Temperament, childhood environment and psychopathology as risk factors for avoidant and borderline personality disorders

OBJECTIVE: To evaluate childhood experiences (neglect and abuse), temperament and childhood and adolescent psychopathology as risk factors for avoidant and borderline personality disorders in depressed outpatients. METHOD: One hundred and eighty depressed outpatients were evaluated for personality disorders. Risk factors of childhood abuse, parental care, temperament, conduct disorder symptoms, childhood and adolescent anxiety disorders, depressive episodes, hypomania and alcohol and drug dependence were obtained by questionnaires and interviews. RESULTS: Avoidant personality disorder can be conceptualized as arising from a combination of high harm avoidance (shy, anxious), childhood and adolescent anxiety disorders and parental neglect. Borderline personality disorder can be formulated as arising from a combination of childhood abuse and/or neglect, a borderline temperament (high novelty seeking and high harm avoidance), and childhood and adolescent depression, hypomania, conduct disorder and alcohol and drug dependence. CONCLUSIONS: Combinations of risk factors from the three domains of temperament, childhood experiences and childhood and adolescent psychopathology make major contributions to the development of avoidant and borderline personality disorders.     

Training general psychiatry residents in child and adolescent psychiatry

The authors describe the nature of current social and economic forces impacting on the education and future practice of general psychiatry residents in child and adolescent psychiatry. They review theoretical and practical reasons for training in child and adolescent psychiatry, analyze the form and content of what is currently taught based on a national survey of general training programs, and suggest guidelines for the training and postgraduate practice of general psychiatrists in evaluating and treating children and adolescents. The authors conclude that while social and economic changes necessitate general psychiatrists' clinical involvement with children and adolescents, insufficient general training may necessitate postgraduate education and supervision. They pose ethical and professional dilemmas for the field in meeting the national shortage of child and adolescent psychiatrists and propose strategies to enhance recruitment into child and adolescent residency training.     

The Organizational Social Context of Mental Health Medicaid Waiver Programs with Family Support Services: Implications for Research and Practice

Peer family support specialists (FSS) are parents with practical experience in navigating children’s mental health care systems who provide support, advocacy, and guidance to the families of children who need mental health services. Their experience and training differ from those of formally trained mental health clinicians, creating potential conflicts in priorities and values between FSS and clinicians. We hypothesized that these differences could negatively affect the organizational cultures and climates of mental health clinics that employ both FSS and mental health clinicians, and lower the job satisfaction and organizational commitment of FSS. The Organizational Social Context measure was administered on site to 209 FSS and clinicians in 21 mental health programs in New York State. The study compared the organizational-level culture and climate profiles of mental health clinics that employ both FSS and formally trained clinicians to national norms for child mental health clinics, assessed individual-level job satisfaction and organizational commitment as a function of job (FSS vs. clinician) and other individual-level and organizational-level characteristics, and tested whether FSS and clinicians job attitudes were differentially associated with organizational culture and climate. The programs organizational culture and climate profiles were not significantly different from national norms. Individual-level job satisfaction and organizational commitment were unrelated to position (FSS vs. clinician) or other individual-level and organizational-level characteristics except for culture and climate. Both FSS’ and clinicians’ individual-level work attitudes were associated similarly with organizational culture and climate.     

Adaptive Resonance Theory: How a brain learns to consciously attend,learn, and recognize a changing world

