Are the subjective complaints of traumatically brain injured patients reliable?

The present study was designed to compare the subjective complaints of 50 traumatically brain injured (TBI) patients with the observations of their significant others. The complaints of the TBI patients and their significant others were contrasted according to the severity of the TBI and the type of complaint (physical, cognitive/behavioural and emotional). While no differences were found in physical complaints, the cognitive/behavioural and emotional complaints of TBI patients, regardless of the severity of the initial TBI, were significantly under-reported in comparison to the observations of their significant others. The data suggests that while this finding was most likely due to the TBI patients' poor awareness, it was unlikely to be the result of psychological denial since all of these individuals were evaluated in the context of being a plaintiff in personal injury litigation or a claimant in a Workers' Compensation claim. The data suggests that the cerebral trauma these patients sustained played a major role in their ability to recognize their cognitive, behavioural and emotional symptoms. Finally, the data suggests that clinicians should obtain information about the TBI patients' cognitive/behavioural and emotional functioning from their significant others, rather than rely entirely on the TBI patients' subjective assessment of these problems.

[The development of alcohol dependence in adolescents with personalities of the affective-excitable type]

Ten 13-17-year-old boys with pathocharacterologic peculiarities in premorbid period were examined. Syndrome of affective excitability was observed in pure form in 5 juveniles, while it was combined with hysteric features in 3 patients and with affective instability in 2 ones. These peculiarities of personality resulted in behavioral deviations which promoted the development of alcoholism and exaggerated of disorders conditioned by this disease. Course of alcoholism in the studied cases was unfavourable (binges, intake of large doses of alcohol and of the substitutes, etc) with pronounced disorders of behaviour up to aggression and delinquency. It was established that psychologic motivation (search of psychologic comfort, satisfaction of the need of actualization of personality, etc) played an important role both in development of the disease and in forming its clinical peculiarities.

[The clinical profile of exogenous organic depressions in subjects who were victims of the accident at the Chernobyl Atomic Electric Power Station]

A total of 200 persons victims of the Chernobyl accident presenting with different exogenous organic depressions were examined. Radiation exposure did not exceed medium levels. The pattern of depressive syndrome of exogenous organic genesis was studied as was the incidence of its varieties. The article contains a description of different varieties of depression and sums up studies on premorbid and neurological status and additional research methods together with studies on suicidal intentions and disposition to alcoholization in the studied groups.

Attributional style and self-esteem: the prediction of emotional distress following a midterm exam

A midterm design was used to determine whether students' attributional style for negative achievement events interacts with self-esteem and a lower-than-expected exam grade to predict changes in measures of specific and nonspecific depression and anxiety. Participants were 141 students who completed baseline measures of attributional style and self-esteem, as well as affective measures on several occasions before and after receipt of midterm grades. A pessimistic attributional style for negative events interacted with self-esteem and outcome to predict residual changes in a combined measure of nonspecific distress and anxious arousal (marginal trend) but not a combined measure of specific depressive symptoms. Unexpectedly, the greatest residual increases in distress occurred among low-self-esteem pessimists who experienced a nonfailure outcome. These effects did not appear to be mediated by changes in hopelessness.

Executive and motivational control of performance task behavior, and autonomic heart-rate regulation in children: physiologic validation of two-factor solution inhibitory control

Forty-two (42) children (mean age 10.6 years) from mainstream public (N = 22) and therapeutic schools (N = 20) completed performance tasks assessing executive and motivational influences on motor responses. In a separate protocol, children underwent physiologic challenges of paced breathing and supine to standing postural change, while heart rate was continuously monitored. Executive control was associated with vagal modulation of respiratory driven, high-frequency heart-rate variability (t = 2.20, p < .03), whereas motivational control was associated with sympathetic modulation of posturally driven, low-frequency heart-rate variability (t = -2.22, p < .03). These findings supported a two-factor solution of inhibitory control derived in a previous study.

[Incidence of psychiatric symptoms and somatic complaints in 4- to 10-year-old children in Germany as judged by parents--a comparison of norm-oriented and criteria-oriented models]

OBJECTIVES

To analyze the frequency of behavioral/emotional problems and somatic complaints of children aged four to ten as rated by their parents.

METHOD

The analysis is based on the PAK-KID study on behavioural and emotional problems and psychosocial competencies of children and adolescents in Germany. In a nationally representative sample of N = 1030 children aged four to ten years the parents rated their child using the Child Behavior Checklist.

