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June 2019 - Volume 207 - Issue 6

  • John A. Talbott, MD
  • 0022-3018
  • 1539-736X
  • 12 issues / year
  • Psychiatry 89/142; Clinical Neurology 134/197
  • 1.940


Is There Anybody Out There? Attachment style and interpersonal facilitators as protective factors against complicated grief among suicide-loss survivors
Yossi Levi-Belz, PhD, and Lilac Lev-Ari, PhD

To date, no studies have fully examined the psychological processes that delineate the risk and resilience factors that contribute to complicated grief (CG) among suicide-loss survivors (SLSs). Questionnaires assessing attachment style, self-disclosure, social support, and CG were completed by 156 SLS participants. A regression model revealed that secure attachment negatively predicted CG, but self-disclosure moderated this association. Secure attachment seems to be a resilient factor for CG. However, SLS with low secure attachment but high in self-disclosure ability use this behavior as a way to impede CG.

Disclosure and Quality of Life among unemployed individuals with mental health problems: A longitudinal study
Nicolas Rüsch, MD, Alexandra Malzer, Nathalie Oexle, PhD, Tamara Waldmann, MA, Tobias Staiger, PhD, Andreas Bahemann, MD, Moritz E. Wigand, MD, Thomas Becker, MD, Patrick W. Corrigan, PsyD

We examined disclosure attitudes at baseline as predictors of quality of life after 6 months, and also assessed social support, depressive symptoms, self-stigma, and perceived discrimination among 301 unemployed individuals with mental health problems. Better quality of life at follow-up was predicted by better attitudes toward disclosure among family and friends, shorter length of unemployment, less symptoms and, at a trend level, less self-stigma at baseline. Thus, disclosure in one's private environment may improve quality of life among unemployed individuals with mental health problems.,_Deliberate_Rumination,_and.5.aspx

Can Social Anxiety Impact Facial Emotion Recognition in Schizophrenia?
Tania Lecomte, PhD, Laurence Théroux, PhD-candidate, Karine Paquin, PhD, Stéphane Potvin, PhD, Amélie Achim, PhD

A total of 47 participants with a diagnosis of schizophrenia and receiving outpatient services answered measures of facial recognition (Ekman; Facial Emotion Identification Test), facial discrimination (Facial Emotion Discrimination Test), role-play, social anxiety (Social Interaction Anxiety Scale and Brief Social Phobia Scale), psychiatric symptoms (Brief Psychiatric Rating Scale), self esteem (Self-Esteem Rating Scale–Short Form), and social functioning (Social Functioning Scale). A total of 22 (47%) participants were rated as socially anxious. Those with social anxiety had worse social functioning in the domains of interpersonal communication and engagement (in conversations), and had lower self-esteem. Participants with social anxiety also had more difficulties in recognizing neutral emotional faces. More studies are warranted to better understand the link between neutral expression recognition and social anxiety in schizophrenia.

The Nose Knows... Or Does It? Olfactory reference syndrome in patients presenting for assessment of unusual body odour
Vanda McNiven, MD, Sarah Mamane, MD, Gwyneth Zai, MD, PhD, Joyce So, MD, PhD

Olfactory reference syndrome (ORS) is a rarely diagnosed psychiatric disorder in which individuals falsely believe that they emit an offensive body odor. This retrospective cohort study characterizes the clinical and demographic features of 54 individuals who presented to a Canadian genetics clinic for query trimethylaminuria (TMAU), an inherited disorder in which a pungent fishy odor is produced. The majority (83%) were found to have a likely diagnosis of ORS and a high rate (73.3%) of concomitant psychiatric disorders; only two patients were diagnosed with TMAU. This study highlights the genetics clinic as an unexpected and major ascertainment point for ORS, and shows that ORS can be differentiated from TMAU by age of onset (~28 years), odor characterization (refuse-related), and the presence of associated comorbid psychiatric diagnoses.

