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Kim HJ, Kim JE, Lee SH. Pathological Worry is Related to Poor Long-Term Pharmacological Treatment Response in Patients With Panic Disorder. Psychiatry Investig 2021; 18:904-912. [PMID: 34500504 PMCID: PMC8473858 DOI: 10.30773/pi.2021.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Several predictors of unfavorable pharmacological treatment response (PTR) in panic disorder (PD) patients have been suggested, such as the duration of the illness, presence of agoraphobia, depression, being a woman, and early trauma. This study aimed to examine whether pathological worry is associated with PTR in PD patients. METHODS This study included 335 PD patients and 418 healthy controls (HCs). The Penn State Worry Questionnaire (PSWQ), the Early Trauma Inventory Self Report-Short Form (ETISR-SF), Beck Depression Inventory (BDI), Panic Disorder Severity Scale (PDSS), and Anxiety Sensitivity Inventory-Revised (ASI-R) were administered. We measured the PTR at 8 weeks and 6 months. Student t-test, chisquare tests, Pearson's correlation analyses, and binary logistic regression model were used. RESULTS Our results showed that the total scores of the PSWQ correlated with the ETISR-SF, BDI, and ASI-R were significantly higher in patients with PD compared with HCs. The PSWQ and BDI could predict unfavorable PTR at 6 months in PD patients. CONCLUSION This is the first study to demonstrate that pathological worry may contribute to poor long-term PTR in PD patients. Therefore, our research suggests that clinicians must be aware of worry to optimize PTR for PD patients.
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Affiliation(s)
- Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ji Eun Kim
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Kim HJ, Kim JE, Lee SH. Early Trauma Is Associated with Poor Pharmacological Treatment Response in Patients with Panic Disorder. Psychiatry Investig 2021; 18:249-256. [PMID: 33735547 PMCID: PMC8016688 DOI: 10.30773/pi.2020.0380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Pharmacotherapy is established as an effective method for reducing symptoms of panic disorder (PD). However, about 20-40% of PD patients are treatment-resistant. Predictors of pharmacotherapy outcomes for PD patients are needed. METHODS This study included 152 PD patients to measure the clinical severities of PD symptoms and used the Early Trauma Inventory (ETI) to measure early trauma. Treatment response was defined as a 40% reduction in the total Panic Disorder Severity Scale score from baseline. We measured the treatment responses at 8 weeks and 6 months. Binary logistic regression was used to predict treatment response after controlling for confounding variables. RESULTS Early sexual trauma alone was associated with poor treatment response at 8 weeks. However, at 6 months, the total ETI score was associated with an unfavorable treatment response. CONCLUSION Therefore, our study suggests that clinicians need to be aware of a history of early trauma to optimize treatment outcomes for PD patients.
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Affiliation(s)
- Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ji Eun Kim
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Kim HJ, Song C, Bang M, Lee SH. Early sexual trauma is related with the tapetum in patients with panic disorder. J Affect Disord 2020; 267:107-113. [PMID: 32063561 DOI: 10.1016/j.jad.2020.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Early trauma exposure is suggested to confer a greater risk for the development of panic disorder (PD) by altering neurodevelopmental processes. A body of studies have shown that white matter microstructures, particularly in the fronto-limbic and callosal regions, could be affected by a history of early trauma in patients with PD. The tapetum, the extended posterior part of the corpus callosum connecting the bilateral temporal lobes, has not yet been studied regarding its relationship with early trauma, especially sexual one. METHODS Seventy participants with PD, sixty age- and sex-matched healthy controls were enrolled. The Early Trauma Inventory Self Report-Short Form (ETISR-SF), Neuroticism Scale, and Panic Disorder Severity Scale (PDSS) were administered. Voxel-wise statistical analysis of diffusion tensor imaging data was performed within the bilateral tapetum regions using Tract-Based Spatial Statistics (TBSS). RESULTS In participants with PD, higher levels of sexual trauma were significantly associated with the increased fractional anisotropies (FAs) in a cluster of the right tapetum. Exploratory correlation analysis revealed that FAs in this cluster were significantly correlated with higher neuroticism and poorer treatment response after one year of pharmacotherapy. No significant correlation was found between FAs of the right tapetum cluster and the PDSS scores. LIMITATIONS The possibility of retrospective recall bias for early trauma cannot be completely ruled out. CONCLUSIONS The findings of this study suggest that the right tapetum may serve as a potential neural marker of early sexual trauma in patients with PD and contribute to personal vulnerability and poorer treatment outcome after pharmacotherapy.
