Abuse Experiences in a Community Sample of Young Adults: Relations with Psychiatric Disorders, Sexual Risk Behaviors, and Sexually Transmitted Diseases

This study documents significant associations among lifetime abuse experiences, psychiatric diagnoses, and sexual risk behaviors in a multiethnic community sample of young men and women (N = 1803) in South Florida. Self-report data were collected via structured interviews as part of a longitudinal follow-up of a larger school-based study. Participants were grouped according to extent of lifetime abuse experiences. Cumulative lifetime abuse experiences were associated with increased risk for a broad range of individual lifetime psychiatric disorders, as well as cumulative lifetime psychiatric disorders. Both cumulative abuse experiences and cumulative psychiatric disorders were independently associated with (a) higher levels of sexual risk behaviors and (b) higher risk for lifetime sexually transmitted diseases (STDs). Implications for selective prevention of sexual risk behaviors and STDs among young adults with histories of abuse and psychiatric disorders are discussed.     

The Value of Measuring Impact Alongside Symptoms in Children and Adolescents: A Longitudinal Assessment in a Community Sample

The impact that psychiatric symptoms have on the lives of young people is central to clinical practice and classification. However, there is relatively little research on impact and its association with symptoms. This paper examines how well impact can be measured and how it relates to psychiatric outcomes. On four separate occasions over 3 years, symptoms and impact were assessed in a UK epidemiological sample (n?=?4,479; 51.5 % boys) using the Strengths and Difficulties Questionnaire (SDQ) as reported by parents, youths and teachers. Disorders were ascertained using the Development and Well-Being Assessment. An impact scale made of items about distress and impairment demonstrated considerable internal consistency, cross-informant correlations, and longitudinal stability by all reporting sources. Impact at baseline was a strong predictor of psychiatric disorder 3 years later after accounting for psychiatric disorders and symptoms measured at baseline: odds ratio OR?=?2.10, 95 % Confidence Interval (CI) [1.50, 2.94] according to parent-rated impact and OR?=?1.71, CI [1.08, 2.72] according to teacher-rated impact. Changes in impact over time were predicted, but not fully accounted for, by symptoms measured at baseline. Impact can be reliably and easily measured across time, and it may be clinically useful as an independent predictor of future symptoms and psychiatric disorders. More studies are needed to understand inter-individual variation in the impact caused by equivalent symptoms.     

Empirically derived personality subtypes of public psychiatric patients: effect on self-reported symptoms, coping inclinations, and evaluation of expressed emotion in caregivers.

Personality scales on the Millon Clinical Multiaxial Inventory-II (MCMI-II) for 195 psychiatric inpatients (93 men and 102 women) in a public facility were cluster analyzed to develop an empirical subtyping according to personality traits. Subjects also completed the Brief Symptom Inventory (BSI), Methods of Coping Scale (MOC), and the Level of Expressed Emotion Scale (LEE). The five personality subtypes that emerged were consistent across two clustering methods (K-means and complete linkage). Subtypes members differed on subscales of the BSI, MOC, and LEE. Results support the relevance of personality traits and disorders in assessing psychopathology in psychiatric patients. Results also support the relevance of subtyping these patients according to MCMI-II results.     

Re-examining the Epidemiology of Sensory Regulation Dysfunction and Comorbid Psychopathology

The aims of this study were threefold: (1) to compare prevalence of sensory regulation dysfunction based on previously established criteria to rates established with a more representative community sample of 796 4-year-olds; (2) to examine ethnic/racial and gender differences in prevalence according to the different criteria; and (3) to examine the co-occurrence of sensory regulation dysfunction and preschool psychiatric disorders. Prevalence rates ranged from 3.4% (current criteria) to 15.6% (previous criteria). In contrast to previous studies with less representative samples, there were no significant ethnic or racial differences using the current criteria. Boys were more likely to have sensory regulation dysfunction than girls according to all criteria. Depending upon impairment criteria used, 33–63% of children meeting criteria for sensory dysregulation also had a psychiatric disorder; 37–67% had only a sensory dysregulation disorder, indicating that sensory regulation dysfunction exists independent of psychiatric disorder, and is also a significant risk factor for disorder.     

