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Jayakody K, Gallagher P, Lloyd AJ, Cousins DA. A quantitative analysis of the relationship between affective state and personality ratings in inpatient depression (RAPID). Psychol Med 2023; 53:3416-3425. [PMID: 35238291 DOI: 10.1017/s003329172100547x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The relationship between major depressive disorder (MDD) and personality disorders is complex, with implications for diagnosis and treatment. We sought to explore the relationship between these disorders quantitatively in an inpatient setting. METHODS We conducted a structured observational study exploring symptoms of depression and selected neurocognitive functions over the span of an inpatient admission in those with depression and personality disorders. Sixty inpatients presenting with symptoms of depression completed ratings of mood and neurocognitive function. Diagnosis was confirmed by structured clinical interview (SCID-5-RV) at discharge and used to allocate patients to one of the two groups for analysis: those with MDD-only and those with a personality disorder (with or without MDD). RESULTS On admission, observer-based ratings of depression were significantly higher in the MDD-only group while subjective ratings were higher in the personality disorder group. Depression rating scores lessened in both groups during the admission, but at discharge, the personality disorder group continued to report higher subjective ratings. The personality disorder group also rated themselves as more cognitively impaired than the MDD-only group and unlike the MDD-only group, they did not report subjective improvements in cognitive function over the course of admission. Objective assessment of cognitive function demonstrated improvements in both groups. CONCLUSIONS In this study, the presence of a personality disorder was associated with greater subjective severity of depressive symptomatology and selected neurocognitive functioning, despite similar or lower objective severity in comparison with those with MDD. This finding has implications for understanding the patient journey through health care settings.
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Affiliation(s)
- Kaushadh Jayakody
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK
| | - Adrian J Lloyd
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK
| | - David Andrew Cousins
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK
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Lewis M, Scott J, Frangou S. Impulsivity, personality and bipolar disorder. Eur Psychiatry 2020; 24:464-9. [DOI: 10.1016/j.eurpsy.2009.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 02/15/2009] [Accepted: 03/23/2009] [Indexed: 11/28/2022] Open
Abstract
AbstractBackgroundIncreased impulsivity is a diagnostic feature of mania in bipolar disorder (BD). However it is unclear whether increased impulsivity is also a trait feature of BD and therefore present in remission. Trait impulsivity can also be construed as a personality dimension but the relationship between personality and impulsivity in BD has not been explored. The aim of this study was to examine the relationship of impulsivity to clinical status and personality characteristics in patients with BD.MethodsWe measured impulsivity using the Barratt Impulsiveness Scale (BIS-11) and personality dimensions using Eysenck Personality Questionnaire in 106 BD patients and demographically matched healthy volunteers. Clinical symptoms were assessed in all participants using the Clinical Global Impressions Scale, the Montgomery-Asberg Depression Rating Scale and the Young Mania Rating Scale. Based on their clinical status patients were divided in remitted (n = 36), subsyndromal (n = 25) and syndromal (n = 45).ResultsThere was no difference in BIS-11 and EPQ scores between remitted patients and healthy subjects. Impulsivity, Neuroticism and Psychoticism scores were increased in subsyndromal and syndromal patients. Within the BD group, total BIS-11 score was predicted mainly by symptoms severity followed by Psychoticism and Neuroticism scores.ConclusionsIncreased impulsivity may not be a trait feature of BD. Symptom severity is the most significant determinant of impulsivity measures even in subsyndromal patients.
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Roth M. Careful Classification Contributes Significantly to the Understanding and Management of Neurotic Disorders: A Debate. J R Soc Med 2018; 83:609-14. [PMID: 2286957 PMCID: PMC1292849 DOI: 10.1177/014107689008301005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M Roth
- Addenbrookes Hospital, Cambridge
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Xia J, He Q, Li Y, Xie D, Zhu S, Chen J, Shen Y, Zhang N, Wei Y, Chen C, Shen J, Zhang Y, Gao C, Li Y, Ding J, Shen W, Wang Q, Cao M, Liu T, Zhang J, Duan H, Bao C, Ma P, Zhou C, Luo Y, Zhang F, Liu Y, Li Y, Jin G, Zhang Y, Liang W, Chen Y, Zhao C, Li H, Chen Y, Shi S, Kendler KS, Flint J, Wang X. The relationship between neuroticism, major depressive disorder and comorbid disorders in Chinese women. J Affect Disord 2011; 135:100-5. [PMID: 21824661 PMCID: PMC3220767 DOI: 10.1016/j.jad.2011.06.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 06/29/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The personality trait of neuroticism is a risk factor for major depressive disorder (MDD), but this relationship has not been demonstrated in clinical samples from Asia. METHODS We examined a large-scale clinical study of Chinese Han women with recurrent major depression and community-acquired controls. RESULTS Elevated levels of neuroticism increased the risk for lifetime MDD (with an odds ratio of 1.37 per SD), contributed to the comorbidity of MDD with anxiety disorders, and predicted the onset and severity of MDD. Our findings largely replicate those obtained in clinical populations in Europe and US but differ in two ways: we did not find a relationship between melancholia and neuroticism; we found lower mean scores for neuroticism (3.6 in our community control sample). LIMITATIONS Our findings do not apply to MDD in community-acquired samples and may be limited to Han Chinese women. It is not possible to determine whether the association between neuroticism and MDD reflects a causal relationship. CONCLUSIONS Neuroticism acts as a risk factor for MDD in Chinese women, as it does in the West and may particularly predispose to comorbidity with anxiety disorders. Cultural factors may have an important effect on its measurement.
