Avoidant personality disorder and social phobia: distinct enough to be separate disorders?

OBJECTIVE: Existing evidence from anxiety disorder research indicates that social phobics (SP) with avoidant personality disorder (AVPD) experience more anxiety and show more impairment than patients with SP alone. The purpose of this study was to examine whether in patients diagnosed with AVPD, the co-occurrence of SP adds to its severity. We hypothesized that the addition of SP will not add to the severity of AVPD alone. METHOD: Two groups of patients (AVPD=224; AVPD/SP=101) were compared at baseline and 2 years later on multiple demographic and clinical variables. RESULTS: Patients with AVPD and an additional diagnosis of SP differed little from patients with AVPD alone. CONCLUSION: These findings suggest that AVPD and SP may be alternative conceptualizations of the same disorder.     

Wisconsin rural women's health study psychological factors and blood cholesterol level: difference between normal and overweight rural women

OBJECTIVE: The aim of the present study is to investigate the effects of psychological factors on plasma lipid levels among rural women of central Wisconsin and to compare the effects of these variables among normal-weight and overweight women. METHODS: Stratified sampling was used to select a random sample (n=1500) of farm and non-farm women aged 25 to 71 years from the Central Marshfield Epidemiologic Study Area. The baseline examination included measurements of blood pressure, skin folds, height, weight, and fasting blood lipids, glucose, and insulin. Framingham study questionnaires were employed to measure anger, anxiety, tension, and marital disagreement. The Spielberger Trait anger-reaction subscale was employed to assess proneness to anger. RESULTS: Among normal-weight women, a positive association was found between anger-reaction scores and cholesterol (b=0.008), ratio (b=0.014), triglycerides (b=0.02), and LDL (b=0.07). The odds of elevated cholesterol were highest among women with high scores on the Speilberger anger-reaction scale (OR=2.0) and anger discussion scale (OR=2.0), while the odds were less among women with high scores on the anger-out scale (OR=0.59). However, among overweight women, we found only scores on the Framingham anger-discussion scale as an important factor to determine the plasma lipid levels. CONCLUSION: Anger management may help to sever the link between psychological factors and CHD risk factors. Intervention intended to prevent cardiac events through the reduction of stress and modification of related psychological risk factors have successfully improved the CHD risk factors profile. Similar studies are needed to determine the efficacy of intervention for the primary prevention of CHD risk factors.     

Longitudinal diagnostic efficiency of DSM-IV criteria for obsessive-compulsive personality disorder: a 2-year prospective study

OBJECTIVE: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for obsessive-compulsive personality disorder (OCPD). METHOD: At baseline, criteria and diagnoses were determined using diagnostic interviews, and blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, using the independent OCPD diagnosis at follow-up as the standard. RESULTS: Longitudinal diagnostic efficiencies for the OCPD criteria varied; findings suggested the overall predictive utility of 'preoccupied with details', 'rigid and stubborn', and 'reluctant to delegate'. CONCLUSION: These findings suggest the predictive validity of three cognitive-interpersonal OCPD criteria.     

Borderline personality disorder criteria associated with prospectively observed suicidal behavior

OBJECTIVE: The authors prospectively examined associations between each DSM-IV borderline personality disorder criterion and suicidal behaviors. METHOD: Borderline personality disorder diagnosis and criteria, major depressive disorder, substance use disorders, and history of childhood sexual abuse were assessed with semistructured interviews. Participants (N=621) were followed for 2 years with repeated structured evaluations that included assessments of suicidality. RESULTS: With the self-injury criterion excluded, the borderline personality disorder criteria of affective instability, identity disturbance, and impulsivity significantly predicted suicidal behaviors. Only affective instability and childhood sexual abuse were significantly associated with suicide attempts (i.e., behavior with some intent to die). CONCLUSIONS: Affective instability is the borderline personality disorder criterion (excluding self-injury) most strongly associated with suicidal behaviors. Since major depressive disorder did not significantly predict suicidal behaviors, the reactivity associated with affective instability (more so than negative mood states) appears to be a critical element in predicting suicidal behaviors.     

