To qualify for a diagnosis of posttraumatic stress disorder the DSM-IV requires that individuals report dominant emotions of fear, helplessness, and horror during the trauma. Despite this stipulation, traumatic events can elicit a myriad of emotions other than fear such as anger, guilt or shame, sadness, and numbing. The present study examined which emotional reactions to a stressful event in a college student sample are associated with the highest levels of PTSD symptoms. Results suggest mixed support for the DSM-IV criteria. Although participants who experienced a dominant emotion of fear reported high PTSD symptomatology, participants who experienced anger, disgust-related emotions, and sadness reported PTSD symptoms of equivalent severity. Participants also reported experiencing other emotions more frequently than they reported experiencing fear. Coping style was unrelated to dominant emotion experienced; however, dysfunctional coping was associated with worse outcomes in terms of PTSD symptoms. These results have diagnostic and treatment limitations.

Classification systems in psychiatry are a work in progress. Therefore, continued efforts to improve their validity are necessary. Epidemiology provides a scientific method to assess the extent of psychiatric morbidity in community populations. However, data from epidemiological surveys have also contributed, either directly or indirectly, to many changes in the classification systems. Recent reviews of the current state of psychiatric classification indicate four unresolved issues: 1) the presence of two differing classification systems, 2) the role of the clinical significance criterion in differentiating psychopathology from normality, 3) the relationship of the exclusion criteria to the co-occurrence of psychiatric disorder pairs, and 4) the relative validity of categorical versus dimensional conceptualizations of psychiatric disorders. The current thesis examines these four unresolved issues, using data from a large-scale epidemiological survey of psychiatric disorders. With regard to GAD, differences in diagnostic criteria between DSM-IV and ICD-10 resulted in different types of cases identified, despite similarities in prevalence. The DSM-IV diagnostic criterion for clinical significance impacted, albeit to different degrees, on the prevalence, health service use and impairment of five disorders. The exclusion criteria in both DSM-IV and ICD-10 were significantly related to the patterns of co-occurrence found in the data. Using the example of depression, symptoms were more consistent with a dimensional rather than a categorical structure. A specific research agenda is proposed, the aim of which is to provide possible avenues of research that may benefit revisions to classification systems and the conduct of epidemiological surveys. This research agenda contains a number of suggestions. Future revisions will benefit from an explicit understanding of the differences between the classification systems. Better definitions of the concepts of clinical significance and psychiatric disorder are required. The co-occurrence of disorder pairs in epidemiological data informs understanding of the exclusion criteria, but the validity of these criteria relies on different data. Dimensional models of classification may yield more information than categorical models, and methods for incorporating them in large-scale surveys are proposed. It is concluded that epidemiological data should continue to play a significant part in the refinement of psychiatric classification.

