Humberto Lizardi

Reports of the childhood home environment in early-onset dysthymia and episodic major depression

This study addressed 2 questions: (a) is early-onset dysthymia associated with reports of a disturbed childhood home environment; and (b) can adverse early experiences account, at least in part, for the differing clinical presentations of dysthymia and major depression? Participants included 97 outpatients with early-onset dysthymia, 45 outpatients with episodic major depression, and 45 normal controls. The early home environment was assessed blind to diagnosis using both interview and self-report measures. Early-onset dysthymia patients reported significantly more physical and sexual abuse and poorer relationships with both parents than normal controls. In addition, patients with dysthymia reported having received significantly poorer parenting than those with episodic major depression. The results could not be accounted for by mood state effects, comorbidity with borderline and antisocial personality disorder, or comorbid major depression.

Long-term stability of parental representations in depressed outpatients utilizing the Parental Bonding Instrument.

This study addressed two questions: (a) What are the 30-month, 60-month, and 90-month test-retest reliabilities of the Parental Bonding Instrument (PBI); and (b) are recollections of parental bonding stable across changes in the level of depressed mood? Participants included 97 outpatients with primary early-onset dysthymic disorder and 45 outpatients with episodic major depressive disorder. Follow-ups were conducted at 30, 60, and 90 months after entry into the study. The PBI was scored using both the original two-factor model and a three-factor solution. As indexed by intraclass correlations, stability for the original two-factor model ranged from .64 to .88, with a median of .77. The intraclass correlations for the three-factor model ranged from .54 to .87, with a median of .73. The intraclass correlations were generally higher between adjacent assessments, but the decrease over increasingly longer intervals was quite small. Overall, the results indicated that the PBI is highly stable for intervals as long as 90 months. In addition, reports of parental bonding were relatively stable despite significant changes in the level of depressed mood. Thus, the present study provides evidence for the long-term stability of parental representations, as measured by the PBI, in depressed outpatients.

Relationship of sociotropy/autonomy and dependency/self-criticism to DSM-III-R personality disorders.

Relationships between Becks constructs of sociotropy/autonomy and Blatts constructs of dependency/self-criticism and the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) Axis II personality disorders were examined. Two measures of personality styles and a structured diagnostic interview for personality disorders were administered to 138 outpatients. Significant relationships were found between both sets of constructs and a number of personality disorders using both categorical and dimensional measures of Axis II psychopathology. These relationships were consistent with previous theory, supporting recent conceptualizations extending the range of psychopathology associated with these personality styles from depression to the personality disorders. However, the autonomy/self-criticism dimension was correlated with a broader range of personality disorder traits and diagnoses than anticipated.

Covergent and Discriminant Validity of Perceived Criticism From Spouses and Family Members

As a more efficient alternative to measuring expressed emotion (EE) in families, Hooley and Teasdale (1989) measured perceived criticism (PC) from spouses by asking patients: “How critical is your spouse of you?” using a 10-point Likert scale. The PC item was highly predictive of relapse of depressive episodes, even more so than EE derived from the lengthy Camberwell Family Interview (CFI; Vaugn & Leff, 1976b ). However, this item has undergone little validation. Hence, PC could be associated with other factors (third variables) that could account for its relationship with relapse of depressive episodes. The present study examined the convergent and discriminant validity of PC from both spouses and family members by correlating it with measures of depression, personality, and social functioning. Subjects included outpatients meeting DSM-III-R criteria for major depression or dysthymia. PC did not correlate with measures of depression or maladaptive personality traits and was moderately correlated with measures of social functioning. Hence, PC demonstrated excellent discriminant validity and moderate convergent validity.

The subaffective-character spectrum subtyping distinction in primary early-onset dysthymia: a clinical and family study

In 1983, Akiskal proposed that primary early-onset dysthymia should be divided into two subtypes: subaffective dysthymia, which is a subsyndromal form of major mood disorder; and character spectrum disorder, which is a form of personality disorder with secondary dysphoria. The present study attempted to validate this distinction. Akiskals (1983) criteria were applied to a sample of 97 early-onset dysthymic outpatients, yielding groups of 41 subaffective and 56 character spectrum patients. Patients were evaluated using structured interviews for Axis I and II disorders, family history of psychopathology, and the early home environment, and a comprehensive battery of questionnaires. In addition, direct and family history interviews were conducted with their first-degree relatives. There was mixed support for Akiskals typology. Consistent with the model, subaffectives exhibited higher rates of major depression, depressive symptoms, and a number of depressive personality and cognitive features. In addition, there was a higher rate of alcoholism among the relatives of character spectrum patients. However, contrary to Akiskals model, the groups did not differ on gender, unstable personality disorders, family history of mood disorders, or the early home environment.

Psychopathology in the adolescent and young adult offspring of parents with dysthymic disorder and major depressive disorder.

This study addressed the following question: are the adolescent and young adult offspring of parents with early-onset dysthymic disorder (DD) at increased risk for psychopathology? Participants included 41 offspring of 21 outpatients with early-onset DD, 19 offspring of nine outpatients with episodic major depressive disorder (MDD), and 32 offspring of 11 normal controls (NCs). Lifetime best-estimate diagnoses were determined for each offspring using a team consensus method. Diagnoses were derived blind to all information about the index parents. The offspring of outpatients with early-onset DD exhibited significantly higher lifetime rates of a broad range of psychiatric disorders than the offspring of NCs. In addition, the offspring of outpatients with early-onset DD exhibited significantly higher lifetime rates of DD, anxiety disorders, and phobia than the offspring of outpatients with episodic MDD. These results support the importance of early-onset DD in parents as a risk factor for psychopathology in their offspring.