Saccadic eye movement disturbances in whiplash patients with persistent complaints.

In order to analyse the possible basis of subjective complaints following whiplash injury, horizontal eye movements were examined in subjects with persistent complaints ('symptomatic group') and subjects who had completely recovered ('recovered group'). The results for the symptomatic and recovered groups were compared with those for age-matched, healthy volunteers (control group). A battery of different saccade paradigms was employed: two were reflexive saccade tasks including a gap and an overlap task, and two were intentional saccade tasks consisting of an antisaccade and a memory-guided saccade task. In addition, the symptomatic and recovered groups also underwent psychiatric evaluation in a structured clinical interview, and all groups were assessed for emotional functioning using the Beck Depression Inventory (BDI). The recovered group did not differ significantly from the control group in saccade performance and emotional functioning. The symptomatic group showed dissociation of their performances of reflexive and intentional saccade tasks: performance in reflexive saccade tasks was normal, but in intentional saccade tasks the symptomatic group showed significantly impaired inhibition of unwanted reflexive saccades, impaired saccade triggering (i.e. increased latency) and a higher percentage error in amplitude in memory-guided saccades. Based on clinical interviews, no signs of major depression or dysthymia were found in any of the groups. Compared with the other two groups, the symptomatic group had significantly higher overall BDI scores, but these resulted from BDI dimensions that were non-specific to depression, viz. 'physiological manifestations' (e.g. fatigue, sleep disturbance) or 'performance difficulty' (e.g. work inhibition). In summary, in the symptomatic group the pattern of eye movement disturbances together with normal performance in reflexive saccade tasks and impaired performance in the intentional saccade tasks, especially impaired inhibitory function, suggests dysfunction of prefrontal and frontal cortical structures.

The association of childhood trauma and personality disorder with adult chronic depression. A cross-sectional study in depressed outpatients

Objective: Chronic depression has often been associated with childhood trauma. There may, however, be an interaction between personality pathology, childhood trauma, and chronic depression. This interaction has not yet been studied. Method: This retrospective analysis is based on 279 patients contacted for a randomized trial in an outpatient psychotherapy center over a period of 18 months from 2010 to 2012. Current diagnoses of a personality disorder and presence of chronic depression were systematically assessed using the Structured Clinical Interview for DSM-IV. Retrospective reports of childhood trauma were collected using the short form of the Childhood Trauma Questionnaire (CTQ-SF). DSM-IV–defined chronic depression was the primary outcome. The association between chronic depression, childhood trauma, and personality disorders was analyzed using correlations. Variables that had at least a small effect on correlation analysis were entered into a series of logistic regression analyses to determine the predictors of chronic depression and the moderating effect of childhood trauma. Results: The presence of avoidant personality disorder, but no CTQ-SF scale, was associated with the chronicity of depression (odds ratio [OR] = 2.20, P = .015). The emotional abuse subscale of the CTQ-SF did, however, correlate with avoidant personality disorder (OR = 1.15, P = .000). The level of emotional abuse had a moderating effect on the effect of avoidant personality disorder on the presence of chronic depression (OR = 1.08, P = .004). Patients who did not suffer from avoidant personality disorder had a decreased rate of chronic depression if they retrospectively reported more severe levels of emotional abuse (18.9% vs 39.7%, respectively). Conclusions: The presence of avoidant personality pathology may interact with the effect of childhood trauma in the development of chronic depression. This has to be confirmed in a prospective study.

Modeling the relationships between adult attachment patterns and borderline personality disorder: The role of impulsivity and aggressiveness

To obtain a better understanding of the associations among Borderline Personality Disorder (BPD), adult attachment patterns, impulsivity, and aggressiveness, we tested four competing models of these relationships: a) BPD is associated with the personality traits of impulsivity and aggressiveness, but adult attachment patterns predict neither BPD nor impulsive/aggressive features; b) adult attachment patterns are significant predictors of BPD but not of impulsive/aggressive traits, although these traits correlate with BPD; c) adult attachment patterns are significant predictors of impulsive and aggressive traits, which in turn predict BPD; and d) adult attachment patterns significantly predict both BPD and impulsive/aggressive traits. We assessed 466 consecutively admitted outpatients using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (V. 2.0), the Attachment Style Questionnaire, the Barratt Impulsiveness Scale-11, and the Aggression Questionnaire. Maximum likelihood structural equation modeling of the covariance matrix showed that model (c) was the best fitting model (chi(2) (21) = 31.67, p >.05, RMSEA = .023, test of close fit p >.85). This result indicates that adult attachment patterns act indirectly as risk factors for BPD because of their relationships with aggressive/impulsive personality traits.