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Affiliation(s)
- Jing Xia
- ShengJing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 110817, PR China
| | - Qiang He
- ShengJing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 110817, PR China
| | - Yihan Li
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
| | - Dong Xie
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
| | - Suoyu Zhu
- Fudan University affiliated Huashan Hospital, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
| | - Jing Chen
- Shanghai Jiao Tong University School of Medicine affiliated Shanghai Mental Health Centre, No. 600 Wan Ping Nan Road, Shanghai 200030, PR China
| | - Yuan Shen
- Shanghai Tongji University affiliated Tongji Hospital, No. 389 Xinchun Road, Shanghai 200065, PR China
| | - Ning Zhang
- Nanjing Brain Hospital, No. 264 Guangzhou Road, Nanjing, Jiangsu, 210029, PR China
| | - Yan Wei
- No. 4 Affiliated Hospital of Jiangsu University, No. 246 Nan Men Da Street, Zhenjiang, Jiangsu, 212001, PR China
| | - Chunfeng Chen
- Zhejiang Traditional Chinese Medical Hospital, No. 54 You Dian Road, Hangzhou, Zhejiang 310006, PR China
| | - Jianhua Shen
- Tianjin Anding Hospital, No.13 Liu Lin Road, Hexi District, Tianjin, 300222, PR China
| | - Yan Zhang
- Shandong Mental Health Center, No. 49 East Wenhua Road, Jinan, Shandong 250014, PR China
| | - Chengge Gao
- No. 1 Hospital of Medical College of Xian Jiaotong University, No. 277 West Yan Ta Road, Xi'an, Shaanxi, 710061, PR China
| | - Youhui Li
- No.1 Hospital of Zhengzhou University, No.1 East Jianshe Road, Zhengzhou, Henan 450052, PR China
| | - Jihong Ding
- No. 1 Mental Health Center Affiliated Harbin Medical University, No 23 You Zheng Jie, Nangang District, Harbin, Heilongjiang, PR China
| | - Wenwu Shen
- Mental Health Center of West China Hospital of Sichuan University, No. 28 Dian Xin Nan Jie, Wu Hou District, Chengdu, Sichuan 610041, PR China
| | - Qian Wang
- Beijing Anding Hospital, Capital Medical University, No.5 An Kang Hutong Deshengmen wai, Xicheng District, Beijing 100088, PR China
| | - Meiyue Cao
- Hebei Mental Health Center, No.572 Dongfeng Road, Baoding, Hebei 071000, PR China
| | - Tiebang Liu
- Shenzhen Kangning Hospital, No.1080, Cui Zu Street, Luo Hu, Shenzhen, 518020, PR China
| | - Jinbei Zhang
- No. 3 Affiliated Hospital of Sun Yat-sen University, No.600 Tian He Road, Tian He District, Guangzhou, Guangdong, 510630, PR China
| | - Huijun Duan
- No.1 Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, Shanxi, 030001, PR China
| | - Cheng Bao
- Mental Hospital of Jiangxi Province, No. 43 Shangfang Road, Nanchang, Jiangxi, 330029, PR China
| | - Ping Ma
- The First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Guangzhou, 510630, PR China
| | - Cong Zhou
- Wuhan Mental Health Center, No.70, You Yi Road, Wuhan, 430022, PR China
| | - Yanfang Luo
- No.3 Hospital of Heilongjiang Province, No.135 Jiao Tong Lu, Beian, Heilongjiang, PR China
| | - Fengzhi Zhang
- Jilin Brain Hospital, No.98 Zhong Yang Xi Lu, Siping, Jilin, 136000, PR China
| | - Ying Liu
- The First Hospital of China Medical University, No.155 Nanjing Bei Jie, He Ping District, Shenyang, 110001, PR China
| | - Yi Li
- Dalian No. 7 People's Hospital & Dalian Mental Health Center, No.179 Ling Shui Lu, Gan Jing Zi District, Dalian, PR China
| | - Guixing Jin
- The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, PR China
| | - Yutang Zhang
- Lanzhou University Second Hospital, Second Clinical Medical College of Lanzhou University, No. 82, Cui Ying Men, Lanzhou, Gansu, 730030, PR China
| | - Wei Liang
- Psychiatric Hospital of Henan Province, No.388 Jian She Zhong Lu, Xinxiang, Henan, PR China
| | - Yunchun Chen
- The Fourth Military Medical University affiliated Xijing Hospital, No.17, Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Changyin Zhao
- No. 4 People's Hospital of Liaocheng, No. 47 Hua Yuan Bei Road, Liaocheng, Shandong, 252000, PR China
| | - Haiyan Li
- Guangzhou Brain Hospital/Guangzhou Psychiatric Hospital, No.36 Ming Xin Lu, Fang Cun Da Dao, Li Wan District, Guangzhou 510370, PR China
| | - Yiping Chen
- Clinical Trial Service Unit, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Shenxun Shi
- Fudan University affiliated Huashan Hospital, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, PR China
- Shanghai Jiao Tong University School of Medicine affiliated Shanghai Mental Health Centre, No. 600 Wan Ping Nan Road, Shanghai 200030, PR China
| | - Kenneth S. Kendler
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA 23298-0126, USA
| | - Jonathan Flint
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
- Corresponding author at: Department of Psychiatry, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 100004, PR China.
| | - Xumei Wang
- ShengJing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 110817, PR China
- Corresponding author at: Department of Psychiatry, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning, 100004, PR China.
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Jylhä P, Melartin T, Rytsälä H, Isometsä E. Neuroticism, introversion, and major depressive disorder--traits, states, or scars? Depress Anxiety 2009; 26:325-34. [PMID: 19263467 DOI: 10.1002/da.20385] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The extent to which measures of the personality dimensions of neuroticism and introversion are influenced by symptoms of depression and anxiety or by episodes of depression, and whether neuroticism alone or both traits predispose one to depression remain unclear. METHODS Major depressive disorder patients (n=193) from the Vantaa Depression Study were interviewed at baseline and at 6 and 18 months, and a general population comparison group (n=388) was surveyed by mail. Patients' scores of neuroticism and extraversion-introversion were compared between time points, and before and after a possible recurrence of depression between interviews. Patients' scores at an index interview, when the level of depression was lowest, were compared with scores of the general population, after controlling for anxiety and depression. RESULTS Among depressive patients, neuroticism scores declined (from 17.2, SD 3.7-13.7, SD 5.6, P<0.001) and extraversion scores increased (from 10.0, SD 4.7-11.2, SD 4.5, P<0.001) with recovery during follow-up. The scores were not influenced by a recurrence of depression between measurements. In logistic regression, patients had higher neuroticism (odds ratio, OR 1.11, P=0.001) and lower extraversion (OR 0.92, P=0.003) than the general population. CONCLUSIONS The overall level of neuroticism is markedly and introversion somewhat higher in depressive patients than in the general population. Anxiety symptoms have some, and depressive symptoms a strong influence on neuroticism scores, but only depression has an impact on introversion during a depressive episode. In medium-term follow-up, depressive episodes are unlikely to result in a personality scar persisting after recovery from an episode.
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Affiliation(s)
- Pekka Jylhä
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
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Fanous AH, Neale MC, Aggen SH, Kendler KS. A longitudinal study of personality and major depression in a population-based sample of male twins. Psychol Med 2007; 37:1163-1172. [PMID: 17407614 DOI: 10.1017/s0033291707000244] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The relationship between personality and psychiatric illness is complex. It is not clear whether one directly causes the other. METHOD In a population-based sample of male twins (n=3030), we attempted to predict major depression (MD) from neuroticism (N) and extraversion (E) and vice versa, to evaluate the causal, scar, state, and prodromal hypotheses. In a longitudinal, structural equation twin model, we decomposed the covariation between N and MD into (a) genetic and environmental factors that are common to both traits, as well as specific to each one and (b) direct causal effects of N at time 1 on subsequent MD, as well as between MD and subsequent N. RESULTS E was negatively correlated with lifetime and one-year prevalence of MD. N predicted the new onset of MD, and was predicted by both current and past MD. It did not predict the time to onset of MD. All of the covariation between N and MD was due to additive genetic and individual-specific environmental factors shared by both traits and a direct causal path between MD and N assessed later. No genetic factors were unique to either trait. CONCLUSIONS In men, N may be a vulnerability factor for MD but does not cause it directly. However, MD may have a direct causal effect on N. The genetic overlap between N and MD in men may be greater than in women.
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Affiliation(s)
- Ayman H Fanous
- Washington VA Medical Center, Washington, DC 20422, USA.