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Affiliation(s)
- Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Chaerim Song
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea; Clinical Counseling Psychology Graduate School, CHA University, Seongnam, South Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea; Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
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Does prior traumatization affect the treatment outcome of CBT for panic disorder? The potential role of the MAOA gene and depression symptoms. Eur Arch Psychiatry Clin Neurosci 2019; 269:161-170. [PMID: 28712090 DOI: 10.1007/s00406-017-0823-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 07/09/2017] [Indexed: 01/27/2023]
Abstract
Although cognitive behavioral therapy (CBT) is highly effective in the treatment of anxiety disorders, many patients still do not benefit. This study investigates whether a history of traumatic event experience is negatively associated with outcomes of CBT for panic disorder. The moderating role of the monoamine oxidase A (MAOA) gene and depression symptoms as well as the association between trauma history and fear reactivity as a potential mechanism are further analyzed. We conducted a post-hoc analysis of 172 male and 60 female patients with panic disorder treated with CBT in a multi-center study. Treatment outcome was assessed at post-treatment using self-report and clinician rating scales. Fear reactivity before treatment was assessed via heart rate and self-reported anxiety during a behavioral avoidance test. Among females, we did not find any differences in treatment response between traumatized and non-traumatized individuals or any two-way interaction trauma history × MAOA genotype. There was a significant three-way interaction trauma history × MAOA genotype × depression symptoms on all treatment outcomes indicating that in traumatized female patients carrying the low-activity allele, treatment effect sizes decreased with increasing depression symptoms at baseline. No such effects were observed for males. In conclusion, we found no evidence for a differential treatment response in traumatized and non-traumatized individuals. There is preliminary evidence for poorer treatment outcomes in a subgroup of female traumatized individuals carrying the low-active variant of the MAOA gene. These patients also report more symptoms of depression symptomatology and exhibit a dampened fear response before treatment which warrants further investigation.
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Personalized medicine in panic disorder: where are we now? A meta-regression analysis. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.pmip.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Costa RM, Brody S. Immature psychological defense mechanisms are associated with greater personal importance of junk food, alcohol, and television. Psychiatry Res 2013; 209:535-9. [PMID: 23866675 DOI: 10.1016/j.psychres.2013.06.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/07/2013] [Accepted: 06/22/2013] [Indexed: 11/27/2022]
Abstract
Immature psychological defense mechanisms are psychological processes that play an important role in suppressing emotional awareness and contribute to psychopathology. In addition, unhealthy food, television viewing, and alcohol consumption can be among the means to escape self-awareness. In contrast, engaging in, and responding fully to specifically penile-vaginal intercourse (PVI) is associated with indices of better emotional regulation, including less use of immature defense mechanisms. There was a lack of research on the association of immature defense mechanisms with personal importance of junk food, alcohol, television, PVI, and noncoital sex. In an online survey, 334 primarily Scottish women completed the Defense Style Questionnaire (DSQ-40), and rated the personal importance of junk food, alcohol, television, PVI, and noncoital sex. Immature defense mechanisms correlated with importance of junk food, alcohol, and television. Importance of PVI correlated with mature defenses, and less use of some component immature defenses. Importance of alcohol correlated with importance of junk food, television, and noncoital sex. Importance of junk food was correlated with importance of television and noncoital sex. The findings are discussed in terms of persons with poorer self-regulatory abilities having more interest in junk food, television, and alcohol, and less interest in PVI.