Variationen im Gen der Tryptophanhydroxylase 2 (TPH2), das den geschwindigkeitsbestimmenden Schritt der Serotoninsynthese katalysiert, wurden mit psychiatrischen Erkrankungen, die durch emotionale Dysregulation charakterisiert sind, in Verbindung gebracht. Die vorliegende Arbeit evaluierte die Rolle von TPH2 Varianten und Haplotypen bei Persönlichkeitsstörungen der Cluster B und C. Dazu wurden 420 Patienten mit Cluster B oder Cluster C Persönlichkeitsstörung (nach DSM-IV-TR) sowie 336 gesunde Probanden als Kontrollgruppe bezüglich TPH2 SNPs (rs4570625, rs11178997, rs4341581, rs4565946) genotypisiert. Die Persönlichkeitsstörungen wurden mit Hilfe des „Strukturierten Klinischen Interviews für DSM-IV-TR, Achse II“ (SKID-II) diagnostiziert und in die Cluster A, B und C eingeteilt. Die vorliegenden Resultate verknüpfen potentiell funktionelle TPH2 Varianten – insbesondere den rs4570625 SNP – mit Cluster B und Cluster C Persönlichkeitsstörungen. Für beide Patientengruppen zeigte sich eine signifikante globale Assoziation. Das T-Allel von rs4570625 war sowohl mit Cluster B als auch Cluster C Persönlichkeitsstörungen signifikant assoziiert. Diese Ergebnisse bestätigen TPH2 als ein Suszeptibilitäts- und/oder Modifier-Gen von affektiven Spektrumsstörungen. Die Relevanz für die Ätiologie von adulten ADHS und dramatisch-emotionalen Cluster B beziehungsweise ängstlich-furchtsamen Cluster C Persönlichkeitsstörungen muss durch weitere Studien untersucht werden. / Variation in the tryptophan hydroxylase-2 gene (TPH2) coding for the rate-limiting enzyme of serotonin (5-HT) synthesis in the brain has been linked to a spectrum of clinical populations characterized by emotional dysregulation. Here, a set of common single nucleotide polymorphisms (SNPs) in and downstream of the transcriptional control region of TPH2 (rs4570625, rs11178997, rs4341581, rs4565946) was testet for association in two cohorts comprising of 336 healthy individuals and 420 patients with personality disorders. Personality disorders were diagnosed with the Structured Clinical Interview of DSM-IV and were allocated to clusters A, B, and C. Individual SNP and haplotype analyses revealed significant differences in genotype frequencies between controls and cluster B as well as cluster C patients, respectively. In both patient groups, overrepresentation of T allele carriers of a functional polymorphism in the upstream regulatory region of TPH2 (SNP G-703T, rs4570625) was observed. The results link potentially functional TPH2 variants to cluster B and cluster C personality disorders. These findings confirm TPH2 as a susceptibility and/or modifier gene of affective spectrum disorders. The relevance for the etiology of adult ADHD as well as Cluster B and Cluster C personality disorders needs further study.

No description available.

Antisocial Personality Disorder (APD) represents a controversial diagnoses which has gone through many revisions over the past 25 years and is scheduled to be revised again for the DSM IV. A comprehensive survey was composed of APD criteria from the DSM II, DSM III, DSM III-R, PCL-R, Psychopathic Personality Disorder, and Dyssocial Personality Disorder. The survey was completed by 321 forensic psychiatrists based on which criteria they believed to be the most prototypical of antisocial personality. The results identified four factors: irresponsibility, unstable self image, and unstable relationships; manipulation and lack of guilt; aggressive behavior; and nonviolent juvenile delinquency. A diagnostic set composed of the most prototypical criteria was proposed for the DSM IV diagnosis of APD.

Background Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition. Method A total of 3021 community subjects (97.7% lifetime AU) aged 14–24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI. Results Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition. Conclusions Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AUD.

