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AbuMadini MS, Rahim SI. (2002)
Department of Psychiatry, College of Medicine, King Faisal University, PO Box 40101, Al-Khobar 31952, Kingdom of Saudi Arabia.
Psychiatric admission in a general hospital. Patients profile and patterns of service utilization over a decade.
Saudi Med J 2002 Jan;23(1):44-50

ABSTRACT: OBJECTIVE: To analyze the socio-demographic and clinical characteristics of admitted patients and the patterns of their service utilization over a decade from March 1988 to March 1998. METHODS: Prospective data compilation using a structured questionnaire, hospital records and follow-up observations at King Fahd Hospital of the University in Al-Khobar, Kingdom of Saudi Arabia. RESULTS: A total of 1366 patients (683 of each sex) had 2217 admissions in 10 years. By the International Classification of Diseases, 10th edition criteria, 19.5% had schizophrenia, 15.2% bipolar disorder, 9.9% depressive episodes, 8.6% acute and transient psychotic disorders, 7.7% adjustment disorders and 7.6% dissociative disorders. Males were more frequently admitted for schizophrenia and females for mood and anxiety disorders. Most non-Arab expatriates were diagnosed as acute and transient psychotic, stress-related or dissociative disorders. Re-hospitalizations constituted 28% of all admissions. The mean length of stay was 25 days per admission and 41 days per patient. The overall bed occupancy rate was 84.9%. A subgroup of 16.9% of patients, mostly with schizophrenia or bipolar disorder, consumed 62.3% of the bed occupancy. CONCLUSION: Gender and immigration were the main determinants of variance in patient characteristics, nosological distribution and pattern of service use. More beds are needed. Psycho-educational programs should be intensified to reduce the social stigma and societal intolerance to mental patients. Active family involvement improves compliance and might reduce re-hospitalization rates. Heavy service consumers should be transferred to long-stay facilities.

Ad-Dab'bagh Y, Greenfield B. (2001)
Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
Multiple complex developmental disorder: the "multiple and complex" evolution of the "childhood borderline syndrome" construct.
J Am Acad Child Adolesc Psychiatry 2001 Aug;40(8):954-64

ABSTRACT: OBJECTIVES: To provide an overview of the history, evolution, and nosology of the diagnostic constructs for "borderline syndrome of childhood," also known as "multiple complex developmental disorder." METHOD: The authors synthesized information found via electronic searches of databases (MEDLINE, PsycINFO, Current Contents, Humanities Abstracts, and Social Sciences Abstracts) and bibliographic directed searches. RESULTS: Although early publications (prior to 1980) were either highly anecdotal or lacking in scientific rigor, they were nonetheless noted for their historic value and influence on research trends. The recent publications (1990s) were characterized by more rigorous methodology and greater generalizability. Current classifications, proposals for diagnostic criteria, epidemiological data, and nosological suggestions were summarized. CONCLUSION: The literature supports the creation of a new diagnostic label to describe a population of children whose symptoms are currently subsumed under the labels "borderline" or "multiple complex developmental disorder." A full characterization of the syndrome, including its evolution, would require prospective studies and may differ from the known evolution for personality disorders and/or pervasive developmental disorders. The authors propose a process by which a new nomenclature is derived.

Adam, K. Anderson and Elisabeth Phelps (2001)
Lesions of the human amygdala impair enhanced perception of emotionally salient events (A Reply)
Nature 411, 305 - 309 (2001)

ABSTRACT: Commensurate with the importance of rapidly and efficiently evaluating motivationally significant stimuli, humans are probably endowed with distinct faculties and maintain specialized neural structures to enhance their detection. Here we consider that a critical function of the human amygdala is to enhance the perception of stimuli that have emotional significance. Under conditions of limited attention for normal perceptual awareness -that is, the attentional blink-we show that healthy observers demonstrate robust benefits for the perception of verbal stimuli of aversive content compared with stimuli of neutral content. In contrast, a patient with bilateral amygdala damage has no enhanced perception for such aversive stimulus events. Examination of patients with either left or right amygdala resections shows that the enhanced perception of aversive words depends specifically on the left amygdala. All patients comprehend normally the affective meaning of the stimulus events, despite the lack of evidence for enhanced perceptual encoding of these events in patients with left amygdala lesions. Our results reveal a neural substrate for affective influences on perception, indicating that similar neural mechanisms may underlie the affective modulation of both recollective and perceptual experience.

