Defining the personality disorders: description of an Australian database

Smoking-related correlates of psychomotor restlessness and agitation in a community sample of daily cigarette smokers

BACKGROUND AND OBJECTIVES

Psychomotor restlessness and agitation (PMA) is a putatively important, yet understudied, psychopathologic correlate of smoking. The scant smoking research on PMA previously conducted has been narrow in scope and conducted among psychiatric patients. To examine the generalizability and relevance of PMA to smoking, this cross-sectional study investigated associations between PMA and a variety of smoking processes in a community sample.

METHODS

Participants in this study were non-treatment-seeking smokers (N = 254, ≥10 cig/day, M age = 44 years) from the community without an active mood disorder. At baseline, they completed a PMA symptom checklist, a composite depressive symptom index, and a battery of smoking questionnaires.

RESULTS

Linear regression models adjusting for depressive symptoms and demographics indicated that PMA level was positively associated with severity of nicotine withdrawal symptoms during prior quit attempts (β = .18, p < .05), anticipated likelihood of withdrawal in a future quit attempt (β = .19, p < .05), motivation to smoke for negative reinforcement (β = .14, p < .05), and smoking expectancies for negative reinforcement (β = .17, p < .05), negative consequences (β = .22, p < .01), and positive reinforcement (β = .14, p < .05). PMA was not significantly associated with smoking chronicity, frequency, or dependence severity.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Smokers with elevated PMA appear to experience greater smoking-induced affect modulation and nicotine withdrawal than the average smoker, regardless of other depressive symptoms. Given that PMA differentiates a qualitatively unique profile of smoking characteristics, PMA warrants consideration in tobacco addiction research and practice.

Does psychomotor retardation define a clinically relevant phenotype of unipolar depression?

BACKGROUND

The recognition and assessment of psychomotor retardation may have implications for better definition of the clinical phenotypes of depression. The aim of this study was to assess the clinical correlates of psychomotor retardation endorsed at any time during the patients' lifetime (LPR).

METHODS

The study sample included 291 patients with non-psychotic major depressive disorder (MDD) participating in the clinical trial, "Depression: The Search for Treatment-Relevant Phenotypes." Psychomotor retardation was measured using a factor derived from the Mood Spectrum Self-Report (MOODS-SR) assessment. Using a pre-defined cut-off score on the lifetime psychomotor retardation (LPR) factor of the MOODS-SR, participants were classified into high and low scorers. Logistic regression analysis was used to evaluate the relationship between LPR and subthreshold bipolarity.

RESULTS

Compared to low scorers, participants with high scores on the LPR factor had greater severity of depression and more bipolarity indicators.

CONCLUSIONS

The MOODS-SR appears to be helpful to identify clinical phenotypes of unipolar depression and to highlight the usefulness of a lifetime approach to the assessment of psychopathology in the characterisation of patients with unipolar depression.

Treatment-resistant depression: resistant to definition?

OBJECTIVE

To better define treatment-resistant depression (TRD) so as to assist clinical management and refine treatment guidelines.

METHOD

In this study, we examine a broad range of clinical variables in depressed patients (n=196) referred to a tertiary referral Mood Disorders Unit (MDU). Information was collected from patients, referrers and assessors over a period of 32 months and included evaluations of treatments, treatment resistance and related variables. Data were analysed across trichotomized 'high', 'low' and 'no' treatment resistance groupings of patients.

RESULTS

A significantly greater proportion of patients with melancholia were amongst the high TRD group, and this was consistent across different strategies for evaluating melancholia.

CONCLUSION

Melancholia perhaps provides a prototypic TRD subset that perhaps reflects some innate aspects of melancholic depression or factors such as the impact of ageing. Research into TRD is needed to both replicate this finding and perhaps explicate it further.

A question of style: refining the dimensions of personality disorder style

The frequent finding that meeting criteria for one type of personality disorder (PD) is commonly associated with meeting criteria for several other PDs indicates significant problems in defining and measuring PDs independently of each other, whether measured categorically or dimensionally. This study was designed to enrich recent DSM descriptor sets and, with the enriched set of descriptors, develop refined PD dimensions. A large sample of patients with a PD or significant personality disturbance were studied, with most analyses based on self-report (SR) data, but with corroborative witness (CW) data also collected to validate refinement analyses. The original descriptor set comprised 139 DSM descriptors and 127 items obtained from other sources. Personality disorder dimensions of interest were refined by factor analyses. We specifically identify items that failed to "belong" to their original PD "base." A refined set of 92 items demonstrated greater independence of the underlying dimensions and suggested an underlying five-factor structure at some variance to the current DSM-IV cluster set. The study should assist measurement of individual PDs by identifying items and constructs that build to more homogeneous dimensions that define lower-order and higher-order PD traits.