Chris Schotte

The Effects of Psychological Stress on Leukocyte Subset Distribution in Humans: Evidence of Immune Activation

The aim of the present study was to examine the effects of academic examination stress on leukocyte subset distribution in university students. Thirty-eight university students had repeated blood collections for white blood cell differentiation and flow cytometric assay of lymphocytic subsets a few weeks before and after (i.e. two baseline conditions) as well as the day before a difficult academic examination (i.e. stress condition). Flow cytometry was used to determine the number of peripheral blood mononuclear cells (PBMC). In students, who were reactors to psychological stress (criterion based on changes in the Perceived Stress Scale, PSS), but not in stress non-reactors, a significant increase in the number of neutrophils, monocytes, CD8+, CD2+CD26+, and CD2+HLA-DR+ T cells and CD19+ B cells, and significant reductions in the CD4+/CD8+ T cell ratio were observed in the stress condition. There were significant and positive relationships between the stress-induced changes in perceived stress (PSS scale) and number of leukocytes, neutrophils, CD2+, CD2+CD26+ and CD2+HLADR+ T cells, and CD19+ B cells. There were significant and negative relationships between the stress-induced changes in the CD4+/CD8+ ratio and the stress-induced changes in the PSS scale. Female students taking oral contraceptives showed significantly higher stress-induced responses in number of leukocytes, neutrophils and CD19+ B cells than male and female students without use of oral contraceptives. The results suggest that academic examination stress induces changes in the distribution of PBMC, which indicate immune activation and which are probably orchestrated by a stress-induced production of cytokines.

The prediction of suicidal intent in depressed patients.

The aim of the present study was to examine the relationships between suicidal ideation or suicidal attempts and severity of depression, presence of personality disorders, and sociodemographic factors in a population of depressed in‐patients. A total of 338 adult depressed psychiatric in‐patients were examined and classified according to DSM‐III criteria as having major depression with or without melancholic or psychotic features, adjustment disorder with depressed mood or dysthymic disorder. Scores on the Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI) and Zung Self‐Rating Depression and Anxiety Scales (SDS and SAS) were measured. We found that suicidal ideation was significantly related to severity of depression (according to the HDRS and all self‐rating scales), a lower global assessment of functioning the year before hospitalization, and previous psychiatric hospitalizations. The items with the strongest predictive value for suicidal ideation were hopelessness, depressed mood, feelings of guilt, loss of interest and low self‐esteem. These symptoms predicted 43% of the variance in suicidal ideation. None of the above predictors of suicidal ideation was related to suicidal attempts. Depressed patients with a personality disorder attempted significantly more suicidal attempts and showed more suicidal ideation than depressed patients without personality disorder. No significant correlations were found between suicidal ideation or suicide attempts and gender, marital status, employment status or psychosocial stressors during the previous 6 months.

Significantly increased expression of T-cell activation markers (interleukin-2 and HLA-DR) in depression : further evidence for an inflammatory process during that illness

1. Recently, the authors have reported that severe depression may be accompanied by a systemic immune activation with an increase in the number of T cells expressing activation receptors. 2. The present large-scale study examines specific T (CD2+HLADR+ and CD7+CD25+) and B (CD7-CD25+) cell activation markers in depressed inpatients and normal volunteers together with the number of leukocytes and monocytes. 3. The authors have established that depression is characterized by a significantly increased expression of T cell activation receptors (CD7+CD25+) and by the appearance of previously unexpressed T cell surface markers (CD2+HLADR+). There was a significant and positive correlation between the number of CD7+CD25+ cells and monocytes, with the expression of the HLADR and CD25 T cell activation markers being significantly and positively correlated. Up to 64% of all depressed subjects exhibit an increased expression of these activation markers with a specificity of 91%. 4. The normal control group and the depressive sample constitute two discrete classes (i.e., qualitatively distinct groups) with respect to the expression of these activation markers and leukocytosis. 5. It is concluded that our results are compatible with the presence of T-cell activation in a considerable number of depressed patients.