Intrusive Rumination, Deliberate Rumination, and Posttraumatic Growth Among Adolescents Following a Tornado: The role of social support
Wei Xu, PhD, Huili Jiang, MSc, Yuyang Zhou, PhD, Linli Zhou, BSc, Hong Fu, PhD

Four hundred forty-three middle school students in the core area of the tornado were administered a revised social support scale based on Furman and Buhrmester's Network of Relationships Inventory, Event-Related Rumination Inventory, and Posttraumatic Growth Inventory. Results showed a nonsignificant relationship between intrusive rumination and posttraumatic growth (PTG), whereas a positive relationship was found between deliberate rumination and PTG. Moreover, social support did not moderate the relationship between intrusive rumination and PTG, but it significantly mediated the relationship between deliberate rumination and PTG. Clinical implications on trauma intervention and limitations, as well as future research directions, were discussed.

How the DSM is Used in Clinical Practice
Michael B. First, MD, Matthew D. Erlich, MD, David A. Adler, MD, Shirley Leong, PhD, Lisa B. Dixon, MD, MPH, David W. Oslin, MD, Beth Goldman, MD, MPH, Steve Koh, MD, MPH, MBA, Bruce Levine, MD, Jeffrey L. Berlant, MD, PhD, Samuel G. Siris, MD

Recognizing public and professional attitudes toward the DSM are integral to future DSM development – to assess a commonly held assumption such as that the DSM is used primarily for coding and to assess its clinical utility. A convenience sample of Psychiatric Times readers was surveyed to assess the DSM's use in clinical practice. A total of 394 behavioral health care practitioners fully completed the online survey. Results suggest that the DSM, beyond administrative and billing use, is used for communication with health care providers, for teaching diagnoses to trainees and, importantly, as an educational tool to inform patients and caregivers alike.

Cultural Identity Confusion and Psychopathology: A mixed-methods study among refugees and asylum seekers in the Netherlands
Simon P.N. Groen, MA, Annemiek J.M. Richters, MD, PhD, Cornelis J. Laban, MD, PhD, Jooske T. van Busschbach, PhD, Walter L.J.M. Devillé, MD, PhD

Although there is ample empirical evidence that traumatic events, postmigration stress, and acculturation problems have a great impact on the mental health of refugees, so far no studies have included cultural identity after migration in the equation. This mixed-methods study conducted among Afghan and Iraqi refugee and asylum-seeker psychiatric patients aims to fill this gap. Associations between postmigration stress, symptoms of anxiety and depression disorders, and symptoms of posttraumatic stress disorder were significant. When differentiated for the two groups, associations with postmigration stress were no longer significant for Afghan patients, who were predominantly younger and more often single, lower educated, and without resident status compared with Iraqi patients. Qualitative results indicate that, in addition to psychopathology and postmigration stress, acculturation problems contribute to confusion of cultural identity.

Effect of Acupuncture on Cognitive Function and Quality of Life in Idiopathic Trigeminal Neuralgia Patients
Jie Gao, MS, Chongfa Zhao, BA, Wenchen Jiang, BA, Baosen Zheng, BA, Yongjin He, BA

To estimate the effect of acupuncture on idiopathic trigeminal neuralgia (ITN), we recruited 116 patients with ITN from December 2016 to April 2018 and further divided into them into two groups: acupuncture intervention group (n = 62) and sham control group (n = 54). Clinical pain, cognitive function, and quality of life (QoL) assessed with the 36-Item Short Form Health Survey (SF-36) were evaluated at the initial time of treatment, at the end of treatment, and 6 weeks after the treatment. Pain intensity, headache, and generalized body pain showed significant decrease both at the end of treatment and after 6 weeks of treatment when compared with initial time. The scores of the cognitive tests (Mini-Mental State Examination, Trail Making Test, Verbal Fluency Test, tracing score, and memory score) and five aspects of the SF-36 assessment (role emotional, general health, body pain, role physical, and mental health scores) showed significant improvement at the end of treatment compared with the initial time. Whereas after 6 weeks of treatment, the Mini-Mental State Examination, memory score, and Trail Making Test-A score and four aspects of the SF-36 assessment (vitality, bodily pain, mental health, and role physical) showed significant improvement when compared with the end of treatment.