Adaptive Resonance Theory, or ART, is a cognitive and neural theory of how the brain autonomously learns to categorize, recognize, and predict objects and events in a changing world. This article reviews classical and recent developments of ART, and provides a synthesis of concepts, principles, mechanisms, architectures, and the interdisciplinary data bases that they have helped to explain and predict. The review illustrates that ART is currently the most highly developed cognitive and neural theory available, with the broadest explanatory and predictive range. Central to ART’s predictive power is its ability to carry out fast, incremental, and stable unsupervised and supervised learning in response to a changing world. ART specifies mechanistic links between processes of consciousness, learning, expectation, attention, resonance, and synchrony during both unsupervised and supervised learning. ART provides functional and mechanistic explanations of such diverse topics as laminar cortical circuitry; invariant object and scenic gist learning and recognition; prototype, surface, and boundary attention; gamma and beta oscillations; learning of entorhinal grid cells and hippocampal place cells; computation of homologous spatial and temporal mechanisms in the entorhinal–hippocampal system; vigilance breakdowns during autism and medial temporal amnesia; cognitive–emotional interactions that focus attention on valued objects in an adaptively timed way; item–order–rank working memories and learned list chunks for the planning and control of sequences of linguistic, spatial, and motor information; conscious speech percepts that are influenced by future context; auditory streaming in noise during source segregation; and speaker normalization. Brain regions that are functionally described include visual and auditory neocortex; specific and nonspecific thalamic nuclei; inferotemporal, parietal, prefrontal, entorhinal, hippocampal, parahippocampal, perirhinal, and motor cortices; frontal eye fields; supplementary eye fields; amygdala; basal ganglia: cerebellum; and superior colliculus. Due to the complementary organization of the brain, ART does not describe many spatial and motor behaviors whose matching and learning laws differ from those of ART. ART algorithms for engineering and technology are listed, as are comparisons with other types of models.     

Affective personality as cognitive-emotional presymptom profiles regulatory for self-reported health predispositions

Three studies that examined the links between affective personality, as constructed from responses to the Positive Affect (PA) and Negative Affect (NA) Scale (PANAS), and individuals' self-report of self-esteem, intrinsic motivation and Beck's Depression Inventory (BDI) depression in high school students and persons in working occupations are described. Self-report estimations of several other neuropsychiatric and psychosocial variables including, the Uppsala Sleep Inventory (USI), the Hospital Anxiety and Depression (HAD) test, Dispositional optimism, Locus of control, the Subjective Stress Experience test (SSE) and the Stress-Energy (SE) test, were also derived. Marked effects due to affective personality type upon somatic and psychological stress, anxiety and depression, self-esteem, internal and external locus of control, optimism, stress and energy, intrinsic motivation, external regulation, identified regulation, major sleep problems, problems falling asleep, and psychophysiological problems were observed; levels of self-esteem, self-motivation and BDI-depression all produced substantial effects on health and well-being. Regression analyses indicated PA was predicted by dispositional optimism (thrice), energy (thrice), and intrinsic motivation, and counter predicted by depression (twice) and stress (twice); and NA by anxiety (twice), stress (twice), psychological stress, identified regulation, BDI depression and psychophysiological problems, and counter predicted by internal locus of control and self-esteem. BDI-depression was predicted by negative affect, major sleep problems and psychophysiological problems (Study III), self-esteem by dispositional optimism and energy, and counter predicted by anxiety, depression and stress (Study I), and intrinsic motivation by dispositional optimism, energy, PA and self-esteem (Study II). These convergent findings are interpreted from a perspective of the cognitive-emotional expressions underlying behavioural or presymptomatic profiles presenting predispositions for health or ill health.     

Protective and damaging effects of stress mediators: central role of the brain

The mind involves the whole body and two-way communication between the brain and the cardiovascular, immune, and other systems via neural and endocrine mechanisms. Stress is a condition of the mind-body interaction, and a factor in the expression of disease that differs among individuals. It is notjust the dramatic stressful events that exact their toll, but rather the many events of daily life that elevate and sustain activities of physiological systems and cause sleep deprivation, overeating, and other health-damaging behaviors, producing the feeling of being "stressed out." Over time, this results in wear and tear on the body which is called "allostatic load," and it reflects not only the impact of life experiences but also of genetic load, individual lifestyle habits reflecting items such as diet, exercise, and substance abuse, and developmental experiences that set life-long patterns of behavior and physiological reactivity. Hormones associated with stress and allostatic load protect the body in the short run and promote adaptation by the process known as allostasis, but in the long run allostatic load causes changes in the body that can lead to disease. The brain is the key organ of stress, allostasis, and allostatic load, because it determines what is threatening and therefore stressful, and also determines the physiological and behavioral responses. Brain regions such as the hippocampus, amygdala, and prefrontal cortex respond to acute and chronic stress by undergoing structural remodeling, which alters behavioral and physiological responses. Translational studies in humans with structural and functional imaging reveal smaller hippocampal volume in stress-related conditions, such as mild cognitive impairment in aging and prolonged major depressive illness, as well as in individuals with low self-esteem. Alterations in amygdala and prefrontal cortex are also reported. Besides pharmaceuticals, approaches to alleviate chronic stress and reduce allostatic load and the incidence of diseases of modern life include lifestyle change, and policies of government and business that would improve the ability of individuals to reduce their own chronic stress burden.     