Elevated amygdala activity to sad facial expressions:a state marker of bipolar but not unipolar depression

Background - Difficulties in emotion processing and poor social function are common to bipolar disorder (BD) and major depressive disorder (MDD) depression, resulting in many BD depressed individuals being misdiagnosed with MDD. The amygdala is a key region implicated in processing emotionally salient stimuli, including emotional facial expressions. It is unclear, however, whether abnormal amygdala activity during positive and negative emotion processing represents a persistent marker of BD regardless of illness phase or a state marker of depression common or specific to BD and MDD depression. Methods - Sixty adults were recruited: 15 depressed with BD type 1 (BDd), 15 depressed with recurrent MDD, 15 with BD in remission (BDr), diagnosed with DSM-IV and Structured Clinical Interview for DSM-IV Research Version criteria; and 15 healthy control subjects (HC). Groups were age- and gender ratio-matched; patient groups were matched for age of illness onset and illness duration; depressed groups were matched for depression severity. The BDd were taking more psychotropic medication than other patient groups. All individuals participated in three separate 3T neuroimaging event-related experiments, where they viewed mild and intense emotional and neutral faces of fear, happiness, or sadness from a standardized series. Results - The BDd—relative to HC, BDr, and MDD—showed elevated left amygdala activity to mild and neutral facial expressions in the sad (p < .009) but not other emotion experiments that was not associated with medication. There were no other significant between-group differences in amygdala activity. Conclusions - Abnormally elevated left amygdala activity to mild sad and neutral faces might be a depression-specific marker in BD but not MDD, suggesting different pathophysiologic processes for BD versus MDD depression.

Patterns of diagnostic comorbidity in children and adolescents with anxiety

Comorbidity is defined as the co-occurrence of two or more psychological disorders and has been identified as one of the most pressing issues facing child psychologists today. Unfortunately, research on comorbidity in anxious children is rare. The purpose of this research was to examine how specific comorbid patterns in children and adolescents referred with anxiety disorders affected clinical presentation. In addition, the effects of gender, age and total number of diagnoses were also examined.^ Three hundred fifty-five children and adolescents (145 girls and 210 boys, hereafter referred to as "children") aged 6 to 17 who presented to the Child Anxiety and Phobia Program during the years 1987 through 1996 were assessed through a structured clinical interview administered to both the children and their families. Based on information from both children and parents, children were assigned up to five DSM diagnoses. Global ratings of severity were also obtained. While children were interviewed, parents completed a number of questionnaires pertaining to their child's overall functioning, anxiety, thoughts and behaviors. Similarly, while parents were interviewed, children completed a number of self-report questionnaires concerning their own thoughts, feelings and behaviors.^ In general, children with only anxiety disorders were rated as severe as children who met criteria for both anxiety and externalizing disorders. Children with both anxiety and externalizing disorders were mostly young (i.e. age 6 through 11) and mostly male. These children tended to rate themselves (and be rated by their parents) equally as anxious as children with only anxiety disorders. Global ratings of severity tended to be associated with the type of comorbid pattern versus the number of diagnoses assigned to a child. The theoretical, development and clinical implications of these findings will be discussed. ^

Developing and Validating a Perinatal Depression Screening Tool in Bungoma County, Kenya

Background: Depression-screening tools exist and are widely used in Western settings. There have been few studies done to explore whether or not existing tools are valid and effective to use in sub-Saharan Africa. Our study aimed to develop and validate a perinatal depression-screening tool in rural Kenya.

Methods: We utilized conducted free listing and card sorting exercises with a purposive sample of 12 women and 38 CHVs living in a rural community to explore the manifestations of perinatal depression in that setting. We used the information obtained to produce a locally relevant depression-screening tool that comprised of existing Western psychiatric concepts and locally derived items. Subsequently, we administered the novel depression-screening tool and two existing screening tools (the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9) to 193 women and compared the results of the screening tool with that of a gold standard structured clinical interview to determine validity.