Aims: To investigate the gender differences in the patterns of cannabis use (CU), namely frequency, times of day, social context and methods and in their association with DSM-IV cannabis dependence. Methods: A sample of 3,904 students from German universities was recruited via an internet survey. Logistic regressions and associated areas under the ROC curve (AUC) were calculated among current cannabis users (at least once a month, n = 843). Results: CU using a water pipe was more often reported by males (50 vs. 34.6%). Usual CU ‘before going to sleep at night’ was more often reported by females (47.3 vs. 35.7%). Most CU patterns showed a similar association with DSM-IV cannabis dependence in both genders. The association of CU ‘with strangers’ was stronger in females (AUC 0.68 vs. AUC 0.56). Slightly different multiple models were found (females AUC 0.86, males AUC 0.77). Conclusions: There are considerable gender differences in the CU patterns and, thus, in the way CU functions. In the association of CU patterns with cannabis dependence, the similarities are rather great. Examining the CU patterns might make a considerable contribution to the better detection of high-risk population segments for prevention and early intervention in both genders. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Notre étude porte sur deux échantillons de patients Tunisiens : un groupe clinique composé de sujets (N = 41) diagnostiqués trouble de personnalité limite par leur psychiatre en référence aux critères du DSM-IV (APA, 2003) et un groupe témoin composé de patients schizophrènes (N = 27). Nous avons utilisé le test de Rorschach en Système intégré (Exner, 1993) et avons fixé comme premier objectif de dégager les caractéristiques du fonctionnement des patients limites au Rorschach selon les paramètres de l’organisation limite de la personnalité décrits par Kernberg (1997). Notre deuxième objectif est de vérifier si le fonctionnement de ces sujets, tel que traduit dans le Rorschach, permet de les différencier des sujets schizophrènes. Le troisième objectif est d’étudier, par une approche test re-test avec un intervalle de 6 à 9 mois, la stabilité des variables du Rorschach à travers le temps. Les résultats de notre étude montrent que les protocoles des patients limites diffèrent par rapport à certaines variables-clés (7 variables) de ceux des schizophrènes. Ces variables constituent des indicateurs pertinents du fonctionnement limite. Néanmoins, nous avons relevé une hétérogénéité à l’intérieur de notre échantillon de sujets limites. En effet, plusieurs niveaux de fonctionnements ont émergé à l’intérieur de ce groupe. Par ailleurs, il n’y a pas eu de différence significative entre la plupart des variables en T1 et T2 aussi bien chez les sujets limites que les schizophrènes. Toutefois, la stabilité semble dépendre du fonctionnement sous-jacent. / This study concerns two samples of Tunisian patients: a clinical group (N = 41) with subjects who received a diagnosis of Borderline personality disorder in reference to DSM-IV (APA, 2003) by their psychiatrist and a control group of schizophrenic patients (N = 27). We used the Rorschach comprehensive system (Exner, 1993) in order to identify, as a first purpose, the characteristics of the Rorschach’s borderline functioning based on the Kernberg’s description of the borderline organisation (1997). In parallel, we aimed, to verify whether the Rorschach’s functioning characteristics are able to distinguish our clinical group from the Schizophrenic group. Furthermore, both of groups were tested once in the beginning of our study and again, with an interval of 6 at 9 months in order to study the stability of the Rorschach’s variables. The results indicated that seven (7) variables distinguish our group of Borderline subjects from the schizophrenics. These variables represent highly relevant indicators of borderline functioning. Nevertheless, our clinical group is heterogeneous. In fact, different ranges of functioning have emerged. Elsewhere, there is no significant difference between the most variables in T1 and T2 but the stability may differ depending on the underlying functioning.