The use of standardized incidence and prevalence rates in epidemiological studies on multiple sclerosis. A meta-analysis study

OBJECTIVE: To demonstrate whether or not the age and sex adjustment of incidence and prevalence rates in multiple sclerosis (MS) could allow more reliable comparison between epidemiological studies performed in different areas of the world and to establish if the latitude gradient theory could be confirmed after the standardization for age and sex distribution. METHODS: A meta-analysis of population-based incidence and prevalence studies on MS from 1980 through 1998 using the terms 'multiple sclerosis', 'prevalence' and 'incidence' in the bibliographic databases MEDLINE and EMBASE was performed. We included studies that reported the diagnostic criteria, number of cases and the population studied, the date of the study, the latitude, and the age- and sex-specific crude incidence and prevalence rates. According to the inclusion criteria, 69 of 127 papers on prevalence and 22 of 70 papers on incidence were considered for age adjustment and 27 prevalence and 8 incidence studies for sex adjustment. The mean incidence and prevalencerates and the 95% confidence intervals age- and sex-adjusted to the World and the European standard populations were calculated. RESULTS: The Spearman rank correlation and the multiple regression analyses indicated that age adjustment to standard populations could overcome the limitations in comparing the crude prevalence and incidence rates of different epidemiological studies on MS. When the mean crude and age- and sex-adjusted prevalence and age-adjusted incidence rates were stratified by latitude (from south to north), the latitudinal gradient, which was highly significant for the crude rates, became less remarkable for the age- and sex-adjusted prevalence rates and not significant for the age-adjusted incidence rates. CONCLUSIONS: The crude incidence and prevalence rates in epidemiological studies on MS should be age- and sex-adjusted to a common standard population to permit a more reliable comparison among studies performed in different countries. Our findings support the opinion that the latitude does not play a key role in determining the onset of MS. Whenever possible, the crude incidence and prevalence rates should be adjusted to the ethnic origin and migration characteristics.     

Subcortical correlates of the somatic, auditory and visual vertex activities. II. Referential EEG responses

A systematic analysis of polarity, amplitude and latency of the referential EEG responses correlated to surface somatic (SVA), auditory (AVA) and visual (VVA) vertex activities (VA) was done in various subcortical structures of a non-specific system of the same group of patients with electrodes implanted and reported in a previous work. These structures included the caudal and rostral mesencephalic reticular formations (cttc and rttc), the subthalamic region (Sth), the centro-median (Ce), parafascicular (Pf), ventrolateral (VL), dorsolateral (DL) and reticularis (Rt) thalamic nuclei; the orbito-frontal cortex (GO), the anterior commissure (Acm), the pallidum medialis and lateralis (Pm and Pl), the putamen (Pt) and the amygdala (Am). Subcortical SVA, AVA and VVA were formed by 4 consecutive components O, A, B and C correlated to components P1, N1, P2 and N2 of the surface VA. Components A and B of the subcortical SVA reversed polarity 4 times when recorded in structures arranged in a caudo-rostral order: between rttc-Ce and VL, between Rt and GO, between GO and Acm and between Acm and Am. Components A and B of subcortical AVA and VVA reversed polarity two times each: AVA between cttc and rttc and between GO and Acm; while VVA between GO and Acm and between Acm and Pm. Components A and B of SVA and VVA attained maximal amplitudes and minimal latencies at GO. From here, their amplitude decreased and latency increased with distance along other structures rostrally and caudally located. Components A and B of AVA attained maximal amplitudes and minimal latencies at cttc.(ABSTRACT TRUNCATED AT 250 WORDS)     

