Personality features related to generalized anxiety disorder

Forty-six patients with generalized anxiety disorder (GAD) without any other coexisting axis I diagnoses were compared with 50 control subjects for assessment on axis II. No specific personality disorder (PD) was found to be significantly associated with chronic anxiety, although the majority of anxious patients showed significantly more maladaptative traits than controls. Discriminant analysis selected a list of items able to provide a correct classification rate of 91% based on personality features selected in canonical function. Factor analysis indicated that personality characteristics of expectation of damage were more closely related to GAD in our sample.     

Morbidity risk for mood disorders in the families of borderline patients.

We analyzed the familial morbidity risk for mood disorders (MR) and the presence of a family history of alcoholism in a group of 58 patients with DSM-III borderline personality disorder (PD). The MR in the families of borderline subjects was not significantly different from that found in a control group of affective patients with other cluster II PD, or without PD. The MR in the families of borderline subjects who had never developed an affective episode was not significantly different from that found in the families of borderline PD with a history of mood disorders. Borderline subjects with mood disorders had higher rates of alcoholism in their families, mainly among parents. Our results support the hypothesis that borderline PD, even in absence of the codiagnosis of a mood disorder in the subject, may be a predictor of higher familial liability to mood disorders, although it may be more informative for the familial clustering of specific subgroups than for mood disorders as a whole.     

The nature of depression in borderline depressed patients.

The symptomatology of 15 borderline (BDL) depressed and 45 non-BDL depressed consecutive inpatients was assessed using the Hamilton depression scale (HAM-D) and the 90-item Symptoms Checklist (SCL-90) self-rating questionnaire. No significant differences were found in the total scorings of the two instruments in the two groups of patients. However, while non-BDL depressive rated significantly higher in items related to melancholic forms of depression, BDL depressives showed less specific symptoms, and the persistence, or possibly the magnification, of their maladaptive personologic structure. Two discriminant analyses, performed on the ratings at the HAM-D and SCL-90 of the two groups of patients, suggested that although the total degree of severity may be the same, the depressive episodes of BDL patients are qualitatively different from those of patients with less maladaptive personologic traits.     

The influence of clinical relapses and steroid therapy on the development of Gd-enhancing lesions: a longitudinal MRI study in relapsing—remitting multiple sclerosis patients

Fifty-three patients with relapsing-remitting multiple sclerosis who had monthly Gd (gadolinium) enhanced MRI (Magnetic Resonance Imaging) and clinical evaluation, were divided into two subgroups: 1) patients with a clinical relapse, treated with IVMP (intravenous methylprednisolone) and at least one enhancing lesion on MRI. 2) patients who did not have a clinical relapse but with at least one enhancing lesion on MRI. In group 1, we evaluated the number and volume of enhancing lesions on the scan before and three scans after IVMP therapy; in group 2, we considered the first scan with enhancing lesions and the subsequent three scans. The mean number and volume of enhancing lesions on the first scan was significantly higher in patients with clinical relapse compared to patients without clinical relapse. In group 1, we found a consistent reduction in the first scan following steroid treatment which returned to initial levels at the following scan. Both volumetric and numerical evaluation are appropiate MRI outcome measures in monitoring therapeutic trials.     

Magnetic resonance imaging changes with recombinant human interferon-beta-1a: a short term study in relapsing-remitting multiple sclerosis.

OBJECTIVE: To evaluate whether recombinant human interferon-beta-1a significantly affects disease activity as measured by a reduction in the number and volume of Gd enhancing lesions on monthly MRI. The study also evaluated the effect on six-monthly T2 weighted abnormality and relapse frequency. METHODS: After a baseline scan and a six month pretreatment period, 68 patients were randomly assigned to receive either 3 MIU or 9 MIU of interferon-beta-1a by subcutaneous injection three times a week for six months. All patients were examined by Gd enhanced MRI every month in both pretreatment and treatment periods. The evaluation of Gd enhancing lesions was performed blind at the end of the study. RESULTS: The mean number of Gd enhancing lesions was higher during the pretreatment period than during treatment. This difference was statistically significant for the two different dose subgroups (3.5 v 1.8, P < 0.001 for the 3 MIU group and 2.4 v 0.9, P < 0.001 for the 9 MIU group, corresponding to a reduction of 49% and 64% respectively). The mean volume of Gd enhancing lesions also significantly decreased by 61% (3 MIU group) and 73% (9 MIU group). These reductions were evident only after the first month of treatment. The six-monthly rate of new lesions as seen in T2 weighted images showed a similar trend of reduction with treatment (65% and 70% respectively). Lesion volume on T2 scans significantly increased during the pretreatment period whereas it remained almost stable during the treatment period in both groups. Clinical relapse rate was significantly reduced by treatment (53% for the 3 MIU group, P < 0.001; 69% for the 9 MIU group, P < 0.001). CONCLUSION: Interferon-beta-1a seemed effective in reducing disease activity in relapsing-remitting multiple sclerosis at both the doses used.     