RESULTS

The prevalence rates of the symptoms are presented. Additionally global prevalence rates based on three different models were calculated and compared. They range from 13.1% to 28.3%. The issues of defining cutoffs necessary for the calculation of prevalence rates are discussed.

[Alexithymia and automatic activation of emotional-evaluative information]

The emotional valence of stimuli seems to be stored in the associative network and is automatically activated on the mere observation of a stimulus. A principal characteristic of alexithymia represents the difficulty to symbolize emotions verbally. The present study examines the relationship between the dimensions of the alexithymia construct and emotional priming effects in a word-word paradigma. The 20-Item Toronto Alexithymia Scale was administered to 32 subjects along with two word reading tasks as measures of emotional and semantic priming effects. The subscale "difficulty describing feelings" correlated as expected negatively with the negative inhibition effect. The subscale "externally oriented thinking" tended to correlate negatively with the negative facilitation effect. Thus, these dimensions of alexithymia are inversely related to the degree of automatic emotional priming. In summary, there is evidence for an impaired structural integration of emotion and language in persons with difficulties in describing feelings. Poor "symbolization" of emotions in alexithymia is discussed from a cognitive perspective.

[Experimental detection of inadequate affect regulation in patients with self-mutilating behavior]

According to DSM-IV affective instability in borderline personality disorder is due to marked reactions to environmental events. The aim of this study was to investigate affective responsiveness of abnormal personalities with self-harming impulsive behaviors by means of an affect-stimulation design. The first experiment was based on the presentation of a short story that allowed affective responses to various stimuli to be assessed in regard to quality, intensity, and alterations over time. The second one presented a typical frustration design, which provoked specific feelings of anger and disappointment. Impulsive personalities showed an affective hyperreactivity that was characterized by a decreased threshold for affective responses, as well as by intensive, rapidly changing affects. Furthermore, affect experiences turned out to be qualitatively diffuse and undifferentiated. Results support that affective instability of patients with borderline personality disorder should be differentiated from the autonomous deviations of mood typical of affective disorders. Their affective hyperreactivity is a crucial part of impulsive personality functioning.

Prediction of behavioural and emotional problems in children and adolescents with operated congenital heart disease

AIMS

The aim of the present study was to determine which medical variables were predictors of long-term behavioural/emotional outcome after surgical correction for congenital heart disease in infancy and childhood.

METHODS

The Child Behavior Checklist (CBCL) was used to predict parent-reported behavioural/emotional problems in 125 10-15 year-old congenital heart disease children from: (1) biographical status (2) medical history (3) heart surgery (4) short-term post-operative course and (5) number of heart operations and (6) extra cardiac concomitant anomalies.

RESULTS

Higher CBCL total problem scores at follow-up were associated with a greater number of heart operations and deep hypothermic circulatory arrest (< 22 degrees). 'Internalizing problems' were associated with a greater number of heart operations, deep hypothermic circulatory arrest, a short gestational age, low systemic oxygen saturation, and older age at surgical repair. 'Externalizing problems' were associated with a greater number of heart operations only.

CONCLUSION

Several medical variables were significant predictors and can be used to identify those congenital heart disease children who are at risk of long-term behavioural/emotional maladjustment.

Psychological stress, emotional behavior & coronary heart disease

Psychological stress and chronic anxious behavior have a tremendous impact on our heart and biological rhythm of the body. Both are responsible for new development or promotion of coronary heart disease and may be associated with unpredictable adverse coronary events.

Depressive personality: associations with DSM-III-R mood and personality disorders and negative and positive affectivity, 30-month stability, and prediction of course of Axis I depressive disorders

The authors addressed 5 issues bearing on the validity of the construct of depressive personality disorder (DPD): its relationship with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) mood and personality disorders and normal personality dimensions of negative and positive affectivity, its stability over 30-months, and its impact on the course of Axis I depressive disorders. Two samples were used: 156 outpatients with mood disorders, personality disorders, or both, and 267 of their 1st-degree relatives. The association between DPD and dysthymia was fairly modest, whereas the associations with major depression and the personality disorders were quite low. DPD was moderately correlated with both negative and positive affectivity; however, it contributed unique information beyond that available from the 2 emotional superfactors. Finally, DPD was moderately stable over a 30-month period and was associated with a poorer course of depression.

[Alexithymia and memory: a more rigorous criterion for acceptance of recognition tasks?]

