Axis II symptomatology, depression, and life stress during the transition from adolescence to adulthood.

This study examined 2 models of the relationship between personality disorder symptomatology and depression, incorporating life stress as an intervening variable. In a community sample of late adolescent women, symptoms of Cluster B disorders predicted interpersonal chronic stress and self-generated episodic stress over 2 years, controlling for initial depression. Cluster A symptoms also predicted subsequent chronic interpersonal stress, over initial depression. Cluster C pathology did not predict subsequent stress. Personality disorder symptomatology was also associated with partner reported relationship dissatisfaction. Support was found for a mediation model whereby women with higher levels of initial personality disturbance in Clusters A and B generated excessive amounts of episodic stress and interpersonal chronic stress in the next 2 years, which, in turn, increased vulnerability for depressive symptoms. A moderation model, whereby the presence of greater personality disorder symptoms would increase the likelihood of depression in response to stress, was not supported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preliminary typology designed for treatment matching of driving-while-intoxicated offenders.

A typology of 156 convicted driving-while-intoxicated (DWI) offenders was developed using cluster analysis and external validation procedures. The typology was derived from 4 variables (alcohol dependence severity, psychiatric severity, bad-driving index, and social instability) selected to maximize the feasibility of performing treatment matching with DWI offenders. Five clusters that suggested specific treatment matching opportunities were identified. The largest, Cluster 4 (31% of cases), showed a low problem profile. However, a moderate-severity group (Cluster 1), a high-risk driver group (Cluster 2), and 2 high problem-severity groups (Clusters 3 and 5) were also found. Clusters 3 and 5 had high levels of alcohol dependence and psychiatric symptoms but differed significantly on social instability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of the Psychiatric Evaluation Form to quantify children's interview data.

Two interview reports for each of 207 children (aged 4–17 yrs) were available as a result of litigation requesting damages for "psychic impairment" of the survivors of a flood. Evidence was present that certain of the symptom scales on the Psychiatric Evaluation Form (PEF) could be reliably rated from the diagnostic reports by nonclinicians. Ratings from interviews conducted 6 mo apart by interviewers with different styles and purposes were significantly correlated. Information was also given about relationships among the scales, and a suggestion was made for clustering them. Clusters from each interview were significantly correlated with a global clinical impairment rating made at the time of the 2nd interview. Clusters from the 2 reports were also differentially predictive of 2 physical symptoms, enuresis and obesity. Evidence thus suggests that the PEF scales are a useful and valid means of quantifying children's interview data and can be used to examine research questions in clinical settings. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Complement activation, cytokines, and adhesion molecules in children undergoing cardiac surgery with or without cardiopulmonary bypass

Although obsessive-compulsive disorder (OCD) is often considered a heterogeneous condition, there is no generally accepted subtype typology. Cluster analysis was used to identify definitive symptom-based groupings of 106 OCD patients. A stable cluster solution was achieved and five patient subgroups were identified based on their pattern of symptoms on the Yale-Brown (Y-BOCS) symptom checklist: harming, hoarding, contamination, certainty and obsessionals. The five subgroups were characterized by dominant symptom patterns and significant secondary concerns reflecting the symptom heterorgenaity often seen in the clinical presentation of obsessional patents. Between cluster differences on multiple symptom measures were evaluated and several meaningful differences were identified. Cluster analytic procedures may prove to be a useful tool for identifying a functional taxonomy of OCD subtypes.     

Development of personality disorder symptoms and the risk for partner violence.

In a community sample (N = 543) followed over 20 years, the authors studied associations among childhood family violence exposure, personality disorder (PD) symptoms, and adult partner violence. PD symptoms (DSM-III-R Clusters A, B, and C) in early adulthood partially mediated the effect of earlier childhood risks on the odds of perpetrating partner violence. The authors tested whether stability of PD symptoms from adolescence to the early 20s differs for individuals who later perpetrated partner violence. Cluster A ("Odd/Eccentric") symptoms declined less with age among partner violent versus nonviolent men and women. Cluster B ("Dramatic/Erratic") symptoms were more stable through late adolescence in partner violent men, compared with nonviolent men and violent women. Cluster C ("Anxious") symptoms were most stable among partner violent men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Minnesota Multiphasic Personality Inventory (MMPI) cluster groups among chronically ill patients: relationship to illness adjustment and treatment outcome