Aims: To investigate the gender differences in the patterns of cannabis use (CU), namely frequency, times of day, social context and methods and in their association with DSM-IV cannabis dependence. Methods: A sample of 3,904 students from German universities was recruited via an internet survey. Logistic regressions and associated areas under the ROC curve (AUC) were calculated among current cannabis users (at least once a month, n = 843). Results: CU using a water pipe was more often reported by males (50 vs. 34.6%). Usual CU ‘before going to sleep at night’ was more often reported by females (47.3 vs. 35.7%). Most CU patterns showed a similar association with DSM-IV cannabis dependence in both genders. The association of CU ‘with strangers’ was stronger in females (AUC 0.68 vs. AUC 0.56). Slightly different multiple models were found (females AUC 0.86, males AUC 0.77). Conclusions: There are considerable gender differences in the CU patterns and, thus, in the way CU functions. In the association of CU patterns with cannabis dependence, the similarities are rather great. Examining the CU patterns might make a considerable contribution to the better detection of high-risk population segments for prevention and early intervention in both genders. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-08T18:44:55Z No. of bitstreams: 1 Marcela Potrich Peluffo.pdf: 226215 bytes, checksum: 738e3b8accac2fd4d75e3a41daded914 (MD5) / Made available in DSpace on 2015-04-08T18:44:55Z (GMT). No. of bitstreams: 1 Marcela Potrich Peluffo.pdf: 226215 bytes, checksum: 738e3b8accac2fd4d75e3a41daded914 (MD5) Previous issue date: 2014-03-27 / The World Health Organization estimated depression as the third cause of disability in the ranking of all diseases, responsible for 4.3% loss of healthy life years (DALY). The depressive disorder impairs the ability to function, leading to deficiency in the production of more than 50% of patients. The treatment may be pharmacotherapy, psychotherapy, and in some cases eletroconvulsive therapy. This study examined the prevalence of the use of antidepression medications in the city of São Paulo, Brazil and is part of a large study Pos traumatic stress disorder on the São Paulo city: prevalence, commordity and associated factors. This is a one phase cross-sectional survey carried out in São Paulo, Brazil. A multistage probability to size sampling scheme was performed in order to select the participants (3000). The measurements included psychiatric diagnoses (CIDI 2.1), and psychoactive medications. The interviews were carried between June/2007 February/2008. The statistical analyses will be weight-adjusted in order to take account of the design effects. The frequency of use of psychoactive medications in individuals with depressive disorder 13%, 12,8% make use of antidepressant medication and 8% benzodiazepines, so with a large number of concurrent use of two medications. Among those who are using antidepressants, 63% use selective serotonin reuptake inhibitors, 34% use a tricyclic antidepressant and the other 3% make use of selective inhibitors of noradrenaline reuptake and various antidepressants. Was associated with the use of antidepressant medications females (2,7; IC 95% 1,5 ¿ 4,9), age over 30 years, being widowed or divorced or separate without living with the partner, with schooling above 13 years. It was concluded that there is a great way to go in our country in relation to mental health policies. Advances such as ensuring access to medicines and qualified professionals have already occurred, but show still insufficient. / A Organização Mundial da Saúde estima a depressão como a terceira causa de incapacidade no ranking de todas as doenças, responsável por 4,3% de perda de anos de vida saudáveis (DALY). O transtorno depressivo prejudica a capacidade laboral de mais de 50% dos pacientes. Os tratamentos podem ser farmacoterapia, psicoterapia e, em alguns casos, o tratamento eletroconvulsivante. O objetivo deste estudo foi avaliar o uso de medicamentos antidepressivos em indivíduos com diagnóstico de transtorno depressivo na população da cidade de São Paulo, Brasil. Um estudo de corte transversal foi realizado com amostra probabilística, em multiestágios, da população da cidade de São Paulo, Brasil. Foram entrevistados 2536 indivíduos. As medidas incluíram diagnósticos psiquiátricos (CIDI 2.1) e o uso de medicamentos psicoativos, incluindo antidepressivos. As entrevistas foram realizadas entre Junho/2007 e Fevereiro/2008. As estimativas foram ajustadas para o efeito do desenho por meio da análise de amostras complexas. A prevalência de uso de medicação psicoativa em indivíduos com transtorno depressivo foi de 13%, 12,8% utilizando de medicação antidepressiva e 8% benzodiazepínicos, portanto com número grande de uso concomitante das duas medicações. Entre aqueles que fazem o uso de antidepressivos, 63% usam inibidores seletivos da recaptação de serotonina, 34% usam antidepressivo tricíclico e os outros 3% fazem o uso de inibidores seletivos da recaptação de noradrenalina e antidepressivos variados. O uso de medicamentos antidepressivos esteve associado ao sexo feminino (2,2; IC 95% 1,0 ¿ 5,0), idade acima de 30 anos (2,7; IC 95% 1,1 ¿ 6,5), ser viúvo ou divorciado ou separado não morando junto com o parceiro (2,0; IC 95% 1,0 ¿ 4,2), com escolaridade acima de 13 anos (3,1; IC 95% 1,2 ¿ 7,9). Foi concluído que há um grande caminho a ser percorrido em nosso país em relação às políticas de saúde mental. Avanços como a garantia de acesso aos medicamentos e profissionais qualificados já ocorreram, mas se mostram ainda insuficientes.