The construct validity of depressive personality disorder

This study examined the construct validity of depressive personality disorder (DPD: American Psychiatric Association, 1994). Adult psychiatric outpatients (N = 900) underwent comprehensive Axis I and II evaluations and provided data on 4,768 of their 1st-degree relatives. Despite modest overlap, DPD was not redundant with any Axis I or II disorder. Participants with DPD exhibited more Axis I and Axis II comorbidity, and greater psychosocial dysfunction, than participants without DPD. Relatives of participants with DPD had higher rates of mood disorders, alcohol abuse, and antisocial personality. Results are consistent with findings of several other similar investigations. The authors argue that DPD is a valid construct and should be conceptualized as a personality disorder as opposed to a mood disorder.     

Should self-defeating personality disorder be revisited in the DSM?

Self-defeating personality disorder (SDPD) was proposed for consideration in the DSM-III-R, but was eventually removed from the manual because of the lack of evidence to support its validity. Yet, after DSM-IV was published, some studies suggested that SDPD may be a viable diagnosis. The purpose of this study was to evaluate SDPD's viability as a diagnostic category. Consequently, SDPD's internal consistency, comorbidity with other Axis I and II disorders, association with psychosocial impairment, and its ability to predict overall impairment in past, current, and global levels of functioning beyond other personality disorder symptomatology was assessed in 1,200 psychiatric evaluated with the Structured Clinical Interview for DSM-IV Personality (Pfohl, Blum, & Zimmerman, 1997). Cronbach's alpha for SDPD criteria was 0.61, and item-total correlations ranged between 0.22-0.38. There was substantial comorbidity of SDPD with depressive, avoidant, and borderline personality disorders, as well as major depression and anxiety disorders. The SDPD group did not significantly differ from psychiatric controls on multiple measures of psychosocial impairment, global functioning, and suicidality. SDPD did not meaningfully add to the prediction of impairment above and beyond other measures of Axis II pathology. It is concluded that the data do not support the reliability, validity, and utility of the SDPD diagnosis.     

The effect of motivation on working memory: an fMRI and SEM study

This study investigated the effective connectivity between prefrontal regions of human brain supporting motivational influence on working memory. Functional magnetic resonance imaging (fMRI) and structural equation modeling (SEM) were used to examine the interaction between the lateral orbitofrontal (OFC), medial OFC, and dorsolateral prefrontal (DLPFC) regions in the left and right hemisphere during performance of the verbal 2-back working memory task under two reinforcement conditions. The "low-motivation" condition was not associated with monetary reinforcement, while the "high-motivation" condition involved the probability of winning a certain amount of money. In the "low-motivation" condition, the OFC regions in both hemispheres positively influenced the left DLPFC activity. In the "high-motivation" condition, the connectivity in the network including the right OFC regions and left DLPFC changed from positive to negative, whereas the positive connectivity in the network composed of the left OFC and left DLPFC became slightly enhanced compared with the "low-motivation" condition. However, only the connection between the right lateral OFC and left DLPFC showed a significant condition-dependent change in the strength of influence conveyed through the pathway. This change appears to be the functional correlate of motivational influence on verbal working memory.     

Trait Anger and Axis I Disorders: Implications for REBT

Anger has a prominent role in basic theories of emotion. And while many psychiatric disorders can be conceived of as emotional disorders (e.g., depressive disorders, anxiety disorders), there are no disorders for which anger is the cardinal feature. We analyzed diagnostic data on 1,687 (as later) psychiatric outpatients and looked at the co-occurrence of high trait anger (as assessed by criterion 8 of Borderline Personality Disorder) and Axis I disorders, and Borderline and Antisocial Personality Disorders. The purpose was to examine whether dysfunctional anger met criteria necessary to be considered a valid diagnostic category. Results showed that high trait anger was not fully accounted for by any particular Axis I diagnosis, or any set of Axis I diagnoses, or by the combination of Axis I diagnoses and Borderline and Antisocial PDs. Trait anger also accounted for significant amounts of unique variance in several indicators of psychiatric impairment and psychosocial functioning. We describe the anger disorder diagnoses of Eckhardt and Deffenbacher (Anger disorders: Definition, diagnosis and treatment. Taylor & Francis, Bristol, PA, 1995), and discuss the implications of those diagnoses for the practice of REBT and CBT.

