Comorbidity of DSM-IV Personality Disorders in unipolar and bipolar affective disorders: a comparative study

The aim of this study was to compare the prevalence of Personality Disorders assessed by Structured Clinical Interview for Axis-II in 155 inpatients diagnosed with Unipolar Disorder vs inpatients with Bipolar Disorder (39). The most frequent Axis II diagnoses among Unipolar inpatients were Borderline (31.6%), Dependent (25.2%), and Obsessive-Compulsive (14.2%) Personality Disorders. Among Bipolar inpatients, the most prevalent personality disorders were Borderline (41%), Narcissistic (20.5%), Dependent (12.8%), and Histrionic disorders (10.3%). Using chi squared analysis, few differences in distribution emerged between the two groups: Unipolar patients had more recurrent Obsessive-Compulsive Personality Disorder than Bipolar patients (chi(1)2=6.24, p<.005). Comorbid Narcissistic Personality Disorder was significantly more frequent in the Bipolar than in the Unipolar group (chi(1)2=6.34, P<.01). Considering the three clusters (DSM-IV classification), there was a significant difference between the groups, Cluster C (fearful, avoidant) diagnoses being more frequent in the Unipolar than in the Bipolar group (48.4% vs 20.5%, respectively). Cluster B (dramatic, emotionally erratic) diagnoses were found more frequently in patients with Bipolar Disorders (71.8% vs 45.2% in Unipolar patients, chi(2)2=10.1, p<.006). The differences in the distribution and prevalence of Personality Disorders between the two patient groups are discussed.     

A comparative study of the self-concepts of adolescents from intact and non-intact families

Data were collected from a sample of 81 6th-, 7th- and 8th-grade children from intact and non-intact families. The self-concepts of the children from both the intact and non-intact families were measured through the use of the Piers-Harris Self-Concept Scale. The data were analyzed through the multiple-regression approach; demographic variables describing the children, the children's family structures and the number of years since the divorce were built into the analysis. Contrary to much of the clinical literature, the self-concepts of the children in the non-intact families were found not to be negative.     

A mechanism for biasing the appraisal process in affective agents

In this paper we present a mechanism to model the influence of agents’ internal and external factors on the emotional evaluation of stimuli in computational models of emotions. We propose the modification of configurable appraisal dimensions (such as desirability and pleasure) based on influencing factors. As part of the presented mechanism, we introduce influencing models to define the relationship between a given influencing factor and a given set of configurable appraisal dimensions utilized in the emotional evaluation phase. Influencing models translate factors’ influences (on the emotional evaluation) into fuzzy logic adjustments (e.g., a shift in the limits of fuzzy membership functions), which allow biasing the emotional evaluation of stimuli. We implemented a proof-of-concept computational model of emotions based on real-world data about individuals’ emotions. The obtained empirical evidence indicates that the proposed mechanism can properly affect the emotional evaluation of stimuli while preserving the overall behavior of the model of emotions.     

Family functioning in families of children with anxiety disorders.

The authors examined maternal and paternal reports of family functioning and their relationship with child outcomes as well as the association between anxiety and depression in family members and family functioning. Results reveal that maternal and paternal reports of family functioning were both significantly associated with worse child outcomes, including child anxiety disorder (AD) severity, anxiety symptoms, and child global functioning. Maternal and paternal anxiety and depression predicted worse family functioning, whereas child report of anxiety and depression did not. Parents of children with ADs reported significantly worse family functioning and behavior control, but only fathers reported worse problem solving and affective involvement compared with fathers of children with no psychological disorders. Findings from this study suggest that paternal as well as maternal anxiety and depression play a role in worse family functioning in children with ADs and that unhealthier family functioning is associated with worse child outcomes in this population.     