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Affiliation(s)
- Rui Miguel Costa
- School of Social Sciences, University of the West of Scotland, Paisley PA1 2BE, United Kingdom
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Evren C, Ozcetinkaya S, Ulku M, Cagil D, Gokalp P, Cetin T, Yigiter S. Relationship of defense styles with history of childhood trauma and personality in heroin dependent inpatients. Psychiatry Res 2012; 200:728-33. [PMID: 22917960 DOI: 10.1016/j.psychres.2012.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 05/26/2012] [Accepted: 07/18/2012] [Indexed: 12/31/2022]
Abstract
In the present study the defense styles were assessed in heroin dependent inpatients to verify whether they used less adaptive defense mechanisms compared to healthy controls and to evaluate if immature defense styles are related with childhood traumas, while controlling the effect of age, temperament and character on this relationship in male heroin dependent inpatients. Participants were consecutively admitted 109 male heroin dependent inpatients and 60 healthy controls. Patients were investigated with the Defense Style Questionnaire, the Childhood Trauma Questionnaire, and Temperament and Character Inventory. Heroin dependent patients were using immature defense style more, particularly acting-out and splitting, than the control group. Together with lower age, immature defense style discriminated heroin dependents from control group (lower age, and higher devaluation and splitting in second regression model). Lower physical neglect score was related with a mature defense style, whereas higher cooperativeness (C) and self-transcendence (ST) were related with a neurotic defense style and lower reward dependence (RD), self-directedness (SD) and higher ST and emotional abuse were related with immature defense style. These suggest that heroin dependents are using maladaptive immature defense styles more, which can be taken into account in the development of therapeutic programs for these patients. Also, immature defense style may mediate the relationship between childhood emotional abuse and some personality dimensions (lower RD, SD and higher ST) in heroin dependent inpatients.
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Affiliation(s)
- Cuneyt Evren
- Bakırköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Alcohol and Drug Research, Treatment and Training Center (AMATEM), Istanbul, Turkey.
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Bomyea J, Lang AJ, Golinelli D, Craske MG, Chavira DA, Sherbourne CD, Rose RD, Campbell-Sills L, Welch SS, Sullivan G, Bystritsky A, Roy-Byrne P, Stein MB. Trauma Exposure in Anxious Primary Care Patients. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2012; 35:254-263. [PMID: 23729989 DOI: 10.1007/s10862-012-9327-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The present study examined rates of trauma exposure, clinical characteristics associated with trauma exposure, and the effect of trauma exposure on treatment outcome in a large sample of primary care patients without posttraumatic stress disorder (PTSD). Individuals without PTSD (N = 1263) treated as part of the CALM program (Roy-Byrne et al., 2010) were assessed for presence of trauma exposure. Those with and without trauma exposure were compared on baseline demographic and diagnostic information, symptom severity, and responder status six months after beginning treatment. Trauma-exposed individuals (N = 662, 53%) were more likely to meet diagnostic criteria for Obsessive Compulsive Disorder and had higher levels of somatic symptoms at baseline. Individuals with and without trauma exposure did not differ significantly on severity of anxiety, depression, or mental health functioning at baseline. Trauma exposure did not significantly impact treatment response. Findings suggest that adverse effects of trauma exposure in those without PTSD may include OCD and somatic anxiety symptoms. Treatment did not appear to be adversely impacted by trauma exposure. Thus, although trauma exposure is prevalent in primary care samples, results suggest that treatment of the presenting anxiety disorder is effective irrespective of trauma history.