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Jylhä P, Isometsä E. The relationship of neuroticism and extraversion to symptoms of anxiety and depression in the general population. Depress Anxiety 2007; 23:281-9. [PMID: 16688731 DOI: 10.1002/da.20167] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Few studies have investigated the relationship of the personality dimensions of neuroticism and extraversion to the symptoms of depression and anxiety in the general population. A random general population sample (ages 20-70 years), from two Finnish cities was surveyed with the Eysenck Personality Inventory (EPI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). In addition, questions regarding diagnosed lifetime mental disorders, health care use for psychiatric reasons in the past 12 months, and history of mental disorders in first-degree relatives were posed. Among the 441 subjects who participated, neuroticism correlated strongly with symptoms of depression (r(s)=.71, P<.001) and anxiety (r(s)=.69, P<.001), and somewhat with self-reported lifetime mental disorder (r(s)=.30, P<.001) and health care use for psychiatric reasons in the past 12 months (r(s)=.24, P<.001). Extraversion correlated negatively with symptoms of depression (r(s)=-.47, P<.001), anxiety (r(s)=-.36, P<.001), self-reported lifetime mental disorder (r(s)=-.17, P<.001), and health care use for psychiatric reasons in the past 12 months (r(s)=-.14, P=.004). In multiple regression models, even after adjusting for gender, age, and education, BDI scores were significantly associated with neuroticism, extraversion, and age, whereas BAI scores were associated only with neuroticism. Neuroticism is strongly associated with depressive and anxiety symptoms, and intraversion is moderately associated with depressive symptoms in the urban general population. The relationship of these personality dimensions to both self-reported lifetime mental disorders and use of health services for psychiatric reasons strengthens the clinical validity of these personality dimensions.
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Affiliation(s)
- Pekka Jylhä
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
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Abstract
Progress in identifying the genetic basis of bipolar affective disorder has been disappointing, most probably because of the genetic and phenotypic heterogeneity of the condition. These setbacks have led to the adoption of alternative strategies such as the use of endophenotypes or intermediate traits to identify those individuals at genetic risk for developing the disorder. Gottesman and Gould [Am J Psychiatry (2003), 160:636], in a review of the endophenotypic concept, have suggested five criteria that should be characteristic of a trait in order for it to qualify as an endophenotype. These five criteria are used in order to assess the viability of using personality traits as endophenotypes for genetic analyses of bipolar disorder. A review of the literature suggests that certain personality traits or temperaments are associated with the illness in a state independent manner, that personality is at least partly heritable, and that various temperaments aggregate in the non-affected relatives of bipolar probands. Nevertheless, it is unclear whether specific personality traits co-segregate with affectively ill individuals. We conclude that personality profiling of probands and their relatives may facilitate molecular genetic work, but given the fact that personality is itself a complex trait, its use as an endophenotype has certain limitations.
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Affiliation(s)
- Jonathan B Savitz
- MRC/UCT Human Genetics Research Unit, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
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Schwan R. Guérison et personnalités pathologiques. Encephale 2005; 31 Pt 3:S29-32; discussion S33. [PMID: 16462643 DOI: 10.1016/s0013-7006(05)82448-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- R Schwan
- INSRM CIC, Clermont-Ferrand, BP, 63000 Clermont-Ferrand;CHU Clermont-Ferrand, Service de Psychiatrie B, BP 69, 63003 Clermont-Ferrand
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Palomo T, Beninger RJ, Kostrzewa RM, Archer T. Gene-environment interplay in affect and dementia: emotional modulation of cognitive expression in personal outcomes. Neurotox Res 2004; 6:159-73. [PMID: 15325956 DOI: 10.1007/bf03033219] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A multitude of factors, that either singly, interactively, or sequentially influence the gene-environment interplay in affective and dementia states, include several phases of neurodevelopmental liability in both humans and laboratory animals. Genetic vulnerability for both affective disorders and dementia describes a scenario distinguished by progressive need for concern, particularly in view of the interplay between these areas of ill-health. The contribution of emotional and cognitive expression to personal outcomes, e.g., as a function of affective personality type, a state-dependent analysis of personality characteristics, appears to pervade both the individual's experience of social and physical environments and the performance of cognitive tasks. The role of the endocannabinoids in mental health may offer insights for the psychopharmacology of both cognition and affect. Maladaptive emotional reactions and a defective cognitive ability will contribution to unsatisfactory/maladaptive coping strategies, in turn, leading to further complications of an affective and dysfunctional nature, eventually with a clinical psychopathological outcome. These considerations impinge upon critical issues concerning predisposition and vulnerability. Classical eye-blink conditioning provides a highly established procedure for assessment of defective physiology in models of Alzheimer's dementia. In order to develop a consideration of the array of situations presenting the variation of outcome due to type of affective personality, the role of fear and anxiety and stress in affective states influencing cognition are examined and the critical role of brain circuits mediating emotions influencing cognitive outcomes is discussed.
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Affiliation(s)
- T Palomo
- Servicio Psiquiátrico, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
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Fanous AH, Kendler KS. The genetic relationship of personality to major depression and schizophrenia. Neurotox Res 2004; 6:43-50. [PMID: 15184104 DOI: 10.1007/bf03033295] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Since ancient times, dimensions of personality have been linked with the liability to psychiatric illness. In modern times, several research approaches suggest that personality and the liability to psychiatric illness such as schizophrenia and major depression (MD) are influenced by many of the same genes. If this is true, it could shed light on the genetic architecture of psychiatric illness. It could also validate the use of personality measures in unaffected relatives in linkage and association studies of psychiatric illness. This approach could potentially increase statistical power to detect genetic effects. The personality trait neuroticism (N) may be genetically related to MD, while schizotypal traits may be genetically related to schizophrenia. Twin studies have reported that most of the covariation between N and MD is due to shared additive genetic factors. Adoption studies have demonstrated that the biological offspring of schizophrenic mothers are more likely to have schizotypal personality disorder than are children of control mothers. At the current time, only one genome wide scan of N has been published, which does show some overlap in linkage results with genome scans of MD. However, this should be replicated and more rigorously studied. At the present time, there are no established susceptibility genes for MD. When these are established, it will be necessary to assess their relationship with N. Currently, no genome scans of schizotypy have been published. Furthermore, although several putative susceptibility genes for schizophrenia have been reported and replicated, only one--catechol-O-methyltransferase (COMT)--has been tested in schizotypy.
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Affiliation(s)
- Ayman H Fanous
- Washington VA Medical Center-Georgetown University Medical Center Schizophrenia Research Program, 50 Irving St. NW, Washington, DC 20422, USA.
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Miller MW, Greif JL, Smith AA. Multidimensional Personality Questionnaire profiles of veterans with traumatic combat exposure: externalizing and internalizing subtypes. Psychol Assess 2003; 15:205-15. [PMID: 12847781 DOI: 10.1037/1040-3590.15.2.205] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study used the Multidimensional Personality Questionnaire (MPQ; A. Tellegen, in press) to identify personality-based subtypes of posttraumatic response. Cluster analyses of MPQs completed by combat veterans revealed subgroups that differed on measures relating to the externalization versus internalization of distress. The MPQ profile of the externalizing cluster was defined by low Constraint and Harmavoidance coupled with high Alienation and Aggression. Individuals in this cluster also had histories of delinquency and high rates of substance-related disorder. In comparison, the MPQ profile of the internalizing cluster was characterized by lower Positive Emotionality, Alienation, and Aggression and higher Constraint, and individuals in this cluster showed high rates of depressive disorder. These findings suggest that dispositions toward externalizing versus internalizing psychopathology may account for heterogeneity in the expression of posttraumatic responses, including patterns of comorbidity.
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Affiliation(s)
- Mark W Miller
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Division of Psychiatry, Boston University School of Medicine, 150 South Huntington Avenue (116B-2), Boston, Massachusetts, USA.