The impact of social support on the acceptance process among RA patients: A qualitative study

Acceptance is an important component of pain management, being associated with improved quality of life and lower levels of pain and depression. In enabling patients with chronic diseases to accept unpleasant consequences and to establish a new way of living, the support they receive from their social environment may play a decisive role. In this article, we identify the key sources and types of social support that are relevant for rheumatoid arthritis (RA) patients, and explore when and how those sources are important across the different stages of the acceptance process. We conducted a qualitative study involving 20 semi-structured interviews with RA patients in Switzerland. Analysis of the data followed the precepts of grounded theory. We found that, amid the complexity and variety of patients’ struggles for acceptance, there were some common experiences or ‘key moments’ in which social support played an important role. While three sources of support – family, physicians and the external social context – are fundamental for RA patients, all three may inhibit as well as encourage acceptance, due to the invisible and unpredictable character of the disease. There is a pervasive risk either of underestimating patients’ suffering or of over-supporting, both of which prevent patients accepting the disease and developing a new ‘normal’ life. We conclude that sources of social support need to find a middle way between scepticism and solicitousness.     

A comparative study of six different inpatient groups with respect to their basic assumption functioning

Seventy-five group therapy sessions of six different inpatient team groups in one short-term, one intermediate term, and one long-term psychiatric ward were studied with Group Focal Conflict Analysis and the Group Emotionality Rating System. The majority of the group sessions (41) functioned as fight-flight groups, twenty-four sessions functioned at a "pseudogroup" level, and ten sessions were dependency groups. The differences between the fight-flight groups and the dependency group on the variables aggression and dependency were highly significant statistically. A mixture of fight-flight groups and pseudogroups were found in the short-term ward with emergency obligations. The author discusses the assets and shortcomings of fight-flight and dependency cultures within psychiatric wards.     

Pharmacological treatment of affective disorders: A review and guide for the non-medical practitioner

Mental health professionals who lack medical training may also lack knowledge and understanding of the potential utility of medications in the treatment of emotional disturbance. They may also lack information regarding the effects and side-effects of medications which their clients may already be taking, or be uncertain when the nature of their client's situation suggests a psychiatric assessment regarding drug therapy. This paper offers an educational review in one such area: the pharmacological treatment of depression. It includes a brief review of theories regarding the aetiology of affective disorder, examines the methodes, mechanisms and efficacy of anti-depressants, and draws conclusions regarding the appropriate use of pharmacological treatment.     

Sex differences on the revised Beck Depression Inventory for outpatients with affective disorders

The revised Beck Depression Inventory (BDI) was administered to 174 male and 276 female psychiatric outpatients diagnosed with affective disorders. The mean BDI scores, mean number of symptoms claimed, and corrected item-total correlations were comparable for both sexes, and the coefficient alpha for each sex was .88. Principal components analyses found four dimensions of depression underlying both sexes' BDI item-intercorrelation matrices. Although men and women had comparable dimensions with respect to weight loss, self-blame, and somatic-performance symptoms, men had affective and performance symptoms loading on the same factor, whereas women had affective and cognitive symptoms loading on the same dimension.     

A comparative evaluation of parent-training interventions for families of chronic delinquents

Fifty-five families of chronically offending delinquents were randomly assigned to parent-training treatment or to service traditionally provided by the juvenile court and community. The families in the parent-training group received an average of 44.8 hours of professional contact (23.3 hours of which were phone contacts), and each control group family received treatment estimated at more than 50 hours on the average. Comparisons of police contact data at baseline and subsequent years for the two groups showed that subjects in both groups demonstrated reduced rates of offending during the followup years. The finding most relevant was significant treatment-by-time effect for offense rates, with most of this effect accounted for by a greater reduction in serious crimes for the experimental group during the treatment year, and a similar reduction of the community control group occurring in the first of three followup years. These early decrements in offense rates persisted during followup for both groups. Throughout the study, boys in the experimental group spent significantly less time in institutional settings than did boys in the control group. Parent training had a significant impact, but the reduction in offending was produced at very high emotional cost to staff. Although it is clear that this population requires substantial treatment resources, this study underscores the need for more work on prevention.Research for this paper was supported by grant MH 37938 from the Center for Studies of Antisocial and Violent Behavior, National Institute of Mental Health (NIMH), U.S. Public Health Service (PHS). The writing was supported in part by grants MH 17126 and MH 37940 from the same Center, grant DA 05304 from the National Institute of Drug Abuse, U.S. PHS., and grant MH 38730 from the Child and Adolescent Disorders Research Branch, NIMH, U.S. PHS. The authors gratefully acknowledge the enduring commitment of the treatment staff that made this study possible: Patricia Chamberlain, Marion Forgatch, and Kate Kavanagh.     

