Michael O'Boyle

Comorbidity of gender dysphoria and other major psychiatric diagnoses.

Previous studies suggest that many transsexuals evidence an Axis I diagnosis according to the DSM-IV classification (e.g., psychoses, major affective disorder). The current study examined retrospectively the comorbidity between gender dysphoria and major psychopathology, evaluating the charts of 435 gender dysphoric individuals (318 male and 117 female). AH had undergone an extensive evaluation, addressing such areas as hormonal/surgical treatment, and histories of substance abuse, mental illness, genital mutilation, and suicide attempts. In addition, a subgroup of 137 individuals completed the MMPI. Findings revealed over two thirds were undergoing hormone reassignment, suggesting a commitment to the real-life cross-gender process. One quarter had had problems with substance abuse prior to entering treatment, but less than 10% evidenced problems associated with mental illness, genital mutilation, or suicide attempts. Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group. Psychological profiles as measured by the MMPI were more “normal” in the desired sex than the anatomic sex. Results support the view that transsexualism is usually an isolated diagnosis and not part of any general psychopathological disorder.

Randomized, placebo-controlled pilot study of divalproex sodium in the treatment of acute exacerbations of chronic schizophrenia.

Experimental and clinical data suggest that GABA-ergic drugs such as valproate may have a potential role in the treatment of schizophrenia. The authors designed a 21-day prospective, double-blind, randomized, placebo-controlled pilot study of divalproex sodium as add-on treatment to haloperidol in 12 hospitalized patients with acute exacerbations of chronic schizophrenia. All patients received haloperidol 10 mg/day for 3 days and 15 mg/day for the remaining 18 days. In addition, five patients were randomly assigned to receive divalproex augmentation and seven to receive placebo. The divalproex dose was adjusted to a target serum concentration of 75 microg/mL for 2 weeks; placebo replaced divalproex during the third and last weeks to determine any carryover effect. Psychiatric rating scales were administered at baseline and on days 7, 14, and 21. Although the placebo group improved with haloperidol treatment, the divalproex group demonstrated greater improvement. On day 21, the divalproex group had greater improvement from baseline on the Clinical Global Impression Scale (p < or = 0.04), Brief Psychiatric Rating Scale (p < or = 0.13), and Schedule for Assessment of Negative Symptoms scores (p < or = 0.007). After divalproex withdrawal on day 15, a carryover effect was observed during week 3. The authors concluded that the addition of divalproex sodium to standard antipsychotic drugs may prove effective in relieving the symptoms of acute schizophrenia. Future studies may benefit from the design of this pilot study. However, it is premature to apply this augmentation strategy in the clinical setting just yet because of the small sample size and the likely heterogeneity of the disorder.

A comparison of two interviews for DSM-III-R personality disorders

The study examined agreement between personality disorder diagnoses obtained using two structured interviews and the effect of depression on the diagnoses obtained. Twenty subjects were interviewed while depressed, using the Personality Disorder Examination and the Structured Clinical Interview for DSM-III-R Personality Disorder; both interviews are designed to yield DSM-III-R personality disorder diagnoses. Eighteen subjects were reinterviewed later, 17 after recovery. Diagnostic agreement between the two instruments for any disorder was fair (kappa = 0.38). Kappas for the personality disorder clusters ranged from 0.08 to 0.83. Kappas for individual personality disorders ranged from 0.18 for paranoid disorder to 0.62 for borderline disorder. While the depressive state did not consistently affect categorical diagnoses, dimensional scores tended to be higher when patients were depressed. A dimensional profile, in which scores on each disorder are generated for subjects, may be more reliable than categorical diagnoses derived from the same instrument.

Cognitive complaints in elderly depressed and pseudodemented patients.

The cognitive complaints of 11 patients with depressive pseudodementia were compared with those of 22 patients with depression alone. Pseudodemented subjects were defined as depressed inpatients showing reversible cognitive impairment as measured by the Mini-Mental State Examination (MMSE); subjects with depression alone had no such impairment. For each group, cognitive complaints were highly correlated with depressive symptoms and were not related to MMSE scores. The pseudodemented group had significantly higher cognitive complaint scores, complaining more of difficulties with concentration and recent memory. Groups did not differ significantly in complaints of difficulties with remote memory.

Perceptions of Mental Health Providers Concerning Cultural Factors in the Evaluation of Hispanic Children and Adolescents

This study analyzed the perceptions of 136 mental health providers toward the consideration ofculturalfactors in the evaluation of Hispanic children and adolescents. Results show that the providers overwhelmingly perceived that cultural issues are important and need to be considered in their evaluations. However, only 54% considered themselves as highly successful in assessing the degree of acculturation, and a higher percentage (69%) reported a high degree of needfor more culturally focused training. The results suggest that a lack of cultural training might be more related to an inability to access training than a lack of understanding of the importance of cultural issues.