缺血性脑卒中颈动脉内膜中层厚度与脑循环动力学的研究

目的探讨颈动脉内膜中层厚度（IMT）与脑循环动力学（CVA）之间相关性及其对缺血性脑卒中的早期临床诊断价值。方法 应用彩色多普勒超声和CVA检测仪检测分析120例急性期和超早期缺血性脑卒中患者的颈动脉IMT，IMT/D比率及CVA各项指标并与健康对照组比较。结果 缺血性脑卒中患者颈动脉IMT及IMT/D比率均明显大于健康成人；缺血性脑卒中超早期组Vmean,Qmean比急性期组明显降低。而R，DR明显增高，超早期组CVA检测阳性率明显高于急性期组，颈动脉IMT及IMT/D比率与Vmean,Qman呈显著直线负相关。与R，Zc呈显著直线正相关。结论 颈动脉IMT及CVA检测对于缺血性脑卒中早期诊断具有重要临床意义。     

Mood disorders in multiple sclerosis: diagnosis and treatment

Emotional disturbances are common in MS and consist of disturbances of mood and disturbances of affect. The important mood disorders are major depressive disorder, dysthymic disorder, bipolar disorder, panic disorder, and generalized anxiety disorder. Their relationship to MS is multi-factorial and complex, and the extent to which they are direct consequences of the disease process or psychological reactions to it remains unclear. Whatever their cause, however, the symptoms of mood disorders in people with MS are no different from the symptoms of mood disorders in people without MS, and respond just as well to standard treatments. The disorders of affect are euphoria, pathological laughing and weeping, and other frontal lobe syndromes. These disorders result from demyelination, are some of the most characteristic symptoms of MS, and have the same implications for treatment as do other aspects of the disease. Mood and affective disturbances can cause enormous pain and suffering and lead to significant disruption of family, work, and social life. Physicians who can identify, diagnose, treat, and manage mood and affective disturbances effectively and who can help their patients and family members acknowledge these difficulties, talk about them, and accept psychiatric consultation and treatment can have a dramatic impact on the quality of their lives. This paper outlines the symptoms and diagnostic criteria for mood disorders and affective disturbances, reviews current treatment options, summarizes data from epidemiologic and pathophysiological studies, and suggests areas for future research.     

多发性硬化、视神经脊髓炎患者血清及脑脊液中脑源性神经营养因子与胶质细胞源性神经营养因子水平

目的 探讨多发性硬化(MS)、视神经脊髓炎(NMO)患者血清及脑脊液中脑源性神经营养因子(BDNF)、胶质细胞源性神经营养因子(GDNF)水平及其神经保护作用.方法 对62例MS、NMO患者及21例对照者进行研究,患者组复发期进行扩展残疾状态量表(EDSS)评分、MRI检查及寡克隆带测定,液相芯片分析技术检测血清及脑脊液BDNF、GDNF浓度.结果 MS、NMO患者复发期血清及脑脊液BDNF(μg/L,MS患者:5.616±0.650、0.186±0.012;NMO患者6.584±0.929、0.176±0.006)、GDNF浓度(μg/L,MS患者:0.039、0.080;NMO患者0.029、0.050)与对照组(μg/L,血清:4.374±0.501、0.040;脑脊液:0.152±0.011、0.065)比较差异无统计学意义;脑脊液BDNF与GDNF浓度水平呈正相关(r=0.756,P=0.000),血清BDNF与GDNF浓度水平呈负相关(r=-0.329,P=0.018).血清及脑脊液BDNF、GDNF浓度与EDSS评分、血脑屏障指数、Delpech指数及Tourtellotte合成率无明显相关性.有或无脑萎缩的MS、NMO患者血清及腩脊液BDNF、GDNF浓度差异无统计学意义.结论 MS、NMO患者体内BDNF与GDNF水平相关,二者可能具有协同的神经保护作用.BDNF及GDNF与NMO、MS患者血脑屏障破坏及中枢神经系统内IgG合成无关,与神经功能残疾及脑萎缩的关系仍需研究.     

The place of culture in trauma studies: an american view

The place of culture in psychiatry and trauma studies has become increasingly important in recent years. In theoretical studies, research and in clinical assessment and treatment, it is essential to incorporate concepts and guidelines from diverse fields, including medicine, psychiatry and psychology and the social sciences. War trauma and migration have greatly influenced the direction of research and clinical care in the field and have underscored the importance and relevance of anthropological perspectives. There are both universal and culturally-specific ways that trauma is experienced and processed by individuals, families and the culture at large. It is important for healers working with those who have experienced trauma to provide a safe, secure and predictable environment for the healing process and to bridge symbolic systems of meaning relevant for effective healing in both the specific cultural group and the majority society. These issues also have important implications for the effective education and training of professionals working with a variety of cultural and ethnic groups.     