Results: The free listing and card sorting exercise produced a set of 60 screening items. Of the items in this set, we identified the 10 items that most accurately classified cases and non-cases. This 10-item scale had a sensitivity of 100.0 and specificity of 81.2. This compared to 90.0, 31.5 and 90.0, 49.7 for the EPDS and the PHQ-9, respectively. Overall, we found a prevalence of depression of 5.2 percent.

Conclusions: The new scale does very well in terms of diagnostic validity, having the highest scores in this domain compared to the EPDS, EPDS-R and PHQ-9. The adapted scale does very well with regards to convergent validity-illustrating clear distinction between mean scores across the different categories. It does well with regards to discriminant validity, internal consistency reliability, and test-retest reliability- not securing top scores in those domains but still yielding satisfactory results.

The Prevalence of Depression among patients and its detection by Primary Health Care Workers at Matawale Health Centre (Zomba)

Background Little information is available on the prevalence of depression in Malawi in primary health care settings and yet there is increased number of cases of depression presenting at tertiary level in severe form. Aim The aim of the study was to determine the prevalence of depression among patients and its detection by health care workers at a primary health care clinic in Zomba. Methods A cross-sectional survey was done among patients attending outpatient department at Matawale Health Centre, in Zomba from 1st July 2009 through to 31st July 2009. A total of 350 adults were randomly selected using systematic sampling. The “Self Reporting Questionnaire”, a questionnaire measuring social demographic factors and the Structured Clinical Interview for DSM-IV Axis I disorders Non-Patient Version (SCID-NP) were administered verbally to the participants. Findings The prevalence of depression among the patients attending the outpatients department was found to be 30.3% while detection rate of depression by clinician was 0%. Conclusion The results revealed the magnitude of depression which is prevalent in the primary health care clinic that goes undiagnosed and unmanaged. It is therefore recommended that primary health care providers do thorough assessments to address common mental disorders especially depression and they should be educated to recognise and manage depression appropriately at primary care level.

Violência conjugal percebida por um menor em contexto familiar e suas consequências psicossociais

A violência como fenómeno social e familiar, não é um problema atual, desde sempre esteve presente, sendo que a sua exposição apresenta diferentes intensidades em diferentes momentos da sua evolução. Como fenómeno mundial, percorreu todas as culturas, etnias, tipos de economia e regimes políticos (Sagim, 2003). O objectivo da presente investigação é a violência conjugal percebida por um menor em contexto familiar e suas consequências psicossociais: estudo de caso. Método: A metodologia escolhida é qualitativa e é designada por naturalista. O método utilizado foi o estudo de caso e a recolha de dados foi a entrevista (semi-estruturada) e fez-se a descodificação desta através da análise de conteúdo, que foi organizada em várias categorias . Instrumentos: Questionário sócio demográficos (filha); Guião de Entrevista para adultos(mãe), semi-estruturada; Entrevista Clínica Semi–Estruturada (SCICA);A Escala de Sinalização do Ambiente Natural Infantil (S.A.N.I.); O teste projectivo Pata Negra de Corman (filha). Participantes: R de 12 anos de idade, sexo feminino, caucasiana, possui o 9º ano de escolaridade Resultados: Verificou-se que R tem uma boa capacidade de coping e resolução de problemas, indo do encontro referido por alguns autores nos meus estudos, sendo que noutros não se enquadra no perfil defendido pela literatura. Referindo segundo o DSM-5, R apresenta alguma sintomatologia clínica como a ansiedade de separação, revelando insegurança e medo da perda dos afetos por parte dos progenitores. Conclusão: : Concluiu-se ainda que alguns estudos referem que nem todas as crianças expostas à violência intrafamiliar responderão negativamente, uma vez que a presença de fatores de proteção tèm um papel fundamental. Entre estes, o ambiente escolar, o relacionamento com a vizinhança e o suporte advindo de demais membros familiares, entre outros (Sani, 2008).

Diagnostic interview for genetic studies (DIGS): inter-rater and test-retest reliability of the French version.

