Janos Csorba

Are there temperament differences between major depression and dysthymic disorder in adolescent clinical outpatients

AIMS The aim of the study was to explore possible differences in temperament and character dimensions between 2 monodiagnostic adolescent groups of depression, namely, one with a present episode of major depression and subjects with the other being their dysthymic peers. SAMPLE From a multisite Western Hungarian sample of consecutively referred 14- to 18-year-old new psychiatric adolescent outpatients, 2 groups were compared: group I, n = 56 (9 males, 47 females), with major depressive disorder (MDD) and group II, n = 27 (6 males, 21 females), with a diagnosis of dysthymic disorder (DD). All other comorbid diagnoses including bipolar and double depression (MDD + DD) cases were excluded. Present suicide events, if the attempter had an underlying diagnosis of depression, were not causes for exclusion. Assessment methods used were the adapted Hungarian versions of the Mini International Neuropsychiatric Interview and the Junior Temperament (Cloninger) Character Inventory. RESULTS The only difference between the major depressive and dysthymic adolescents was harm avoidance, adolescents with major depression having a higher level practice of harm avoidance, whereas the temperament type of MDD vs DD seems to differ only in the aspect of avoiding painful stress. Expectations regarding a worse degree of self-directedness and lower levels of persistence and cooperativeness in the MDD sample were not proved. CONCLUSIONS No essential temperament differences were found between the 2 adolescent depressive groups. Scarce differences between temperament qualities of MDD and DD may support Akiskals continuum theory of depressive disorders. More research and the use of closer clinical personality typologies are warranted to explore possible personality trait differences (if they exist) between clinical diagnostic groups of adolescent patients.

Profiles of Suicidality and Clusters of Hungarian Adolescent Outpatients Suffering from Suicidal Behaviour

Background: The aim of the study was to reveal the background dimensions of suicidal behaviour (SB) and to identify clusters of Hungarian adolescent outpatients suffering from suicidality by means of the following correlates of SB: depression, inadequate conflict-solving methods, dysfunctional attitudes, maladaptive coping, help-seeking strategies and negative life events. Sampling and Methods: A self-report test battery was completed by every consecutive new adolescent outpatient from a representative patient pool of 5 local child psychiatric centres in Western Hungary over an 18-month period (n = 644). The questionnaires used were the pilot version of the Columbia Depression Scale, the Hungarian standard versions of the Beck Depression Inventory, the Ways of Coping Questionnaire, the Dysfunctional Attitude Scale and the Junior High Life Experiences Survey. A total of 110 adolescent outpatients (88 females, 22 males, mean age = 16.21 years, SD = 1.38) suffering from SB were included in the study. All diagnoses including SB were confirmed by the MINI Plus Mini International Neuropsychiatric Interview. K means clustering was used to compare variances of 19 variables to decide which ones are the major criteria for assigning subjects to clusters, and principal component analysis was utilized to identify background SB dimensions in the patient sample. Results: The cluster analysis identified 3 homogenous clusters differentiating suicidal adolescents characteristically: ‘stress-laden/medium depressive’, ‘low depressive/low achievement’ and ‘high depressive’ cluster groups. While cluster analysis confirmed the role of the severity of depression only, principal component analysis explored the following 4 underlying profiles of SB: stress-laden, dysfunctional, maladaptive and depressive/risky factors. Conclusions: Although important coping qualities failed to register as major criteria in the development of separate groups of suicidal adolescent outpatients, distinct background profiles of SB among Hungarian adolescents were found covering the risk groups according to clinical experience. Future research is warranted to identify possible variation in the coping strategies among different adolescent suicidal samples.

Differential characteristics of anxiety syndromes in clinical adolescents

AimsTo identify the differential predictors of three main child psychiatric anxiety disorders using personality, attitudinal, coping and stress variables.MethodsThe Hungarian adapted versions of 1) JTCI using four temperament and three character traits, 2) the brief DAS of Burns, 3) the Ways of Coping questionnaire of Lazarus and Folkmann, and 4) the JHLES were administered to 498 14- to 18-year -old youths drawn from 5 Hungarian regional child and adolescent outpatient facilities. 3 anxiety disorders were chosen assessed by MINI Plus questionnaire. Seeking differential predictors between the syndromes a 2 dtep logistic regression was performed.ResultsThe main predictors of Panic-agoraphobia were harm-avoidance and autonomy/outward control, the differential characteristics regarding Social phobia were HA and lack of persistence coupled with avoidance of risky problem solving. Generalized anxiety disorder (GAD)showed only HA again as an important predictor distinguishing GAD from the other anxiety syndromes. Stresses and suicidal factors had no differentiating role between the disorders.ConclusionA few but significant differential predictors were found distinguishing Panic-agoraphobic patients, social phobics and those suffering from GAD from one another. There are only few specific predictive risk factors evident as essentially differing within anxiety syndromes.