Childhood stressful events,HPA axis and anxiety disorders

Anxiety disorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal (HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder (OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxiety disorders, as well as, more broadly, to all psychiatric disorders.     

Could PANSS be a useful tool in the determining of the stages of schizophrenia? A clinically operational approach

Staging in schizophrenia might be an important approach for the better treatment and rehabilitation of patients. The purpose of this study was to empirically devise a staging approach in a sample of stabilized patients with schizophrenia. One hundred and seventy patients aged ≥18 years (mean = 40.7, SD = 11.6) diagnosed by DSM-5 criteria were evaluated with the Positive and Negative Syndrome Scale (PANSS). Principal components analysis (PCA) with varimax rotation was used. The model was examined in the total sample and separately across a hypothesized stage of illness based on three age groups and between the two sexes. The PCA revealed a six factor structure for the total sample: 1) Negative, 2) Positive, 3) Depression and anxiety, 4) Excitement and Hostility, 5) Neurocognition and 6) Disorganization. The separate PCAs by stage of illness and sex revealed different patterns and quality of symptomatology. The Negative and Positive factors were stable across all examined groups. The models corresponding to different stages differed mainly in terms of neurocognition and disorganization and their interplay. Catatonic features appear more prominent in males while in females neurocognition takes two forms; one with disorganization and one with stereotype thinking with delusions. This study suggests that the three arbitrary defined stages of illness (on the basis of age) seem to reflect a progress from a preserved insight and more coherent mental functioning to disorganization and eventually neurocognitive impairment. Sexes differ in terms of the relationship of psychotic features with neurocognition. These results might have significant research and clinical implications.     

General psychopathology,anxiety, depression and self-esteem in couples undergoing infertility treatment: a comparative study between men and women

Objective

To compare measures of psychological distress between men and women undergoing ART in the Unit of Reproductive Medicine “UMR” in the Department of Obstetrics and Gynecology at “Farhat Hached” Hospital in Sousse, Tunisia.

Study design

We conducted a gender comparative study of psychological profile in infertile couples. Recruitment was done during period from January to May 2009. 100 infertile couples with primary infertility were recruited. Scores of general psychopathology, depression, anxiety and self-esteem were evaluated. We administrated questionnaires on psychological factors among infertile couples before starting a new infertility treatment cycle. Psychological factors included the symptom check-list (SCL-90-R), the hospital anxiety and depression scale (HAD-S) and the Rosenberg self-esteem scale (RSE).

Result(s)

Infertile women had higher scores than their spouses in the three global scores of the SCL-90-R and in several items such as somatisation, obsessive symptoms, interpersonal sensitivity and phobias. Scores of HADS were higher among women for both depression and anxiety. Scores of self-esteem were lower among women.

Conclusion(s)

Women endorsed higher psychological distress than men across multiple symptoms domains: general psychopathology, anxiety, depression and self esteem.     

The interface of clinical psychopharmacology and psychopathology

Summary Four areas of common interest for clinical psychopharmacology and psychopathology are identified: (1) the diagnostic-based approach in clinical psychopharmacology; (2) the characterization of psychotropic drugs according the main psychopathologically defined target symptoms; (3) prediction of treatment response; (4) development of rating scales. The current state of research strategies in these areas is discussed and the need for new strategies is stressed. In particular, diagnosis-based research strategies in clinical psychopharmacology are not fully justified by empirical data; an alternative approach is discussed.Parts of this article were presented on the occasion of the inauguration ceremony of the Department of Psychiatry of the University of Mainz on April 2 and 3, 1987     

Nonverbal expression of psychological states in psychiatric patients

Summary Nonverbal behavior, especially facial expression, appears as one of the most important means for communicating affective states. Studies on groups of psychiatric patients and control subjects are reported in which nonverbal behavior is analyzed from videotaped dialogues. Using a quantitative approach, results on facial behavior, speech, and gaze are described, which shed light on the expressive and communicative functions of nonverbal behavior. From longitudinal observations on depressed patients it emerged that individual-specific associations have to be taken into account for the relationship between expressive behavior and mood changes.The predominance of facial behavior in the speaker role of an individual found in patients and control groups points to the integrated communicative function of the verbal and nonverbal elements. However, recovered schizophrenic patients exhibited a dissociation of these elements. Implications for our understanding of nonverbal communications are discussed.     

Long-term effects of spinal cord stimulation in chronic pain syndromes

Summary A total of 50 patients with chronic pain syndromes were selected for treatment with spinal cord stimulation. Correct positioning of electrodes was obtained in 44 patients, leading to an initial alleviation of pain in 25 patients. In 6 patients, electrodes (though still effective in 4) had to be removed because of surgical complications within the first 5 months of use. Only 8 patients had at least some beneficial effect lasting for more than 3 years. The long-term results in patients with more severe psychological disturbances were no worse than those of the other patients.     

Visual search,EEG, and psychopathology in schizophrenic patients

Summary Twenty acutely admitted schizophrenic inpatients diagnosed according to RDC and 8 normal controls were instructed to search for a randomly located target letter (Z) in ten lists of 284 distractor letters of either rounded or angular shape projected on a screen (23° × 15°). Eye movements were recorded using infrared corneal reflection-pupil centre measurement. Search performance was defined as the search time in seconds from onset of the display until localization of the target. The EEG was recorded simultaneously in schizophrenics, in whom assessment took place shortly after admission and before discharge. The psychopathological status was assessed at the same time with the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Search performance was not significantly different in schizophrenics and normal controls, but was heavily affected by target/distractor similarity in both groups. Moreover, search performance in schizophrenics was not significantly affected by illness severity. However, search performance was differently related to negative and positive symptoms. Schizophrenics and normal controls differed with respect to the relationship between search performance and visuomotor microbehaviour. Additionally, two relatively time-stable eye movement patterns in schizophrenics could be distinguished, which were differently related to psychopathology, performance measures and EEG.This article was presented in part at the Symposium on Eye Movements and Psychopathology, Berlin, 23–24 June 1988     

Neuroendocrine effects of clonidine in chronic schizophrenic patients under long-term neuroleptic therapy and after drug withdrawal: Relations to psychopathology

The sensitivity of the alpha-adrenergic hypothalamic pituitary system, as indicated by growth hormone (GH) release after clonidine (0.15 mg i.v.), was studied in nine chronic schizophrenic in-patients (study 1) under long-term neuroleptic (NL) therapy and after 5 days' drug withdrawal and in 17 chronic schizophrenic in-patients (study 2) under long-term NL therapy and after 12 days' drug withdrawal. GH response after 5- and 12-day drug-free periods did not differ significantly from that under NL treatment; however, it was significantly lower after 12 days' drug withdrawal (AUC: 319.9±445.5 ng/ml×min) compared to age- and sex-matched normal controls (579±611 ng/ml×min). The basal norepinephrine (NE) plasma levels under long-term NL therapy were significantly elevated in both studies (study 1:894±553 pg/ml; study 2:432±268 pg/ml) compared to controls (study 1:253±55 pg/ml, study 2:234±126 pg/ml), and were decreased significantly after 5 days' drug withdrawal compared to NL treatment.There was no significant correlation between age, duration of NL therapy, last daily dosage, psychopathology, and NE plasma levels and GH response.The data presented suggest hyposensitivity of alpha-adrenergic receptor function in the hypothalamic-pituitary axis after 12 days' drug withdrawal in chronic schizophrenics. The significantly elevated NE plasma levels under NL therapy indicate that there is no adaption mechanism, even after long-term treatment.This paper is dedicated to Prof. Hippius on his 60th birthday