wished to assess the distribution of abnormal personality traits in nonulcer dyspepsia and the irritable bowel syndrome, define any relation among personality and symptoms, and determine whether personality factors discriminate among patients with functional, psychiatric, or organic gastrointestinal diseases. Patients with nonulcer dyspepsia (n = 31), irritable bowel syndrome (n = 67), organic gastrointestinal disease (n = 64), somatoform disorder (n = 36) and healthy controls (n = 128) were studied. Before diagnostic evaluation by an independent physician, all patients completed the Minnesota Multiphasic Personality Inventory and a symptom questionnaire. Symptom scores for abdominal pain and the Manning criteria, which is considered to be diagnostic for the irritable bowel syndrome, were evaluated. Personality scales in patients with nonulcer dyspepsia, irritable bowel syndrome, and organic disease were very similar. However, patients in the other groups differed from somatoform disorder on nearly all scales. In nonulcer dyspepsia, irritable bowel syndrome, and organic disease, hypochondriasis weakly correlated with pain. Subgroups of irritable bowel syndrome patients with predominant constipation and those with predominant diarrhea had similar personality traits, although hypomania was minimally increased in constipation. Patients who fulfilled the Manning criteria for irritable bowel syndrome had more psychological distress than those who did not. The Minnesota Multiphasic Personality Inventory correctly classified somatoform disorder and health 81% and 75% of the time, respectively, but it classified nonulcer dyspepsia and irritable bowel syndrome correctly in only 32% and 34% of cases. Our results suggest that psychopathology may not be the major explanation for functional gastrointestinal disorders.     

Depression during interferon therapy for chronic viral hepatitis: early identification of patients at risk by means of a computerized test

OBJECTIVES: At the doses used for the treatment of chronic viral hepatitis, interferon (IFN)-related side-effects are usually modest, even though in some cases they require the interruption of therapy. Neuropsychiatric disturbances that range from modest depression and irritability to forms of manic-depressive psychosis and attempted or successful suicides are among the most important side-effects. The aim of our study was to determine whether the Minnesota Multiphasic Personality Inventory (MMPI) is a sensitive and reliable test for the early identification of patients at risk of depression before IFN therapy is commenced, and whether it could be useful for the monitoring of these patients during treatment. METHODS: We prospectively studied 67 patients with chronic active liver diseases, consecutively enrolled in open studies and treated with r-IFNalpha2. Before starting therapy and after 3 months of treatment, all patients underwent a clinical neurological evaluation and MMPI. RESULTS: At baseline, the correlation between the clinical evaluation and the score of the depression scale of the MMPI was statistically significant (P< 0.0001). Nine of 14 (64.3%) patients with a baseline score > or = 60/100 showed a depressive mood after 3 months of therapy. Five of 44 patients (11.3%) with a baseline score < 60/100 showed a depression of medium level after 3 months of treatment. This difference was highly significant (P< 0.0001). CONCLUSIONS: According to our results, the MMPI is a reliable and sensitive test for the early identification of patients at risk of depression before and during IFN therapy for chronic viral liver diseases.     

Using the General Behavior Inventory to Screen for Mood Disorders Among Patients With Psychoactive Substance Dependence

The General Behavior Inventory (GBI), a self-report instrument that measures mood disorders, was completed by 224 drug-dependent subjects, who also completed other psychometric tests, underwent clinical psychiatric evaluation blind to GBI results, and provided urine toxicology specimens during outpatient treatment. The GBI found unipolar and bipolar disorders in 10.7% and 15.6% of subjects, respectively. Less than optimal concordance occurred between clinical diagnoses and GBI findings. GBI unipolar patients and bipolar patients appeared globally significantly more disturbed than subjects without GBI mood disorders on the Minnesota Multiphasic Personality Inventory-168 and the Millon Clinical Multiaxial Inventory. GBI bipolar patients tended to have greater frequency of cocaine use prior to and during treatment than the other two groups. The GBI delineates subgroups of addicts with distinctive psychopathology, who in some cases escape clinical detection. Cocaine use shows an association with GBI bipolar disorders.     