Alexithymia, the lack of words for affects, is often explained in a neurophysiological way. Many epidemiological studies have shown that this personality characteristic is a common one, frequently observed in the general population and, at least sometimes, context-dependent. Thus, alternatives to the split-brain alike hypothesis are required. In this paper, we focus on promising findings reported by Montreuil and Pedinielli (15): poorer alexithymic performances on memory taks in an incidental learning session. We tried to duplicate these results for a recognition task but failed to do so. Surprisingly, observed data show a trend in the opposite direction and alexithymic subjects perform better on distractors. Response times for the right answers (recognition of targets, elimination of distractors) are longer for this group. Taken together, these results suggest a difference in the managing of uncertainty. Alexithymic criterion for adoption/rejection of candidates to recognition is assumed to need a longer completion because of a greater number of attributes to recover in memory (considering a componential approach of representations in memory). Such a decision model explains why alexithymics perform better on elimination (they need more certainty) and why they show a slight decrease (unsignificant) on target acceptation (for a similar level of uncertainty alexithymics use a more rigorous criterion than the control group). From this decision model an alternative explanation is proposed for the results of Montreuil and Pedinielli in the recognition task. Further, it is suggested that a similar process might be implicated in the alexithymic difficulties about the translation of feelings into words. As it requires a matching between an ambiguous-continuous information (the inner feeling) and a consensual-discrete label (the emotional term), this process probably involves a great degree of uncertainty.

Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal

Using outpatients with anxiety and mood disorders (N = 350), the authors tested several models of the structural relationships of dimensions of key features of selected emotional disorders and dimensions of the tripartite model of anxiety and depression. Results supported the discriminant validity of the 5 symptom domains examined (mood disorders: generalized anxiety disorder, GAD; panic disorder; obsessive-compulsive disorder; social phobia). Of various structural models evaluated, the best fitting involved a structure consistent with the tripartite model (e.g., the higher order factors, negative affect and positive affect, influenced emotional disorder factors in the expected manner). The latent factor, GAD, influenced the latent factor, autonomic arousal, in a direction consistent with recent laboratory findings (autonomic suppression). Findings are discussed in the context of the growing literature on higher order trait dimensions (e.g., negative affect) that may be of considerable importance to the understanding of the pathogenesis, course, and co-occurrence of emotional disorders.

Therapeutic approaches to problems of meaninglessness

Paradigmatically, meaningful action, and by extension meaningful living, inhere in immersed participation in activities from which one derives substantial instrumental, intrinsic, and/or spiritual value. The greater the departure from this paradigm (the existentialist's "absurd" being the extreme case), the more meaningless will one's existence seem. Employing this paradigm case as a point of departure, the job of the psychotherapist becomes that of (a) diagnosing obstacles to clients securing such value in their behavior, and (b) assisting them in the removal or diminution of these obstacles. The empirically most common of these obstacles, as well as some therapeutic approaches to addressing them, have been discussed in this article.

The development of early externalizing problems among children from low-income families: a transformational perspective

The present study examined pathways leading to early externalizing problems from age 1 to 3 1/2 in a design that took advantage of our knowledge of normative progression and normative socialization as well as findings from research on risk. A sample of 130 low-income participants was followed longitudinally from 12 to 42 months using observational measures of developmentally salient parenting and child disruptive behavior to predict early externalizing problems. Results are best accommodated by concepts such as transformation and transaction from developmental psychology. For boys, both child and parent variables predicted later externalizing. For girls and boys, the interaction between child noncompliance and maternal rejection was significant.

Problem behaviors and personality of children and adolescents with Prader-Willi syndrome

OBJECTIVE

Compare behavioral and emotional problems of children and adolescents with Prader-Willi Syndrome (PWS) and clients consulting mental health centers (MHC) and related behavioral and emotional problems to the children's personality in the PWS group.

METHODS

Participants were 39 children with PWS and 585 matched MHC clients. Child Behavior Checklist (CBCL) syndromes were related to the Big-Five personality factors measured with the California Child Q-sort (CCQ).

RESULTS

Mean CBCL Total Problems scores were not different for the PWS and MHC groups, but differences were found for several of the CBCL subscales. Patterns of correlations among CBCL scales were similar in both groups, although coefficients were generally higher in the PWS group, indicating higher comorbidity or co-absence of CBCL syndromes in children and adolescents with PWS. Personality profiles were specific for internalizing and Externalizing problems of children and adolescents with PWS.

Identification of psychosocial problems in pediatric primary care: do family attitudes make a difference?