Cluster analysis of the MMPI has been utilized widely in the chronic low back pain literature to try to identify reliable patient subtypes predictive of treatment outcome. We extended this methodology to patients with heterogeneous chronic medical conditions by replicating prototypic MMPI cluster group profiles and by relating cluster groups to clinical baseline and outcome data. Subjects were two independent samples (n = 254 and n = 263) of chronically ill patients admitted to an inpatient medicine/psychiatry unit. Using a four-cluster solution, similar cluster profile groups were replicated in both samples. Consistent differences emerged between cluster groups on functional impairment, psychiatric diagnoses, depression, and psychosomatic symptoms. Cluster group membership also predicted changes in functional impairment and depression six months after treatment. Results are discussed in terms of similarities between chronic low back pain and chronic illness and tailoring treatment to different patient types.     

A multicentre study of 513 Danish patients with systemic lupus erythematosus. I. Disease manifestations and analyses of clinical subsets

A Danish multicentre study was undertaken of the manifestations, infections, thrombotic events, survival and predictive factors of survival in 513 Danish patients with systemic lupus erythematosus (SLE) according to the 1982 classification criteria of the American College of Rheumatology. The mean duration of follow-up was 8.2 years from diagnosis and 12.8 years from first symptom. This paper describes the most common clinical and laboratory manifestations and their relationship to sex and age at the time of onset and diagnosis. Cluster analysis revealed three clinically defined clusters at the time of disease onset. Cluster 1 (57% of patients) consisted of relatively elderly patients without nephropathy or malar rash, but with a high prevalence of discoid lesions. Cluster 2 (18%) consisted of patients with nephropathy, a third of whom also developed serositis and lymphopenia. The patients of the third cluster (25%) all had malar rash and half were photosensitive. Follow-up showed that the patients of cluster 2 developed azotaemia, large proteinuria, arterial hypertension and myositis significantly more often than did the rest of the patients, but the mortality was not increased. The risk of developing renal end-stage disease was highest in men with early-onset disease.     

The early course of depression: A longitudinal investigation of prodromal symptoms and their relation to the symptomatic course of depressive episodes.

The present study explored longitudinal evidence for prodromal symptoms of depression episodes. A model based on previous findings of the relations between prodromal and residual symptoms was described and used to generate hypotheses tested in this study. Data were analyzed from 160 participants from the Cognitive Vulnerability to Depression (CVD) project (L. Alloy & L. Abramson, 1999) who experienced an episode of depression during the prospective follow-up period and 60 CVD participants who did not. Congruent with the hypothesis, individuals who subsequently developed an episode of depression experienced significantly greater numbers of depression symptoms in the period of time leading up to the acute episode compared with those who did not develop a depressive episode. Seven depression symptoms were particularly likely to appear before the onset of an acute episode. Furthermore, all 3 predictions from the model were supported: the durations of prodromal and residual phases were correlated, the prodromal and residual symptom profiles were quite similar, and the order of symptom onset was significantly and highly negatively correlated with the order of symptom remission. Additionally, residual symptom profiles were similar to subsequent prodromal symptom profiles in individuals who experienced more than 1 depressive episode. These findings are discussed in terms of the importance of understanding the earliest prodromal symptoms to appear and their relation to the symptomatic course of depression episodes. Implications for early intervention are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

5-HT2A and 5-HT2C receptor polymorphisms and psychopathology in late onset Alzheimer's disease