Psychoanalysis and the Hindi cinema

Psychoanalysis was developed in nineteenth-century Vienna and led to a major change in thinking about emotions and feelings, and entered common parlance. Psychoanalysis raises notions of individual's growth and development, and defence mechanisms are used to suppress anxiety and stress. Portrayal of psychoanalysis in modern Hindi cinema is rare. In this paper we look at two films released in the late 1960s which dealt directly with psychoanalysis. Using these films we illustrate the relationship between males and females and the interaction between mothers and sons in the Indian context. The role of nurses as nurturing maternal figures and the role of tradition and modernity related to gender and westernization are discussed. These films represent the emergent India and its relationship with modernity and traditional values.     

Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder

OBJECTIVE: The purpose of the study was to test the relative and combined efficacy of clomipramine and exposure and ritual prevention in the treatment of obsessive-compulsive disorder (OCD) in adults. Serotonin reuptake inhibitors (SRIs) and cognitive behavior therapy by exposure and ritual prevention are both established treatments for OCD, yet their relative and combined efficacy have not been demonstrated conclusively. METHOD: A double-blind, randomized, placebo-controlled trial comparing exposure and ritual prevention, clomipramine, their combination (exposure and ritual prevention plus clomipramine), and pill placebo was conducted at one center expert in pharmacotherapy, another with expertise in exposure and ritual prevention, and a third with expertise in both modalities. Participants were adult outpatients (N=122 entrants) with OCD. Interventions included intensive exposure and ritual prevention for 4 weeks, followed by eight weekly maintenance sessions, and/or clomipramine administered for 12 weeks, with a maximum dose of 250 mg/day. The main outcome measures were the Yale-Brown Obsessive Compulsive Scale total score and response rates determined by the Clinical Global Impression improvement scale. RESULTS: At week 12, the effects of all active treatments were superior to placebo. The effect of exposure and ritual prevention did not differ from that of exposure and ritual prevention plus clomipramine, and both were superior to clomipramine only. Treated and completer response rates were, respectively, 62% and 86% for exposure and ritual prevention, 42% and 48% for clomipramine, 70% and 79% for exposure and ritual prevention plus clomipramine, and 8% and 10% for placebo. CONCLUSIONS: Clomipramine, exposure and ritual prevention, and their combination are all efficacious treatments for OCD. Intensive exposure and ritual prevention may be superior to clomipramine and, by implication, to monotherapy with the other SRIs.     

针灸结合康复训练对颅脑损伤患者运动和认知功能的影响

目的 观察中、重型外伤性颅脑损伤(TBI)患者经针刺疗法结合康复训练后对患者运动功能、平衡功能、认知功能及ADL的影响.方法 将160例入选病例随机分为针康组和常规组,所有患者均接受常规药物治疗、胃肠营养、防治并发症,针康组在此基础上进行针刺结合康复训练,为期6周.采用Fugl-Meyer量表分别对2组患者下肢运动功能、平衡功能进行评定,用Barthel指数评定患者日常生活能力(ADL);认知功能评定采用简明精神状态检查(MMSE).结果 治疗后2组间患者下肢运动功能、平衡功能及ADL积分、MMSE总分等指标均有改善;与治疗前比较,差异均有统计学意义(P《0.05),而针康组疗效更优于常规组(P《0.05).结论 康复训练加针刺疗法可明显提高中、重型TBI患者下肢运动功能、平衡功能、认知功能及ADL积分值,对功能恢复有积极作用.     