Curative potential of multimodality therapy for locally recurrent rectal cancer

OBJECTIVE: To assess the results of multimodality therapy for patients with recurrent rectal cancer and to analyze factors predictive of curative resection and prognostic for overall survival. SUMMARY BACKGROUND DATA: Locally recurrent rectal cancer is a difficult clinical problem, and radical treatment options with curative intent are not generally accepted. METHODS: A total of 394 patients underwent surgical exploration for recurrent rectal cancer. Ninety were found to have unresectable local or extrapelvic disease and 304 underwent resection of the recurrence. The latter patients were prospectively followed to determine long-term survival and factors influencing survival. RESULTS: Overall 5-year survival was 25%. Curative, negative resection margins were obtained in 45% of patients; in these patients a 5-year survival of 37% was achieved, compared to 16% (P <.001) in patients with either microscopic or gross residual disease. In a logistic regression analysis, initial surgery with end-colostomy and symptomatic pain (both univariate) and increasing number of sites of the recurrent tumor fixation in the pelvis (multivariate) were associated with palliative surgery. Overall survival was significantly decreased for symptomatic pain (P <.001) and more than one fixation (P =.029). Survival following extended resection of adjacent organs was not different from limited resection (28% vs. 21%, P =.11). Patient demographics and factors related to the initial rectal cancer did not affect outcome. Perioperative mortality was only 0.3%, but significant morbidity occurred in 26% of patients, with pelvic abscess being the most common complication. CONCLUSIONS: This study demonstrates that many patients with locally recurrent rectal cancer can be resected with negative margins. Long-term survival can be achieved, especially for patients with no symptoms and minimal fixation of the recurrence in the pelvis, provided no gross residual disease remains.     

Excellent results of HA coating on a grit-blasted stem: 245 patients followed for 8-12 years

We report the outcome of a grit-blasted titanium stem designed for press-fit insertion and entirely plasma sprayed with HA. During the years 1988-1993, we performed 323 primary total hip replacements in 276 patients (189 women) with a HA-coated prosthesis. Their mean age was 48 (15-79) years. During the follow-up, 12 patients died. 19 other patients did not attend the follow-up examination, but had no major symptoms according to telephone interviews and written replies. Thus, 245 patients (291 hips) were followed for a mean of 10 (8-12) years with radiographic and clinical examinations. Only 1 stem was revised due to mechanical failure. None were revised because of infection. Osteolysis was significantly associated with wear, and wear was significantly associated with the size of the femoral head. We found a small amount of proximal bone loss (37/291) and a low incidence of distal hypertrophy of the bone (23/291). These observations indicate an essentially physiological weight distribution from the stem to the femoral bone. The changes in the bone confirmed that the femoral component was well fixed in asymptomatic patients. To conclude, we found excellent 8-12-year results with a fully HA-coated femoral prosthesis designed for press-fit insertion.     

Endocavitary radiation therapy for rectal adenocarcinoma: 10-year results

Local control, survival, and toxicity in patients treated with endocavitary radiation therapy for rectal cancer were evaluated. Thirty-five patients received a total of 20 to 155 Gy in 1 to 5 fractions with 50 kV x-rays through a treatment proctoscope. Twenty-nine of the 35 patients were treated with curative intent. Median follow-up was 102 months. Local control was achieved in 23 of the 29 patients treated curatively and in 3 of the 6 treated palliatively. Local control for patients treated curatively was 76% at 10 years. No local failures occurred after 21 months. For patients treated curatively, survival was 65% at 5 years and 42% at 10 years. Toxicity within 90 days after treatment was observed in 77% of the patients. Toxicity occurring more than 90 days after treatment was observed in 80%, but only 1 patient needed a colostomy, which was for a perforation after the biopsy of a benign ulcer. In conclusion, radiation therapy resulted in a local control rate of 76% at 10 years in curatively treated patients. Although most patients experience toxicity from this treatment, loss of sphincter function is rare.