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Affiliation(s)
- J Bomyea
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, University of California, San Diego
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Relationship between defense styles, alexithymia, and personality in alcohol-dependent inpatients. Compr Psychiatry 2012; 53:860-7. [PMID: 22341212 DOI: 10.1016/j.comppsych.2012.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 12/30/2011] [Accepted: 01/11/2012] [Indexed: 11/21/2022] Open
Abstract
In the present study, the defense styles were assessed in alcohol-dependent patients to verify whether they used less adaptive defense mechanisms compared with healthy controls and to evaluate if immature defense styles (IDSs) are related with alexithymia, while controlling the effect of age, temperament, and character on this relationship in male alcohol-dependent inpatients. Participants were consecutively admitted 118 male alcohol-dependent inpatients and 60 healthy controls. Patients were investigated with the Defense Style Questionnaire, the Toronto Alexithymia Scale, and the Temperament and Character Inventory. The alcohol-dependent patients were using neurotic defense style, some IDSs (projection, acting out, splitting, and somatization) more, and the mature defense style humor less than the control group. Together with higher age, IDS discriminated alcohol dependents from the control group (higher age, acting out, and splitting and lower humor in the second regression model). Immature defense style was positively correlated with novelty seeking, harm avoidance, self-transcendence, difficulty in identifying feelings (DIF), difficulty in describing feelings, external oriented thinking, and total alexithymia score in the present study, whereas it was negatively correlated with self-directedness and cooperativeness. Mean scores of neurotic and IDS were higher in the alexithymic group than the nonalexithymic group, and alexithymia was correlated with some IDSs. Higher difficulty in describing feelings predicted mature defense style, higher harm avoidance and DIF predicted neurotic defense style, and lower cooperativeness and self-transcendence and higher DIF predicted IDS. These suggest that alcohol dependents are using maladaptive IDS more, which can be taken into account in the development of therapeutic programs for these patients. In addition, IDS seems to be related with alexithymia, particularly DIF factor, whereas low cooperativeness and high self-transcendence are significant covariants. Thus, these results could indicate the use of specific strategies in the clinical and psychotherapeutic management of patients with alexithymic feature and IDS.
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Kipper L, Wachleski C, Salum GA, Heldt E, Blaya C, Manfro GG. Can psychopharmacological treatment change personality traits in patients with panic disorder? BRAZILIAN JOURNAL OF PSYCHIATRY 2011; 31:307-13. [PMID: 20098823 DOI: 10.1590/s1516-44462009000400005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 04/15/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects that a particular psychopharmacological treatment has on personality patterns in patients with panic disorder. METHOD Forty-seven patients with panic disorder and 40 controls were included in the study. The Mini International Neuropsychiatric Interview and Minnesota Multiphasic Personality Inventory were used to assess Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnoses and personality traits, respectively. Patients were treated with sertraline for 16 weeks. RESULTS There was a significant decrease in the score on 8 of the 10 Minnesota Multiphasic Personality Inventory scales. In addition, neurotic triad and psychasthenia personality scores were higher among panic disorder patients, even during the posttreatment asymptomatic phase, than among controls. CONCLUSION In the asymptomatic phase of the disease, panic disorder patients present a particular neurotic/anxious personality pattern. This pattern, although altered in the presence of acute symptoms, could be a focus of research.
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Affiliation(s)
- Letícia Kipper
- Postgraduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Marchesi C, Parenti P, Aprile S, Cabrino C, De Panfilis C. Defense style in panic disorder before and after pharmacological treatment. Psychiatry Res 2011; 187:382-6. [PMID: 20692044 DOI: 10.1016/j.psychres.2010.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 07/02/2010] [Accepted: 07/03/2010] [Indexed: 11/26/2022]
Abstract
Whether or not the use of maladaptive defense style is a trait, as opposed to a state dependent phenomenon, in panic disorder (PD) is a topic still very much up for debate. The aim of the study was to verify whether PD patients, both before and after treatment, used different defense style than the control group. Sixty-one PD patients (recruited from an original sample of 90 patients) and 64 healthy controls were evaluated against the Structured Clinical Interview for DSM-IV disorders, the Symptoms Check List-90, the Hamilton Rating Scales for Anxiety and for Depression and finally the Defense Style Questionnaire-40 (DSQ). The patients were treated with paroxetine or citalopram and were evaluated monthly for one year to assess the remission. The DSQ was re-administered to the patients at the end of the study. Before treatment, PD patients used more neurotic and immature forms of defense than controls. After treatment, those in remission used the same defense styles as the control group, whereas non-remitters still used more immature defenses. However, all the aforementioned difference disappeared, after excluding the effect of symptom severity. Our data supports the hypothesis that the use of maladaptive defenses might be the consequence of PD: when subjects fall ill, their capacity to use mature adaptive defenses may diminish, but when they recover their defensive style returns to a greater maturity. The present results are however limited by the dropout rate (one third of patients did not complete the study) and the use of just one questionnaire to evaluate the complexity of defense styles.