Retrosplenial cortex lesion affected segregation of spatial information in place avoidance task in the rat

Retrosplenial cortex (RSC) together with the hippocampus is a component of the spatial memory circuit. To elucidate the role of the RSC in spatial memory formation in the immediate presence of both relevant and irrelevant spatial stimuli, we used a new place avoidance task, in which rats learn to avoid shock in an unmarked place. In the present study, we manipulated the relevance of distal "Room" stimuli and local "Arena" stimuli for place avoidance. Rats with ibotenate lesions of RSC, control sham lesions (Csl) and intact control rats (Cint) initially learned the (Room&Arena)+ task variant in which both Room and Arena stimuli are relevant for defining the shock sector. Afterwards, different subsets of rats from each group were trained in the following task variants: (i) Room+Arena-, in which the arena continuously rotated so that Room stimuli were relevant and Arena stimuli were irrelevant for avoiding shock; (ii) Arena+, in which the arena and shock sector rotated in a dark room so that Arena stimuli were relevant and Room stimuli were irrelevant for avoiding shock; (iii) Room+, in which the arena was covered in shallow water so that only Room stimuli were relevant for avoiding the shock sector whether the arena was stationary or rotating. We found that damage of RSC impaired the Room+Arena- variant that required relevant and irrelevant stimuli to be segregated. Importantly, the same lesions spared task variants that did not require segregation. Our results suggest an involvement of retrosplenial cortex in the segregation of spatial information.     

The Importance of Assessing for Childhood Abuse and Lifetime PTSD in Bariatric Surgery Candidates

For bariatric surgery candidates, history of child abuse and PTSD may be under-recognized or under-reported at pre-surgical evaluation. On a range of clinically relevant factors, we studied 3045 candidates for bariatric surgery: (1) those with a history of childhood abuse compared to those without such history; and (2) among candidates with a history of abuse, those with a lifetime diagnosis of PTSD compared to those without that diagnosis. We compared them on current and lifetime eating disorders, physical health problems, health behaviors, physical functioning, psychosocial functioning, psychiatric disorders, emotional wellness, body satisfaction, and self-esteem. We hypothesized that patients with a history of childhood abuse, and within that group, those with a lifetime PTSD diagnosis, would display greater overall impairment. Patients were interviewed with semi-structured interviews and completed self-report questionnaires. Results showed that (1) patients with a history of childhood abuse exhibited significantly greater impairment than those without abuse; and (2) among candidates with a history of abuse, those with a lifetime history of PTSD displayed significantly greater impairment than those without a PTSD diagnosis. The findings suggest that a history of both childhood abuse and lifetime PTSD should be thoroughly assessed for at pre-surgical evaluation, and that greater attention be paid to the experience of PTSD symptoms in abuse survivors presenting for bariatric surgery.     

The validity of DSM-IV passive-aggressive (negativistic) personality disorder

Passive-Aggressive (Negativistic) Personality Disorder (NEGPD), listed in Appendix B of the DSM-IV, is not an officially recognized personality disorder. Its future as a discrete disorder is uncertain (Widiger, 2003). Yet, NEGPD occupies a role in some theoretical formulations of personality pathology (Millon & Davis, 1996), and many clinicians believe that passive-aggressive traits are not adequately represented by other PDs (Westen, 1997). In this study, 1158 psychiatric outpatients were assessed for Axis I and Axis II disorders. Thirty-five (3.02%) met criteria for NEGPD. Participants with NEGPD did not differ significantly from those without NEGPD on demographic variables. The internal consistency of the DSM-IV's seven NEGPD items was 0.50. Corrected item- total correlations for the 7 criteria averaged 0.27. Participants with NEGPD had higher rates of lifetime anxiety disorders, and almost 90% had an additional PD. An exploratory factor analysis suggested a two- factor solution that accounted for 43.4% of the variance. The first factor reflected the belief that life is unfair, while the second factor seemed to reflect modes of anger expression. A confirmatory factor analysis showed that the two-factor model fit the data better than a unidimensional model. We discuss implications of these results for the future of the NEGPD diagnosis.     

Dissociable contributions of the left and right posterior medial orbitofrontal cortex in motivational control of goal-directed behavior

Several findings from both human neuroimaging and nonhuman primate studies suggest that the posterior medial orbitofrontal cortex (OFC) may be critical for the motivational control of goal-directed behavior. The present study was conducted to clarify the role of the left and right posterior medial OFC in that function by examining the effects of focal unilateral lesions to this region on the performance on an incentive working memory task. The study covered patients who had undergone surgery for an ACoA aneurysm and normal control subjects (C). The patients were subdivided into three groups: those with resection of the left (LGR+) or right (RGR+) posterior part of the gyrus rectus, and without such a resection (GR−). Participants performed a 2-back working memory task under three motivational conditions (penalty, reward, and no-incentive). The C group performed worse in the penalty condition and better in the reward condition as compared to the no-incentive condition. Similar results were obtained for the GR− group. Performance of the LGR+ group did not depend on incentive manipulations, whereas the RGR+ group performed better in both the penalty and reward conditions than in the no-incentive condition. The results show that the posterior medial OFC is involved in the motivational modulation of working memory performance. Our findings also suggest that the left posterior medial OFC plays a crucial role in this function, whereas the right posterior medial OFC is particularly involved in the processing of the punishing aspect of salient events and it probably mediates in guiding behavior on the basis of negative outcomes of action.