Peter Fiedler

Reconfirming the role of life events for the timing of depressive episodes: A two-year prospective follow-up study

BACKGROUND Since the 1960s the association of stressful life events and depression seemed to be firmly established. However, a few recent studies did not confirm those earlier findings. One of the reasons discussed for the inconsistencies was the sampling of milder depressed neurotic out-patients in the earlier studies vs. more severely ill endogenous type in-patients in recent studies. METHODS This investigation was carried out with 50 consecutively admitted in-patients with endogenous depression according to ICD 9 and unipolar major depression according to DSM-III-R as ascertained by SCID. The control sample consisted of 26 healthy volunteers. Life events and chronic distressing life conditions were recorded with the Munich Interview for the Assessment of Life Events and Conditions (MEL) every 3 months over a period of 2 years along with psychopathological symptoms and recurrencies. Hence the design was prospective in the sense that life events were recorded for one 3-month cross-section, the depressive reaction for the subsequent one. BDI scores taken at the respective cross section were used to control for depressive bias of the subjective part of the patients life event evaluation. RESULTS Three months prior to the index hospitalization patients were more often affected by life events and conditions than controls. The number of stressful conditions prior to the index hospitalization indicated the time to relapse after discharge. Controls showed more desirable positive conditions than patients. Relapse patients suffered more often stressful life events and conditions than non-relapsers 3 months prior to their relapse. Multivariate analysis indicates that the cumulative number of life events within the 2-year course is the best predictor of the BDI score at the end of the follow-up period. LIMITATIONS Since the subjective component of life event assessment by MEL displayed a higher impact on the course of depression than the objective part of the assessment, confounding of subjective ratings, attributional styles, and depressive symptoms may be a problem although controlled for in this study. CONCLUSION The results support the importance of stressful life events and chronic distressing conditions for the 2-year course and outcome of major depression in an in-patient sample. Since the overall consistency of significant results was more pronounced in the subjective than in the objective part of the MEL the results fit best a circular pathogenetic model of interactions between life events, their individual evaluation by the patient, and depressive symptoms.

Personality and endogenous/major depression: an empirical approach to typus melancholicus. 2. Validation of typus melancholicus core-properties by personality inventory scales.

The purpose of this study was to objectify some of the personality dimensions of the typus melancholicus (TM) personality formation in endogenous depressives and to compare the consistency of the term used in questionnaires with the original concept as delineated in our preceding paper. The prevalence of TM in endogenous-depressive inpatients was 51% for patients with clearly salient TM features. In addition 25% of the sample showed TM features to a minor extent. These findings are consistent with the literature. MMPI and MPI could not separate TM and non-typus melancholicus (NTM) in univariate analyses. However, the Munich Personality Test (MPT) contributes to validating the TM concept. TM depressives scored significantly higher in MPT subscales rigidity and norm orientation. According to its item structure the MPT rigidity subscore can be considered to conceptually encompass hypernomia, i.e. the patients incapacity to change the norms that were once adopted. Based on the characteristics of item formulations in the MPT subscore norm orientation it was hypothesized that this subscore corresponds to the concept of heteronomia, i.e. conformism towards externally determined and uncritically followed social norms. Since MPT norm orientation in TM does not covariate with control scales of the other inventories used in this study, it is likely that MPT norm orientation refers to the TM patients sincere commitment to social norms rather than to a sham reaction in the sense of a lie scale. There was no consistent indication that TM shows lower neuroticism scores than NTM.

Initial Orienting to Emotional Faces in Female Adolescents with Borderline Personality Disorder

Background: Previous research has implicated a general hypervigilance for negative emotional words in adults with borderline personality disorder (BPD) as compared to healthy controls. The purpose of this study was to assess initial orienting to negative and positive emotional faces in female adolescents with BPD. Method: Adolescent patients with BPD (n = 30), adolescent patients with other psychiatric diagnoses (n = 29) and adolescent healthy comparison subjects (n = 29) were tested with the visual dot probe task to examine attentional orienting to emotional and neutral faces. Results: In contrast to the adolescent healthy comparison subjects, both the adolescent patients with BPD and the adolescent patients with other psychiatric diagnoses showed a stronger orienting to negative emotional stimuli. However, no differences were found between the clinical groups. Data regarding positive stimuli showed that BPD is not associated with a specific orienting to positive faces. Conclusions: These findings suggest that attentional orienting to negative faces is not specific to adolescent patients with BPD but also affects adolescent patients with other psychiatric diagnoses. Furthermore, no distortion in information processing concerning positive cues was observed in adolescent patients with BPD. If these findings were confirmed, further BPD research could no longer assume that BPD is specifically associated with distortions in initial orienting processes.