Epidemiologic and phenomenological aspects of post-traumatic stress disorder: DSM-III-R diagnosis and diagnostic criteria not validated

The aim of this cohort study was: (i) to validate the diagnostic criteria for post-traumatic stress disorder (PTSD) of the DSM-III-R; and (ii) to examine the incidence rate of PTSD in a study population exposed to two different traumatic events, i.e. a fire in a hotel ball-room and a multiple collision car-crash on a Belgian highway. One hundred and eighty-five victims (130 fire and 55 car accident victims) were assessed between 7 and 9 months after the traumatic event using the Composite International Diagnostic Interview (CIDI), PTSD Module, a fully structured diagnostic interview for the assessment of PTSD according to DSM-III-R criteria. Twenty-three percent of the study population met DSM-III-R criteria for PTSD. By means of unsupervised and supervised multivariate statistical analyses we were unable to validate the three-factorial structure, i.e. criteria B, C and D, of the DSM-III-R PTSD diagnosis. The latter relies heavily on the C diagnostic criteria, which appear to be too restrictive. Women were more likely to develop symptoms of reexperience (B) and arousal (D) than men. There was a significantly higher incidence of criteria B, C and D, but not of PTSD, in fire than in car-accident victims. Between 42 and 57% of the victims developed the first PTSD symptoms on the day of the trauma; within the next week these incidence rates increased to 77.1, 57.8 and 73.5% for criteria B, C and D, respectively. In conclusion, this study was unable to demonstrate the validity of the diagnostic criteria for PTSD according to DSM-III-R. The present cohort study has defined a number of factors that may predict new occurrences of PTSD symptoms after a traumatic event, i.e. gender, type of trauma and time delay between the trauma and the assessment of the diagnostic criteria.

The two-factorial symptom structure of post-traumatic stress disorder: depression–avoidance and arousal–anxiety

UNLABELLEDnThe first part of this study showed that the DSM-III-R symptom structure of post-traumatic stress disorder (PTSD), i.e. criteria B (reexperience), C (avoidance-numbing), and D (arousal), and, consequently the diagnosis of PTSD, could not be validated in fire and car-accident victims. The aims of this study were to: (i) determine the factors as well as their structure in the symptoms of PTSD; and (ii) develop a new classification or typology of PTSD. Exploratory and confirmatory factor analyses and cluster analyses were employed to: (i) examine the factors in PTSD symptomatology; and (ii) find and validate adequate diagnostic criteria for PTSD. The Composite International Diagnostic Interview (CIDI), PTSD Module, was used between 7 and 9 months after the traumatic event in a study group of 185 victims of two different traumatic events, i.e. 130 fire and 55 car-accident victims. Our findings support the existence of two factors, i.e. a first labeled depression-avoidance (DAV) dimension, as it contains items reminiscent of depression and avoidance, and a second labeled the anxiety-arousal (AA) dimension, as it contains symptoms reminiscent of anxiety and increased arousal. Cluster analysis yielded two clusters, i.e. a cluster of subjects with PTSD cases and another with non-cases. Our PTSD algorithm was significantly less restrictive than the DSM-III-R diagnosis of PTSD. There are only quantitative, but no qualitative, differences between the cluster analytically derived classes.nnnIN CONCLUSIONnPTSD is not a well-delineated clinical entity, as there is a clinical continuum from PTSD non-cases to cases with less and more severe DAV and AA symptoms. It is more appropriate to express PTSD in terms of general severity of PTSD and severity of the DAV and AA dimensions.

Cluster analytic validation of the DSM melancholic depression. The threshold model: integration of quantitative and qualitative distinctions between unipolar depressive subtypes

Cluster analysis was performed on the DSM-III symptoms of major depression and symptoms of melancholia identified in a study group consisting of 220 unipolar depressed inpatients a melancholic and non-melancholic cluster. Patients allocated to the melancholic cluster were more severely depressed and they were characterized by psychomotor disorders, a distinct quality of mood, diurnal variation, early morning awakening, and non-reactivity. Our results support the construct validity of the DSM-III melancholic subtype of major depression. This study supports the integrated threshold model:. (i) melancholic and non-melancholic depression may be regarded as continuous classes in terms of overall severity of depression; and (ii) both groups form discrete categories with regard to the melancholic symptoms, which emerge as the severity of depression increases.

