Stress and limbic iritability in depression and alcohol dependency Denisa Jasová Abstract Depressive disorders and alcohol dependency recently present epidemiologically most significant psychiatric disorders. According to current research both diseases are multifactorial, mainly represented by genetic and environmental conditions. Several recent research studies are mainly focused on social factors related to stress and traumatic events such as neglect, deprivation, verbal, emotional, physical and sexual abuse, bullying and others. Important feature of these pathological conditions present disbalance between excitatory and inhibitory systems. In this context in affective disorders as well as in alcohol dependency these inhibitory deficits are represented by increased sensitivity and excitability of the limbic system called limbic irritability. Several studies suggested that these pathological changes may be described using the kindling model that potentially may explain limbic changes similar to temporal lobe epilepsy which may produce affective, cognitive and psychosensory symptoms but without typical changes that occur in neurologically diagnosed epilepsy. Following these findings significant correlations between depression and limbic irritability and between limbic irritability and alcohol craving have...

Stress and limbic iritability in depression and alcohol dependency Denisa Jasová Abstract Depressive disorders and alcohol dependency recently present epidemiologically most significant psychiatric disorders. According to current research both diseases are multifactorial, mainly represented by genetic and environmental conditions. Several recent research studies are mainly focused on social factors related to stress and traumatic events such as neglect, deprivation, verbal, emotional, physical and sexual abuse, bullying and others. Important feature of these pathological conditions present disbalance between excitatory and inhibitory systems. In this context in affective disorders as well as in alcohol dependency these inhibitory deficits are represented by increased sensitivity and excitability of the limbic system called limbic irritability. Several studies suggested that these pathological changes may be described using the kindling model that potentially may explain limbic changes similar to temporal lobe epilepsy which may produce affective, cognitive and psychosensory symptoms but without typical changes that occur in neurologically diagnosed epilepsy. Following these findings significant correlations between depression and limbic irritability and between limbic irritability and alcohol craving have...

Background: Physical therapists regularly make decisions regarding intervention intensity based upon pathoanatomy and symptom irritability, but the reliability and validity of classifying patients by symptom irritability are unknown. Purpose: Examine the reliability and construct validity of the shoulder symptom irritability classification (SSIC) system for the purposes of determining an appropriate treatment intensity. Design: Prospective repeated-measures cross-sectional single-blinded design. Methods: 101 consecutive subjects with primary complaints of shoulder pain were assessed by a pair of blinded raters. Raters recorded the SSIC level and selected the appropriate intervention intensities for the subjects. Data Analysis: Prevalence-adjusted, bias-adjusted Kappa for ordinal scales (PABAK-OS) and observed agreement were the primary measures of reliability. Analysis of variance (ANOVA) was used to compare functional disability across different levels of irritability. Receiver operating characteristic (ROC) curve analysis was utilized to derive cut-off scores for the patient-reported outcome (PRO) measures. Ordinal regression was utilized to compare the strength of patient-reported pain and disability in the determination of shoulder symptom irritability. Results: Inter-rater reliability (PABAK-OS) was 0.69 (95% Confidence Interval [CI] = 0.59, 0.78). ANOVA demonstrated significant differences in functional limitation between SSIC groups for all PRO measures. ROC curve analysis found significant cut-off scores for all PRO measures. Lastly, rater agreement between SSIC and treatment strategy was found to have PABAK-OS of 0.82 (95% CI 0.75, 0.88) with 80% agreement. Discussion: The inter-rater reliability of the SSIC system good and is not contingent upon experience or expertise. Despite lack of predominance of the function in the components of SSIC, functional limitation significantly influences SSIC along with aspects of pain that influence function. While the cut-off scores show promising results, further work is needed to validate the results. Ultimately, there appears to an excellent relationship between rater selected SSIC and treatment strategy demonstrating a foundation for construct validity of the SSIC. Therefore, the results of this study should serve as a foundation for future work for refinement of the SSIC as a component of the STAR-Shoulder diagnostic classification system. Clinical Significance: The shoulder symptom irritability classification scale is reliable and clinically useful for improvement of communication between medical providers.