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Affiliation(s)
- Carlo Marchesi
- Psychiatric Section, Department of Neuroscience, University of Parma, Parma, Italy.
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Braga DT, Manfro GG, Niederauer K, Cordioli AV. Full remission and relapse of obsessive-compulsive symptoms after cognitive-behavioral group therapy: a two-year follow-up. BRAZILIAN JOURNAL OF PSYCHIATRY 2011; 32:164-8. [PMID: 20658055 DOI: 10.1590/s1516-44462010000200012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 12/03/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether the results obtained with 12 sessions of cognitive-behavioral group therapy with obsessive-compulsive patients were maintained after two years, and whether the degree of symptom remission was associated with relapse. METHOD Forty-two patients were followed. The severity of symptoms was measured at the end of cognitive-behavioral group therapy and at 18 and 24 months of follow-up. The assessment scales used were the Yale-Brown Obsessive-Compulsive Scale, Clinical Global Impression, Beck Depression Inventory, and Beck Anxiety Inventory. RESULTS The reduction in symptom severity observed at the end of treatment was maintained during the two-year follow-up period (F = 57.881; p < 0.001). At the end of the treatment, 9 (21.4%) patients presented full remission, 22 (52.4%) presented partial remission, and 11 (26.2%) had unchanged scores in the Yale-Brown Obsessive-Compulsive Scale. After two years, 13 patients (31.0%) presented full remission, 20 (47.6%) had partial remission, and 9 (21.4%) had unchanged Yale-Brown Obsessive-Compulsive Scale scores. The full remission of symptoms at the end of the treatment was a protective factor against relapse (chi2 = 4,962; df = 1; p = 0.026). CONCLUSION Our findings underscore the importance of attaining full remission of obsessive-compulsive symptoms during treatment and the need for new therapeutic strategies to achieve this.
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Affiliation(s)
- Daniela Tusi Braga
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Porto Alegre, RS, Brazil.
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Calati R, Oasi O, De Ronchi D, Serretti A. The use of the defence style questionnaire in major depressive and panic disorders: a comprehensive meta-analysis. Psychol Psychother 2010; 83:1-13. [PMID: 19671241 DOI: 10.1348/147608309x464206] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The issue of defence mechanisms is of great importance in clinical practice. The aim of this meta-analysis is to compare different defence styles (Mature, Neurotic, and Immature), assessed using the three-factor defence style questionnaire (DSQ), in major depressive disorder (MDD), and panic disorder (PD) in order to evaluate potential differences in defence profiles among these disorders. METHODS We assessed all publications listed in PubMed, PsycINFO, ISI, and Lilacs databases focusing on DSQ defence styles in MDD and PD. To be included studies had to be published in English, to include psychiatric patients, to provide defence style mean scores, and to employ the three-factor DSQ versions. Data were entered into the Cochrane Collaboration Review Manager Software and analysed by RevMan version 4.2. RESULTS MDD patients reported significantly lower scores in Mature style and both MDD and PD patients reported significantly higher scores in Neurotic and Immature styles. CONCLUSIONS A dissimilarity between depressive and anxious profiles emerged, since the former profile was characterized by low Mature and high Neurotic and Immature scores while the latter by high Neurotic and Immature scores only. These results could indicate the use of specific strategies in clinical and psychotherapeutic management of patients with these diagnoses. Nevertheless, present results should be considered with caution because of the high heterogeneity of the studies and some weaknesses in the psychometric properties of the DSQ.