Use of the Temperament and Character Inventory (TCI) for Assessment of Personality in Chronic Fatigue Syndrome

BACKGROUNDnChronic fatigue syndrome (CFS) is characterized by severe and prolonged fatigue, along with a set of nonspecific symptoms and signs, such as sore throat, muscle pain, headaches, and difficulties with concentration or memory.nnnOBJECTIVEnThe study examined whether CFS is associated with specific dimensions of Cloningers psychobiological model of personality.nnnMETHODnPersonality profiles were compared between 38 CFS patients and 42 control subjects by means of the Temperament and Character Inventory (TCI).nnnRESULTSnThe CFS group showed significantly higher scores on Harm-Avoidance and Persistence.nnnCONCLUSIONnThe current study shows a significant association between specific personality characteristics and CFS. These personality traits may be implicated in the onset and/or perpetuation of CFS and may be a productive focus for psychotherapy.

Results of the 8 a.m. Dexamethasone Suppression Test Constitute a Suitable Tool for Confirming the Diagnosis of Melancholia

This prospective study was conducted in order (1) to examine which postdexamethasone cortisol value i.e., 8 a.m., 4 p.m. or peak cortisol - is most suitable as a laboratory test to help confirm the diagnosis of melancholia and (2) to investigate the influence of the dexamethasone levels in the results of the dexamethasone suppression test (DST). To this end we administered the DST to 48 controls and 115 depressed inpatients categorized according to DSM-III. The 8 a.m. and 4 p.m. dexamethasone levels were determined in 100 subjects. We found that an 8 a.m. postdexamethasone cortisol value greater than or equal to 3.5 micrograms/dl was of the most significant diagnostic value in order to separate melancholia from normal controls and/or minor depressives. The 8 a.m. and 4 p.m. dexamethasone values did not differ between healthy controls, minor and severely depressed patients. Although cortisol nonsuppressors exhibited significantly lower dexamethasone values, the predictive value of the DST for melancholia was not affected by the large variation in the bioavailability of dexamethasone.

Prevalence of DSM-IV personality disorders in patients with chronic fatigue syndrome: A controlled study

Background It is not yet clear whether chronic fatigue syndrome (CFS) is associated with elevated levels of personality disorders.PurposeThis study aims to determine the prevalence of DSM-IV axis II personality disorders among patients with CFS.MethodsWe examined the prevalence of personality disorders in a sample of 92 female CFS patients and in two well-matched control groups, i.e., normal community individuals (Nu2009=u200992) and psychiatric patients (Nu2009=u200992). Participants completed the assessment of DSM-IV personality disorders questionnaire (ADP-IV), which yields a categorical and dimensional evaluation of personality disorder features.ResultsThe prevalence of personality disorders in CFS patients (16.3xa0%) was significantly lower than in psychiatric patients (58.7xa0%) and was similar to that in the community sample (16.3xa0%). Similar results were found for dimensional and pseudodimensional scores, except for the Depressive (DE) and Obsessive–Compulsive Personality Disorder (O-C) subscales. Patients with CFS had significantly higher levels of DE features compared to normal controls and similar dimensional scores on the O-C scale compared to psychiatric controls.ConclusionsAlthough the CFS sample was characterized by depressive and obsessive–compulsive personality features, this study provides no evidence for the assumption that these patients generally show a higher prevalence of axis II pathology. Given the conflicting findings in this area, future studies using multiple measures to assess personality disorders in CFS are needed to substantiate these findings.

De adp-iv: een vragenlijst voor een therapeutisch georiënteerde diagnostiek van persoonlijkheidsstoornissen

Sinds de introductie van de persoonlijkheidsstoornissen als aparte as (As ii) in de dsm staan deze stoornissen sterk in de belangstelling. Dit blijkt onder andere uit de grote belangstelling voor symposia en workshops over de diagnostiek en de behandeling van persoonlijkheidsstoornissen. Vanuit diverse therapeutische scholen is er eveneens een duidelijke interesse gegroeid voor deze problematiek. Die tendens is ook merkbaar binnen richtingen waarin traditioneel met enige aversie op de concepten persoonlijkheid en persoonlijkheidsstoornissen werd gereageerd, zoals de gedragstherapeutische of systeemgeorienteerde benadering. Het begrip persoonlijkheids- of As-ii-stoornis heeft zich ontwikkeld van een negatief en bijzonder ongewenst etiket tot een diagnostische uitspraak die meer en meer begrepen wordt als het (eind)resultaat van interacties tussen de persoon zelf, zijn of haar ontwikkelingsgeschiedenis en omgevings- en biologische factoren. Deze benadering wordt binnen de cognitief-gedragstherapeutische denkkaders op treffende wijze geillustreerd door de benadering van Jeffrey Young1.