Susan E. Dickens

Sexual dysfunction before antidepressant therapy in major depression

BACKGROUND Decreased sexual interest and function both occur as a consequence of antidepressant medication use, and are especially associated with serotonin reuptake inhibitors (SRIs). However, few investigators have reported the base rate for disturbances in sexual desire, arousal and orgasm or ejaculation in patients with major depression (MD) prior to antidepressant treatment. The purpose of this report is to define the frequency of sexual dysfunction (SD) in 134 patients with MD and examine the relationship between SD and demographic, clinical and personality variables. METHOD A consecutive series of 55 male and 79 female MD patients diagnosed by SCID-DSM IV assessment completed a series of psychometric measures including a Sexual Function Questionnaire, which asked about change in sexual interest and function as well as sexual activity during the preceding month. RESULTS Only 50% of women and 75% of men reported sexual activity during the preceding month. Over 40% of men and 50% of women reported decreased sexual interest. Reduced levels of arousal were more common in both men and women (40-50%) than ejaculatory or orgasm difficulties (15-20%). In women, problems with arousal and orgasm correlated with higher neuroticism and lower extraversion. There was no relationship between SD and personality measures in men. While age at onset of depression and number of prior episodes showed a modest correlation with SD measures, there were no correlations with severity of depression or specific symptoms clusters. LIMITATIONS AND CONCLUSIONS Although limited by a relatively small sample of drug free patients with MD, and by the absence of a non-depressed comparison sample, these results emphasize the importance of factors beyond specific drug effects in the assessment of antidepressant related sexual dysfunction.

The Development of the Toronto Structured Interview for Alexithymia: Item Selection, Factor Structure, Reliability and Concurrent Validity

Background: Assessments of personality constructs increasingly use self-report and structured interview instruments, which allow for a multimethod measurement approach and decrease specific measurement method bias. The aim of this study was to develop a valid and reliable structured interview for assessing the alexithymia construct. Methods: Sixty interview questions were written initially, each with a set of scoring criteria and prompts and probes to elicit information assisting in the scoring of the respondents’ answers. Results: After pilot testing, the number of questions was reduced to 43, which were administered to 136 community participants and 97 psychiatric outpatients. A series of item and scale analyses further reduced the item pool to 24 items. Principal component analysis and confirmatory factor analysis of these 24 items revealed preliminary evidence of a hierarchical, four-factor structure, with four lower factors nested within two higher-order latent factors. This structural configuration resulted in the Toronto Structured Interview for Alexithymia (TSIA) with two domain scales and four facet scales. The TSIA and its six scales demonstrated acceptable levels of interrater, internal, and retest reliability. The TSIA and its scales correlated modestly but significantly with the 20-item Toronto Alexithymia Scale and its three factor scales, providing some support for the concurrent validity of this interview. Conclusion: The TSIA appears to be a promising structured interview for assessing alexithymia.

Bipolar disorder, unipolar depression and the Five-Factor Model of Personality.

We examined differences between personality characteristics of euthymic bipolar disorder patients (BD) (n = 34) and recovered unipolar depressed patients (UD) (n = 74) using the taxonomy of the Five-Factor Model of personality (FFM) as measured by composite scales derived from the NEO Personality Inventory (NEO PI) and the revised NEO PI (NEO PI-R). Euthymic BD patients scored significantly higher on the Openness (O) dimension and the Positive Emotions facet of the E dimension than did recovered UD patients. For O, euthymic BD patients scored higher on the Feelings facet. These results suggest not only that euthymic BD patients are more likely to experience positive affects than recovered UD patients, but also that euthymic BD patients are more receptive to their positive and negative feelings than are recovered UD patients.

Faking specific disorders : a study of the Structured Interview of Reported Symptoms (SIRS)

An untested assumption of malingering research is that persons who feign mental illness will not attempt to fake a particular disorder, but will be content to fabricate non-specific and possibly global psychiatric impairment. We tested the effectiveness of the Structured Interview of Reported Symptoms (SIRS) to detect feigning of three diagnostic groupings: schizophrenia, mood disorders, and PTSD on 45 psychologically knowledgeable correctional residents. We found that the SIRS maintained its powers of discrimination with respect to clinical samples. Similar research on faking specific disorders is needed on the MMPI-2 and other psychological measures.