Defense Mechanism Test (DMT) and Kernberg's theory of personality organization related to adolescents in psychiatric care

75 adolescent psychiatric patients were diagnosed with the perceptual projective test the Defense Mechanism Test (DMT) and also according to Kernberg's theory of personality organization (PO). The test protocols were scored in respect of 130DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis. The objective was to try to separate the three types of PO, psychotic (PPO), borderline (BPO) and neurotic (NPO) by means of the DMT and also to compare the results with a similar study on adult psychiatric patients. The results showed that it is possible to separate significantly the three groups of PO. The BPO group seemed to be heterogeneous. The results were fairly similar to those obtained with adult psychiatric patients. The overall results supported the concurrent validity of Kernberg's theory of PO and for the DMT as well. The DMT seems to be a useful diagnostic method in respect of adolescent psychiatric patients.     

Youth suicides unknown to psychiatric care providers.

Less than 50% of young suicides have consulted psychiatric care providers. Thus the population not found within the psychiatric care sector is described in this paper. Fifty-eight consecutive suicides among adolescents and young adults, studied by psychological autopsies, were classified according to presence or absence of previous psychiatric care. Fifteen of the sixteen subjects without previous care were males, six of these were diagnosed as having an adjustment disorder related to a recent event. Unemployment was less common (p < 0.01), the suicidal processes were shorter (p < 0.001), and previous parasuicide was less frequent (p < 0.001) among nonpatients. Evaluation in accordance with DSM-III-R criteria showed fewer substance abuse disorders (p < 0.01). Open suicidal communication prior to the suicide was less frequent but active methods were used by this population as often as by subjects known to care providers.     

EPQ and the psychiatric patients of Bangladesh

The Eysenck Personality Questionnaire, standardized in Bangladesh, was administered to a group of 358 psychiatric patients—109 male and 108 female neurotics and 78 male and 63 female psychotics. The neurotic Ss were analysed separately according to sex, and were also divided into groups according to psychiatric nosology. The major findings that clearly emerged from the study of neurotic individuals were that they returned very elevated N scores and depressed E scores as against the norms, while the depressive patients of both sexes gave the lowest E scores. Most of the psychotic Ss of both sexes were diagnosed schizophrenic. The major finding of the investigation of psychotic individuals was that they returned much elevated scores on the psychoticism scale as compared with norms, and they also gave low E and high N scores. It is suggested that the EPQ be used to promote a better understanding and more efficacious therapeutic intervention of the psychiatrically ill person in this culture.     

The relationship between childhood abuse and adult personality disorder symptoms

This study assessed personality disorder symptomatology in a community sample of healthy adults without diagnosable DSM-IV-TR Axis I psychiatric disorders who reported a history of childhood abuse. Twenty-eight subjects with a history of moderate to severe physical, sexual, and/or emotional abuse according to the Childhood Trauma Questionnaire were compared to 33 subjects without an abuse history on symptoms of personality disorders. Subjects in the Abuse group were more likely to report subclinical symptoms of paranoid, narcissistic, borderline, antisocial, obsessive compulsive, passive-aggressive, and depressive personality disorders. These findings link reports of childhood abuse with symptoms of personality disorders in the absence of Axis I psychiatric disorders in a community sample of healthy adults.     

Color and number preferences of patients with psychiatric disorders in eastern Turkey

Color and number preferences have not been studied in healthy sublets and psychiatric patients in Turkey. The study group consisted of a total of 500 patients who had been referred to Firat University Medical Faculty Psychiatry Clinic between March and July 2000 and diagnosed with a psychiatric disorder according to DSM-IV criteria. Preferred colors were requested as a selection from the Lüscher Color Test. Then the patients were told to choose a number between 0 and 9. Green was the most frequently preferred of all colors and the number 3 was the most preferred number. Our results demonstrate that patients' choice of color and number reflect the region's religious and cultural milieu.     