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Bieling PJ, MacQueen GM, Marriot MJ, Robb JC, Begin H, Joffe RT, Young LT. Longitudinal outcome in patients with bipolar disorder assessed by life-charting is influenced by DSM-IV personality disorder symptoms. Bipolar Disord 2003; 5:14-21. [PMID: 12656933 DOI: 10.1034/j.1399-5618.2003.00014.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Few studies have examined the question of how personality features impact outcome in bipolar disorder (BD), though results from extant work and studies in major depressive disorder suggest that personality features are important in predicting outcome. The primary purpose of this paper was to examine the impact of DSM-IV personality disorder symptoms on long-term clinical outcome in BD. METHODS The study used a 'life-charting' approach in which 87 BD patients were followed regularly and treated according to published guidelines. Outcome was determined by examining symptoms over the most recent year of follow-up and personality symptoms were assessed with the Structured Clinical Interview for DSM-IV (SCID-II) instrument at entry into the life-charting study. RESULTS Patients with better outcomes had fewer personality disorder symptoms in seven out of 10 disorder categories and Cluster A personality disorder symptoms best distinguished euthymic and symptomatic patients. CONCLUSIONS These results raise important questions about the mechanisms linking personality pathology and outcome in BD, and argue that conceptual models concerning personality pathology and BD need to be further developed. Treatment implications of our results, such as need for psychosocial interventions and treatment algorithms, are also described.
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Affiliation(s)
- Peter J Bieling
- Mood Disorders Program, Department of Psychiatry and Behavioral Neurosciences, McMaster University and St Joseph's Healthcare, Hamilton, Ontorio, Canada.
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Miller MW. Personality and the etiology and expression of PTSD: A three-factor model perspective. ACTA ACUST UNITED AC 2003. [DOI: 10.1093/clipsy.bpg040] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Corruble E, Duret C, Pelissolo A, Falissard B, Guelfi JD. Early and delayed personality changes associated with depression recovery? A one-year follow-up study. Psychiatry Res 2002; 109:17-25. [PMID: 11850047 DOI: 10.1016/s0165-1781(01)00366-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Many studies have shown the state effect of depression on personality. However, the chronology of personality changes associated with depression recovery remains unstudied. The objective of this study is to assess early (first month) and delayed personality changes associated with depression recovery. Fifty-seven depressed inpatients were assessed with the Temperament and Character Inventory (TCI) at admission, 1 month, and 1 year post-treatment. Patients were divided into poor and favorable outcome. No significant personality change was observed in patients with poor depression outcome. Conversely, a favorable outcome of depression was associated with early and delayed personality changes. Early changes were: decrease in Harm avoidance (HA(1):Worry and pessimism), increase in Cooperativeness and Self-directedness (SD(1):Responsibility, SD(4):Self-acceptance, SD(2):Purposefulness and SD(3):Resourcefulness). Delayed changes were changes in character: increase in Self-Directedness (SD(1):Responsibility, SD(4):Self-acceptance, SD(5): Congruent second nature), decrease in Self-transcendence (ST(2):Transpersonal identification). This study shows the different status of personality changes associated with depression recovery, and it contributes to a better knowledge of the state effect and of subtle clinical changes in patients who are recovering from depression. It may also have implications for the prediction of depression outcome.
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Affiliation(s)
- Emmanuelle Corruble
- Psychiatry Department, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Paris XI University, 12 Avenue P.V. Couturier, F-94804 Cedex, Villejuif, France.
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Sato T, Narita T, Hirano S, Kusunoki K, Sakado K, Uehara T. Is interpersonal sensitivity specific to non-melancholic depressions? J Affect Disord 2001; 64:133-44. [PMID: 11313080 DOI: 10.1016/s0165-0327(00)00222-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated whether melancholic and non-melancholic Japanese depressive patients differed in regard to a personality feature, interpersonal sensitivity, as measured by the Interpersonal Sensitivity Measure (IPSM). METHODS In addition to 154 normal controls, 66 remitted melancholic patients and 55 remitted non-melancholic patients filled out the IPSM and two widely-used comprehensive personality inventories, the Temperament and Character Inventory (TCI) and the Munich Personality Test (MPT). The subdivision of patients was made according to three major symptom-based criteria for melancholia (those of RDC, DSM-III, DSM-IV). RESULTS Multivariate and post-hoc univariate analyses of variance revealed significant differences among the three groups in several personality dimensions after Bonferroni's adjustments of P values. While reported scores of both melancholic and non-melancholic patients deviated from normative scores on several personality dimensions, non-melancholic patients reported significantly higher scores on the total IPSM and the 'fragile inner-self' (a subscore of the IPSM) than did normal controls or melancholic depressives. The principal component analysis isolated two factors related to depressive disorders: one factor corresponding to the five IPSM scores; and the other corresponding to harm avoidance, neuroticism and frustration tolerance. The scores on the former factor differentiated non-melancholic depressives from melancholic depressives and normal controls. The scores on the latter factor differentiated both melancholic and non-melancholic depressives from normal controls. LIMITATIONS Prospective studies in which depressive subjects are subdivided into melancholic and non-melancholic subjects will be required to see whether the personality deviations here related to depressive disorders strongly reflect the premorbid personality function. CONCLUSIONS These results indicate that the IPSM scales (particularly, the fragile inner-self scale and the total IPSM scale) are relatively independent of all dimensions included in the two comprehensive personality inventories, and have a capability to describe personality differences between non-melancholic depression and melancholia.
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Affiliation(s)
- T Sato
- Department of Psychiatry, Fujita Health University School of Medicine, Kutsukake-cho, Dengakugakubo 1-98, Aichi, 470-1192, Toyoake City, Japan.
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Abstract
BACKGROUND The relationship between personality and depressive illness is complex. The aim of this study was to assess whether the presence of a personality disorder or high neuroticism (N) scores predicted longer times to discharge or remission onset or higher risks of relapse for a cohort of depressed subjects admitted for the first time. METHODS 100 consecutive subjects with ICD-10-defined depression were recruited on admission and followed up prospectively over an 18-month period. Personality function was rated using the informant-rated Standard Assessment of Personality in addition to the self-rated Maudsley Personality Inventory. Remission onset and relapse were defined operationally by scores on the Hamilton Rating Scale using recommended criteria. RESULTS The presence of a personality disorder predicted longer times to remission onset. Personality trait accentuation did not. Higher end N-scores correlated with longer times to remission onset. Neither personality disorder nor high N-scores predicted relapse or discharge risk. Subjects with a personality disorder were treated as aggressively as those without but those with higher N-scores were not. LIMITATIONS It is an in-patient sample. Fifteen subjects dropped out of follow-up and those who did so were more likely to have met criteria for two or more personality disorder categories or four or more traits from one personality disorder category. The analysis assumes that state and scar effects on N-scores were minimised. Treatment decisions were not controlled. CONCLUSIONS These findings support the view that the presence of a personality disorder and high N-scores modify the short-term course to remission onset in depression.
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Affiliation(s)
- D O'Leary
- Department of Psychiatry, University of Dublin, Trinity College, Dublin, Ireland
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20
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Hamburg SR. Inherited Hypohedonia Leads to Learned Helplessness: A Conjecture Updated. REVIEW OF GENERAL PSYCHOLOGY 1998. [DOI: 10.1037/1089-2680.2.4.384] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The reformulated learned helplessness theory posits depressogenic explanatory style (DES) as a vulnerability factor in depression. Early-life adversity has been suggested as the source of DES, but this is contradicted by empirically established features of the learned helplessness phenomenon itself and by the evidence for human resilience in the face of adversity. This article extends a conjecture first advanced by P. E. Meehl (1975) and argues that an inherited defect in hedonic capacity would be sufficient to produce DES by causing intermittent schedules of reinforcement to be experienced as extinction schedules, resulting in a pervasive and unremitting sense of helplessness. This proposed hedonic defect also provides a means for integrating the original and reformulated versions of learned helplessness theory and for integrating learned helplessness with emerging research and theory on the biology of vulnerability to depression.