Mehmet Yücel Agargun, M.D. , Ömer Akil Özer, M.D., Hayrettin Kara, M.D., Ramazan ekerolu, Ph.D., Yavuz Selvi, M.D., and Buket Eryonucu, M.D. (2004)
Serum Lipid Levels in Patients With Dissociative Disorder
Am J Psychiatry 161:2121-2123, November 2004

ABSTRACT: OBJECTIVE: There may be an association between a low serum cholesterol level and dissociative disorders. METHOD: The subjects of the study were 16 patients with dissociative disorder and 16 normal comparison subjects (two men and 14 women in each group). Total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, and very low density lipoprotein levels were compared. RESULTS: Patients with dissociative disorders had lower serum triglyceride, total cholesterol, low-density lipoprotein, and very low density lipoprotein levels than normal comparison subjects. CONCLUSIONS: Low serum lipid concentrations may be related to a high incidence of self-injurious behaviors and borderline features in patients with dissociative disorders.

Alao, A.O.; Yolles, J.C.; Armenta, W. (1999)
Genital self-mutilation: A Reply.
Psychiatric Services, 50, 1362-1363.
ABSTRACT Replies to the comment by R. M. Waugaman concerning the article by A. O. Alao et al (see record 1999-03162-023) which discussed female genital self-mutilation. The author believes careful assessment for dissociative symptoms is warranted in patients who present with genital self-mutilation. Confirmations of such a diagnosis has implications for treatment.

Allen, Jon G; Huntoon, Janis; Fultz, Jim; Stein, Helen; Fonagy, Peter; Evans, Richard B. (2001)
Menninger Clinic, Topeka KS, USA; Sub-Department of Clinical Health Psychology, University College London, London, England; College of Veterinary Medicine, Iowa State University, Ames IA, USA.
A model for brief assessment of attachment and its application to women in inpatient treatment for trauma-related psychiatric disorders.
Journal of Personality Assessment (ISSN: 0022-3891), v. 76, no. 3, pp. 421-447 (June 2001).

ABSTRACTWe adapted self-report measures of attachment style to the psychological assessment of women in specialized inpatient treatment for trauma-related disorders. The study employed 2 measures of adult attachment style, the Relationship Questionnaire and the Adult Attachment Scale, as well as our Current Attachment Relationships questionnaire, which assesses the extent of social support in secure attachments. We administered these measures to 99 patients and to a convenience sample of 154 women in the community. We found modest correspondence between the 2 attachment style measures and substantial relations between attachment styles and range of secure attachment relationships. Women in the trauma sample reported insecure attachment styles and relatively few secure attachment figures. We discuss the implications of these findings for clinical assessment.

Allen, John J. B.; Iacono, William G.(2001)
Assessing the validity of amnesia in dissociative identity disorder: A dilemma for the DSM and the courts.
Psychology, Public Policy, & Law. 2001 Jun Vol 7(2) 311-344

ABSTRACTAmnesia, as a central descriptive and diagnostic feature of dissociative identity disorder (DID), has received little empirical study. The few published studies are generally consistent in finding that direct tests of memory (e.g., recall and recognition) produce reports of interidentity amnesia but less transparent indirect tests of memory tend to show evidence of memory transfer between identities. Such findings highlight the need for more objective measures of memory in DID and raise questions concerning the nature of amnesia in DID. At present, empirical research fails to unequivocally substantiate patients' claims of amnesia between identities, and reports of such amnesia should not be regarded as conclusive in legal proceedings. The authors propose that psychophysiological measures of memory may provide such an objective measure and can further illuminate the nature of the reported memory deficits in DID. (PsycINFO Database Record (c) 2003 APA, all rights reserved)

Allen JJ, Movius HL 2nd (2000)
Department of Psychology, University of Arizona, P.O.B. 210068, 85721-0068, Tucson, AZ, USA
The objective assessment of amnesia in dissociative identity disorder using event-related potentials.
Int J Psychophysiol 2000 Oct;38(1):21-41

ABSTRACTAssessment of amnesia in Dissociative Identity Disorder (DID) typically relies on self-report, the veracity of which cannot often be independently verified. Memory in DID was therefore assessed using an objective method that involved event-related potentials (ERPs) as well as indirect behavioral measures of memory, and that provided statistically supported assessments for each participant. Four participants who met DSM-IV criteria for DID participated in an ERP memory assessment task, in which words learned by one identity (identity A) were then presented to a second identity (identity B). All four participants - tested as identity B - produced ERP and behavioral evidence consistent with recognition of the material learned by identity A. While it would be premature to generalize all cases of DID, the results suggest that there may be reasons to question the veracity of reports by individuals who meet diagnostic criteria for DID on the basis of a structured clinical interview.