The assessment of personality characteristics in depressed and dependent psychiatric inpatients

The diagnosis and treatment of depression may be complicated by the presence of excessive dependency needs. Previous research has found stable personality traits useful in identifying depressive subtypes. This study was designed to assess the personality characteristics of 106 psychiatric inpatients. Subjects were grouped according to the presence or absence of two primary dimensions: depression and dependency. Results indicated that both depression and dependency were significantly related to various indices of psychopathology. Main effects were more useful than interactions, implying that depression and dependency both affect symptomology directly rather than interactively. Although the assessment of personality traits may be complicated by the presence of a major psychiatric disorder, results from our study suggest that the assessment of both Axis I and Axis II variables can be useful in understanding the current clinical picture.     

Brief report: Psychometric properties of the adaptive behavior scale with psychiatric inpatients

This study investigated the psychometric properties of the Adaptive Behavior Scale (ABS) with a sample of chronic psychiatric inpatients. Patients (N = 117) on extended care wards of a state hospital were assessed with the ABS. An orthogonal principal-components analysis revealed three underlying factors (independent functioning, general maladaptation, and inappropriate social behavior). Evidence for construct validity was demonstrated by analyses demonstrating that the ABS could discriminate among patients according to age, diagnosis, and length of hospitalization. The results are consistent with previous data which suggest that the ABS can be appropriately used with psychiatric patients. Implications of the results for suggestions regarding possible revision of the ABS are discussed.     

Embracing the other: Revisiting the epistemological foundations of family systems therapy

Family systems therapy originated in the 1960s, 1970s, and 1980s through the work of innovative thinkers and clinicians. However, despite the creative contributions of the mentioned colleagues and of later innovations in family therapy theory and practice, it seems as though the dominant culture of establishment psychiatry in the United States (and in most Western countries) to this day has not seriously incorporated relationships, social context, or community connectedness into the treatment of individuals with psychiatric diagnoses. For the “psychiatric” patients diagnosed according to the DSM-5, the dominant underlying epistemological perspective is the medical “scientific” paradigm. Within this approach there is a dearth of reflections about the truthfulness of so-called “empirical facts” and a lack of skepticism about the techniques of “measurement” of the psychiatric illness. The alternative, relationship-oriented, context-sensitive, and community-connected thinking paradigm is highlighted here in contrast to the “psychiatric” foundation. This paradigm consists of (a) the awareness that all human Subjects (including “psychiatric” clients) are constituted as such by their relational connection to others; (b) the awareness of our sensitivity to and embeddedness in a socio-economic, cultural, and racial context; and (c) the awareness of our involvement in and connectedness with many kinds of communities.     

Schizophrene Patienten der forensischen Psychiatrie im Vergleich zu schizophrenen Patienten der Allgemeinpsychiatrie

Background

The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Some researchers assume that these forensic patients form a group of patients with very complex mental disorders, a number of risk factors and insufficient pretreatment in general psychiatry. This study aimed to identify differences regarding the history of treatment of forensic and general psychiatric patients diagnosed with schizophrenia.

Method

The matched samples included 72 male patients from forensic wards and 72 male patients from general psychiatric institutions diagnosed with schizophrenia. The history of psychiatric treatment was reconstructed by interviewing the patients as well as outpatient psychiatrists and patients’ legal custodians and by analyzing patient medical records.

Results

In contrast to the general psychiatric patients, prior to admission forensic patients were less integrated into psychiatric care and showed a lower rate of treatment compliance. They also showed a higher rate of previous compulsory treatment because of aggressive behavior towards other persons as well as higher rates of treatment difficulties and violent behavior during previous inpatient treatment. Furthermore, forensic patients had a higher number of previous criminal convictions and had been convicted more often for violent offences. With regard to other relevant risk factors (e.g. comorbid substance abuse disorder, age, education, conduct disorder, antisocial personality disorder, previous exposure to violent and abusive behavior) the two patient groups were, however, comparable.

Conclusions

Regarding schizophrenic patients with comorbid substance abuse disorders, previous violent delinquency and violent behavior during previous inpatient treatment, an intensive outpatient aftercare should be arranged before they are discharged from general psychiatric institutions.     