The National Institute of Mental Health developed the semi-structured Diagnostic Interview for Genetic Studies (DIGS) for the assessment of major mood and psychotic disorders and their spectrum conditions. The DIGS was translated into French in a collaborative effort of investigators from sites in France and Switzerland. Inter-rater and test-retest reliability of the French version have been established in a clinical sample in Lausanne. Excellent inter-rater reliability was found for schizophrenia, bipolar disorder, major depression, and unipolar schizoaffective disorder while fair inter-rater reliability was demonstrated for bipolar schizoaffective disorder. Using a six-week test-retest interval, reliability for all diagnoses was found to be fair to good with the exception of bipolar schizoaffective disorder. The lower test-retest reliability was the result of a relatively long test-retest interval that favored incomplete symptom recall. In order to increase reliability for lifetime diagnoses in persons not currently affected, best-estimate procedures using additional sources of diagnostic information such as medical records and reports from relatives should supplement DIGS information in family-genetic studies. Within such a procedure, the DIGS appears to be a useful part of data collection for genetic studies on major mood disorders and schizophrenia in French-speaking populations.

Accuracy of predicting a child's response to potential threat: A comparison of children and their mothers

Considerable research has indicated that children and their parents often demonstrate marked discrepancies in their reporting of anxiety-related phenomena. In such cases, the question arises as to whether children are capable of accurately reporting on their anxiety. In the present study, 50 children (aged 5 to 14 years) were asked to approach a large, German Shepherd dog. Prior to the task, both the mother and child independently predicted the closest point likely to be reached by the child and the degree of anxiety likely to be experienced. These predictions were then compared with the actual phenomena displayed by the child during the task. On the behavioural measure (closest step reached), both the child and mother demonstrated equivalent predictive accuracy. On the subjective measure (fear ratings) children were considerably more accurate than their mothers. The data were not influenced by gender, age, or clinical status. The results indicate the ability of children to accurately predict their anxious responses, and support the value of incorporating children's self-reports in the assessment of emotional disorders.

Detection of psychiatric morbidity in the primary medical care setting in Brazil

The aims of this study were a) to assess the ability of primary care doctors to make accurate ratings of psychiatric disturbance and b) to evaluate the use of a case-finding questionnaire in the detection of psychiatric morbidity. The estudy took place in three primary care clinics in the city of São Paulo, Brazil, during a six-month survey. A time sample of consecutive adult attenders were asked to complete a case-finding questionnaire for psychiatric disorders (the Self Report Questionnaire - SRQ) and a subsample were selected for a semi-structured psychiatric interview (the Clinical Interview Schedule - CIS). At the end of the consultation the primary care doctors were asked to assess, in a standardized way, the presence or absence of psychiatric disorder; these assessments were then compared with that ratings obtained in the psychiatric interview. A considerable proportion of minor psychiatric morbidity remained undetected by the three primary care doctors: the hidden morbidity ranged from 22% to 79%. When these were compared to those of the case-finding questionnaire, they were consistently lower, indicating that the use of these instruments can enhance the recognition of psychiatric disorders in primary care settings. Four strategies for adopting the questionnaire are described, and some of the clinical consequences of its use are discussed.

A Brazilian version of the "Children's Interview for Psychiatric Syndromes" (ChIPS)

OBJETIVE: The advance of research in child and adolescent psychiatry in Brazil heavily depends on the existence of instruments for the investigation of psychiatric syndromes adapted to Brazilian Portuguese. METHODS: This article describes a careful process of translation of the Children's Interview for Psychiatric Syndromes for the purpose of use in research in Brazil. The Children's Interview for Psychiatric Syndromes has a version for parents (P-ChIPs) and a version for children (ChIPS). In this article, the sections of P-ChIPS referring to attention-deficit hyperactivity disorder, oppositional-defiant disorder, conduct disorder, mania/hypomania, anorexia nervosa, bulimia nervosa and psychotic disorders were translated to Brazilian Portuguese. The sections of the ChIPS referring to substance use disorders, social anxiety disorder, specific phobias, obsessive-compulsive disorder, generalized anxiety disoder, separation anxiety disorder, post-traumatic disorders and depression/dysthimia were also adapted. Each section was translated by two independent translators and later discussed in a committee composed of experts in the field of Psychiatry and a professional of the field of linguistics. RESULT: A final version containing an interview for the main psychiatric syndromes was defined. CONCLUSION: The translated P-ChIPS is a helpful instrument in children and adolescent clinical evaluation.

