Interrater reliability and internal consistency of the structured clinical interview for DSM-IV axis II personality disorders (SCID-II), version 2.0

Interrater reliability and internal consistency of the SCID-II 2.0 was assessed in a sample of 231 consecutively admitted in- and outpatients using a pairwise interview design, with randomized rater pairing and blind interview assessment. Interrater reliability coefficients ranged from .48 to .98 for categorical diagnosis (Cohen kappa), and from .90 to .98 for dimensional judgements (Intraclass correlation coefficient). Internal consistency coefficients were satisfactory (.71-.94). The results suggest that the SCID-II 2.0 has adequate interrater and internal consistency reliability.

Personality traits and metabolic control: a study in insulin-dependent diabetes mellitus patients

BACKGROUND

In the present study the authors evaluated the relationship between personality traits (according to DSM-III-R) and poor metabolic control in an adult onset insulin-dependent diabetes mellitus sample (n = 77).

METHODS

Personality traits were assessed with the Personality Diagnostic Questionnaire--Revised. Metabolic control was evaluated through glycosilated hemoglobin (HbA1c): poor metabolic control was defined as HbA1c > or = 9% (normal values < 6.0%).

RESULTS

Principal Component Analysis revealed three personality profiles: 'Cluster A/C Mixed', 'Cluster B Dependent' and 'Cluster B Aggressive'. Oneway ANCOVA, using sex as covariate, revealed a significant association (p = 0.01) only between poor metabolic control and Cluster B Dependent profile. No correlation was found between HbA1c and the other profiles.

CONCLUSION

These data suggest that a specific personality profile is associated with poor metabolic control.

Psychological stress in nurses' relationships with HIV-infected patients: the risk of burnout syndrome

To assess the role played by psychological stress and sociodemographic factors as predictors of burnout in nurses, we administered the AIDS Impact Scale (AIS) and the Maslach Burnout Inventory (MBI) to nurses in the AIDS field. The sample was composed of 410 nurses from 19 departments for the treatment of infectious diseases. In these subjects we observed a low level of burnout in the MBI, but a small proportion had a high level of burnout We did not find significant associations between sociodemographic variables and the MBI scales. We found significant correlations between the MBI and three AIS scales that specifically assessed the emotional involvement of nurses in their relationships with patients. The results suggest that an empathic involved relationship seems to be protective towards burnout rather than a frustrating involved relationship. Moreover nurses tolerate stress better if they receive supportive social rewards. We found that the impact of working with HIV-infected patients causes psychological stress (measured with the AIS), but it is a weak predictor of burnout (measured with the MBI). The results indicated the incompatibility between the relational/defensive model of the AIS and the environmental/work performance model of the MBI.

An assessment of self-esteem in HIV-positive patients

The objective of this research is to assess how self-esteem levels differ in HIV-infected subjects in three different risk behaviours: drug addicts, homosexuals, heterosexuals. The sample (n = 104) consisted of: drug addicts (n = 46); homosexual (n = 26); heterosexuals (n = 32). The Rosenberg Self-Esteem Scale (RSES) and the Eysenck Personality Inventory (EPI) were used. A covariance analysis was used to assess the effect of the different personality traits on the 'self-esteem variable' and to eliminate the variance caused by the personality variables. Bonferroni's T-test was used to assess which group contributed to confute the hypothesis of equivalence between the RSES means of the groups. A significant association between the HIV-infection risk behaviour and the level of self-esteem was shown; this association was assessed by eliminating the effect of personality traits. The risk behaviour as well as the personality traits were both indicative of the level of self-esteem. The assessment of each group revealed that the drug addicts had a relatively lower self-esteem level (mean = 35.251) than the homosexuals (mean = 38.698) and the heterosexuals (mean = 38.227). In conclusion the RSES enables clinicians to identify subjects with low levels of self-esteem who need to be psychologically assessed within a vast population of HIV-infected patients.

