Rorschach correlates of adolescent self-mutilation

Association between thyroid function and comorbid anxiety in first-episode and drug naïve patients with major depressive disorder

OBJECTIVE

Existing studies have shown that thyroid dysfunction is associated with depression. However, its role in major depressive disorder (MDD) with comorbid anxiety remains unclear. The main purpose of this study was to compare thyroid function in a large sample of first episode drug naïve (FEDN) MDD patients with and without anxiety.

METHODS

This cross-sectional study examined 1718 outpatients who were drug-naïve and diagnosed as MDD at first episode. Socio-demographic and clinical data, as well as thyroid function-related parameters, including free thyroxine (FT4), free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin (TGAb), were evaluated. The Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and the positive subscale of the Positive and Negative Syndrome Scale (PANSS) were used to evaluate depressive, anxiety and psychotic symptoms, respectively.

RESULTS

Compared to MDD patients without anxiety, MDD patients with anxiety were more likely to have more suicide attempts and psychotic symptoms, as well as higher serum levels of TSH, TPOAb and TGAb (all p < 0.001). Among patients with abnormally elevated serum TSH, TPOAb, and TGAb, 83.5% (872/1044), 89.3% (391/438) and 89.6% (266/297) had comorbid anxiety disorders, respectively. The odds ratio between patients with comorbid and without comorbid anxiety was 1.657 (95% CI 1.304-2.105) for elevated TSH levels, 1.943 (95% CI 1.444-2.613) for elevated TGAb levels, and 2.448 (95% CI 1.760-3.403) for elevated TPOAb levels. Furthermore, multivariable linear analysis showed that elevated TSH and TGAb were significant predictors of anxiety in MDD patients.

CONCLUSIONS

Our results suggest that comorbid anxiety in FEDN MDD patients is positively associated with elevated TSH and TGAb levels, which may be promising biomarkers of comorbid anxiety in MDD patients. Clinical treatment of impaired thyroid function may be useful for comorbid anxiety in MDD patients.

The Rorschach Comprehensive System (CS) Psychometric Validity of Individual Variables

Since the publication of the Rorschach Inkblot Method (Rorschach, 1921/1942 ), theorists, researchers, and practitioners have been debating the nature of the task, its conceptual foundation, and most important its psychometric properties. The validity of the Rorschach Comprehensive System (CS; Exner, 1974 , 2003; Exner & Weiner, 1995 ) has been supported by several meta-analyses that used different types of nontest external criterion for validating individual variables. In a recent meta-analysis, Mihura, Meyer, Dumitrascu, and Bombel ( 2013 ) found coefficients ranging from modest to excellent for most of the selected CS variables, with 13 of them reported as showing "little to no support." This article focuses on these variables. Although endorsing Mihura et al.'s mainly validating findings, we also suggest that the evidence presented for the little or no validity of these 13 variables is not quite compelling enough to warrant changing their definition or coding, or removing them from the system. We point to some issues concerning the description and interpretation of these variables and the appropriateness of the external criteria used for exploring their validity, and suggest considering these issues in further CS research. Implications of Mihura et al.'s meta-analysis for clinical and forensic practice are discussed.