The psychopathology of Alzheimer's disease (AD) is varied and includes both behavioural and psychological symptoms. Behavioural and psychological symptoms are common and contribute to the difficulties experienced by carers. However, the mechanism whereby these symptoms occur in some individuals with AD is not understood. We hypothesized that common genetic polymorphisms in neurotransmitter systems are risk factors for these symptoms in the course of AD. A total of 211 subjects from a population-based prospective study of psychopathology within late-onset AD were genotyped for the 5-HT2A receptor polymorphism 102-T/C and the 5-HT2C receptor polymorphism Cys23Ser. Associations were found between the presence of the C102 allele and the presence of visual (Fisher's exact test, one-tailed, P = 0.003) and auditory hallucinations (Fisher's exact test, one-tailed, P = 0.004) and between the presence of the Ser23 allele and visual hallucinations (chi2 = 7.5, df = 1, P = 0.006) (P = 0.03, 0.04 and 0.06, respectively, after Bonferroni correction). In addition, there was an association between the Cys23Ser polymorphism and hyperphagia (chi2 = 6.7, df = 2, P = 0.03) (P = 0.3 after Bonferroni correction). We conclude that common 5-HT2A and 5-HT2C genetic polymorphisms previously showing only weak associations with psychotic illness are associated with psychotic symptoms in AD but are clinically silent until the onset of the neurodegenerative process.     

Effect of diuretics on sodium and chloride permeability in the rat papillary collecting duct

Consecutive male (n=100) and female (n=100) DSM-IV schizophrenics newly registered for treatment in a large psychiatric hospital were examined with regard to age at onset of the first psychotic symptom. Age at onset of the first psychotic symptom did not differ between the sexes regardless of whether schizophrenia was diagnosed by DSM-IV or by several alternative systems. Age at onset defined by other criteria, namely age at first contact with a physician, and age at first admission for psychiatric care, also did not show any differences between the sexes. Survival analysis of subjects having a documented date of birth revealed a female preponderance at younger ages. A higher positive symptom score predicted older age at onset of the first psychotic symptom in the total sample. These findings call into question the universality of the traditional view of a younger age at onset of schizophrenia among males. Tentative neurodevelopmental and cultural explanations are presented to explain why there is no sex difference in age at onset of schizophrenia in India.     

Groundwater Classification Using Multivariate Statistical Methods: Birimian Basin, Ghana

Groundwater from the aquifers of Birimian system in the northern and southern sections of the country was sampled for the concentrations of the major ions in the area. The objective was to determine the spatial groundwater associations which will in turn be used to infer the position of each groundwater group in the flow system. In addition, this study intended to determine the major sources of variation in the hydrochemistry and the suitability of groundwater from aquifers of the Birimian system for irrigation activities. R-mode factor and Q-mode hierarchical cluster analyses were used together with conventional graphical techniques. This study revealed four groundwater associations (clusters) representing three major groundwater types in the Birimian System: the Ca–HCO3 water types which make up Clusters (groups) 1 and 2 members; the Na-K-Cl water types comprising cluster 3 members, and Mg–HCO3 water types comprising Cluster 4 members. Cluster 2 has the lowest average electrical conductivity of 194 mS/m with total dissolved solids (TDS) ranging between 50 and 250 mg/L. This is the freshest groundwater type in the area and is typical of groundwater in recharge areas of the groundwater flow system. Cluster 1 members range in salinity between 50 and 500 mg/L. The highest average salinity is contained in Cluster 3, with TDS in the range of 300 to 1,000 mg/L, which is characteristic of groundwaters in discharge areas of the groundwater flow system. Members of this group are also characterized by high fluoride concentrations; average fluoride concentration in this group is 4.60 mg/L. Cluster 3 is the least desirable of the four clusters, for domestic water supply. Cluster 4 has TDS in the range of 300 and 1,000 mg/L, with low fluoride content. This study finds that the hydrochemistry of groundwater in the terrain is controlled by three major factors: silicate mineral weathering and cation exchange, carbonate mineral weathering, and chemical fertilizers from farms in the area. All the groundwater clusters have low sodium content and will not pose the sodium hazard when used for irrigation. However, as a result of high permeability indices, all but one of the Cluster 2 members plot within the class III region of the Doneen’s chart and are therefore unsuitable for irrigation on these grounds. Clusters 3 and 4 members are the best water types, while Cluster 1 members are equally distributed between Classes II and III categories.     