Effects of personality on metabolic control in IDDM patients

OBJECTIVE

The aim of this study was to evaluate the relationship between poor metabolic control and maladaptive personality traits (according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised) in an adult-onset insulin-dependent diabetes mellitus sample group (n = 77).

RESEARCH DESIGN AND METHODS

Metabolic control was evaluated through glycosylated hemoglobin (HbA1c). Personality traits were assessed with the Personality Diagnostic Questionnaire-Revised, a self-administered questionnaire. Residual pancreatic secretion (fasting serum C-peptide) was also evaluated.

RESULTS

Principal components analysis revealed three personality profiles: "withdrawn-suspicious" (P1), "dramatic-dependent" (P2), and "aggressive-irresponsible" (P3). Multiple linear regression analysis showed that C-peptide levels and P2 personality profiles were significant and independent predictors of HbA1c plasma levels: P2 predicted high HbA1c values and C-peptide predicted low HbA1c levels.

CONCLUSIONS

These data suggest that a P2 personality profile is a significant predictor of poor metabolic control.

DSM-III-R brief reactive psychosis and personality disorders

DSM-III and DSM-III-R defined the diagnostic criteria of brief reactive psychosis (BRP) identifying some personality disorders (PDs) as predisposing factors: up to now no experimental data support this hypothesis. In this research, the authors studied the link between BRP and PDs, assessing axis II diagnosis (SIDP-R), after recovery of BRP in a group of 23 patients. Eighty-seven percent of the patients (n = 19) received at least one diagnosis of PDs. The widespread presence of PDs and, particularly, the high prevalence of cluster C (n = 11, 47.8%), are only partially in accordance with the hypothesis of DSM-III. A possible alternative model of interaction is suggested.

Personality disorders and psychopathologic symptoms in patients with androgenetic alopecia

BACKGROUND AND DESIGN

The few articles published on the interactions between psychological factors and alopecia seem to yield contrasting results. To assess the relationships between alopecia, gender, Diagnostic Statistical Manual of Mental Disorders, Revised Third Edition personality disorders, and psychopathologic symptoms reactive to alopecia, we administered the Personality Disorders Questionnaire-Revised and the Symptoms Checklist-90 to a randomly selected sample of 116 outpatients with androgenetic alopecia.

RESULTS

The prevalence of personality disorders in subjects with androgenetic alopecia proved to be significantly higher than the prevalence of such diagnoses in the general population. Women did not show a higher prevalence of personality disorders or more psychopathologic symptoms than men. The factor analysis demonstrated the existence of three personality profiles (F1, F2, and F3) significantly and specifically associated with the subject's gender and with the psychopathologic reactive symptoms, measured using the Symptoms Checklist-90.

CONCLUSIONS

The most important factor in developing a psychopathologic reaction to alopecia seems to be the presence of a Diagnostic Statistical Manual of Mental Disorders, Revised Third Edition personality disorder and not the subject's gender.

[A new growth curve]

A growth curve is presented, that using the Tanner and Whitehouse's 50th centile, plots the height versus weight, both for males and females. The age is gives as parameter on the curves. In this way, weight, height and age are merged on a single chart for every sex. After exemplifying its advantages, the simpler relief of deviation from the values of the height-weight medians on the various ages, because the values of weight refer to the real height (and back), not to the age. With the same rule, curves relating to 10th and 90th centiles are processed by Tanner and Whitehouse's values. Collating between them, curves allow some morphological relief. Moreover, for both referred to the 50th centile of Tanner and Whitehouse curves (for the male sex and the female one), is presented a simple mathematical expression of interpolation, which shows and excellent representation of the measured dates. This expression is composed of a third-degree polynomial (cubic), which is fitted to the dates by the method of least square. The result of the correlation height-weight allows both to synthesize the dates in a sole expression and a simpler relief of discordance in the growth.