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Hecht H, van Calker D, Berger M, von Zerssen D. Personality in patients with affective disorders and their relatives. J Affect Disord 1998; 51:33-43. [PMID: 9879801 DOI: 10.1016/s0165-0327(98)00154-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In studies of both patients and high-risk subjects, particular patterns of personality have been found to be associated with affective disorders. Neuroticism and features of the melancholic type of personality seem to be risk factors for depression while premorbid features of the manic type of personality predominate in patients with more manic than depressive episodes. While neuroticism prevails in the majority of mental disorders, the 'affective' personality variants appear to be more specifically associated with affective disorders. METHODS Personality features were investigated in 122 recovered patients with affective disorders, 58 first-degree relatives (high-risk subjects (HR)) and in the respective control groups (n=48; n=29). Patients were subdivided into: unipolar depression (melancholic subtype); bipolar II; bipolar I with more depressive episodes and bipolar I with more manic episodes. Personality measures were based on the Biographical Personality Interview (BPI) and the Munich Personality Test (MPT). RESULTS The melancholic personality type (BPI) decreased from the unipolar depressives to the mainly manic group, while features of the manic type increased. MPT scores failed to discriminate between subgroups of patients. HR were significantly more introverted and had a stronger orientation towards social norms than controls according to the MPT, and showed a tendency towards the melancholic type according to the BPI. LIMITATIONS The sizes of some groups or subgroups are relatively small. Therefore, they have to be enlarged in the continuation of the study so as to increase the power of the statistical tests and thus to ascertain the robustness of the results. CONCLUSION Features of the typus melancholicus seem to be a risk factor for depression. The identification of highly predictive risk factors provides an opportunity for the development of prevention programs.
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Affiliation(s)
- H Hecht
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Germany
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22
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Sato T, Sakado K, Uehara T, Sato S, Nishioka K, Kasahara Y. Personality differences in the Munich Personality Test between patients with major depression and panic disorder. Psychiatry Clin Neurosci 1998; 52:403-6. [PMID: 9766688 DOI: 10.1046/j.1440-1819.1998.00409.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study attempted to determine whether patients with major depression and panic disorder could be differentiated by personality features, measured by the Munich Personality Test (MPT). One of the six MPT personality dimensions, 'rigidity', was developed in relation to the 'melancholic type of personality', which may be a specific personality feature of depressive subjects. We therefore hypothesized that the MPT might be sensitive to possible personality differences between patients with major depression and panic disorder. Sixty-six patients with major depression and 27 patients with panic disorder, taken from consecutive intakes at an outpatient unit, were compared in terms of six personality dimensions of the MPT. The results demonstrated that rigidity could significantly differentiate the two patient groups, even after the possible confounding effects on the personality assessments were statistically partialled out. The MPT was suggested to be powerful for describing distinctive personality features of depressive subjects from anxiety subjects.
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Affiliation(s)
- T Sato
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake City, Japan
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23
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Furukawa T, Hori S, Yoshida S, Tsuji M, Nakanishi M, Hamanaka T. Premorbid personality traits of patients with organic (ICD-10 F0), schizophrenic (F2), mood (F3), and neurotic (F4) disorders according to the five-factor model of personality. Psychiatry Res 1998; 78:179-87. [PMID: 9657422 DOI: 10.1016/s0165-1781(98)00014-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present article aims to examine premorbid personality traits of psychiatric patients with various diagnoses by asking their close relatives to retrospectively rate the patients' usual self with a questionnaire designed for the five-factor model of personality, a rapidly emerging comprehensive theory of personality structure. Data for 140 patients and 84 controls were analyzed. Although psychiatric patients as a group were characterized by high neuroticism and low conscientiousness when compared with the healthy controls, there were only a few traits that distinguished a particular diagnostic group from either the normal control or from the rest of the patients: neurotic disorder patients had higher neuroticism scores than the normal controls; unipolar depressives had a higher conscientiousness score than the rest of the patient group. No salient premorbid trait was noted for patients with organic mental disorders, schizophrenic disorders or bipolar disorders.
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Affiliation(s)
- T Furukawa
- Department of Psychiatry, Nagoya City University School of Medicine, Nagoya, Japan.
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24
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Furukawa T, Nakanishi M, Hamanaka T. Typus melancholicus is not the premorbid personality trait of unipolar (endogenous) depression. Psychiatry Clin Neurosci 1997; 51:197-202. [PMID: 9316163 DOI: 10.1111/j.1440-1819.1997.tb02582.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present paper aims to examine whether Typus melancholicus is a distinguishing premorbid personality of unipolar (endogenous) depressive patients vis-à-vis psychiatric patients with different diagnoses and healthy control subjects. Two observer-rated scales for Typus melancholicus were administered to a consecutive series of psychiatric patients (n = 140) and a group of control subjects (n = 84). To the authors' own surprise, the only statistically significant finding was the low Typus melancholicus score among unipolar (endogenous) depressives in comparison with normal controls but not with other psychiatric patients. In addition, this finding held only for one of the two rating scales and among women only. According to the other rating scale for Typus melancholicus, there was no difference between unipolar (endogenous) depressives and the normal control or other psychiatric patients. These findings are discussed with particular emphasis on the methodological aspects of studies of premorbid personality of psychiatric disorders, a favored subject in the psychiatric science for decades.
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Affiliation(s)
- T Furukawa
- Department of Psychiatry, Nagoya City University School of Medicine, Japan
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25
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Tome MB, Cloninger CR, Watson JP, Isaac MT. Serotonergic autoreceptor blockade in the reduction of antidepressant latency: personality variables and response to paroxetine and pindolol. J Affect Disord 1997; 44:101-9. [PMID: 9241570 DOI: 10.1016/s0165-0327(97)00030-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
No antidepressant currently in use exerts a significant antidepressant effect for at least two to three weeks after the patient starts taking it. Open studies suggest that, for selective serotonergic re-uptake inhibitor (SSRI) antidepressants, this latency may be reduced when the drug is taken with the 5HT1A receptor blocker pindolol. We have undertaken a randomised, placebo controlled, double blind trial of augmentation of the selective SSRI antidepressant paroxetine in combination with pindolol. All our patients (n = 54; mean age 36 [range 19-65]) met criteria for major depression and received a standard dose (20 mg o.d.) of paroxetine plus, randomly, either pindolol (2.5 mg t.d.s.) or placebo for six weeks. We examined personality variables in 48 consecutive subjects according to a short version (TCI-125) of Cloninger et al's self-rated Temperament and Character Inventory (Cloninger et al., 1994) and correlated the results with clinical responses in the trial. The results suggest that personality can influence clinical outcome. After the double blind period patients were offered paroxetine 20 mg or 40 mg for up to 6 months. Twenty-six patients took this up. The results suggest that high scores in the temperament dimension of Reward Dependence and low scores in the temperament dimension of Harm Avoidance had a better outcome at 6 weeks. Patients who had received paroxetine and pindolol during the trial and who reported high Novelty Seeking and low Harm Avoidance scores had a better outcome at 6 weeks and 6 months. We suggest that temperament factors may influence outcome of antidepressant treatment.