Social Discomfort in Preadolescence: Predictors of Discrepancies between Preadolescents and Their Parents and Teachers

The present study investigated whether salient preadolescent behaviors and experiences predicted parents’ and teachers’ underestimation of preadolescents’ shyness. Participants included a community sample of 129 fifth and sixth graders, along with one parent and teacher per preadolescent. Preadolescents, parents, and teachers provided reports about preadolescents’ shyness, and parents and teachers rated preadolescents’ prosocial and aggressive behaviors, peer victimization experiences, and academic performance. Results indicated that parent- and teacher-reported prosocial behavior, teacher-reported aggressive behavior, and parent-reported peer victimization were associated with lower parent and teacher reports of preadolescent shyness, relative to preadolescent reports, controlling for demographic variables and parent stress. Additionally, higher parent-reported academic performance was associated with lower teacher reports of preadolescent shyness, compared to preadolescent reports. These findings suggest that preadolescents with higher levels of relatively conspicuous behaviors and experiences feel more shyness than their parents and teachers report.     

Neuronal damage and protection in the pathophysiology and treatment of psychiatric illness: stress and depression

The discovery that stress and depression, as well as other psychiatric illnesses, are characterized by structural alterations, and that these changes result from atrophy and loss of neurons and glia in specific limbic regions and circuits, has contributed to a fundamental change in our understanding of these illnesses. These structural changes are accompanied by dysregulation of neuroprotective and neurotrophic signaling mechanisms that are required for the maturation, growth, and survival of neurons and glia. Conversely, behavioral and therapeutic interventions can reverse these structural alterations by stimulating neuroprotective and neurotrophic pathways and by blocking the damaging, excitotoxic, and inflammatory effects of stress. Lifetime exposure to cellular and environmental stressors and interactions with genetic factors contribute to individual susceptibility or resilience. This exciting area of research holds promise and potential for further elucidating the pathophysiology of psychiatric illness and for development of novel therapeutic interventions.     

Thalamic structures and associated cognitive functions: Relations with age and aging

The thalamus, with its cortical, subcortical, and cerebellar connections, is a critical node in networks supporting cognitive functions known to decline in normal aging, including component processes of memory and executive functions of attention and information processing. The macrostructure, microstructure, and neural connectivity of the thalamus changes across the adult lifespan. Structural and functional magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) have demonstrated, regional thalamic volume shrinkage and microstructural degradation, with anterior regions generally more compromised than posterior regions. The integrity of selective thalamic nuclei and projections decline with advancing age, particularly those in thalamofrontal, thalamoparietal, and thalamolimbic networks. This review presents studies that assess the relations between age and aging and the structure, function, and connectivity of the thalamus and associated neural networks and focuses on their relations with processes of attention, speed of information processing, and working and episodic memory.     

Mammillary bodies and fornix fibers are injured in heart failure

Cognitive abnormalities, including memory deficits, are common in heart failure (HF). Brain structures, including the hippocampus, fornix, and thalamus participate in memory processing, and most show structural injury and functional deficits in HF. The mammillary bodies and fornix play essential roles in spatial and working memory processing, interact with other structures, and may also be injured in HF. We assessed mammillary body volumes and cross-sectional fornix areas in 17 HF and 50 control subjects using high-resolution T1-weighted magnetic resonance images. Mammillary body volumes and fornix cross-sectional areas were significantly reduced bilaterally in HF, and these differences remained after controlling age, gender, and intracranial volume. Mammillary body and fornix injury may contribute to the compromised spatial and working memory deficits in HF. Pathological processes eliciting the damage may include injury accompanying hypoxic/ischemic processes in pathologic HF perfusion and breathing, and thiamine deficiency accompanying diuretic use and nutritional mal-absorption in the condition.     

The self and schizophrenia: a cultural perspective

Much of what is known about schizophrenia necessarily reflects and deals with what is expected of and known about the self and human subjectivity. Schizophrenia is a disorder that by definition affects individual perception and cognition, and compromises social identity and functioning. The changes wrought by schizophrenia affect the self in a broad context, encompassing such things as self-concepts, self-awareness, self-functioning, and self-career. Thus, schizophrenia erodes and undermines the organization and functioning of the self, and because of this, schizophrenia and self/subjectivity are integrally linked. However, our knowledge of self and human subjectivity is a Western European-influenced knowledge. A basic assumption of this article is that there exist other, non-Western varieties of selves and human subjectivities that provide essential information for understanding human psychological and social behavior. The aim of this article is to show how an account of such alternative psychologies through cross-cultural anthropological studies may contribute to a fuller understanding of schizophrenia and the self in a cultural and cross-cultural perspective.