Anxiety in Children and Adolescents Rated by Patients,Parents, and Teachers: Factor Structure and Psychometric Properties of an ICD-10 and DSM-IV-based Rating Scale in a Large Clinical Sample

This study examined the psychometric properties of the German Self-Report and Parent Report Rating Scale for Anxiety Disorders (SRS-AD and PRS-AD), and a shortened teacher version of the PRS-AD (TRS-AD) in a large clinical sample. Data were collected from 585 children, adolescents and young adults with psychiatric disorders (aged 6–21 years), 821 parents and 378 teachers. Factorial validity, reliability and discriminating validity of the scales were examined and the agreement between different informants was assessed. Analyses were performed in the complete sample including a wide range of different psychiatric disorders as well as in a subsample of children, adolescents and young adults with anxiety disorders. Confirmatory factor analyses mostly supported a model with first-order factors according to the subscales and a second-order overall anxiety factor. Only for the SRS-AD analysed in the sample of participants with anxiety disorders, the results did not clearly favour a first-order solution with correlated factors according to the subscales or the second-order solution adopted for the other questionnaires. Internal consistencies for the total scale and subscales were mostly satisfactory. Significant mean differences between anxious and non-anxious participants were found for the mean total scores of the SRS-AD and PRS-AD, but not for the TRS-AD. The informant agreement was low-to-moderate. We concluded that the SRS-AD, PRS-AD and TRS-AD demonstrate satisfactory psychometric properties for use with clinically-referred children and adolescents.     

The role of psychopathology and gender in respiratory self-regulation

A group of 12 male and 12 female psychiatric patients were recruited among an anxiety-disordered population, and their performance on a respiratory modulation test was compared with that of a matched non-patient sample. Inferior performance was expected in the patient group, and males were expected to show better respiratory modulation than females. Results supported the conclusion that females were less able than males in modulating respiratory muscle behaviour according to requested patterns, and female psychiatric patients showed a relative lack of flexibility in the thorax or abdomen regions or in both trunk levels.     

L’intelligence artificielle peut-elle aider à estimer le risque de récidive dans les comportements violents ?

In forensic psychiatry, magistrates raise the question of the existence of a risk of recidivism and dangerousness to psychiatric experts. Follow-up studies in forensic psychiatry showed that the psychiatric elements predictive of recidivism were mainly related to serious mental illnesses, toxic consumption, addictions, high levels of impulsivity, low insight, associated personality disorders, in particular antisocial personality disorders. There are also protective factors, in particular the observance of treatments. Given the complexity of psychiatric and criminological risk factors and protection, can artificial intelligence (AI) help psychiatrists and magistrates to improve the predictivity of recidivism?MethodsSystematic review of the literature on AI applications in the prediction of recidivism in forensic psychiatry, conducted according to PRISMA criteria, using the: “Artificial Intelligence”, “Recidivism”, “Personality Disorder”, “Impulsive” Behavior”, “Alcohol abuse”, “Drug Abuse”, “Schizophrenia”, “Bipolar disorder” on the PubMed, Science Direct, Clinical Trial and Google Scholar databases.ResultsThe vast majority of studies come from legal or computer reviews and very few from medical databases. The studies evaluating the AI in Forensic Psychiatry most often used Machine Learning based on sociodemographic, sociological and criminological data, notably the age of the first offense and the number of previous convictions. To date, there are very few studies evaluating psychiatric parameters, focusing on psychopathic personality disorders.Discussion/conclusionThe applications of the AI in Forensic Psychiatry are still very premature. However, some psychiatric criteria should be more prominent in this field, especially those from Webster's HCR-20 and Hare PCL-R scales. The challenge will also be to find relevant behavioral, psychological and psychiatric keywords to include in AI.     