The psychosocial impact of systemic lupus erythematosus and rheumatoid arthritis

Seventy-six ambulatory patients with systemic lupus erythematosus and a comparison group of 23 ambulatory patients with rheumatoid arthritis were given a structured interview and standard psychological tests, including the Minnesota Multiphasic Personality Inventory, to determine the psychosocial impact of the illness. Both groups had significantly elevated scores on 3 Minnesota Multiphasic Personality Inventory scales: Hypochondriasis, Depression, and Hysteria. Psychological difficulties are an integral part of systemic lupus erythematosus and are as common as most other manifestations. The implications for clinical practice are discussed.     

Serotonin and its implication in the side‐effects of interferon‐based treatment of patients with chronic viral hepatitis: Pharmacological interventions

Depression is a frequent side‐effect of interferon‐based treatment of patients with chronic viral hepatitis, that may lead to reduction or discontinuation of treatment. Clinical trials data showed the importance of therapy of psychiatric disorders for a successful antiviral treatment. Emerging evidence suggests that interferon may cause depression affecting serotonin synthesis via increased activity of indoleamine 2,3‐dioxygenase. Serotonin reuptake inhibitors significantly improve mood disorders, but the use of these drugs requires caution because some studies reported the emergence of mania in patients treated for depression during antiviral therapy. Therefore, this review will examine and discuss the putative role of serotonin and its metabolism in the development of depression during antiviral therapy, focusing on pharmacological interventions to reduce side‐effects.     

Addiction Severity and MMPI-Derived Typologies in Cocaine Abusers

This study replicated the two Minnesota Multiphasic Personality Inventory subtypes (psychopathic and severe psychiatric) found in inpatient male cocaine abusers in an outpatient sample of 132 men and women. The Addiction Severity Index validated these subtype differences on the basis of psychiatric severity.     

Symptom improvement from prokinetic therapy corresponds to improved quality of life in patients with severe dyspepsia

Prokinetic therapy has been shown to improve patients' symptoms associated with gastrointestinal motility disorders and quality of life. This study investigated the correlation between clinical improvement and quality of life after 12 months of treatment with cisapride or domperidone in patients with severe dyspepsia. Psychological and quality-of-life measures were assessed at baseline and after 12 months of therapy using three patient-administered, standardized questionnaires: the Minnesota Multiphasic Personality Inventory, the Millon Behavioral Health Inventory, and the Sickness Impact Profile. Changes in clinical symptoms were correlated with changes in these measures. Twenty-seven patients with symptoms of severe dyspepsia were treated with cisapride or domperidone (60–80 mg/day) for 12 months. Symptoms and quality-of-life measures were improved at the end of therapy. There were significant correlations between improvement in clinical symptoms and improvement in quality of life parameters. Patients with more marked symptom improvement had more significant improvements in quality of life measures. We conclude that prokinetic therapy improved symptoms and quality of life. Standardized questionnaires can be used to quantify response to prokinetic therapy and to individualize treatment regimens for patients with dyspepsia who have specific psychologic or behavioral characteristics.     

Psychiatric complications of long-term interferon alfa therapy

Ten (17%) of 58 patients with chronic viral hepatitis treated with a four- to 12-month course of recombinant human interferon alfa developed psychiatric side effects. The psychiatric side effects fell into three categories: an organic personality syndrome characterized by irritability and short temper; an organic affective syndrome marked by extreme emotional lability, depression, and tearfulness; and a delirium marked by clouding of consciousness, agitation, paranoia, and suicidal potential. These psychiatric side effects appeared after one to three months of therapy, usually improved within three to four days of decreasing the dose of interferon alfa, and invariably resolved once therapy was stopped. The organic personality and affective syndromes tended to occur in patients who received the highest dose of interferon alfa, who had relatively mild hepatitis, and who lost weight during interferon treatment. Delirium tended to occur in patients with severe hepatitis who had previous evidence of organic brain injury or dysfunction or previous drug and alcohol abuse. Failure to recognize these side effects quickly and to treat them with supportive therapy and modification of the dose of interferon alfa could result in limitation of therapy and serious personal and interpersonal consequences.     