Emotional Responsiveness in Borderline Personality Disorder: The role of basal hyperarousal and self-reported emotional regulation
Roberta Bortolla, PhD* Emanuela Roder, Pietro Ramella, Andrea Fossati, Cesare Maffei

The present study aims to test the hypothesis of biological hyperarousal and hyperreactivity underpinning the dysfunctional emotional processes of borderline personality disorder (BPD). Self-reported (quality and intensity of emotions) and physiological (respiratory sinus arrhythmia [RSA] and heart rate) data were collected in 14 clinical subjects with BPD and in 14 control subjects (healthy controls [HCs]), during the administration of six video clips with different emotional contents. Our findings showed a constant hyperarousal state (lower RSA) in the clinical group, supporting the hypothesis of a biological vulnerability to emotional dysregulation. BPD patients showed lower self-reported happiness in positive stimuli compared with HCs and a significant association between emotional dysregulation and physiological hyperreactivity to neutral stimuli. Our data support the hypothesis of a constant condition of physiological preparedness to threat and danger in BPD subjects. Moreover, our results highlight the influence of self-reported ability in regulating emotions in explaining BPD responses to specific emotional situations.

High-Intensity Interval Training (HIIT) in Panic Disorder Patients: A pilot study
Jens Plag, MD, Deniz-Levent Ergec, MSc, Thomas Fydrich, PhD, Andreas Ströhle, MD

High-intensity interval training (HIIT) may produce strong physiological but also psychological effects within a short period. However, it is questionable if this type of training is applicable and effective in patients with panic disorder (PD) because they are more vulnerable to the adverse effects of exercise. Twelve PD patients performed a 12-day HIIT trial. Every second day, patients performed 10 high-intensive 1-minute intervals at 77% to 95% of their maximum heart rate separated by 1-minute intervals with moderate to low intensity. All patients completed the 12-day training period. PD severity, agoraphobia, depression, general disorder severity, and endurance performance improved substantially with moderate to large effects sizes. Moreover, the increase in endurance performance was correlated with the reduction of depression and agoraphobia. HIIT was well tolerated by patients with PD and may induce rapid and strong therapeutic effects.

Tonic Seizure As a Different Seizure Type Presented in Autoimmune Epilepsy Caused by Systemic Lupus Erythematosus: A case report
Yudan Lv, PhD, Xiangyu Zheng, PhD, Xiao Zhang, MD, Danyang Zhao, MD, Li Cui, PhD

Autoimmune epilepsy has a strong association with other autoimmune diseases, especially systemic lupus erythematosus (SLE). In addition, autoimmune epilepsy was reported to present with complex partial seizure (CPS), simple partial seizure (SPS), and secondarily generalized tonic-clonic seizure (sGTCS). In our case, we present a different seizure type of tonic seizure in autoimmune epilepsy caused by SLE, which has not been reported, and it will provide with a new understanding of autoimmune epilepsy. A 17-year-old Chinese girl was diagnosed as having SLE for 1month but with no epilepsy history. After this admission, she presented with different seizure types. Then EEG, magnetic resonance imaging, and lumbar puncture were performed. We have found generalized tonic seizure and excluded CNS infection and lupus encephalopathy. After antiepileptic therapy, no improvement has been found in seizure control. According to the previous history, clinical manifestation, and relevant examinations, we have made a clinical diagnosis of autoimmune epilepsy (tonic seizure) and SLE has been confirmed again by the immunological test. After the hormonotherapy, anti-inflammatory, and anti-tuberculosis therapy, the tonic seizure decreased significantly, and patient's consciousness improved. 

Alcohol Use Problems, Posttraumatic Stress Disorder, and Suicide Risk Among Trauma-Exposed Firefighters
Hanaan Bing-Canar, BS, Rachel M. Ranney, MS, Sage McNett, BS, Jana K. Tran, PhD, Erin C. Berenz, PhD, Anka A. Vujanovic, PhD