[Childhood trauma and personality disorders]

The influence of the model of object relations on modern psychodynamic research has led to increased emphasis on the importance of relations and traumatic events in the genesis of some psychic disorders, especially with regard to personality disorders. The development of axis II in the DSM-III system has increased the number of empiric studies in this field. In this paper, the Authors report data relating to a sample of 49 subjects with personality disorders (DSM-III-R) in which the presence of sexual abuse, physical maltreatment and negative family atmosphere was examined using a self-administered questionnaire (CAT). The results suggest a significant presence of these events throughout the sample and reveal a correlation between some personality disorders and specific traumatic events. It may therefore be hypothesized that the presence of these events represents an important factor from the point of treatment, both in technical and in prognostic terms.

Epilepsy in an Italian community as assessed by a survey for prescriptions of antiepileptic drugs: epidemiology and patterns of care

The prescriptions of antiepileptic drugs in the years 1985 and 1986 were used to identify all possible cases of epilepsy in a population of about 50,000 people. The general practitioners of the study area filled out a questionnaire for each user of antiepileptic drugs registered as a patient of theirs. This information was integrated using data obtained by local specialist services or directly collected by visits and/or phone interviews. Two-hundred and fifty-six of the 417 antiepileptic drug users proved to be active epileptics with a prevalence rate of 5.2/1000, the annual incidence rate for 1986 being 51.8/100,000. The main patterns of the disease appeared to be consistent with those of the literature while the prior history of seizures in the previous five years was generally lower. The health care of epileptic patients involved a wide range of specialists. The general practitioners were responsible for the final diagnosis of epilepsy in 10% of patients and for the management of the disease in 22%, most of the patients being over 50 years old. The calculated mean prescribed daily doses of the antiepileptic drugs suggested that many epileptics were taking therapeutic schedules lower than those of the literature.

Nosocomial outbreak of systemic candidosis associated with parenteral nutrition

Eight patients in two surgical units developed systemic candidosis during a 40-day period from June 5 to July 13, 1987 (in five cases Candida albicans was identified). Three of them died. All cases belonged to a group of 27 patients receiving parenteral nutrition (PN), while among the 108 patients who did not receive PN, no cases were observed (p = .000001). Candida was cultured from two PN bags administered to the cases. A specialized nutrition nurse was responsible for the PN compounding and for maintaining administration sets in the two wards involved. An epidemiological investigation, in which 19 uninfected patients who had had PN were used as controls, showed no significant difference between cases and controls except that lipids were more frequently added to bags administered to cases (p = .0005). Furthermore, the bags administered to cases contained a higher average number of multidose constituents (p = .0008) when the comparison was focused on the two days before the onset of symptoms. Given the favorable medium provided by lipids, even a low level contamination of PN solutions during compounding and/or administration could have been responsible for the exposure of cases to multidose vials suggests, although not conclusively, that an extrinsic contamination occurred during compounding. Six isolates of C albicans were available from four cases. C albicans was cultured from the pharyngeal swabs of two physicians and three nurses, including the specialized nutrition nurse.

[Schizophrenia and family-expressed emotions. Study of an Italian population]

Expressed Emotion (EE) is a method of assessing the emotional make-up of a family, widely used in English-speaking countries, with particular reference to schizophrenia. This research programme arose out of a trial application of EE to a group of Italian families. Data are given here relative to a sample of 19 families with a schizophrenic member (according to DSM III criteria). The results confirm the hypothesised correlation between family EE and recidivist symptomatology of schizophrenic subjects: "high family EE" is associated with the most serious and habitual schizophrenic cases. The necessary adaptations which had to be made in order to apply EE assessment methods to Italian families are also discussed.

An international perspective on assessment of negative and positive symptoms in schizophrenia

The authors used the Scale for Assessment of Negative Symptoms and the Scale for Assessment of Positive Symptoms in interviews of 96 psychiatric inpatients in Italy. They evaluated the interrater reliability and the internal consistency of these scales for the assessment of negative and positive symptoms in schizophrenia. Their findings indicate that the results of these scales are similar in Italy and the United States, countries with different languages and cultures.