The MMPI profiles of narcotics addicts. I. A review of the literature

This paper reviews three approaches to using the Minnesota Multiphasic Personality Inventory (MMPI) in the assessment of narcotics addicts' psychopathology. Two approaches examine the relationship of MMPI profiles to established sociodemographic or psychiatric typologies; the third pertains solely to MMPI-derived personality typologies. Findings from the research literature are presented and their implications for clinical assessment and treatment are discussed.     

Hepatitis C treatment in "difficult-to-treat" psychiatric patients with pegylated interferon-alpha and ribavirin: response and psychiatric side effects

We investigated and compared the results of treating the chronic hepatitis C (HCV) infection of different groups of psychiatric-risk patients and controls with pegylated interferon alpha (pegIFN-alpha) plus ribavirin. Seventy patients were prospectively screened for psychiatric disorders. Seventeen patients without psychiatric diseases or drug addiction (controls), 22 patients with psychiatric disorders, 18 patients who had received methadone substitution treatment and 13 patients who were former drug users were treated with pegIFN-alpha plus ribavirin. Sustained virological response (SVR), adherence, and psychiatric side effects (using the Montgomery-Asberg Depression Rating Scale and the Brief Psychiatric Rating Scale) in the groups were compared. An SVR was found in 58.6% of all patients: 58.8% of the controls, 50% of psychiatric patients, 72.2% of methadone patients, and 53.8% of former drug users. Methadone-substituted patients and former drug users had significantly higher dropout rates. Scores for neither depressive nor psychotic symptoms differed significantly between groups during treatment. However, the controls had lower pretreatment scores, followed by a significant higher increase to maximum scores. A stepwise logistic regression model showed that only genotype, not group (control, psychiatric, methadone, or former drug abuse), type of psychiatric diagnosis (affective disorder, personality disorder, or schizophrenic disorder), depression scores before and during treatment, change in depression score, antidepressive treatment, sex, or liver enzymes before treatment, was associated with SVR. CONCLUSION: In an interdisciplinary treatment setting psychiatric diseases and/or drug addiction did not negatively influence psychiatric tolerability of and antiviral response rate to HCV treatment with pegIFN-alpha and ribavirin.     

GERD患者的心理因素及综合治疗

目的: 探讨胃食管反流病GERD患者心理健康水平与治疗方法的选择.方法:随机选取符合胃食管反流病诊断患者80例, 采用诊断胃食管反流病GERD患者的问卷评分及MMPI问卷测评, 使用质子泵抑制剂, 胃黏膜保护剂, 胃动力剂, 抗抑郁药等药物联合应用及心理辅导治疗. 比较治疗前后的评分变化.结果: 治疗前GERD评分均大于12分, 治疗后小于10分, 治疗前GERD评分及MMPI评分各项均明显高于治疗后(P<0.01). 结论:治疗胃食管反流病的同时需对患者进行综合心理辅导治疗.     

An Evaluation of the Effects of Lithium in the Treatment of Chronic Alcoholism, Clinical Results

To evaluate the efficacy of lithium in chronic alcoholism, we enrolled 47 male alcoholics in a prospective double-blind two-period crossover study. Nineteen subjects completed the 6-mo study during which they received lithium and placebo each for a 3-mo period. Self-reported alcohol intake and social and psychological factors were monitored. Three subjects claimed that they did not drink during the study. Mean self-reported alcohol intake of the remaining 16 was less during lithium therapy but was also less during the first treatment period. Neither of these differences reached statistical significance. The nine depressed patients, diagnosed from their profiles on the Minnesota Multiphasic Personality Inventory did not consume significantly less alcohol and did not change scores for depression significantly during lithium therapy. We could not demonstrate that lithium therapy was of benefit in our group of alcoholic patients.     