Made available in DSpace on 2016-04-28T20:39:35Z (GMT). No. of bitstreams: 1 Joao Paulo F Barretta.pdf: 1027000 bytes, checksum: 00e7b78fd29fddd5e78195ac9fcc37ae (MD5) Previous issue date: 2007-11-28 / The main aim of this work is to iluminate Heidegger s ontological criticism of the freudian theory, which was collected by Medard Boss in the Zollikon s Seminars (1987). This criticism can only be understood in the light of the developments made by the philosopher in relation to Husserl s phenomenology. The main point is that Heidegger had investigated, in the 1920 s, the way of being of human beings, in order to have access to the fundamental question of the meaning of being in general (Seinsfrage). Such a procedure brought Heidegger to the development of a fundamental ontology which has psique as its subject matter. Therefore, he is able to approach phenomenologically something which is only implicit in the freudian theory. This one is concerned itself explicitly with certains pathologicals (neurotical symptoms) and non-pathologicals (dreams, misbehaviors, lapsos linguae etc) psiquic processes, on the base of which it developed a model of the mental functioning. Based on this common subject matter, Heidegger will criticize Freud for not having understood correctly the meaning of being of the psiquic, for having done an objetification, that means, for having understood it in the light of the unproper category of substance. Notwithstanding, both the philosopher nor the specialists after him, succeeded in identifying which substance is the psiquism in Freud s theory. What we intend to show is that for him it is an irritable substance. This is a caracterization that comes from the XIX century s physiology. Such a substance should further be understood in the light of physical (physicalism) and biological (darwinism) concepts. With this caracterization we were able then to contrast Freud s way of conceiving psiquism with Heidegger s proposal, that is to say, to contrast the concepts of irratable substance and fundamental openness. This can only be properly understood thou on the base of the differences in the way each one of the autors here in question understands what does it means to have an experience. The concept of experience plays, therefore, a decisive role, as we tried to show, in the determination of the being of the psiquic / Este trabalho teve por objetivo fundamental explicitar a crítica ontológica de Heidegger à teoria freudiana, compilada por Medard Boss nos Seminários de Zollikon (1987). Essa crítica só pode ser compreendida à luz das reformulações levadas a cabo pelo filósofo em relação à fenomenologia de Husserl. No essencial, Heidegger irá perguntar, nos anos 1920, pelo modo de ser do ente homem para, com isso, ter acesso à pergunta fundamental do sentido do ser em geral (Seinsfrage). Ao proceder dessa forma, Heidegger é levado a uma ontologia fundamental que tem como tema o modo de ser da psique. Com isso, ele aborda fenomenologicamente algo que é apenas implícito na teoria freudiana, que se ocupa, explicitamente, de certos processos psíquicos patológicos (sintomas neuróticos) e não patológicos (sonhos, chistes, atos falhos, lapsos de linguagem, etc) e a partir dos quais constrói um modelo do funcionamento mental. Com base nessa temática comum a ambos, Heidegger irá criticar Freud por esse último não ter compreendido corretamente o sentido do ser do psiquismo, de objetificá-lo, isto é, de compreendê-lo à luz da categoria não adequada de substância. Contudo, nem o filósofo, nem os estudiosos da área, identificaram que tipo de substância é o psiquismo para Freud. Pretendemos mostrar, no presente trabalho, que Freud o concebe como uma substância irritável, caracterização essa oriunda da fisiologia do século XIX, e essa última como devendo ser compreendida à luz de conceitos físicos (fisicalismo) e biológicos (darwinismo). Com essa caracterização pudemos, então, contrapor a maneira como Freud concebe o psiquismo com a maneira proposta por Heidegger, isto é, contrapor os conceitos de substância irritável ao de abertura fundamental. Contudo, essa contraposição só pode ser corretamente compreendida com base na maneira como se concebe a experiência humana. Essa última joga um papel decisivo, como procuramos mostrar, na determinação do ser do psiquismo

Background: Suicidal young adults often confide their distress to peers. It is unclear, however, what types of assistance a friend may offer in response to various symptoms of distress as well as whether the sex of either individual affects responses. Aims: We examined open-ended responses to e-mail vignettes from a fictitious friend exhibiting depressed, irritable, or overtly suicidal communications. Method: College student participants (n = 106) read e-mail messages from a fictitious friend, to which they composed a reply. Replies were coded to reflect the presence/absence of mention of professional help, problem-oriented (personal) help, and social support. Results: Problem-oriented help was offered the most across conditions; professional help was offered least in response to depressed or irritable vignettes. Women were more likely to offer any type of help than men. Patterns of help-giving and sex differences in help-giving varied by condition. Conclusions: Results indicate students’ preferences for solving peer problems personally rather than professionally. Campus prevention and intervention efforts should focus on enhancing students’ peer support and referral skills.