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Affiliation(s)
- M B Tome
- Department of Psychological Medicine, UMDS (Guy's Campus), London, UK
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26
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Enns MW, Cox BJ. Personality dimensions and depression: review and commentary. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1997; 42:274-84. [PMID: 9114943 DOI: 10.1177/070674379704200305] [Citation(s) in RCA: 162] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The relationship between dimensionally assessed personality and the onset, features, and course of depressive illness will be critically examined and considered in relation to 4 hypothesized models: predisposition or vulnerability: pathoplasty: complication or scar: and spectrum or continuity. METHOD Studies that have used clinically depressed adult patients to explore the relationship between personality dimensions and depression will be reviewed. RESULTS Higher-order personality factors that have shown a significant and consistent association with major depressive illness include neuroticism, extraversion (negative relationship), and the factors of Cloninger's Tridimensional Personality Model. Neuroticism appears to be the most powerful predictor of depression. Lower-order factors showing a significant and consistent relationship with depressive illness include dependency, self-criticism, obsessionality, and perfectionism. The links between depression and dependency and self-criticism have the strongest empirical support. CONCLUSIONS Several personality dimensions are significantly associated with depressive illness, but the evidence that unequivocally demonstrates a true personality predisposition for depression is modest. Measures of personality may prove to be clinically useful for treatment selection.
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Affiliation(s)
- M W Enns
- Department of Psychiatry, University of Manitoba, Winnipeg
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27
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Emery CF, Huppert FA, Schein RL. Health and personality predictors of psychological functioning in a 7-year longitudinal study. PERSONALITY AND INDIVIDUAL DIFFERENCES 1996. [DOI: 10.1016/0191-8869(95)00219-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Boyce P, Mason C. An overview of depression-prone personality traits and the role of interpersonal sensitivity. Aust N Z J Psychiatry 1996; 30:90-103. [PMID: 8724331 DOI: 10.3109/00048679609076076] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A number of personality styles have been proposed as vulnerability traits to depression. In this paper methodological problems associated with identifying such traits are discussed. These include state effects contaminating personality scales and the issue of depressive heterogeneity. Potential depression-prone personality traits are then discussed, including obsessionality, neuroticism, dependency and cognitive dysfunction. High interpersonal sensitivity as a risk factor to depression is then discussed.
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Affiliation(s)
- P Boyce
- Department of Psychological Medicine, University of Sydney, New South Wales
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29
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Abstract
As part of the Health and Lifestyle Survey (HALS), 6096 adults from a representative sample of community residents completed a standardized questionnaire which elicited psychiatric symptoms--the General Health Questionnaire (GHQ-30) of Goldberg (1972). Their survival status at 7 years was determined, and 474 had died. Respondents whose GHQ score was above the conventional threshold (4/5), used when screening for psychiatric disorder, were 60% more likely to die over the 7-year interval than respondents whose GHQ score was below threshold (risk ratio 1.64 for men and 1.58 for women). The differences were statistically significant for both sexes when the effects of age, physical disorder, social class and smoking behaviour were taken into account. Personality traits (neuroticism, extraversion) were not related to mortality, neither was self-reported difficulty in sleeping. However, a low subjective rating of one's general health was associated with increased mortality. We explored a range of cut-points and found reliable effects for both sexes at all cut-points from 3/4 to 6/7. Possible differences related to natural versus unnatural causes of death were explored and found not to explain the results. The findings from this general population study confirm that is is not only psychiatric disorders, but also psychiatric symptoms, which are associated with subsequent mortality, and thereby reinforce the importance of appropriate intervention to alleviate these symptoms.
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Affiliation(s)
- F A Huppert
- Department of Psychiatry, University of Cambridge
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30
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Rush AJ, Laux G, Giles DE, Jarrett RB, Weissenburger J, Feldman-Koffler F, Stone L. Clinical characteristics of outpatients with chronic major depression. J Affect Disord 1995; 34:25-32. [PMID: 7622736 DOI: 10.1016/0165-0327(94)00101-e] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A cross-sectional evaluation of 243 unipolar, nonpsychotic outpatients with major depression was conducted. All subjects were diagnosed by RDC with SADS-L structured interviews. Diagnoses included RDC primary/secondary, RDC endogenous/nonendogenous and Winokur's family-history subtypes. Symptom severity was assessed by the 17-item Hamilton Rating Scale for Depression. Chronic depression was defined as the current episode of major depression lasting at least 2 years, corresponding to DSM-III-R and -IV criteria. Patients with chronic depression (n = 64) were compared with those with nonchronic depression (n = 179). Chronicity was not related to gender, symptom severity, prior length of illness, age at onset of illness, RDC endogenous/nonendogenous, RDC primary/secondary or Winokur's family-history subtypes. Those with chronic depression were older and had fewer major depressive episodes than the nonchronic group. That the chronic group had fewer total episodes of depression than the nonchronic group, but a similar age at onset, is consistent with the notion that patients in a current chronic episode have characteristically longer depressive episodes throughout the course of their illness. Those with chronic episodes may be subject to psychological, biological and/or sociocultural factors that preclude an earlier episode remission for these individuals.
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Affiliation(s)
- A J Rush
- Mental Health Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, USA
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31
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Abstract
Clinical predictors of drug response in major depression have been weak and inconsistent. Eighty-four patients suffering from a current major depressive episode completed a 6-week double-blind trial of either clomipramine or desipramine. Temperament, as measured by the Tridimensional Personality Questionnaire, accounted for 35% of the variance in treatment outcome, compared with less than 5% predicted by clinical variables. In the more severely depressed patients, temperament predicted nearly 50% of the variance in treatment outcome, which is the first time that such a substantial predictor of drug response has been identified. Within depressed women, temperament also predicted response to different antidepressant drugs. The potential importance of temperament, and the need for replication of these findings is discussed.
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Affiliation(s)
- P R Joyce
- University Department of Psychological Medicine, Christchurch School of Medicine, New Zealand
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32
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Bradley BP, Mogg K, Perrett A, Galbraith M. The effect of depressed mood on personality measures. PERSONALITY AND INDIVIDUAL DIFFERENCES 1993. [DOI: 10.1016/0191-8869(93)90153-t] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Fifty-five patients with primary major depression were followed up prospectively from time of onset of the index illness episode until recovery. The course of depression in hospital-treated patients was protracted, with a median length of episode of one year. Two factors significantly predicted persistence of symptoms: interval between onset and receipt of treatment, and premorbid neuroticism, which accounted for 55% of the variance in length of episode.
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Affiliation(s)
- J Scott
- University Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne
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Abstract
The relationship between alexithymia assessed by the Toronto Alexithymia Scale (TAS) and the five-factor model of personality measured by the NEO Five-Factor Inventory (FFI) was investigated in a group of psychiatric outpatients (n = 114) and normal volunteers (n = 71). When controlling for depression, the domains of neuroticism, introversion, and low openness predicted alexithymia. These three dimensions accounted for 57.1% of the explained variance in the patient cohort and 38.1% in the volunteer group. In the patient cohort, neuroticism contributed the majority of explained variance, which may reflect the state effect of distress that elevates neuroticism. Introversion was the most significant predictor in the volunteer group. These data suggest alexithymia is a unique personality trait that is not fully explained by the five-factor model of personality.