Chapter III. Maternal Sensitivity, Child Functional Level, and Attachment in Down Syndrome

A principal hypothesis of attachment theory is that parental sensitivity influences the quality of parent-child attachment (Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1969). This association has been verified metaanalytically (de Wolfe & van IJzendoorn, 1997). By demonstrating that intervention aimed at maternal sensitivity may increase the probability of secure attachment, van IJzendoorn, Juffer, and Duyvesteyn (1995) showed that the link between these two constructs might be a causal one. Nevertheless, in a review of the sensitivity-attachment literature, Schneider-Rosen and Rothbaum (1993) pointed out that there remains relatively little research addressing maternal precursors of security, considering the detail with which theorists have described the experiential origins of attachment relationships. The dearth of predictive research with atypical samples confirms this observation (van IJzendoorn, Goldberg, Kroonenberg, & Frenkel, 1992). This paucity handicaps theorizing in so far as atypical samples provide the greatest yield of atypically attached individuals (e.g., Crittenden, 1985; Radke-Yarrow, Cummings, Kuczynski, & Chapman, 1985; Vaughn et al., 1994). Only through the longitudinal study of atypical attachment can we fully encompass the human attachment experience. Furthermore, Schneider-Rosen and Rothbaum (1993) argued that the modest association between parental sensitivity and attachment security indicates the need for an interactional approach to attachment security; we must move beyond main effects to investigate both parental and child contributions to the relationship. In assessing interactional hypotheses, the use of atypical samples

Standardized assessment of malingering : validation of the structured interview of reported symptoms

The Structured Interview of Reported Symptoms (SIRS) was constructed to assess specific strategies identified in the clinical literature for the evaluation of malingering. Two studies were conducted to evaluate the discriminant and concurrent validity of the SIRS

The Stability and Validity of the Sociotropy and Autonomy Personality Dimensions as Measured by the Revised Personal Style Inventory

A. T. Beck (1983) has proposed the existence of two personality dimensions, sociotropy and autonomy, as specific and influential factors in the onset, course, and treatment of major depression. In this study, the stability and discriminant validity of the Revised Personal Style Inventory (PSI-II), a measure designed to assess the sociotropy and autonomy dimensions, was examined with a sample of outpatients diagnosed with major depression receiving pharmacotherapy. Sociotropy and autonomy were found to be relatively stable across time, despite significant reductions in depression severity. The two personality dimensions also produced a distinct and thematically consistent pattern of correlations with the dimensions and facets of the five-factor model of personality. These results suggest that the sociotropy and autonomy dimensions, as measured by the PSI-II, are reliable and valid measures of these personality constructs.

Adolescent Standardized Patients: Method of Selection and Assessment of Benefits and Risks

Background: Our psychiatric Objective Structured Clinical Examination (OSCE) group wishes to develop adolescent psychiatry OSCE stations. The literature regarding adolescent standardized patient (SP) selection methods and simulation effects, however, offered limited assurance that such adolescents would not experience adverse simulation effects. Purpose: Evaluation of adolescent SP selection methods and simulation effects for low- and high-stress roles. Method: A two-component (employment-psychological) SP selection method was used. Carefully selected SPs were assigned across three conditions: low-stress medical role, high-stress psychosocial role, and wait list control. Qualitative and quantitative measures were used to assess simulation effects. Results: Our selection method excluded 21% (7% employment and 14% psychological) of SP applicants. For SP participants, beneficial effects included acquisition of job skills and satisfaction in making an important contribution to society. SP reactions of discomfort to roles were reported. Long-term adverse effects were not identified. Conclusions: A two-component adolescent SP selection method is recommended. Adolescent SP benefits outweigh risks.

Predictors of professional and personal satisfaction with a career in psychiatry.

Background: Many factors, including personal experience and personality traits, contribute to the emotional difficulties that psychiatrists experience in their professional work. The nature of the work itself also plays a significant role. Objective: To determine those personal and professional characteristics that predict satisfaction with the practice of psychiatry. Method: We mailed a questionnaire that included items pertaining to aspects of personal and professional life to the entire population of psychiatrists in Ontario (N = 1574). Results: Of the 1574, 52% (n = 802) responded. We conducted a series of regression analyses to determine factors related to career satisfaction or regret. A belief in the intrinsic value of psychiatry, a low perceived degree of emotional burden from patients, financial success, and satisfaction with psychotherapeutic work emerged consistently as significant predictors. A subsequent discriminant function analysis indicated that all 4 of these variables accurately predicted those psychiatrists with extreme satisfaction or dissatisfaction with work. Conclusions: These results reveal several variables associated with career satisfaction in the practice of psychiatry that might be useful to discuss with residents who are beginning their careers.

Personality and symptom profiles of the angry hostile depressed patient

Fava, Rosenbaum, McCarthy, Pava, Steingard and Bless (1991) have recently proposed the existence of a subtype of depressed patients who experience anger attacks. The aim of this study was to assess if depressed patients categorized as high angry hostile have symptoms and personality profiles distinct from depressed patients categorized as low angry hostile. From a sample of 125 depressed outpatients, 26 patients were classified as high angry hostile and 25 patients as low angry hostile. The symptom profiles of these tow groups were remarkably similar, with the high angry hostile patients exhibiting more interpersonal sensitivity. The high angry hostile patients were rated as less interpersonally agreeable and less conscientious than low angry hostile patients. These results provide only partial support for the angry hostile subtype of depression.