A child's experience of parental depression: encouraging relational resilience in families with affective illness

In this article, we describe an approach that parents with affective illness can use to foster the emotional resilience of their children. Building on current research that emphasizes the need to formulate concepts of risk and resilience in terms of family or relational processes, we propose that affectively ill parents can promote resilience in their children by helping them express the affect they experience as a result of parental illness-related behavior. Risk and resilience are conceptualized in terms of a family's ability to process emotion or affect: a family's need to constrict affect is a risk factor, while the family's ability to elaborate affect encourages relational resilience. An object relations model is used to discuss the ways in which encouraging this elaboration of affect, especially negative affect, contributes to resilience in children. We describe ways in which a preventive intervention helps to increase parents' emotional responsiveness to their children. Using extensive narrative data from followup interviews with families and children, constriction and expansion of emotion in children concerning affectively ill parents are documented, by multiple interviewers, over a span of more than 5 years.     

Psychoeducation: A promising intervention strategy for families of children and adolescents with mood disorders

Mood disorders and suicide in youth represent major health concerns requiring effective intervention strategies. This paper briefly summarizes the literature on childhood mood disorders and discusses expressed emotion (EE) and the link between lowering EE and improved outcome for mood disordered individuals. Family psychoeducation is discussed as a means of reducing EE and similarities and differences between psychoeducation and other therapeutic interventions explored. The authors' adaptations that made psychoeducation developmentally appropriate for families of children and adolescents are reviewed. Psychoeducation for families of mood disordered youth is suggested as worthy of further clinical and empirical effort.     

A comparative study of personality in adults and children: Hong Kong vs England

The 90-item adult version of the Eysenck Personality Questionnaire was translated into Chinese and administered to 270 male and 462 female subjects in Hong Kong. In a second study the 81-item version of the Junior EPQ (JEPQ) was translated into Chinese and given to 698 boys and 629 girls.Reasonably valid scales for use in Hong Kong are suggested for both adult and junior forms of the questionnaire. In a direct comparison of British and Chinese (Hong Kong) groups, using reduced scales comprising only items both scoring keys had in common. Hong Kong adults scored higher on Psychoticism and Social Desirability and lower on Extraversion than the British while children from Hong Kong scored lower on Extraversion and Neuroticism but higher on Social Desirability than their British counterparts. Indices of factor comparison were universally high, indicating that the major dimensions of personality were very similar in Hong Kong Chinese as in British subjects.     

Psychological impact of benign breast biopsy: a longitudinal, comparative study.

The impact of benign breast biopsy (BBB) on distress and perceptions of risk for breast cancer (BC) was examined. Interviews were conducted with 100 women shortly after notification of biopsy results and 4 and 8 months post-BBB. Compared with matched healthy comparison (HC) women without BBB, the BBB group evidenced greater BC-specific distress at baseline. BC-specific distress declined after BBB, remaining elevated relative to the HC group at the 8-month follow-up. Dispositional (optimism, informational coping style), demographic (education), clinical (family history of BC), and cognitive (BC risk perception) variables were associated with baseline levels of BC-specific distress or persistence of distress. Results support the monitoring process model (S. M. Miller, 1995) and the cognitive social health information processing model (S. M. Miller, Y. Shoda, & K. Hurley, 1996).