Attentional Bias in Later Stages of Emotional Information Processing in Female Adolescents with Borderline Personality Disorder

Background: Bias in emotional information processing has been described in patients with borderline personality disorder (BPD). This study investigates whether adolescent patients with a diagnosis of BPD demonstrate abnormalities in attentional maintenance in viewing emotional faces. Sampling and Methods: Thirty female adolescents with a diagnosis of BPD, 29 female adolescents with mixed psychiatric diagnoses, and 30 healthy participants were tested with the visual dot probe task. The task involved showing photographs of actors with faces depicting neutral, negative, and positive expressions for 1,500 ms each. Results: Attentional bias to negative faces was not generally associated with BPD, but patients with BPD did show a strong correlation between current mood and attentional bias to negative faces. Only in adolescents with BPD did attention to negative faces narrow when they were currently in a state of negative mood. Conversely, both control groups avoided negative faces in conjunction with a decline in positive mood. Conclusions: This study indicates that borderline pathology is linked to an inability to disengage attention from negative facial expressions during attentional maintenance when in a negative mood. Based on these findings, mood-dependent therapeutic interventions focusing on attentional processes may represent a useful add-on to established therapies in patients with BPD.

Intra-individual variability in high-functioning patients with schizophrenia.

Intra-individual variability of reaction times (IIV) can be employed as a measure of the stability of information processing, which has been proposed to be fundamentally disturbed in schizophrenia. However, the theoretical and clinical significance of IIV is not clear, in part because it has previously been investigated in subject groups with generalized cognitive impairment. Therefore, the purpose of the study was to assess IIV in high-functioning patients with schizophrenia and relatively preserved cognitive performance. 28 high-functioning patients with schizophrenia and 28 controls performed a Go/Nogo task and a Continuous Performance Test. In contrast to average measures of task performance, IIV differentiated consistently and with large effect size between groups. Modelling with an Ex-Gaussian distribution revealed that patients have a higher proportion of slow responses reflected by an increased tau parameter. The tau parameter was correlated with work capability in the sample with schizophrenia. In conclusion, IIV is an easily obtained measure, which is highly sensitive to fundamental cognitive deficits not directly visible in a high-functioning patient group. The response pattern with more exceedingly slow reactions could reflect a core deficit in the stability of information processing. The relationship with work capability suggests investigation of IIV as a clinical measure.

Dimensions of the Typus melancholicus personality type.

AbstractThe Typus melancholicus personality type (TMP) is characterised by orderliness, conscientiousness and interpersonal dependence. Several standardised instruments have been developed for the assessment of the Typus melancholicus personality. To date there has been no systematic comparison of these instruments and in particular it has been unclear whether TMP represents a single trait or a personality trait constellation. The aim of this study was the comparison of four TMP questionnaires and the investigation of the dimensionality of the personality as revealed by these questionnaires. The factorial validity of four TMP questionnaires was examined based on a sample of n = 264 psychiatric inpatients and normal controls. In a factor analysis of the items of the TMP questionnaires, four dimensions could be differentiated: Dependence, Intolerance of Ambiguity, Norm–Orientation, and Perfectionism. Psychometric evaluation showed good values for the individual items and the new TMP scales. The four subscales had a differential correlation profile in relation to the dimensions of the five–factor model of personality. The TMP scales could distinguish a group of depressed patients from a group of normal controls. The results show that TMP personality is not a single trait but consists of four related but separate traits. These can be clearly distinguished from those of the five–factor model of personality. The analysis of the TM concept therefore also represents a theoretical perspective for the integration of the personality characteristics which are relevant for depression. Based on this analysis, we constructed a multidimensional TMP inventory which forms the basis for the investigation of the effect of TM personality on clinical outcome and on psychotherapeutic treatment.

