Michael Bagby

The Revised Toronto Alexithymia Scale: Some reliability, validity, and normative data.

Addressing certain problems with the compositional structure of the self-report Toronto Alexithymia Scale, this paper reports the development of a revised version of the scale as well as results from a preliminary series of studies evaluating its reliability and validity. The Revised Toronto Alexithymia Scale (TAS-R) demonstrated good internal consistency and a stable and replicable two-factor structure that is congruent with the two major dimensions of the alexithymia construct. Evidence of convergent and discriminant validity for the TAS-R was provided by correlations with measures of other constructs. Criterion validity was demonstrated by the ability of TAS-R scores to discriminate between behavioral medicine outpatients designated alexithymic and those designated non-alexithymic on the basis of clinical interview ratings. Normative data are provided for university student, normal adult, and psychiatric outpatient populations.

Disorders of affect regulation: Affect dysregulation and alexithymia

Because the capacities for experiencing and regulating affects cognitively are acquired during the developmental years, opportunities easily arise for failure (Dodge & Garber, 1991; Taylor, 1992 b ). Such failures result in a proneness to affect dysregulation that is evident in personality traits or psychopathology and poor physical health. The major psychopathologies and physical pathologies are conceptualized in this book as disorders of affect regulation and are linked to failures at, or regressions to, lower levels within the model of an epigenetic sequence of affect development proposed by Lane and Schwartz (1987). As was noted in the previous chapter, the self-regulation of affect has been linked also with the recently introduced construct of emotional intelligence (Goleman, 1995; Salovey et al ., 1993). Individuals who are described as low in emotional intelligence manifest difficulties in the accurate appraisal and expression of emotion, in the effective regulation of emotion, and in the ability to use feelings to guide behaviour (Salovey & Mayer, 1989/90). As a continuum construct, emotional intelligence at its lower end corresponds to the preconceptual levels of emotion organization and regulation within Lane and Schwartzs hierarchical model. Lane and Schwartz, and also Salovey and his colleagues, acknowledge that individuals functioning at the lower levels of these conceptual frameworks have been described previously in the literature as alexithymic .

Dopamine response to psychosocial stress in humans and its relationship to individual differences in personality traits

BACKGROUNDnPrevious studies have reported inter-individual variability in the dopamine (DA) response to stress. This variability might be related to individual differences in the vulnerability to experience the negative effect of stress.nnnOBJECTIVEnTo investigate whether personality traits as measured by the revised NEO personality inventory explain variability in DA response to a psychosocial stress task.nnnMETHODSnEleven healthy adults, mean age of 26 ± 3.87 underwent two positron emission tomography (PET) scans using the dopamine D(2/3) agonist, [11C]-(+)-PHNO under a control and stress condition. The simplified reference tissue model (SRTM) was used to obtain [11C]-(+)-PHNO binding potential (BP(ND)). Stress-induced DA response was indexed as a percent change in [11C]-(+)-PHNO BP(ND) between control and stress conditions. The regions of interest were defined into D2-rich regions, which included the Associative and Sensorimotor Striatum (AST and SMST); D(2/3) mixed regions, which included the limbic striatum (LST) and globus pallidus (GP); and D3-rich region, which included the Substantia Nigra (SN).nnnRESULTSnSeveral personality traits within the Neuroticism and Openness to Experience domain were significantly correlated with blunted DA response to stress. Specifically, the Angry-Hostility, Vulnerability, and Depression trait were associated with blunted DA stress response in the AST (r = -0.645, p = 0.032), LST (r = -0.677, p = 0.022) and GP (r = -0.736, p = 0.010), respectively. The Openness to Values was correlated with a decreased DA release in the SN (r = -0.706, p = 0.015).nnnCONCLUSIONnVariability in DA stress response might be related to individual differences in personality.

Elevated Striatal Dopamine Function in Immigrants and Their Children: A Risk Mechanism for Psychosis

Abstract Migration is a major risk factor for schizophrenia but the neurochemical processes involved are unknown. One candidate mechanism is through elevations in striatal dopamine synthesis and release. The objective of this research was to determine whether striatal dopamine function is elevated in immigrants compared to nonimmigrants and the relationship with psychosis. Two complementary case–control studies of in vivo dopamine function (stress-induced dopamine release and dopamine synthesis capacity) in immigrants compared to nonimmigrants were performed in Canada and the United Kingdom. The Canadian dopamine release study included 25 immigrant and 31 nonmigrant Canadians. These groups included 23 clinical high risk (CHR) subjects, 9 antipsychotic naïve patients with schizophrenia, and 24 healthy volunteers. The UK dopamine synthesis study included 32 immigrants and 44 nonimmigrant British. These groups included 50 CHR subjects and 26 healthy volunteers. Both striatal stress-induced dopamine release and dopamine synthesis capacity were significantly elevated in immigrants compared to nonimmigrants, independent of clinical status. These data provide the first evidence that the effect of migration on the risk of developing psychosis may be mediated by an elevation in brain dopamine function.

The Observer-Rated Scale for Mania (ORSM): development, psychometric properties and utility

BACKGROUNDnThe diagnosis of mania largely depends on the quality of information the physician is provided with. Often, the patient cannot give an accurate account of the symptom development and thus information from relatives and friends is required. No systematic rating instrument is available, however, to facilitate this.nnnOBJECTIVEnIn this study, the psychometric properties of the 49-item Observer-Rated Scale for Mania (ORSM) are reported.nnnMETHODSnThe scale was used in 113 inpatients and the following psychometric aspects were assessed: reliability, test-retest reliability, construct validity (factor analysis, discriminant analysis, comparison of means), extreme-group validity, prognostic validity, sensitivity, specificity, positive and negative predictive values.nnnRESULTSnThe ORSM proved highly valid and reliable. Factor analysis revealed three factors which were labelled euphoric mania, instable mania and psychotic mania.nnnCONCLUSIONnThe ORSM is a useful instrument to help non-professionals who are in regular contact with the patient diagnosed a manic/mixed episode. It thus complements existing rating scales for mania, which are either designed for professionals or are self-rating instruments.

0179 Independent Medical Evaluations - Important, neglected, in need of reform: a systematic review

Objectives Independent medical evaluations (IMEs) are a common and influential form of assessment, often influencing whether patients receive compensation for an injury or illness. To inform the evidence-base underlying IMEs, we conducted a systematic review of all primary literature conducted in North America. Method We searched CINAHL, EMBASE, MEDLINE and PsycINFO and other sources for studies published through to Sept. 20, 2011. We included all primary literature on the topic of IMEs from a North American perspective. Assessment for study inclusion, data extraction and risk-of-bias analyses were performed in duplicate. Results We included 52 studies, all of which were observational in design and most of which focussed on determining the rate of malingering among examinees. Estimates of non-credible symptom over-reporting among patients presenting for IMEs ranged from 16% to 55%, with studies at lower risk of bias finding higher estimates. Other studies found that inter-rater reliability among IME assessors for assigning degree of impairment to the same IME report was poor, and that patients presenting for an IME with external incentive (e.g. litigation, disability benefits) perform systematically worse across a range of psychometric tests versus patients presenting with similar illness/injury but without external incentive. Conclusions Symptom exaggeration is common among patients presenting for IMEs, and particularly among those patients with external incentive. IME assessors reviewing the same case demonstrate little agreement regarding the degree of impairment that should be assigned. Standards for IME assessment and reporting are urgently needed to ensure greater reliability and validity of this common form of assessment.