Females and males in an intake psychiatric setting

Alexithymia and temperament and character model of personality in patients with major depressive disorder

Alexithymia is thought to be a stable personality trait and a predisposing risk factor for depression. In this study, we aimed to identify the prevalence of alexithymia in a depressed and nondepressed sample and examined the relationship between Cloninger's psychobiological model of personality with alexithymia. The Turkish version of the 20-item Toronto Alexithymia Scale (TAS-20), the Turkish version of the Temperament and Character Inventory, and the 21-item Beck Depression Inventory (BDI) were administered to 81 depressed patients and 51 controls. The mean age of the groups was 30.5 +/- 7.7 and 32.75 +/- 8.73, respectively. Depression severity was evaluated with the BDI. In the depressed group, 33.3% were alexithymic, and alexithymic subjects had significantly higher BDI scores. Depressed individuals were significantly more alexithymic than the controls on the total and all the 3 subscales of TAS-20. The TAS-20 total score was negatively correlated with the temperament dimension of Reward Dependence (RD) and the character dimension of Self-Directedness (SD). In the TAS-20 subscale, difficulties in identifying feelings was positively correlated with Self-Transcendence and negatively correlated with SD. The difficulties in expressing feelings subscale was negatively correlated with RD and SD. In the depressed patient group, the temperament dimension of RD was significantly lower in the alexithymic group. The rate of alexithymia is found high among this sample of Turkish depressed patients, and the results suggested a strong connection between alexithymia and depression. Alexithymia is explained by specific dimensions and subscale within Cloninger's psychobiological model of personality in this sample of depressed Turkish patients.

Associations between chemical odor intolerance and sleep disturbances in community-living adults

OBJECTIVE

To investigate associations between sleep disturbances and chemical odor intolerance (COI), which is the subjective report of feeling ill from common odors, such as carpet glue or pesticides.

METHODS

This cross-sectional study consisted of government employees and their family members (n=140; 61% women, mean age=46.3 years) derived from a stratified cluster population living in Pima County, Tucson, AZ. Subjects completed a standard survey that included sleep symptoms, a validated measure of COI, and two questions regarding anxiety and depression. Odds ratios (OR) with 95% confidence intervals (CI) were computed to test the association between COI and sleep symptoms. Stratification according to the Mantel-Haenszel method and logistic regression models were used to test for confounding and/or effect modification.

RESULTS

After adjusting for age and gender, subjects with COI were significantly more likely to report difficulty staying asleep (OR=3.06; CI=1.17-8.03), insufficient sleep (OR=3.93; CI=1.43-10.79), and nightmares (OR=3.17; CI=1.14-8.81) compared to persons without COI. Associations between COI, sleep maintenance problems and insufficient sleep were still significant after adjusting for gender and depression; however, the association between COI and nightmares became borderline.

CONCLUSIONS

Compared to the non-COI, persons with COI are more likely to report sleep maintenance insomnia and insufficient sleep independent of self-reported depression. Nightmares appear to be related more to depression than to COI.

Gender differences in the receipt of aftercare and psychiatric hospitalization among adults with severe mental illness

Gender differences in receiving aftercare and being hospitalized for persons with severe mental illness were examined. For women, unique predictors for receiving aftercare were primarily treatment system responsiveness variables. For men, unique predictors of aftercare were from all categories and included being accompanied to the psychiatric emergency room (PER) by family or friends and having previous psychiatric admissions. More recent outpatient treatment and a greater number of previous admissions predicted hospitalization for both men and women. Receiving less intense aftercare predicted hospitalization for women but not men. Unique predictors of hospitalization for men were a higher level of education and a psychotic disorder diagnosis.

Race as a moderator of the prediction of receipt of aftercare and psychiatric hospitalization

Race proved to be an important moderator variable in the prediction of the receipt of aftercare and psychiatric hospitalization. Only one variable, currently receiving outpatient treatment, predicted receipt of aftercare for both African-Americans and Caucasians. Other predictors for African-Americans were not receiving a substance abuse referral, receiving a mental health referral, and having an appointment. For Caucasians, other predictors were being female, having previous psychiatric admissions, no substance use disorder diagnosis, and not being admitted at index. More previous admissions and recent outpatient treatment predicted hospitalization for both racial groups. Additional predictors for African-Americans were being male, not being accompanied to the psychiatric emergency room (PER) by family, and receiving less intense aftercare. The only other predictor for Caucasians was being accompanied to the PER by the police.

Racial effects on the clinical presentation of alcoholics at a psychiatric hospital

Despite the clinical importance of race effects on comorbidity and symptom patterns in recent community studies, little is known about such effects in various treatment facilities. This study evaluated the effect of race on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatric hospital. The factor that most strongly distinguished the racial groups was socioeconomic status (SES). After controlling for SES and other factors, no significant difference was noted between ethnic groups in the prevalence of major depressive disorder (MDD) or antisocial personality disorder. However, after controlling for SES and other factors, alcohol and drug use were more severe in African-American alcoholics, along with four symptoms associated with alcohol and drug use. In contrast, reversed neurovegetative symptoms, anxiety-related symptoms, and some personality-related symptoms were more severe in white alcoholics.

Gender effects on the clinical presentation of alcoholics at a psychiatric hospital

Despite the clinical importance of gender effects on symptom patterns and comorbidity patterns in alcoholics, little is known about such effects in treatment facilities other than alcoholism treatment centers. This study evaluated the effect of gender on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatric hospital. It demonstrated that major depression and accompanying depressive and anxiety-related symptoms are more prominent in female alcoholics than in male alcoholics, whereas antisocial personality disorder and antisocial symptoms are more prominent in male alcoholics presenting to a psychiatric hospital. The study also demonstrated that reversed neurovegetative symptoms are more severe in female than in male alcoholics.

Do Caucasian and black adolescents differ at psychiatric intake?

A large sample of adolescents brought for psychiatric evaluation to a public University based facility are the subjects of the study. Material incorporated in a DSM-III multiaxial formulation plus symptoms constituted the dependent variables. Analyses concentrated on ethnic differences, with variation associated with gender and social class controlled statistically. Caucasians showed comparatively greater clinical morbidity: higher number of Axis I definite diagnoses and level of symptoms. Eating disorder diagnoses were more common in Caucasians. There were no significant differences pertaining to level of stress or social impairment. Blacks showed higher levels of symptoms scored as "social aggression" and diagnosed as conduct disorders. The pattern of results raised the question of a possible referral bias, with blacks shunted to the psychiatric facility with lower levels of standard clinical psychopathology, but higher levels of social oppositional behavior. Further research is needed to verify if such a bias does exist.