Age at onset and language disturbances in Alzheimer's disease

This study examined the effect of age at symptom onset of Alzheimer's disease (AD) on the pattern of language disturbance. We assessed 150 consecutive patients with a clinical diagnosis of mild-to-moderate AD using the Western Aphasia Battery and a 100-item picture-naming test. A multivariate linear regression analysis examined the effect of age at onset after controlling for gender, education, severity of dementia and duration of the disease. Patients with early onset performed significantly worse than did patients with late onset on the word comprehension and sequential commands subtests. On the other hand, late-onset patients performed more poorly than early-onset patients on the picture-naming test in a subgroup with mild language deficits. However, the trend disappeared in other subgroups with more degraded language function. We consider that the concomitant effects of normal aging worsened the picture-naming deficits in the late-onset patients, and the rapid decline of naming ability in the early-onset patients masked the aging effect with the progression of language deficits. The deterioration of word comprehension and the rapid decline of naming ability are the characteristics of early-onset patients. The different patterns of language deficits between early- and late-onset patients may correspond to the genetic heterogeneity of AD.     

Relations of sociotropic and autonomous personality characteristics to specific symptoms in depressed patients.

A number of writers have suggested that two sets of personality characteristics are associated both with vulnerabilities to depression in response to different classes of events and with different clinical presentations of depression. The present study examined the relations between levels of sociotropic and autonomous personality characteristics and specific, theoretically derived clusters of symptoms in 80 unipolar depressed patients. As was predicted, sociotropy was related to the cluster of symptoms associated with the concept of anxious-reactive depression and was unrelated to the autonomous symptoms cluster. In contrast, the predicted relations of autonomous personality characteristics and symptoms were not found. These results support the idea that the symptom picture in depression may be related to personality characteristics, but they also suggest that the measurement of autonomy may require revision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative affect and the reporting of physical symptoms among college students.

This study examined relations between negative affect and the reporting of physical symptoms for a group of college students by empirically deriving, through cluster analyses, two profiles that differed in their levels of trait anxiety, trait anger, and depressive symptoms, and then evaluating differences in symptom reporting between these two profiles. Analyses revealed that persons with an elevated profile of negative affect reported being bothered by physical complaints statistically more often than those persons with the converse profile. Additional analyses indicated that the relation between levels of negative affect and physical complaints was mediated by trait anxiety. Physical symptom reporting is discussed in the context of its being a possible correlate of neuroticism. The mediating role of anxiety and implications for counseling are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Visiting the father''s grave

General population data are presented on patterns and predictors of temporal progression of alcohol dependence symptoms in the general population. The data come from the National Comorbidity Survey, a nationally representative general population survey of respondents ages 15-54. Lifetime symptom classes were estimated with latent class analysis (LCA). A 4-class LCA solution, including a 1st asymptomatic class and 3 progressively more serious symptomatic classes, was found to fit the data. Probability of initial symptom onset among drinkers was found to be highest in the 10-24 age range, to be higher among men than women, and to have increased dramatically in the past 4 decades. Age, gender, and cohort effects were less powerful in predicting symptom progression. A narrowing of the gender difference over time was due largely to a convergence in initial symptom onset among men and women ages 10-24. These results suggest that a rise in initial problems was more important than an increase in the transition from problems to dependence in accounting for the growing prevalence of alcohol dependence during the post-World War II years in the United States.     

The symptom perception hypothesis revised: Depression and anxiety play different roles in concurrent and retrospective physical symptom reporting.

