Wilson McDermut

Comorbidity burden and its impact on psychosocial morbidity in depressed outpatients.

BACKGROUND Many studies have examined the co-occurrence of depression and one or two nondepressive disorders; however, little research has looked at broad spectrum comorbidity (i.e., comorbidity across several diagnostic categories) in depressed patients. Research on diagnostic practices in routine clinical settings--in which unstructured interviewing is the norm--suggests that comorbid conditions are often not detected [Zimmerman, M., Mattia, J. 1999. Psychiatric diagnosis in clinical practice: Is comorbidity being missed? Compr. Psychiatry, 40, 182-191]. In this study we examined the independent impact of different comorbid diagnostic categories on psychosocial morbidity in psychiatric outpatients with Major Depressive Disorder (MDD). METHODS Participants were drawn from a pool of 1000 psychiatric outpatients interviewed with the Structured Clinical Interview for DSM-IV diagnoses (SCID-IV; [First, M.B., Spitzer, R.L., Williams, J.B.W., Gibbon, M., 1995. Structured Clinical Interview for DSM-IV (SCID). American Psychiatric Association, Washington, D.C.]). We compared the demographics, clinical characteristics, and psychosocial functioning of depressed outpatients with and without different axis I comorbidities, then conducted multivariate analyses to determine the respective impact of comorbid axis I disorders. RESULTS Three hundred and seventy-three patients had a principal diagnosis of unipolar MDD. One hundred twenty-nine (34.6%) were diagnosed with MDD only, and 244 (65.4%) had MDD and at least one other axis I disorder. Comorbidity was associated with longer duration of index episode, more psychiatric morbidity, and more social and occupational impairment. There was also a significant relationship between increasing number of comorbid axis I disorders and greater psychiatric and psychosocial impairment. In regression analyses, comorbidity burden (i.e., the number of comorbid axis I disorders) showed the strongest relation to psychiatric and psychosocial impairment. LIMITATIONS This is not a random sample of depressed outpatients and, thus, may not be generalizable to all outpatients with depression. Second, Axes II and III comorbidity were not assessed. CONCLUSIONS Comorbidity burden showed the strongest relation to impairment over and above the presence of any particular class of disorders.

The construct validity of depressive personality disorder.

This study examined the construct validity of depressive personality disorder (DPD: American Psychiatric Association, 1994). Adult psychiatric outpatients (N = 900) underwent comprehensive Axis I and II evaluations and provided data on 4,768 of their 1st-degree relatives. Despite modest overlap, DPD was not redundant with any Axis I or II disorder. Participants with DPD exhibited more Axis I and Axis II comorbidity, and greater psychosocial dysfunction, than participants without DPD. Relatives of participants with DPD had higher rates of mood disorders, alcohol abuse, and antisocial personality. Results are consistent with findings of several other similar investigations. The authors argue that DPD is a valid construct and should be conceptualized as a personality disorder as opposed to a mood disorder.

Effect of stage of change on cue reactivity in continuing smokers.

Three classical conditioning models (the conditioned compensatory response, conditioned withdrawal, and conditioned appetitive motivational models) postulate that drug cues evoke physiological and emotional responses associated with motivational states that prompt drug use. There is accumulating evidence to suggest that factors other than classical conditioning can influence emotional and physiological reactivity to drug stimuli. This study tested whether stage of change affects the nature of reactivity to smoking cues among continuing smokers. Precontemplators (smokers not considering quitting) and contemplators (smokers considering quitting in the near future) watched videotapes containing smoking cues. Emotional and physiological responses to the smoking video were contrasted with responses to a neutral videotape. Precontemplators had lower heart rates than did contemplators in response to the smoking videotape. Both contemplators and precontemplators evinced increased positive affect in response to the smoking cue. A comparison sample of nonsmokers did not show any reactivity to the smoking cue. Implications of these findings for conditioning theories of smoking are discussed.

Personality and family functioning in families of depressed patients

In this cross-sectional study, the authors attempted to identify correlates of family functioning in 86 couples with a depressed member during the acute phase of the patients depression. Demographic variables, psychiatric status, and personality traits of both the patient and spouse were investigated as potential predictors of family functioning. Regression analyses indicated that lower levels of personality pathology in the patient, higher levels of patient conscientiousness, and less psychological distress in the spouse were associated with healthier family functioning. Future research implications and clinical importance of these findings are discussed.

Affective ratings and startle modulation in people with nonclinical depression.

This study tested predictions based on the emotion context insensitivity (ECI) hypothesis of Rottenberg, Gross, and Gotlib (2005) that a nonclinical sample of people with depressive symptoms would show reduced responses to both positive and negative stimuli relative to people without depression and would show an enhanced response to novelty. Seventy individuals completed diagnostic questionnaires, made ratings of 21 affectively valenced pictures, and then viewed the same 21 pictures and 21 novel pictures while startle blink responses were recorded from electromyographic activity of the orbicularis oculi. People with scores on the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) indicative of depression demonstrated a lack of affective startle modulation compared to the nondepression group. For all participants, the startle response was larger for novel pictures than for previously viewed pictures, but scores on the BDI were not related to response to novelty. Taken together, the results suggest that nonclinical depression is associated with a lack of affective modulation of startle, as has been shown for clinical depression.

Religious Fundamentalism and Religious Orientation Among the Greek Orthodox

The experimenters explored how religious fundamentalism related with religious orientation, irrational thinking, and immature defense mechanisms. They also explored the possible moderational role of the Big 5 personality factors. The participants were predominantly Greek Orthodox College students from a Cypriot University. The experimenters employed a cross-sectional design and required participants to complete a series of self-report measures. Religious fundamentalism significantly predicted irrational thinking. Intrinsic and personal extrinsic religious orientations significantly predicted religious fundamentalism. The results provide support for the idea that the more dogmatically one holds their religious beliefs, the more likely they are to think irrationally.

Associations Between the Rotter Incomplete Sentences Blank and Measures of Personality and Psychopathology

The Rotter Incomplete Sentences Blank (RISB; Rotter, Lah, & Rafferty, 1992) is a sentence completion test intended to detect psychological maladjustment. To investigate the construct validity of the measure, we investigated what aspects of personality and psychopathology are correlated with the RISB and also tested the incremental validity of the RISB in a combined sample of clinical (n = 72) and undergraduate participants (n = 69). Interrater reliability of the RISB was good (intraclass correlation > .80). The RISB overall adjustment score discriminated between clinical and undergraduate participants, and high scores on the RISB were associated with higher negative affect, more anxiety and depression, irrational thinking, and interpersonal problems. The incremental validity of the RISB was modest, but it did explain variance in satisfaction with life and personality disorder symptoms above and beyond an extracted measure of general psychological distress. Our findings support the construct validity of the RISB.