The present study investigated the main and interactive effects of alcohol use problems (Alcohol Use Disorders Identification Test) and PTSD symptoms on suicide risk (Suicide Behaviors Questionnaire-Revised) in a sample of 632 trauma-exposed firefighters (93.5% men; M age = 38.44 years, SD = 8.59). Hierarchical logistic regression analyses evaluated whether the main and interactive effects of PTSD symptom severity and alcohol use disorders were significantly related to suicide risk, above and beyond age, and cumulative trauma. The main effects of PTSD symptom severity (odds ratio, 1.76; p < 0.001) and alcohol use problems (odds ratio, 1.37; p = 0.391) significantly positively predicted suicide risk; however, PTSD symptoms did not moderate an association between alcohol use problems and suicide risk after accounting for these main effects (p > 0.05). A secondary, exploratory aim demonstrated that all PTSD symptom clusters significantly positively predicted suicide risk (p's < 0.001), although none of these clusters interacted with alcohol use problems to predict suicide risk (p's > 0.05). 

Validating the Alternative DSM 5 Criteria for Personality Disorders: A study in the Basque region of Spain
Naiara Ozamiz-Etxebarria, PhD, Miren Agurtzane Ortiz-Jauregi, MD, Javier I. Escobar, MD

In 2010, the Working Group of Personality and Personality Disorders of the DSM-5 task force proposed a thorough diagnostic reformulation of the category of personality disorders. After debates and negotiations, these alternative criteria ended in Section III of the DSM-5 manual. We tested these alternative criteria in a sample of Basque-speaking patients from the Basque region of Spain who had clinical diagnoses of personality disorder, using instruments that had been developed and used as part of the DSM-5 field trials in the United States for assessing the proposed new diagnostic category. The results demonstrated that the DSM-5 alternative criteria worked well in this clinical sample, with highly satisfactory levels of reliability being attained and a good level of clinician's satisfaction related to the use of the new criteria. The alternative criteria in personality disorders seemed to work well in this European sample with unique linguistic features.

Analysis of Influencing Factors of Poststroke Depression: Is higher BMI always a risk factor of Poststroke Depression?
Zhiqiang Xue, MASc, Yanjun Wang, MASc, LijuanWang, PhD, Li Shen, MASc, Anning Zhang, MASc, Pan Pan, MASc, Hongjie Wang, MASc, Jing Dou, MASc, Xin Guo, MASc, Yaogai Lv, MASc, Lina Jin, PhD, Yan Yao, PhD

A total of 397 stroke patients in a hospital in Qiqihar City, China, were included in this study in 2016. The order of independent variable importance was the score of the National Institute of Health Stroke Scale, frequency of stroke, age, BMI, and sleep duration. Sleep duration of 7 hours or more (compared with <7 hours) was negatively associated with the Self-Rating Depression Scale (SDS) score in all quantiles. BMI of 28.0 kg/m2 or more (compared with 24.0–28.0 kg/m2) was negatively associated with SDS score, and the coefficients manifested a continuous increasing trend from P30 to P84.1 in patients aged 65 years or more. In addition, the relationship between BMI and SDS score demonstrated a "U"-shaped curve in patients aged less than 65 years. The National Institute of Health Stroke Scale score, the frequency of stroke, sleep duration, and BMI were the influencing factors of post stroke depression (PSD). BMI played different roles in the two age groups.

The Detection of the Negative Effects of Interictal Epileptiform Discharges on Cognition: An event-related potential (ERP) study
Lihua Sun, PhD, Xiangyu Zheng, PhD, Chang Liu, MD, Mingchao Shi, PhD, Yudan Lv, PhD

Evidence from a neuropsychological test revealed that interictal epileptiform discharges (IEDs) may have significant impact on cognitive performance. Sometimes, neuropsychological tests may not be sensitive to detection of mild cognitive changes. We applied P300 and mismatch negativity (MMN) to detect mild cognitive changes caused by small amount of IEDs. Sixty-seven adult epilepsy patients and participants were divided into six groups according to different IEDs index. The patients with IED index greater than 7.5% showed longer latency and lower amplitude in the test of P300 and MMN than patients with IED index less than 7.5%, which indicated mild impaired cognitive function. The negative effect of IED index greater than 10% on cognitive has been found by neuropsychological test, whereas the mild negative effect of IED index greater than 7.5% has only been found by P300 and MMN. So, P300 and MMN may be more sensitive than neuropsychological tests to detect mild cognitive impairment caused by IEDs.

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