DSM-III-R AND EYSENCK PERSONALITY MEASURES AMONG PATIENTS IN A SUBSTANCE ABUSE PROGRAMME

Abstract The relationship between DSM-III-R personality disorder scale scores and scores on Eysencks dimensions of neuroticism (N), extraversion (E), and psychoticism (P, toughmindedness) was examined among patients in a substance abuse program. Ninety-seven patients completed the Personality Diagnostic Questionnaire—Revised (PDQ-R) and Eysencks Personality questionnaire (EPQ). Scales were jointly factored, the analysis yielded three factors accounting for 65% of the variance. The first factor had significant (> 0.4) positive loadings on neuroticism and on all personality disorder scores other than schizoid and antisocial. The second factor had a significant positive loading on psychoticism, as well as on DSM-III-R passive-aggressive, narcissistic, borderline, and antisocial scores. The third factor had a negative loading on extraversion, and a positive loading on DSM-III-R schizoid scores. The results suggest that in this population personal distress is related to most DSM-III-R disorder scores, and that toughmindedness (P) is related to the DSM-III-R dramatic personality disorder cluster.

Glucocorticoid receptor binding in three different cell types in major depressive disorder: Lack of evidence op receptor binding defect

1. In order to further understand the apparent glucocorticoid resistance in major depressive disorder, circadian variation in cortisol concentration, dexamethasone suppression and glucocorticoid receptor binding in mononuclear leukocytes, polymorphonuclear leukocytes and cultured skin fibroblasts were measured in rigidly defined major depressive disorder patients and non-depressed psychiatric controls. 2. Mononuclear leukocytes binding to glucocorticoid correlated significantly with polymorphonuclear leukocytes binding to glucocorticoid, but both determinations failed to differentiate major depressive disorder and control subjects. 3. Initial and post-dexamethasone in vitro fibroblast binding to glucocorticoid was not different between major depressive disorder and non-depressed control subjects. 4. The phenomenon of glucocorticoid resistance in major depressive disorder remains unexplained.

DSM-III-R personality disorders and Eysenck's personality dimensions

Abstract The relationship between DSM-III-R personality disorder scale scores and scores on Eysencks dimensions of neuroticism, extraversion (E), and psychoticism (P, toughmindedness) was examined to test the idea that DSM-III-R personality disorders are variants of basic personality traits. One hundred and seventy-three medical students completed the Personality Disorder Questionnaire-Revised (PDQ-R) and Eysencks Personality Questionnaire (EPQ). Scales were jointly factored, the analysis yielded three factors accounting for 61% of the variance. The first factor had significant (>0.4) positive loadings on neuroticism, and positive loadings on all personality disorder scores other than schizoid and antisocial. The second factor had a negative loading on E, as well as on DSM-III-R schizoid scores. The third factor had a positive loading on P, as well as on DSM-III-R schizotypal and antisocial scores. The results suggest that in a non-clinical population personal distress is related to most DSM-III-R disorder scores, and that toughmindedness (P) is related to the DSM-III-R odd and dramatic personality disorder clusters.

Comprehensively Assessing Cognitive and Behavioral Risks for HIV Infection among Middle-Aged and Older Adults.

A comprehensive survey of HIV/AIDS with middle-aged and older adults should include six domains (e.g., factual knowledge regarding the acquisition and transmission of HIV, traditionally-accepted behavioral risks for HIV infection). A sample of 23 women (54.8%) and 19 men (45.2%), ranging in age from 51 to 85 were surveyed across such domains. Although the majority of participants (92.2%) reported a good understanding of factual knowledge, strongly agreed with both their intention to engage in nonrisky sexual behaviors and their sense of internal self-control behaviors, they also reported high-risk behaviors (e.g., sexual intercourse without condoms).

What is a difficult mental health case? An empirical study of relationships among domain variables

A difficult case in psychotherapy can be defined in many ways. This study proposes a model for that definition, in which three domains (patient characteristics, case characteristics, and therapist characteristics) are considered to impact on that definition. A total of 264 professionals received a questionnaire to assess the relative importance of a series of variables within and across these domains. Wilcoxon Matched-Pairs Signed-Ranks tests indicated that patient characteristics were considered more important than therapist or case characteristics in defining a difficult case. Case characteristics were considered more important than therapist characteristics. Pearson correlations, however, suggested that the three domains in the model are related. Correlations (for years of experience) and Kruskal-Wallis one-way ANOVA for ranks (for professions) also indicated that participants were able to identify variables within domains as important in that definition regardless of years of experience or professions. Across domains, the most important variables included the motivation of the client (a patient characteristic), dropout/attrition and multiple diagnoses (case characteristics), and the degree of therapist-client racial similarity (a therapist characteristic).