According to the classic symptom perception hypothesis (Costa & McCrae, 1987; Watson & Pennebaker, 1989), the global predisposition to frequently experience a variety of negative emotions—that is, neuroticism (N) or trait negative affectivity (NA)—is associated with inflated physical symptom reporting. We tested a revision of this hypothesis, which posits distinctive roles for depression and anxiety in the physical symptom experience. Three studies tested predictions from the revised symptom perception hypothesis: (a) that depressive affect should be related to inflated retrospective physical symptom reports and (b) that anxious affect should be related to inflated concurrent, or momentary, physical symptom reports. Study 1 assessed the relations among N/NA, depressive affect, and recall of physical symptoms experienced in the previous 3 weeks. Depressive affect was uniquely and positively associated with recalling more symptoms. When entered with depressive affect in multiple regression analyses, neuroticism was not associated with level of symptoms recalled. In Study 2, participants were randomly assigned to anxious, depressed, angry, happy, or neutral mood inductions and then reported about concurrent symptom experience. Participants in the anxious mood condition reported significantly more concurrent physical symptoms than did those in the other 4 conditions. In Study 3, anxious, depressed, or neutral mood was induced, followed by assessment of both concurrent and retrospective physical symptoms. Those assigned to the anxious mood induction reported more concurrent symptoms, while those in the depressed mood condition reported having experienced more symptoms in the past. These findings are consistent with the idea that encoding and retrieval processes, which are differentially associated with anxious versus depressed affect, influence different aspects of physical symptom reporting. The results have implications for self-diagnosis, medical treatment-seeking, and care, and potential insights about other complex social and interpersonal behaviors are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal progression of alcohol dependence symptoms in the U.S. household population: Results from the National Comorbidity Survey.

General population data are presented on patterns and predictors of temporal progression of alcohol dependence symptoms in the general population. The data come from the National Comorbidity Survey, a nationally representative general population survey of respondents ages 15–54. Lifetime symptom classes were estimated with latent class analysis (LCA). A 4-class LCA solution, including a 1st asymptomatic class and 3 progressively more serious symptomatic classes, was found to fit the data. Probability of initial symptom onset among drinkers was found to be highest in the 10–24 age range, to be higher among men than women, and to have increased dramatically in the past 4 decades. Age, gender, and cohort effects were less powerful in predicting symptom progression. A narrowing of the gender difference over time was due largely to a convergence in initial symptom onset among men and women ages 10–24. These results suggest that a rise in initial problems was more important than an increase in the transition from problems to dependence in accounting for the growing prevalence of alcohol dependence during the post-World War II years in the United States. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

EEG spectral abnormalities and psychosis as predictors of cognitive and functional decline in probable Alzheimer's disease

We examined whether either psychotic features (e.g., delusions and hallucinations) or EEG abnormalities are associated with more rapid progression of Alzheimer's disease (AD). AD patients with psychosis have exhibited more EEG abnormalities than those without psychosis, and both abnormal EEG and psychosis have been noted to be predictors of functional and cognitive decline in AD. Ninety-five probable AD patients participating in a longitudinal study of dementia had an EEG and a semistructured psychiatric interview at baseline. Using EEG spectral analysis, we classified records as normal/abnormal based on the parasagittal mean frequency. Patients with abnormal EEGs were more functionally (e.g., Blessed Rating Scale for activities of daily living) and cognitively (e.g., Mini-Mental State) impaired than patients with normal EEG. AD patients with psychosis were only more functionally impaired than patients without psychosis. A two-factor analysis showed no interaction between abnormal EEG and psychosis. In addition, using a Cox proportional hazard model adjusted for age and education, the presence of an abnormal EEG or psychotic symptom at study entry was associated with higher risk of reaching severe cognitive and functional impairment during follow-up. Neither abnormal EEG nor the presence of psychosis predicted death. These results indicate that both abnormal EEG and psychosis are independent predictors of disease progression but not of physical survival.     

Externalizing and Internalizing Subtypes of Combat-Related PTSD: A Replication and Extension Using the PSY-5 Scales.

This study replicated and extended prior findings of internalizing and externalizing subtypes of posttraumatic response (M. W. Miller, J. L. Greif, & A. A. Smith, 2003). Cluster analyses of the Minnesota Multiphasic Personality Inventory-2 Personality Psychopathology-Five (MMPI-2 PSY-5; A. R. Harkness, J. L. McNulty, Y. S. Ben-Porath, 1995) profiles obtained from 736 veterans with posttraumatic stress disorder (PTSD) partitioned the sample into a low pathology cluster defined by personality scores in the normal range, an externalizing cluster characterized by low constraint and high negative emotionality, and an internalizing cluster with high negative emotionality and low positive emotionality. Externalizers showed the highest rates of alcohol-related and antisocial personality disorders; internalizers, the highest rates of panic and major depressive disorder. These findings support the development of a personality-based typology of posttraumatic response designed to account for heterogeneity in the expression of PTSD and associated psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)