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<p>Premenstrual dysphoria, so severe that it affects the lives of the women afflicted, is the condition studied in this thesis. Physiological and pharmacological mechanisms of pathogenetic relevance were investigated. </p><p>Women with premenstrual dysphoria showed a stronger and less dampened response of LH to an estradiol challenge than asymptomatic women, indicating an altered neuroendocrine regulation. In women with premenstrual dysphoria, the LH response was correlated to the severity of irritability and bloating, and the early FSH response was correlated to the severity of depressed mood. </p><p>The positron-emission study showed strong, consistent correlations between worsening of mood symptoms and a decrease in brain trapping of the immediate serotonin precursor, from the mid-follicular to the late luteal phase in women with premenstrual dysphoria. The strongest correlations were seen for the cardinal mood symptoms of premenstrual dysphoria, and for their opposites. Physical symptoms showed weaker or no correlations with the exception of nociceptive symptoms from erogenous body regions which showed positive correlations to serotonin precursor trapping in the right caudate nucleus. The findings are consistent with the serotonin hypothesis of premenstrual dysphoria, and might possibly explain the observed effects of serotonin-augmenting drugs in this condition.</p><p>The partial 5-HT_1A receptor agonist buspirone was superior to placebo in the treatment of premenstrual dysphoria. The weak SRI and 5-HT₂ receptor antagonist nefazodone was not superior to placebo. For women with premenstrual dysphoria in need of medication and who do not tolerate SRIs because of the sexual sideeffects, buspirone may be an alternative drug, since it had no adverse effects on sexual function. </p><p>The prevalence of polycystic ovaries and serum levels of androgens were not higher in women with premenstrual dysphoria than in their asymptomatic counterparts. The findings are not consistent with the hypothesis that irritability in women with premenstrual dysphoria is induced by elevated testosterone levels. </p><p>Thesis results, which are in line with the serotonin hypothesis of premenstrual dysphoria, may imply that increased brain sensitivity is one of the factors underlying severe premenstrual mood symptoms, thereby further supporting a common serotonergic dysregulation in this condition.</p>

Premenstrual dysphoria, so severe that it affects the lives of the women afflicted, is the condition studied in this thesis. Physiological and pharmacological mechanisms of pathogenetic relevance were investigated. Women with premenstrual dysphoria showed a stronger and less dampened response of LH to an estradiol challenge than asymptomatic women, indicating an altered neuroendocrine regulation. In women with premenstrual dysphoria, the LH response was correlated to the severity of irritability and bloating, and the early FSH response was correlated to the severity of depressed mood. The positron-emission study showed strong, consistent correlations between worsening of mood symptoms and a decrease in brain trapping of the immediate serotonin precursor, from the mid-follicular to the late luteal phase in women with premenstrual dysphoria. The strongest correlations were seen for the cardinal mood symptoms of premenstrual dysphoria, and for their opposites. Physical symptoms showed weaker or no correlations with the exception of nociceptive symptoms from erogenous body regions which showed positive correlations to serotonin precursor trapping in the right caudate nucleus. The findings are consistent with the serotonin hypothesis of premenstrual dysphoria, and might possibly explain the observed effects of serotonin-augmenting drugs in this condition. The partial 5-HT1A receptor agonist buspirone was superior to placebo in the treatment of premenstrual dysphoria. The weak SRI and 5-HT2 receptor antagonist nefazodone was not superior to placebo. For women with premenstrual dysphoria in need of medication and who do not tolerate SRIs because of the sexual sideeffects, buspirone may be an alternative drug, since it had no adverse effects on sexual function. The prevalence of polycystic ovaries and serum levels of androgens were not higher in women with premenstrual dysphoria than in their asymptomatic counterparts. The findings are not consistent with the hypothesis that irritability in women with premenstrual dysphoria is induced by elevated testosterone levels. Thesis results, which are in line with the serotonin hypothesis of premenstrual dysphoria, may imply that increased brain sensitivity is one of the factors underlying severe premenstrual mood symptoms, thereby further supporting a common serotonergic dysregulation in this condition.