The Influence of Psychopathology, Personality, and Marital Interaction on the Short-Term Course of Major Depression

By means of an aggregated variables design the domains of ‘psychopathology’, ‘personality’, and ‘social interaction’ were weighted according to their impact on the 2-year course of 50 patients with unipolar major depression. Preindex course ranked highest, asthenic personality second. Variables of social interaction disappeared in the second-order logistic regression. These findings fit in well with the recent literature. They are interpreted in terms of habituation processes and residual personality changes which lower the vulnerability threshold for relapse and unfavorable course. As a consequence of this conclusion early relapse prevention would be most important.

„Expressed Emotion” (EE), Ehequalität und das Rückfallrisiko depressiver Patienten

ZusammenfassungDie Langzeitverläufe depressiver Erkrankungen scheinen in erheblichem Maße von der Qualität der ehelichen bzw. partnerschaftlichen Beziehung abhängig zu sein. Ziel der vorliegenden Studie ist die Überprüfung bereits früher mitgeteilter Befunde, nach denen sich ein in Partnerschaften depressiver Patienten gefundenes „Expressed-Emotion” (EE) auch im Bereich depressiver Störungen als rückfallbedeutsam erweist. Gleichzeitig sollen 2 weitere Befundgruppen früherer Studien erneut überprüft werden: a) die möglichen Zusammenhänge zwischen Partner-EE und Schwere der Depression sowie b) die Rückfallbedeutsamkeit der von Patienten erlebten Qualität ihrer ehelichen Beziehung. Zusammengefaßt lassen die dargestellten Analysen folgende Schlußfolgerungen zu: Mit dem von uns bestimmten Partner-EE lassen sich Rückfälle depressiver Patienten nicht voraussagen. Der EE-Index hängt nicht mit dem Symptomstatus der Patienten zusammen. Wie in 2 Vorläuferstudien lassen sich auch durch uns 2 spezifische Selbstratingmerkmale von Patienten erneut als rückfallprädiktiv validieren: die „Ehezufriedenheit” der Patienten und die von ihnen „wahrgenommene Kritik” durch den Partner. Zusätzlich erweist sich eine Diskrepanz beider Partner hinsichtlich der Einschätzung ihrer Ehezufriedenheit als rückfallprädiktiv. In der Diskussion wird auf die klinisch-praktische Bedeutung der Ergebnisse eingegangen.SummaryLong-term course of depression appears to be clearly correlated to marital quality and quality of the relationship with spouses. Aim of the present study is the replication of results, indicating that expressed emotion (EE) is an important factor in prediction of relapse in depression. Additionally, the correlation between EE shown by spouses and the severeness of depressive symptomatology as well as the importance of marital quality as seen by patients for relapse are investigated. Results of our study indicate that spouses EE does not predict relapse, and status of EE does not correlate with the extent of depressive symptoms. However, patient self ratings of satisfaction with marital relationship and of perceived criticism are related to relapse frequency. Additionally, discrepant ratings of marital satisfaction given by spouses predict relapse to some extent. Implications for research in affective disorders and clinical practice are discussed.

Expressed emotion, perceived criticism and 10-year outcome of depression.

Outcome studies of patients suffering from depression indicate a high relapse rate and a tendency towards chronicity. A family atmosphere characterised by expressed emotion (EE) and perceived criticism (PC) was reported to be a robust predictor of outcome in affective disorders. The aim of the study was to analyze the association between EE, PC and long-term outcome of depression. Fifty inpatients with major depression were followed up 1, 2 and 10 years after discharge from the hospital. After 10 years, 26 patients (56.5%) had at least one recurrence. Spousal EE, assessed with the Five-Minute Speech Sample (FMSS), and the Perceived Criticism Index (PCI) were not significant prognostic factors for depression outcome. The significance of EE and PC for the long-term course of depression has to be questioned. The findings indicate a need to examine factors that may partly mediate the effect of EE and PC on the outcome of depression.

Wahrnehmung und Bewertung von emotionalen Gesichtsausdrücken bei weiblichen Jugendlichen mit einer Borderline-Persönlichkeitsstörung

Zusammenfassung: Fragestellung: Untersuchung der Wahrnehmung von emotionalen und neutralen Gesichtsausdrucken bei weiblichen Jugendlichen mit einer Borderline-Personlichkeitsstorung (BPS). Methodik...