Psychosomatik der Kopfschmerzen

Headaches are subdivided into primary and secondary headaches according to the classification of the International Headache Society. While primary headaches represent the disease itself, secondary headaches are a manifestation as symptoms of another primary disease. This results in different therapeutic approaches so that secondary headaches are initially treated according to the actual cause of the headache. In contrast primary headaches have no further causes and necessitate fundamentally different treatment in comparison to secondary headaches. The psychosomatics integrate somatic procedures with psychiatric and social processes. This integration forms the basis of the biopsychosocial model which has the great advantage of being able to offer several approaches to psychiatric processes and accomanying alterations. For primary headaches psychotherapeutic strategies and modifications in the social environment of the patient can be applied in addition to medicinal (i.e. biological somatic) treatment procedures, in order to be able to positively influence the underlying disease. This article presents the most important primary headache diseases, migraine and tension-type headache and demonstrates treatment options which can be used in accordance with the biopsychosocial model presented.     

The Use of Psychoeducation for a Patient with Hepatitis C and Psychiatric Illness in Preparation for Antiviral Therapy: A Case Report and Discussion

The standard of care treatment for chronic hepatitis C viral infection (HCV) is a combination of pegylated interferon alfa and ribavirin for 24-48?weeks according to the virus genotype. This therapy is known to have multiple neuropsychiatric side effects. A major concern when evaluating a patient for HCV treatment with a known history of a psychiatric disorder is the risk that the patient's psychiatric disorder will flare or become unmanageable. The possibility of precipitating depression, confusion, mania, psychosis, hallucinations, or suicidal ideation or attempt is frequently an obstacle to treatment. We present the case of a 50?year-old man with HCV and an extensive psychiatric history involving alcoholism, depression, and suicidality who participated in a psychoeducation group to help prepare him for treatment with pegylated interferon alfa/ribavirin therapy. Though the patient derived much benefit from the psychoeducation group, by the time of evaluation for HCV treatment two months after the group ended he had relapsed back into a depressive episode with suicidal thoughts. His acute psychiatric status made him unacceptable for pegylated interferon alfa/ribavirin therapy. Psychoeducation groups show promise for helping patients with chronic medical illness to be ready for and endure intensive medical treatment that has substantial psychiatric side effects. The challenge is to help patients overcome barriers to treatment, particularly psychosocial problems, because available treatments are increasingly effective.     

Paternal Psychiatric Symptoms and Maladaptive Paternal Behavior in the Home During the Child Rearing Years

Data from the Children in the Community Study, a community-based longitudinal study were used to investigate associations between paternal psychiatric disorders and child-rearing behaviors. Paternal psychiatric symptoms and behavior in the home were assessed among 782 families during the childhood and adolescence of the offspring. Paternal anxiety, disruptive, mood, personality, and substance use disorders were independently associated with specific types of maladaptive paternal behavior in the home during the child-rearing years after paternal age, education, income, co-occurring paternal psychiatric symptoms, offspring age, sex, intelligence, temperament, and psychiatric symptoms were controlled statistically. Paternal psychiatric disorders that were present by mean offspring age 14 were associated with elevated risk for maladaptive paternal behavior in the home at mean age offspring 16, after prior maladaptive paternal behavior was controlled statistically. These findings suggest that paternal psychiatric disorder may be an important determinant of maladaptive paternal behavior in the home during the child-rearing years. Improved recognition and treatment of paternal psychiatric disorders may help to reduce the amount of maladaptive parenting behavior that many children and adolescents might otherwise be likely to experience.     

Social information processing in child psychiatric populations

This study examined three kinds of social information-processing deficits in child psychiatric populations. The deficits studied were response decision biases, hostile attributional biases, and cue-utilization deficiencies. Subjects were diagnosed as hyperactive/aggressive (H/A) (n=24), exclusively hyperactive (n=14), exclusively aggressive (n=14), psychiatric control (n =23), and normal control (NC) (n=60) boys according to procedures suggested by Loney and Milich (1982). They were administered several tasks to solicit information-processing patterns. The H/A group was found to be deficient in all three areas asssessed, relative to the NC group. They were also deficient in response decisions and cue-utilization, relative to the other three groups of psychiatrically referred boys. Discriminant function analyses demonstrated that the H/A group displayed a distinct processing pattern. These results were found to be relevant to the study of behavior disorders, to social information processing theory, and to intervention efforts with these boys.This work was supported by NIMH Grant No. 32992, awarded to the first author, and NIMH Grant No. 37062, awarded to the second author.