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Affiliation(s)
- T N Wise
- Department of Psychiatry, Fairfax Hospital, Falls Church, VA
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Abstract
We attempted to prospectively examine the effects of personality traits in 68 acutely depressed patients treated with desipramine over 4-5 weeks to assess whether the presence or absence of these traits played a role in response to antidepressant treatment. Overall the 39 responders had statistically significantly lower cluster III personality trait scores than non-responders, and a trend toward lower cluster I and cluster II scores. We then followed the 39 desipramine responders for up to 6 months on the dose to which they responded in accordance with standard clinical practice. Overall 23 of the 39 sustained their initial improvement, with eight relapsing and eight dropping out between 5 weeks and 6 months. When comparing these three groups with the 29 initial non-responders, those who sustained the 6-month response had statistically significantly lower cluster II, cluster III, and total personality scores than initial responders who relapsed, initial responders who dropped out and did not complete 6 months of treatment, and initial non-responders.
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Abstract
The hypothesis that recurrent or chronic depressive illness produces a long-term change in neuroticism was examined in a sample (N = 34) from a consecutive series of 89 depressed patients admitted to the Maudsley Hospital in 1965/6. The Eysenck Personality Inventory (EPI) was administered at the time of the index illness both when the patients were depressed and on recovery, and then again at follow-up 18 years later. The change in the neuroticism (N) score over the 18-year-period was compared in good and poor outcome groups defined variously by a global rating of outcome, frequency of episodes, extent of subsequent hospitalization and the presence or absence of subsequent chronicity. The mean N score for the sample as a whole did not change significantly over the 18 years, and no differential change in the N score was observed between any of the good and poor outcome groups. Thus, the hypothesis was not supported.
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Affiliation(s)
- C F Duggan
- Department of Psychological Medicine, Institute of Psychiatry, London
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37
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Abstract
The article reviews research and presents our results on the natural history of 2 forms of anxiety disorder, panic disorder and generalized anxiety disorder. Data from our epidemiological cohort study give evidence of premorbid anxiousness and overadaptation already in childhood. Distressing conditions in the family are more prevalent among subjects with anxiety disorders or major depression than among controls. Anxiety disorders frequently begin between age 20-30 and can be triggered by life events. The course is often characterized by a certain chronicity that manifests itself in residual symptoms and mild impairment in social roles even after many years and is frequently complicated with depression. The best predictors are severity and duration of symptoms, as well as comorbidity with depression. Future studies of the natural history should take into account these factors in multivariate approaches.
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Affiliation(s)
- J Angst
- Research Department, Psychiatric University Hospital, Zurich, Switzerland
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38
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Abstract
The authors examined an interview and paper-and-pencil assessment of the DSM-III personality disorders (PDs) in depressed inpatients, and depressed relatives of psychiatric patients and never-ill controls who had a lifetime history of major depression. The rates of PDs according to the Structured Interview for DSM-III Personality Disorders (SIDP) were similar in the two groups, except for borderline PD which was more frequent in the inpatients. Of the individuals with a PD, the patients were more likely than the relatives to have two or more PDs, and the borderline and histrionic patients were more prototypic of these disorders than were the borderline and histrionic relatives. In contrast to the SIDP results, the rates of PDs according to the Personality Disorders Questionnaire (PDQ) were higher in the patient sample. These results thus extend the previously described high rates of PDs in depressed patients to a sample of individuals with a lifetime history of treated or untreated depression, and they suggest that interview assessments of personality may be less sensitive to the state effects of depression than are questionnaires.
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Affiliation(s)
- M Zimmerman
- Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Philadelphia 19129
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Southwick SM, Yehuda R, Giller EL, Perry BD. Platelet alpha 2-adrenergic receptor binding sites in major depressive disorder and borderline personality disorder. Psychiatry Res 1990; 34:193-203. [PMID: 1962862 DOI: 10.1016/0165-1781(90)90019-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Platelet alpha 2-adrenergic receptor binding sites were measured in a group of patients with major depressive disorder (MDD) (n = 23) and in normal controls (n = 25). When all depressed subjects were compared to controls, there were no differences in either Kd (affinity of the ligand) or total binding site (number/platelet), although a significant change in the ratio of high to low affinity states was observed in the depressed group. When the depressed patients were subdivided into those with and without a co-occurring borderline personality disorder (BPD), the BPD group had significantly fewer alpha 2 high affinity binding sites, while the group with depression alone had significantly more binding sites (both low and high affinity) than the control group. The results support the concept that assessment of comorbid diagnoses may be essential to biological studies of depression.
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Affiliation(s)
- S M Southwick
- Posttraumatic Stress Disorder Program, West Haven VA Medical Center, CT
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40
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Abstract
The study of the age of onset of psychiatric conditions can provide some clues to the aetiology of these disorders. A number of studies have examined the age of onset in agoraphobia but results have varied. This may be associated with small sample sizes or differences in populations. There has been very little work examining the factors determining age of onset. The present study examines age of onset in relation to sex and personality. Results indicate no sex differences in age of onset, but an association with age and high levels of neuroticism.
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Affiliation(s)
- J Kenardy
- Department of Psychology, University of Newcastle, Australia
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41
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Reich JH. Effect of DSM-III personality disorders on outcome of tricyclic antidepressant-treated nonpsychotic outpatients with major or minor depressive disorder. Psychiatry Res 1990; 32:175-81. [PMID: 2367602 DOI: 10.1016/0165-1781(90)90084-i] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This is the first outcome report of the effect of a personality disorder on nonhospitalized major depressive patients that used a standardized DSM-III measure and did not prescreen to eliminate certain personality disorders. Six-month outcome was compared for nonpsychotic patients with major depression and a DSM-III personality disorder (n = 26) and those who did not have a personality disorder (n = 11). Patients without a personality disorder had significantly better outcome as measured by the Global Assessment Scale and employment status. There was also a trend for less physician utilization in this group.
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Affiliation(s)
- J H Reich
- Harvard University, Massachusetts Mental Health Center, Brockton
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42
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Brent DA, Zelenak JP, Bukstein O, Brown RV. Reliability and validity of the structured interview for personality disorders in adolescents. J Am Acad Child Adolesc Psychiatry 1990; 29:349-54. [PMID: 2347829 DOI: 10.1097/00004583-199005000-00003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Structured Interview for the DSM-III Personality Disorders was administered to 23 currently affectively ill adolescents and their parents. Interviews were videotaped and rerated; interrater agreement was moderate (weighted K = 0.49; unweighted K = 0.59). Moreover, there was evidence of convergent validity for Cluster II traits and disorders (borderline, histrionic, narcissistic), insofar as these diagnoses were associated with higher scores on the novelty-seeking subscale of the Tridimensional Personality Questionnaire as predicted. Cluster II patients tended to have higher rates of attention deficit disorder and bipolar disorder, and higher rates of suicidal gestures among second-degree relatives. Some difficulty was encountered differentiating symptoms of affective illness from those of personality disorder and in deciding when personality traits were impairing enough to call them disorders. Reliability may be improved by: (1) interviewing patients when out of affective episode; and (2) using standardized functional impairment criteria for differentiating personality style from disorder. Additional work is advocated to learn if personality disorders are precursors, epiphenomena, or the consequences of affective disorder.