Is the MMPI invalid for assessing psychological disturbance in pain related organic conditions?

The Minnesota Multiphasic Personality Inventory (MMPI) was analyzed in 30 patients with fibromyalgia and 30 patients with rheumatoid arthritis (RA). Eighteen statements on the hypochondriasis, depression and hysteria scales and 14 statements on the schizophrenia scale differentiated patients with fibromyalgia and RA. Patients with fibromyalgia had higher scores on 29 of the 32 statements. Patients with RA seemed appropriately concerned about health and the possibility of additional illness. By contrast, patients with fibromyalgia were more symptomatic and presented a more unusual and complex syndrome, raising the possibility of a somatoform disorder and also greater personal distress in these patients. On the basis of analyzing the scores of patients with RA, one can also conclude that physical illness alone is not sufficient to drive MMPI profiles into the abnormal range. Patients with fibromyalgia who have a similar degree of pain intensity compared with patients with RA (61.3 vs 60 on a scale of 100) have significantly more abnormal MMPI, and analysis of their MMPI suggest a more complex somatic syndrome and greater psychological disturbance.     

Role of affect and personality in gastric acid secretion and serum gastrin concentration. Comparative studies in normal men and in male duodenal ulcer patients.

The role of mood state (affect) and personality on basal acid secretion and basal serum gastrin concentrations were examined in seven healthy men and eight patients with duodenal ulcer. In each subject, gastric secretion and affect were assessed simultaneously on 5 separate days. None of 10 self-reported affect variables correlated with daily fluctuations in basal acid secretion in either group. Three variables (tension, conflict, and anxiety) correlated significantly with serum gastrin fluctuations in normal subjects, but these relationships were not present in patients with ulcer, who were hypergastrinemic regardless of their affective state. The degree to which serum gastrin fluctuated was unrelated to personality, as assessed by Minnesota Multiphasic Personality Inventory. On the other hand, several Minnesota Multiphasic Personality Inventory scales correlated with the degree of variability in basal acid secretion, including scales that measured impulsivity and social isolation/alienation. These studies indicate that serum gastrin concentrations are related to affective state in normal men, that this relationship is altered in men with duodenal ulcer, and that certain personality traits, such as impulsivity and social isolation, are associated with more labile basal acid secretion rates.     

Neuropsychiatric dysfunction in primary Sj?gren's syndrome

Neuropsychiatric complications developed in 40 patients with primary Sj?gren's syndrome, none of whom met American Rheumatologic Association criteria for systemic lupus erythematosus. Twenty-five patients had psychiatric abnormalities, the commonest of which were affective disturbances. Of 30 patients tested, 23 had an abnormal pattern in the Minnesota Multiphasic Personality Inventory, the commonest pattern being a "conversion V." In general, patients presented with hysteroid dysphoric features. Of 16 patients undergoing cognitive function testing, 7 showed mild memory impairment with attention and concentration deficits. On clinical evaluation, 27 patients had neurologic abnormalities unattributable to other causes (central and peripheral nervous system in 16 and 19 patients respectively). There was a significant correlation between psychiatric disturbances and neurologic dysfunction, suggesting a possible organic basis for psychiatric dysfunction. The diagnosis of primary Sj?gren's syndrome should be considered in patients with unexplained neuropsychiatric illness.     

老年卒中后抑郁与非抑郁患者人格特征分析

目的调查卒中后抑郁的影响因素、临床结局及采用明尼苏达多相人格测验研究老年卒中后抑郁患者的心理特征。方法对160例老年卒中患者进行回顾性病例对照研究,根据有无卒中后抑郁分为2组,采用logistic回归分析卒中后抑郁的影响因素,并统计分析卒中后抑郁患者的人格特征。结果抑郁人格、疑病人格、精神衰弱人格量表分值差异显著(P0.05);疑病分值、抑郁分值与老年卒中后抑郁呈正相关;配偶支持、卒中部位、简易智能评分量表分值和美国国立卫生研究院卒中评分量表分值与老年卒中后抑郁发生相关。老年卒中后抑郁组卒中后30 d Bathel生活能力评分比对照组显著降低(P0.05),30 dRankin评分0-1级抑郁组人数显著减少(P0.001)。结论老年卒中后抑郁患者人格以抑郁人格、疑病人格、精神衰弱人格为主;缺乏配偶支持、前循环病变、认知障碍和卒中严重的患者更易发生老年卒中后抑郁;老年卒中后抑郁的发生延长平均住院时间、影响卒中的临床康复。     