Quantitative magnetic resonance analysis in vascular dementia

The potential role of magnetic resonance imaging (MRI) in differentiating between specific causes of cognitive decline in patients with vascular dementia (VD) has not yet been fully established. We therefore decided to assess the supratentorial cerebral contents in 24 patients with a diagnosis of probable VD and in 24 normal subjects, matched for age and education level, using MRI volumetric parameters obtained by means of a quantitative method. The volumes of subarachnoid and ventricular spaces, cerebral tissue, and hyperintense areas on T2-weighted images were calculated. In order to reduce interindividual variability caused by differences in intracranial size, each absolute measurement was normalized to the relative size of the intracranial volume. In addition, we calculated the ratio between the areas of the corpus callosum (CC) and supratentorial brain at the same level on the T1-weighted image midsagittal plane. The MRI data were correlated with the deterioration of cognitive functions. Patients with VD showed significantly lower cerebral tissue volume and CC area, and higher ventricular space volume than normal subjects. Furthermore, the total volume of the T2 signal alterations was higher in VD patients than in normal subjects. In VD patients, this volume was found to be proportional to the increase in the volume of the ventricular space. On the other hand, no correlation was found between the volume of the T2 signal alterations and the area of the CC. The degree of global cognitive dysfunction and the score of each neuropsychological test did not show any correlation with the MRI data. Our results suggest that ventricular enlargement in VD patients is correlated with the increase in volume of the T2 signal abnormalities, but that the degree of global cognitive dysfunction is not influenced by the volume of these T2 signal abnormalities. Furthermore, the CC atrophy does not influence the score of any neuropsychological test or the degree of global cognitive dysfunction. Received: 22 Februar 1996 Received in revised form: 14 October 1996 Accepted: 30 December 1996     

A Preliminary Study Comparing the Sensitivity of Serial Monthly Enhanced MRI After Standard and Triple Dose Gadolinium-DTPA for Monitoring Disease Activity in Primary Progressive Multiple Sclerosis

We performed this study to evaluate and compare the numbers of total and new enhancing lesions detected on serial monthly brain magnetic resonance imaging (MRI) after the injection of a standard dose (SO) and a triple dose (TO) of gadolinium-OTPA (Gd) in patients with primary progressive multiple sclerosis (PPMS). Every 4 weeks for 3 months and in two separate sessions, MRI scans were obtained from 5 patients with PPMS, 5 (early) and 20 minutes (delayed) after SO (0.1 mmol/kg) or TO (0.3 mmol/kg) Gd injection. In 2 patients, T1-weighted scans with a magnetization transfer pulse (MT) after SD and TD injection were also obtained. There were 13 enhancing lesions (5 of which were new) on the early SO scans, 15 (5 new) on the delayed SD scans, 17 (6 new) on the early TO scans and 18 (7 new) on the delayed TO scans. TO MRI scans detected more enhancing lesions than SO scans in 3 patients (two of them were those with the lowest disability). The application of the MT pulse did not change the numbers of enhancing lesions seen after the injection of SO and TO of Gd in the remaining two patients. No side effects were reported and no significant changes in blood test parameters were found throughout the study. Our results suggest that serial monthly TO MRI, delayed scanning, MT T1-weighted scans or their combination, although safe, have a limited role for monitoring disease evolution in patients with PPMS.     

The effect of legal abortion on teenage fertility in Trieste, Italy

Abortion has been legal and publicly funded in Italy since 1978. However, unmarried women under 18 must obtain parental consent or written permission from their legal guardian or from a judge to undergo the operation. In this study an assessment is made on whether the recent law has had a particular impact upon the fertility of teenagers living in Trieste, a city of 250,000 inhabitants, located in northeast Italy. Data were obtained on 1st births among women aged 15-19 for the years 1977-81. 1st births were classified as: premaritally conceived, uncertain or postmaritally conceived. During the study period, the total number of births to Trieste residents fell from 1878 to 1326, a 29% decline. The number of out-of-wedlock births remained quite stable and the number of postmarital cenceptions fluctuated. Marital births resulting from premarital conception declined appreciable from 66% to 51%. It seem s likley that the most relevant factor accounting for the overall decline in teenage fertility is the availability of legal abortion. The very high legal abortion ratios for all women of reproductive age further confirms this hypothesis. The ratios are particularly high among younger teenagers, who had just over 2 abortions, an average, for every live birth in 1980 and 1981. The estimated age-specific abortion rates for woman aged 15-19 living in Trieste are very much higher than the 1981 rate for Italy as a whole. The historical and geographical nature of Trieste may, to some extent, help explain why Trieste women resort to abortion more frequently than other Italian women. When it was an important seaport, Trieste was an affluent city, but today most citizens view its decline as irreversible and consequently try to enjoy the present. Couples have only 1 child not expecting life to improve for the future generation. The trend also probably reflects the enhanced capability of young women to assume control over their reproductive lives. Voluntary interruption of pregnancy is sought by those who feel not yet ready to start a family or to marry the father.     

Red blood cell plasma Li ratio variability in affective patients

In the light of the existence of controversial reports on the stability of Li ratio, we investigated a group of affective patients wishing to verify intraindividual stability of this parameter in the different phases of the disease, that is normothymia and manic and depressive episodes. We found lower Li ratios for the periods preceding any relapse. Further, we analyzed whether or not some epidemiological factors, such as polarity, sex, actual age, age of onset, might affect interindividual variability of the Li ratio. We found that they did not as single factors. Interaction between polarity and the presence of relapses appeared to significantly affect the Li ratio.