OBJECTIVE

To evaluate the affect of families' attitudes about the appropriateness of discussing psychosocial concerns on pediatric providers' identification of psychosocial problems.

DESIGN

These data were collected as part of the Greater New Haven Child Health Study, New Haven, Conn. The study design was a prospective cohort.

SETTING

Families were recruited from a stratified random sample of all primary care practices in the greater New Haven area. Nineteen of 23 invited practices agreed to participate including 2 prepaid practices, 2 neighborhood health centers, and 7 fee-for-service group and 8 fee-for-service solo practices.

PARTICIPANTS

All families of children aged 4 to 8 years who attended these practices during 2 separate 3-week periods (1 in fall 1987 and 1 in spring 1988) were invited to participate in the study. Families were invited to participate only once, on the first contact with any eligible child, using approved procedures. Of 2006 eligible families, 1886 (94%) chose to participate.

MAIN OUTCOME MEASURE

The outcome variable for these analyses is the identification of any behavioral, emotional, or developmental problem by the pediatrician on the 13-category checklist. Overall, pediatric clinicians identified 27.5% of children with 1 or more psychosocial problems.

RESULTS

Our data suggest that there is a great deal of discrepancy between what parents report is appropriate to do when their children have psychosocial problems and what they actually do when they recognize such problems in their children. Most (81.1%) believed it was appropriate to discuss 4 or more of the 6 hypothetical situations with their children's physician, while only 40.9% actually did discuss any of these problems with a physician when a problem occurred. Given the correlates of parents who intended to discuss such problems (higher education, older age, Euro-American ethnicity, higher income, married, availability of medical insurance) the possibility that parents are providing socially acceptable responses to such questions seems likely. Further, our data indicate that parents' actual reports of discussions of psychosocial problems is unrelated to whether physicians identified those problems in children.

CONCLUSIONS

Pediatricians'judgments about the presence of psychosocial problems in their young patients seem to be based on their own observations rather than on what parents report. Physician-parent communication about psychosocial problems will be increasingly important as primary care physicians assume their role as gatekeepers to more expensive services such as mental health interventions.

Environmental stressors and emotional status of adolescents who have been in special education classes

OBJECTIVE

To identify environmental and psychosocial factors associated with receiving special education services.

DESIGN

The 1992 Minnesota Student Survey, an anonymous, self-report survey.

SETTING

Minnesota public schools.

PARTICIPANTS

A total of 121848 adolescents in the 6th, 9th, and 12th grades.

MAIN OUTCOME MEASURES

Emotional status and potential environmental risk factors including family structure, family substance use problems, family violence, and sexual abuse were compared between adolescents reporting a history of having been in classes for learning problems and a grade- and race-matched comparison group of adolescents who had never been in classes for learning problems. Comparisons were conducted separately for male and female respondents.

RESULTS

Compared with adolescents who had never been in classes for learning problems, a significantly greater proportion of male and female students who had been in special education classes lived in single-parent and nontraditional households, indicated that a family member had an alcohol or other drug problem, had witnessed or experienced physical abuse, and reported a history of sexual abuse and poor emotional health. Most of these associations remained significant when simultaneously controlling for the other factors in logistic regression. Significant factors showed modest odds ratios in the multivariate analyses (<1.6), except for the emotional status variable. Students with a history of receiving special education services had from 6 to 14 times the odds of reporting poor emotional health. This association was strongest among the youngest adolescents.

CONCLUSION

Several environmental stressors and psychosocial factors, most notably poor emotional health, are associated with a history of special class placement for learning problems.

Clients' positive and negative expressiveness within their families and alexithymia

49 prospective clients from a midwestern urban community, who sought counseling at a university training clinic, completed the Self-expressiveness in the Family Questionnaire and the 20-item Toronto Alexithymia Scale. As predicted, the positive self-expressiveness scores were significantly negatively correlated -.52 with scores on alexithymia, and the negative self-expressiveness scores were significantly positively correlated .34 with alexithymia. These results support the premise that mental health clients' self-reported lack of positive expressiveness and abundance of negative expressiveness within their family context may be attributes associated with their tendency to be alexithymic.

[Comparative study of the frequency and features of emotional disturbances in patients in primary care clinics]

BACKGROUND

Psychological problems are a frequent cause of consultation in primary care outpatient clinics.

AIM

To report the results for Santiago de Chile of the World Health Organisation multicentric collaborative study on Psychological Symptoms in General Health Care.