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a popular measure of psychosocial functioning and psychopathology in the assessment of individuals in a variety of settings. However, the method of construction employed with the MMPI more than 60 years ago with psychiatric patients challenges the applicability of the scales for determining the psychosocial functioning of individuals from different settings. The restandardisation conducted in 1987 made no effort to eradicate the item overlap that was a result of the criterion keying method with contrasted groups. Although restandardized and updated with more contemporary language and content, the original psychiatric constructs were retained in order to maintain continuity with its predecessor. The aims of this investigation were to develop a new structure for the MMPI-2 constructed at the item-level, empirically derived and which specifically represents the dimensions that are relevant and appropriate in evaluating the psychosocial functioning of personal injury claimants. This task included comparisons with a comparable scale-level analysis and developing optimal scoring strategies where items in components and facets are allocated weightings based upon their strength of association. Study 1 was conducted using a sample of 2989 personal injury claimants assessed in Australia and the United States of America. The final sample of 3230, included 241 normal individuals, was utilized to develop a scale-level structure from 79 standard MMPI-2 scales and subscales. A nine-component solution consisting of General Maladjustment /Emotional Distress, Asocial Beliefs, Social Vulnerability, Somatic Complaints, Psychological Disturbance, Impulsive Expression, Antisocial Practices, Stereotypic Fears and Family Difficulties was derived using principal component analysis. However, intercorrelation between components in the structure signaled the need to develop a structure that would eradicate problems that were perpetuated by item overlap. The second study was conducted with a set of best practice procedures with the same clinical sample of 2989 personal injury claimants as Study 1. Forty-one components were derived through principal component analysis. Through the application of a set of criteria, a 35-component solution was retained. The pattern coefficients from the allocation of items to components determined the weightings to be applied to each item. Further analysis of the 35 components derived a substructure of 37 facets. The 35 components included only 442 of the 567 items, with the reliability coefficients of the first 25 components that ranged between .5 and .97, and the remaining 10 components that ranged from .29 to .49. The latter unreliable components were not included in the final Structural Summary, leaving 25 components (400 items) and their 33 facets for interpretation. Hence, in demonstrating the utility of the newly-derived structure, only 25 components and their 33 facets were interpreted. The 25 components were grouped conceptually into six domains. In the emotional domain were Psychological Distress (PsyDist), Anger, Fears, Psychotic Symptoms (PsyS), Paranoia (Par), Irritability (Irrit), Elation (Elat), Fear of the Dark (FD), and Financial Worry (FinWo). Somatic Complaints (SomC), Sexual Concerns (SexCon), and Gastrointestinal Problems (GasP) made up the measures in the physiological domain. In the behavioural domain were Cognitive Difficulties (CogDiff), Stimulus-Seeking (StimuS), Discipline (Dis), and Delinquency (Del) whilst the interpersonal domain was formed by Social Withdrawal (SoW), Negative Interpersonal Attitude (NIA), Timidity (Tim), Lie, Dissatisfaction with Self (DWS) and Family Relationship Difficulties (FReD). Alcoholism (Alco) was the only measure in the substance abuse domain, and the gender domain was comprised of Masculinity (Mas) and Femininity (Fem). The third study established preliminary normative means and standard deviations using a small opportunistic Australian university student sample (N = 219). No substantial gender differences were found but gender norms were maintained to facilitate comparisons with the traditional MMPI-2 approach. Comparisons of frequency of 'true' item response between the Australian university student sample and the U.S. restandardisation sample found relatively little differences and permitted evaluation of between sample differences on components and facets. The utility of the structure was demonstrated with the illustration of two clinical case examples, and a comparison was made with the standard MMPI-2 scales and subscales. The Structural Summary for the MMPI-2 demonstrated discriminative measures of psychosocial functioning that were a result of no item overlap, and the ability to attend to the different levels of intensity of self-report items because of differential weightings.