Forensic neuropsychological assessment: clinical case of depression and working incapacity

Issues related to mental health in relation to court matters have increasingly required the participation of the psychologist. We present the use of forensic neuropsychological assessment in a case of retirement reversal. Incapacity was attested due to disability resulting from depression of a 35-year-old attorney, and the case was forwarded from the courts to the Forensic Psychiatry and Psychology Unit at the USP Clinical Hospital. A clinical interview and application of cognitive tests was conducted. Despite the depression, significant cognitive losses that would prevent return to his professional assignments were not detected. The neuropsychological assessment has been shown to be an important tool in the forensic context, as it assists with diagnostic value for clarification of functional aspects in the various psychopathological areas in terms of disabilities or potentialities.

Observer-rated Coping Associated with Borderline Personality Disorder: An Exploratory Study.

BACKGROUND: Little is known about coping specificities, as operationalization of the concept of affect regulation, in borderline personality disorder (BPD). It is most important to take into account methodological criticisms addressed to the self-report questionnaire approach and to compare BPD coping specificities to the ones of neighbouring diagnostic categories, such as bipolar disorder (BD). SAMPLING AND METHODS: The present exploratory study compared the coping profiles of N = 25 patients presenting BPD to those of N = 25 patients presenting BD and to those of N = 25 healthy controls. All participants underwent a clinical interview that was transcribed and rated using the Coping Patterns observer-rater system. RESULTS: Results partially confirmed study hypotheses and showed differences between BPD patients and healthy controls in all coping domains (competence, resources and autonomy), whereas the only coping domain presenting a BPD-specific lack of skills, compared with the BD patients, was autonomy, a set of coping strategies facing stress appraised as challenge. These coping processes were linked to general and BPD symptomatology. CONCLUSIONS: These results extend conclusions of earlier studies on affect regulation processes in BPD and bear important clinical implications, in the context of dialectical behavior therapy and other therapeutic approaches. Limitations of this exploratory study, such as the small sample size, are acknowledged. Copyright © 2012 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Coping can be reliably assessed in the narrative process in an non-structured interview frame. Patients with borderline personality disorder present with a specific lack of skills in affect regulation related to autonomy issues, compared to patients with bipolar disorder and healthy controls. Lack of skills in accommodation to distressing emotions in borderline personality disorder is related to symptom gravity and may be treated using radical acceptance strategies.

Prevalence and correlates of DSM-5 bipolar and related disorders and hyperthymic personality in the community.

BACKGROUND: To 1) establish the lifetime and 12-month prevalence of DSM-5 bipolar and related disorders including the new algorithmically defined conditions grouped within Other Specified Bipolar and Related Disorders (OSBARD) as well as hyperthymic personality in a randomly selected community sample, and 2) determine the clinical relevance of the OSBARD category in terms of sociodemographic characteristics, course, comorbidity and treatment patterns by comparing the subjects of this category to those with bipolar-I (BP-I), bipolar-II (BP-II), major depressive disorder (MDD), and those with no history of mood disorders. METHODS: The semi-structured Diagnostic Interview for Genetic Studies was administered by masterslevel psychologists to a random sample of an urban area (n=3'719). RESULTS: The lifetime prevalence was 1.0% for BP-I, 0.8% for BP-II, 1.0% for OSBARD and 3% for hyperthymic personality. Subjects with OSBARD were more severely affected than subjects without a history of mood disorders regarding almost all clinical correlates. Compared to those with MDD, they also revealed an elevated risk of suicidal attempts, lower global functioning, more treatment seeking and more lifetime comorbidity including anxiety, substance use and impulse-control disorders. However, they did not differ from subjects with BP-II. LIMITATIONS: Small sample sizes for bipolar and related disorders and potential inaccurate recall of symptoms. CONCLUSIONS: The modifications of diagnostic criteria for manic/hypomanic episodes according to the DSM-5 only marginally affect the prevalence estimates for BP-I and BP-II. The new DSM-5 OSBARD category is associated with significant clinical burden, is hardly distinct from BP-II with respect to clinical correlates and deserves similar clinical attention.