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Affiliation(s)
- Raffaella Calati
- Institute of Psychiatry, University of Bologna, 40123 Bologna, Italy
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Abstract
Past suicide attempt has been consistently reported to be the best predictor of future suicide attempt. The need to identify predictors that can be targets of therapy is of great importance. Coping styles and defense mechanisms have now been linked to suicide in numerous reports. In this study, we expand on past research by exploring differences in defense mechanism use between three groups: 1) without current suicide ideation/attempt; 2) with current suicide ideation/no attempt; and 3) with current suicide attempt. We also explored the contribution of covariates, such as symptom severity and past attempt. Seventy-five adult patients who were within 48 hours of hospital admission for current major depressive episode were recruited. Clinical interview was conducted to verify diagnosis and assess symptom severity. Patients completed the Defense Style Questionnaire within 48 hours of admission based on their current thoughts and beliefs. Logistic regressions were used to determine the best predictors of current suicide status. Consistently, the use of more image-distorting mechanisms was the best predictor of current suicide attempt. Symptom severity and past attempt were not significant predictors after controlling for influence of defense styles. Decreased use of image-distorting mechanisms in adult patients with major depressive disorder should be considered as a distinct target of therapy.
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Affiliation(s)
- Shushan Hovanesian
- Jamaica Hospital Medical Center, Department of Psychiatry, Jamaica, NY 11418, USA
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Brody S, Costa RM. Vaginal orgasm is associated with less use of immature psychological defense mechanisms. J Sex Med 2008; 5:1167-1176. [PMID: 18331263 DOI: 10.1111/j.1743-6109.2008.00786.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Freud implied a link between inability to have a vaginal orgasm and psychosexual immaturity. Since Kinsey, many sexologists have asserted that no such link exists. However, empirical testing of the issue has been lacking. AIM The objective was to determine the relationship between different sexual behavior triggers of female orgasm and use of immature psychological defense mechanisms. METHODS Women reported their past month frequency of different sexual behaviors and corresponding orgasm rates and completed the Defense Style Questionnaire (DSQ-40). MAIN OUTCOME MEASURE The association between ability to have vaginal intercourse orgasm (versus clitoral orgasm) and the use of DSQ-40 immature psychological defense mechanisms (associated with various psychopathologies) was examined. RESULTS In a sample of 94 healthy Portuguese women, vaginal orgasm (triggered solely by penile-vaginal intercourse) was associated with less use of DSQ-40 immature defenses. Vaginal orgasm was associated with less somatization, dissociation, displacement, autistic fantasy, devaluation, and isolation of affect. Orgasm from clitoral stimulation or combined clitoral-intercourse stimulation was not associated with less use of immature defenses, and was associated with more use of some immature defenses. In one regression analysis, more masturbation and less vaginal orgasm consistency made independent contributions to the statistical prediction of immature defenses. In another regression analysis, any use of extrinsic clitoral stimulation for intercourse orgasm, and lack of any vaginal orgasm, made independent contributions to the statistical prediction of immature defenses. Vaginally anorgasmic women had immature defenses scores comparable to those of established (depression, social anxiety disorder, panic disorder, and obsessive-compulsive disorder) outpatient psychiatric groups. Results were not confounded by social desirability responding or relationship quality. CONCLUSIONS The results linking penile-vaginal orgasm with less use of immature psychological defense mechanisms are consistent with both early psychoanalytic personality theory and recent advances in sexual physiology. Implications for diagnosis and sex therapy are noted.
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Affiliation(s)
- Stuart Brody
- Division of Psychology, School of Social Sciences, University of the West of Scotland, UK;.
| | - Rui Miguel Costa
- CEDEMA-Associação de Pais e Amigos dos Deficientes Mentais Adultos, Lisbon, Portugal
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Wachleski C, Blaya C, Salum GA, Vargas V, Leistner-Segal S, Manfro GG. Lack of association between the serotonin transporter promoter polymorphism (5-HTTLPR) and personality traits in asymptomatic patients with panic disorder. Neurosci Lett 2008; 431:173-8. [DOI: 10.1016/j.neulet.2007.11.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 11/05/2007] [Accepted: 11/29/2007] [Indexed: 12/16/2022]
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