Frank W. Brown

The comorbidity of DSM-III-R personality disorders in somatization disorder

In order to understand psychiatric factors that complicate the medical management of somatizing patients, 94 subjects with known somatization disorder (SD) were evaluated for 13 personality disorders with the Structured Clinical Interview for DSM-III-R Personality Disorders. Referred from multiple primary care settings, the patient sample was predominantly female (85%), married (67%), high school graduates (64%), and had a mean age of 43. Structured interviews documented that 23.4% of SD patients had one personality disorder, and 37.2% had two or more disorders. The four most frequently identified personality disorders were avoidance 26.7%, paranoia 21.3%, self-defeating 19.1%, and obsessive-compulsive 17.1%. Interestingly histrionic personality disorder was identified in only 12.8% of the sample and antisocial personality disorder in 7.4%. In making the diagnosis of SD, health care providers need to avoid the common clinical impression that histrionic behavior often accompanies the disorder. Further research with SD patients is needed to examine the relationship of co-occurring personality disorders to symptom recurrence, health care utilization, and readiness for psychiatric referral.

Schizophrenia, substance use, and brain morphology

The high rate of comorbid substance abuse in schizophrenia and the consistently poor outcome of this comorbidity are well established findings in the research literature. However, the reasons for the high rate of comorbidity are not adequately understood, and the question of why some patients with schizophrenia abuse substances and others do not remains unanswered. There is widespread agreement about the clinical heterogeneity of schizophrenia, and there is some evidence suggesting that the heterogeneous clinical presentation may reflect a parallel underlying heterogeneity of brain morphology. We were interested in examining the possibility that the high rate of substance abuse and the characteristically poor outcome may be associated with the underlying brain morphology. Our hypothesis was that study subjects with schizophrenia and substance abuse would have higher rates of gross brain abnormalities than subjects with only schizophrenia. In an attempt to explore this possibility, we looked at qualitative differences in magnetic resonance imaging scans for a large sample (n = 176) of schizophrenia patients. In the group of patients who abused both alcohol and drugs, we found the rate of gross brain abnormalities to be slightly less than half the rate found among the patients with no history of alcohol or substance abuse (8 vs. 19). Although these results are not statistically significant, they reflect a trend that is compatible with previous findings, suggesting that substance abuse history may be accompanied by less impairment in certain areas, which in turn may be reflected in a better premorbid adjustment. However, our findings are not compatible with previous findings that show substance abuse to be associated with more severe symptoms and a poorer outcome in schizophrenia.

Screening indexes in DSM-III-R somatization disorder

A sample of 196 general medical patients with multiple unexplained somatic complaints was used to compare the performance (sensitivity and specificity) and positive and negative predictive values for the published screening indexes for somatization disorder. This study shows similar performances for both the DSM-III-R and the Swartz et al. screening indexes for somatization disorder with use of DSM-III-R diagnostic criteria. By use of Receiver Operating Characteristic (ROC) curve analysis, graphs of achievable sensitivity and specificity through the range of possible symptom thresholds allow for a more informed decision to be made concerning which screening index to use at a given symptom threshold. Positive predictive values for screening indexes ranged from 68% to 79%, and negative predictive values ranged from 72% to 81%. Use of a screening index is suggested in medical patients with unexplained complaints and in patients seen in the consultation-liaison (CL) setting.

Characteristics of an Adenylate Cyclase Coupled β-Adrenergic Receptor in a Smooth Muscle Tumor Cell Line

AbstractWe have shown that binding of 3H-dihydroalprenolol ([3H] DHA) to DDT1 MF-2 cells and cell membranes was of high affinity, saturable, stereoselective and reversible. The [3H]DHA dissociation constants were 0.63 ± 0.15 nM (n=6) and 0.83 ± 0.04 nM (n=5) for intact cells and cell membranes, respectively, with a binding site concentration for cells of 27,300 ± 5,200 sites/ cell (n=6) and for membranes 468 ± 24 fmoles/mg protein (n=5). The order of agonist competition for the [3H]-DHA binding site of DDT1 cell membranes was isoproterenol (Ki = 0.20 ± 0.07 μM) > epinephrine (Ki = 0.4 ± 0.2 μM) > norepinephrine (Ki = 66.5 ± 5.15 μM) consistent with a β2-selective receptor interaction. Zinterol, a β2-selective antagonist, (Ki = 0.05 ± 0.01 μM) was 18x more effective than metoprolol, a β1-selective antagonist (Ki = 0.9 ± 0.1 μM), in competing for the DHA binding site. A nonlinear iterative curve fitting analysis of zinterol and metoprolol binding isotherms indicated that (p>0.05) DDT1 cells possess a pure p...

Diagnostic Concordance in Primary Care Somatization Disorder

A sample of 196 primary care patients with multiple unexplained complaints was used to examine diagnostic concordance between the Feighner criteria, the Research Diagnostic Criteria, DSM-III criteria, and DSM-III-R criteria for somatization disorder. The DSM-III-R diagnostic criteria for somatization disorder maintain a high concordance with the DSM-III criteria for somatization disorder (Kappa = 0.91), a moderate concordance with the Feighner criteria (Kappa = 0.66), but only a fair concordance with the Research Diagnostic Criteria (Kappa = 0.47). These results provide further evidence that DSM-III-R describes a slightly different sample of somatization disorder patients than does the Feighner and Research Diagnostic Criteria.

White matter hyperintensity signals associated with vascular risk factors in schizophrenia

1. A sample of 165 schizophrenic subjects was compared to a normal control group in order to evaluate associations between white matter hyperintensity signals and vascular risk factors. 2. A comprehensive medical chart review was completed on all subjects evaluating potential vascular risk factors. Brain MRI acquisition was performed with 0.5 and 1.5 Telsa Philips scanners. 3. Prevalence rates of WMH signals in schizophrenic subjects and normal controls were 4.8% and 4.9%, respectively. 4. A significant association was found for schizophrenics with WHM signals to schizophrenics without signals for hypertension and history of CVAs. 5. This finding is consistent with an etiology of WMH signals in schizophrenia being related to vascular disease.