Psychological Test Data of Depressed,Nondepressed and Relapsed Alcoholics Receiving Pharmacological Aversion *

A test battery consisting of the Beck Depression Inventory, Zung Self-Rating Depression Scale, Rathus Assertiveness Schedule, and Minnesota Multiphasic Personality Inventory was administered to newly admitted alcoholic patients receiving pharmacological aversion treatment at a private facility. The results found 42 per cent of these patients to be clinically depressed. This depressed group was also significantly more depressed than relapsed patients readmitted for further treatment. The depressed group appeared qualitatively different in being younger and in reporting significantly more psycho-pathology on the MMPI. In addition, significant sex differences appeared in that women reported more psychopathology and less overall social skill than their male counterparts. Arguments were presented for both assessing and treating depression and social skill deficits in multifaceted treatment programmes for alcoholics.     

Personality profiles of mothers of children with mitochondrial disorders

Mothers of children with mitochondrial disorders, inherited neurodegenerative diseases, are faced with a frightening diagnosis and numerous demands associated with caring for these children. The psychological profile of mothers whose children carry a mitochondrial disorder is unknown. Forty-two mothers of children with mitochondrial disorders were interviewed and administered the Minnesota Multiphasic Personality Inventory – Second Edition (MMPI-2). Fifty-six per cent of the mothers had scores in the pathological range on three or more scales, most notably on Hypochondriasis, Hysteria and Paranoia scales. The MMPI-2 profile is associated with situational anxiety and stress or may be associated with carrier status characteristics. Whatever the cause, future studies need to determine whether supportive services can reduce the level of anxiety and stress in mothers of children with these disorders.     

Personality Patterns Seen in Irritable Bowel Syndrome Patients

A study of the personality styles seen in individuals having irritable bowel syndrome was done in a group of 82 patients with this diagnosis. An objective personality test, the Minnesota Multiphasic Personality Inventory, was administered to the irritable bowel syndrome patient group to produce individual profiles for each patient. The 82 profiles were subjected to q-factor analysis resulting in four subgroupings of the original sample. Titles used to describe the personalities seen in the four groups included: inadequate dependency; somatization of affect; reactive depression; and 4) anger and denial. Future studies on the behavioral treatment of irritable bowel syndrome patients may well include a personality inventory as a consideration of how irritable bowel syndrome patients have different personality styles.     

Assessing depression in fibromyalgia patients

Purpose. This study investigated the relationships among four methods of detecting depression in patients with fibromyalgia. Methods. Data were obtained from 100 women (mean age 43 years) who had been diagnosed with fibro-myalgia. Instruments included a computerized Diagnostic Interview Schedule (C-DIS), Beck Depression Inventory (BDI), an adjusted “disease-free” BDI (BDI-A), and Minnesota Multiphasic Personality Inventory depression subscale (MMPI-D). Chance-corrected concordance, sensitivity, specificity, and accuracy among the four methods were calculated. Results. The C-DIS detected 22% and BDI-A 29% with current major depression. The BDI and MMPI-D yielded higher estimates of 55% of the 44%, respectively. Agreement on the diagnosis among the four methods was significantly greater than chance. When compared with the C-DIS, the BDI was the most sensitive instrument and the BDI-A most specific. Conclusions. The C-DIS and BDI-A appear to be more reliable methods for determining the presence of major depression in women with fibromyalgia than are the MMPI-D or standard BDI.