Psittacosis in a highly endemic area in Italy

In one locality in Italy where the incidence of psittacosis has increased rapidly since 1980, a hospital-based study and a seroepidemiological survey were carried out in order to define the clinical and epidemiological features of psittacosis in that area. Registers of the Virology Unit of the University of Ancona, Italy, were reviewed and all hospitalized patients with a serological diagnosis of psittacosis were identified. A total of 76 cases were found and studied. A presumptive bird source was identified in 80% of 62 patients, on whom a detailed investigation had been possible. Poultry represented the most frequent probable source of infection. Clinically, the predominant pattern of illness was a moderately severe lower respiratory tract infection, with chest X-rays showing pulmonary shadowings in 68 patients (89%). In the seroepidemiological study, 51 out of 143 subjects were exposed to birds (35.7%), but only 7 out of 96 urban adult blood donors (7.3%) were positive for chlamydial antibodies using the microimmunofluorescence test.

A waterborne outbreak of leptospirosis

During the period from July 10-26, 1984, 33 cases of serologically confirmed leptospirosis occurred in a small town in central Italy. The fatality rate, including the deaths of two unconfirmed cases, was 8.6% (3 of 35). Based on serologic evidence, the infection was caused by leptospires of the serogroup Australis. Epidemiologic study showed that the patients contracted the infection by drinking water from a fountain. The source of leptospiral contamination was probably a hedgehog trapped in a reservoir of water not in use but still connected to the water system of the fountain.

[A small epidemic focus of pulmonitis caused by Legionella]

A mini-epidemic consisting of 5 cases of Legionnaire's disease treated during september 1983 is reported. These patients shared many of the symptoms distinguishing the most common form of this disease in its severe or very severe form and some characteristic features of this case series are emphasised. It was impossible to trace the source of the outbreak, in spite of the fact that the mini-epidemic took place in an open situation. It is underlined that diagnosis is mainly clinical. The Legionella pneumophila bacteria should always be considered as one of the causal agents of bronchopneumonia, particularly when the following conditions are fulfilled: a) the disease takes the form of a confined, out-of-season, mini-epidemic; b) it is accompanied by multisystemic symptomatology and/or much greater involvement of general conditions that is usually to be expected in normal cases of bronchopneumonia. Since the disease is often fatal, erythromycin or rifampicin treatment should be started upon the slightest suspicion of contagion.

Chromatofocusing coupled with automated assay for beta-hexosaminidase isoenzymes in GM2 gangliosidosis

Good separations of the two major beta-hexosaminidase forms from human leukocytes were achieved by chromatofocusing, a technique which separates proteins on the basis of their isoelectric points. The use of an automated and reliable method is described for the identification of homozygotes and carriers of the GM2 gangliosidosis.

alpha-L-Fucosidase activity and isoenzyme characteristics analyzed by chromatofocusing in normal and leukemic lymphocytes

alpha-L-Fucosidase (EC 3.2.1.51) activity and isoenzyme characteristics were analyzed in normal lymphocyte subpopulations, chronic lymphocytic leukemia subpopulations, and acute lymphoblastic leukemia blasts. Similar pH activity profiles revealed that pH 5.0 was optimal in normal and leukemic cells. Unfractionated CLL lymphocytes had a lower specific activity than normal unfractionated lymphocytes (2.5 +/- 1.0 u/10(6) cells v. 4.0 +/- 1.1). CLL B cells and T-cells had lower specific activity than their respective normal counterparts (1.8 +/- 0.2 v. 5.9 +/- 2.0) (B-cells); (2.2 +/- 0.5 v. 3.7 +/- 1.0) (T-cells) suggesting T and B cells in CLL are abnormal. ALL blasts had a higher specific activity compared to unfractionated normal lymphocytes (9.7 +/- 3.0 v. 4.0 +/- 1.1; p less than 0.001). The isoenzyme pattern of normal, CLL and ALL lymphocytes were obtained by automated chromatofocusing on PBE 94 microcolumns using 0.025 M histidine and polybuffer 74. Two major isoenzyme components (B and A) were isolated. The activity ratio of B/A was different in normal, ALL, and CLL cells.