PATIENTS AND METHODS

The results of 1453 patients that attended three primary care clinics in East Metropolitan Santiago were compared with those of patients studied in 15 other centers throughout the world. Two hundred fifty three cases were studied in detail with a structured diagnostic interview (CIDI-PHC). The capacity of general physicians to recognise emotional disorders as well as their management of psychological cases was also assessed.

RESULTS

Among the 253 patients studied in detail, 53% of patients had a definite psychiatric diagnosis, compared with 24% of patients, as an average, in other countries. There was a higher prevalence of depression, generalised anxiety disorder, neurasthenia and harmful use of alcohol. Chilean physicians recognised 74.1% of patients with psychiatric conditions, as compared with 48.9% of physicians abroad. Tranquilizing agents were the most often prescribed medications (40%) followed by antidepressants (18%).

CONCLUSIONS

There is a high prevalence of emotional disorders in patients consulting at the primary care level.

Reasons for initiation and cessation of eating in obese men and women and the affective consequences of eating in everyday situations

Reasons for the initiation and termination of eating were investigated in 78 female and 36 male obese subjects following a weight control programme. Self-monitoring diaries were completed during a 24-h period, in which subjects selected the main reason for starting and stopping an eating episode. Additionally, subjects recorded mood before and after eating using visual analogue scales. Hunger was chosen as a reason to start eating in only 20% of cases. Environmental cues such as mealtime were selected as the main reason for the initiation of the majority of eating episodes. In contrast, self-assessments such as "I felt I had eaten enough" was the main reason for terminating eating (39.4%). Gender differences in the reasons for initiating eating revealed a greater tendency for men to initiate eating for environmental reasons than women, whereas the opposite was found for the termination of eating, with women more likely to stop eating for environmental reasons than men. Changes in affect during eating revealed a significant decline in negative emotions such as tension and tiredness, and in the heavier subjects a trend for increased happiness was observed following eating. As hunger was less commonly reported as a reason to start eating than external reasons, treatment strategies for the obese might benefit by targeting individual reasons for meal initiation.

Clinical outcome, consumer satisfaction, and ad hoc ratings of improvement in children's mental health

Mental health clinics and managed care organizations assess treatment effectiveness with consumer satisfaction measures and ad hoc measures of improvement obtained from a single informant; some of these measures are as simple as asking clients whether they improved during treatment. In the present correlational study of 199 treated adolescents, we used a multitrait-multimethod analysis to examine psychometrically measured pathology change (pre- and postassessment of symptoms and functioning), consumer satisfaction, and perceived improvement reported by multiple informants. Confirmatory factor-analytic results indicate that (a) outcome variance due to multiple informants cannot be ignored, (b) consumer satisfaction is unrelated to pathology change, and (c) parent-reported perceived improvement ratings are more akin to satisfaction than to pathology change.

The relationship between alexithymia, depression, and axis II psychopathology in eating disorder inpatients

OBJECTIVE

The major purpose of this study was to examine alexithymia in relationship to depression and Axis II psychopathology in eating disorder patients.

METHOD

Fifty-three female inpatients representing three DSM-IV eating disorder diagnostic groups and 14 control subjects completed the Toronto Alexithymia Scale (TAS), the Eating Disorder Inventory-2, and the Beck Depression Inventory within the first week of their hospital admission and shortly before discharge. Structured Clinical Interviews for DSM-III-R (SCID) I and II were also conducted. Multiple regression analyses were used to determine the contribution of mood, diagnostic, and personality variables in predicting the alexithymia score.

RESULTS AND DISCUSSION

After controlling for depression, only the TAS factor, "difficulty expressing feelings," remained significantly different between groups, with the anorexia nervosa-restrictors (AN-R) having significantly higher scores than controls and bulimia nervosa patients. This factor appears to be a relatively stable personality characteristic in AN-R. The level of depression and the presence of avoidant personality disorder were the most predictable variables for the alexithymia total score.

[Alexithymia in personal characteristics of patients with coronary heart diseases]

Psychological status was assessed in 120 patients with coronary heart disease (CHD) according to MMPI, Toronto alexithymic scale. Alexithymia was diagnosed in 49.1% of the examinees. They were characterized by difficulties in definition of their feelings, absence of dreams and fantasies, introversion, inclination to depressive response to stress, hypochondria eventuating in senesthopathy. The above psychological and pathopsychological traits in CHD patients require psychotherapeutic and chemotherapeutic correction in order to enhance efficacy of the treatment.