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Affiliation(s)
- D A Brent
- Western Psychiatric Institute and Clinic, Pittsburgh, PA
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43
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Wetzler S, Kahn RS, Cahn W, van Praag HM, Asnis GM. Psychological test characteristics of depressed and panic patients. Psychiatry Res 1990; 31:179-92. [PMID: 2326397 DOI: 10.1016/0165-1781(90)90120-t] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study compared the psychological test performance of patients with major depression (MD) (n = 23), patients with panic disorder (PD) (n = 20), and normal subjects (n = 24). Results indicated that scores of normal subjects were significantly less pathological than those of both patient groups on almost all psychological test scales, but that the test performance of the two patient groups did not differ. The only difference between the two patient groups was on the level of self-reported and observer-rated depression. Both patient groups exhibited significant personality pathology, and the rate of personality disorders diagnosed by the Millon Clinical Multiaxial Inventory (MCMI) (base rate greater than 84) was 73% for PD patients and 86% for MD patients. The problems of assessing personality during episodes of MD and PD and the possible overdiagnosis of personality disorders by the MCMI are discussed.
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Affiliation(s)
- S Wetzler
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467
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44
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Boyce P, Hadzi-Pavlovic D, Parker G, Brodaty H, Hickie I, Mitchell P, Wilhelm K. Depressive type and state effects on personality measures. Acta Psychiatr Scand 1990; 81:197-200. [PMID: 2327283 DOI: 10.1111/j.1600-0447.1990.tb06478.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We examine the hypothesis that the effect of mood state on personality questionnaire scores is more a function of diagnosis than of depression severity. Sixteen endogenous and 83 neurotic depressives completed a battery of personality questionnaires at a baseline assessment and again 20 weeks later. Scores on the personality measures changed significantly. Endogenous depressives were found to have more pronounced changes on measures of dependence and timidity, but when change in mood state was partialed out only one of the dependence measures and timidity remained significant. Thus the hypothesis only received partial support--change in mood state appears to be the major factor in elevating personality questionnaire scores.
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Affiliation(s)
- P Boyce
- Mood Disorders Unit, Prince Henry Hospital, Australia
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45
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Duncan-Jones P, Fergusson DM, Ormel J, Horwood LJ. A model of stability and change in minor psychiatric symptoms: results from three longitudinal studies. PSYCHOLOGICAL MEDICINE. MONOGRAPH SUPPLEMENT 1990; 18:1-28. [PMID: 2236383 DOI: 10.1017/s0264180100000813] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A statistical model designed to estimate the contributions of stable and changing symptomatology to levels of minor psychiatric symptoms is developed. This model is fitted to data obtained from three longitudinal studies. These studies involved subjects from Canberra (Australia), Christchurch (New Zealand) and Groningen (Holland). Data from all three data sets were shown to fit the proposed model adequately. However, there were systematic differences in the findings of the study. The findings from the Canberra and Groningen studies suggested that a large amount (50-75%) of the variance in symptom levels could be attributed to between subject difference in stable levels of symptomatology. In contrast the Christchurch study suggested a smaller contribution of stable symptomatology. These differences may be explained by the nature of the samples studied. All three studies showed evidence of strong correlations (0.79-0.94) between stable levels of symptomatology and the measure of trait neuroticism. It is concluded on the basis of this evidence that the neuroticism may be little more than a way of measuring the subject's characteristic level of minor psychiatric symptoms. The model also made it possible to secure estimates of the extent to which measures of neuroticism were contaminated by short-term mental state. Estimates of contamination effects varied between studies. For the Canberra data contamination was negligible, for the Groningen data mild contamination effects were present but for the Christchurch data contamination was larger. These differences may be explained by differences in the nature of the samples studied.
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Affiliation(s)
- P Duncan-Jones
- Christchurch Child Development Study, Department of Paediatrics, Christchurch Hospital, New Zealand
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46
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Fergusson DM, Horwood LJ, Lawton JM. The relationships between neuroticism and depressive symptoms. Soc Psychiatry Psychiatr Epidemiol 1989; 24:275-81. [PMID: 2512644 DOI: 10.1007/bf01788029] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A structural equation model designed to estimate the reciprocal associations which may exist between mental state and personality trait variables is presented. This model is applied to measures of neuroticism and depression obtained for a sample of over 1000 women studied over a two year period. The fitted model suggests that while measures of neuroticism are contaminated by the effects of short term mental state on the reporting of personality, there is still a fairly substantial relationship between trait neuroticism (corrected for the effects of mental state contamination) and reports of depressive symptoms.
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47
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Reich J, Boerstler H, Yates W, Nduaguba M. Utilization of medical resources in persons with DSM-III personality disorders in a community sample. Int J Psychiatry Med 1989; 19:1-9. [PMID: 2722402 DOI: 10.2190/3kux-bfkt-md6y-x47q] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A community survey of 401 randomly selected subjects yielded 249 responders, of which twenty-six had DSM-III criteria personality disorders (PDs), and 167 had no personality disorder traits (controls). More PDs than controls were medically hospitalized during the last year (38% vs 17%, p = .006). A number of significant associations was found between the number of DSM-III personality trait questions answered in a positive fashion and medical utilization. These associations varied by gender. Most striking was the .50 correlation for females between flamboyant personality disorder scores and visits to the family doctor for mental health reasons.
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Affiliation(s)
- J Reich
- Harvard University, Massachusetts Mental Health Center
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48
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Huppert FA, Gore M, Elliott BJ. The value of an improved scoring system (CGHQ) for the General Health Questionnaire in a representative community sample. Psychol Med 1988; 18:1001-1006. [PMID: 3270825 DOI: 10.1017/s0033291700009922] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The value of a new method of scoring the General Health Questionnaire (CGHQ) has been assessed in a representative sample of 6317 British community residents aged 18+. The CGHQ, which takes account of the chronicity of psychiatric symptoms, is found to be superior to the conventional scoring method in yielding a wider range of scores, a more normal distribution and in its close association to a well validated measure of neurotic illness. On the other hand, the conventional GHQ and the CGHQ score appear equally sensitive to a number of socio-demographic variables, including social class, marital status and employment. An important finding is that the two methods identify different individuals as cases. Compared with the GHQ, the CGHQ identifies a higher proportion of the middle-aged. The implications of these findings with respect to the optimal method of scoring the GHQ are discussed.
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Affiliation(s)
- F A Huppert
- Department of Psychiatry, Cambridge University Clinical School, Addenbrooke's Hospital
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49
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Abstract
Defining chronic depression as persistent symptoms for 2 or more years, a prevalence of chronic depression of 12-15% is found in the literature. A four-part classification of chronic depression is proposed: Chronic Primary Major Depression; Chronic Secondary Major Depression; Characterological or Chronic Minor Depression (Dysthymic Disorder); and 'Double Depression'. The literature indicates several factors predicting chronicity in primary major depression: more at risk are female patients, particularly those with premorbid neurotic personality traits, individuals with unipolar disorders, and those with higher familial loading for such disorders. Other factors are the adequacy and appropriateness of the treatment given, and the length of illness episode prior to treatment being received. Larger studies with well-matched controls are needed.
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Affiliation(s)
- J Scott
- University Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne
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50
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Abstract
Several studies suggest that measures of personality traits and disorders are affected by depressed state. However, none of the studies to date have evaluated the effect of depressed mood on personality using current diagnostic criteria. The effect of depressed mood on personality scale scores and personality disorder diagnoses using the Millon Clinical Multiaxial Inventory was assessed in 42 depressed patients. There was a significant alteration in mean personality trait scores and reduction in personality disorder diagnosis between the depressed and remitted states. The clinical and theoretical implications of these findings are discussed.
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Affiliation(s)
- R T Joffe
- Department of Psychiatry, St Michael's Hospital, Toronto, Ontario, Canada
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