Allen, Jon.G, PhD Lolafaye Coyne, PhD, and David A. Console, MD (2000)
Course of illness following specialized inpatient treatment for women with trauma-related psychopathology
Bulletin of the Menninger Clinic, Vol. 64, No. 2, pp. 235-256, Spring 2000.

ABSTRACT The authors report findings from repeated assessments of 101 women who received intensive inpatient treatment focused on trauma-related disorders. All patients were assessed at admission and discharge, and half were reassessed at 1-year follow-up. Measures included the Global Assessment Scale, Brief Psychiatric Rating Scale, Brief Symptom Inventory, Role Functioning Scales, Follow-up Adjustment Scale, and Client Satisfaction Questionnaire. As a group, patients improved substantially during hospitalization and maintained gains at follow-up, although they showed a trend toward relapse in some symptom areas. However, a substantial minority of patients continued to show severe impairment at follow-up. In light of continual need for changes in clinical programs in the face of declining reimbursement, there is a pressing need for future outcome research on specialized trauma programs to relate subsequent clinical course to specific treatment interventions.

Allen, J.G.; Console, D.A.; & Lewis, L. (1999)
Dissociative detachment and memory impairment: Reversible amnesia or encoding failure?
Comprehensive Psychiatry, 40, 160-171.

ABSTRACT The authors propose that clinicians endeavor to differentiate between reversible and irreversible memory failures in patients with dissociative symptoms who report "memory gaps" and "lost time." The classic dissociative disorders, such as dissociative amnesia and dissociative identity disorder, entail reversible memory failures associated with encoding experience in altered states. The authors propose another realm of memory failures associated with severe dissociative detachment that may preclude the level of encoding of ongoing experience needed to support durable autobiographical memories. They describe how dissociative detachment may be intertwined with neurobiological factors that impair memory, and they spell out the significance of distinguishing reversible and irreversible memory impairment for diagnosis, patient education, psychotherapy, and research.

Allen JG, Huntoon J, Evans RB (1999) Menninger Clinic, USA.
Complexities in complex posttraumatic stress disorder in inpatient women: evidence from cluster analysis of MCMI-III Personality Disorder Scales.    
J Pers Assess 1999 Dec;73(3):449-71

ABSTRACT Herman's (1992a) clinical formulation of complex posttraumatic stress disorder (PTSD) captures the extensive diagnostic comorbidity seen in patients with a history of repeated interpersonal trauma and severe psychiatric disorders. Yet the sheer breadth of symptoms and personality disturbance encompassed by complex PTSD limits its descriptive usefulness. This study employed cluster analysis of the MCMI-III (Millon, 1994) personality disorder scales to determine whether there is meaningful heterogeneity within a group of 227 severely traumatized women who were treated in a specialized inpatient program. The analysis distinguishes 5 clinically meaningful clusters, which we label alienated, withdrawn, aggressive, suffering, and adaptive. The study examined differences among these 5 personality disorder clusters on the MCMI-III clinical syndrome scales, as well as on the Brief Symptom Inventory (Derogatis, 1993), Dissociative Experiences Scale (E. M. Bernstein & Putnam, 1986), Adult Attachment Scale (Collins & Read, 1990), and Childhood Trauma Questionnaire (D.P. Bernstein, 1995). We present a classification-tree method for determining the cluster membership of new cases and discuss the implications of the findings for diagnostic assessment, treatment, and research.
Anderson, A.K. & Phelps, E.A. (2000)
Expression Without Recognition: Contributions of the Human Amygdala to Emotional Communication.
Psychological Science,11, 106-111.
ABSTRACT A growing body of evidence from humans and other animals suggests the amygdala may be a critical neural substrate for emotional processing. In particular, recent studies have shown that damage to the human amygdala impairs the normal appraisal of social signals of emotion, primarily those of fear. However, effective social communication depends on both the ability to receive (emotional appraisal) and the ability to send (emotional expression) signals of emotional state. Although the role of the amygdala in the appraisal of emotion is well established, its importance for the production of emotional expressions is unknown. We report a case study of a patient with bilateral amygdaloid damage who, despite a severe deficit in interpreting facial expressions of emotion including fear, exhibits an intact ability to express this and other basic emotions. This dissociation suggests that a single neural module does not support all aspects of the social communication of emotional state.
Andrews B, Brewin CR, Ochera J, Morton J, Bekerian DA, Davies GM, Mollon P (1999)
Department of Psychology, Royal Holloway University of London, Egham, Surrey.
Characteristics, context and consequences of memory recovery among adults in therapy.
Br J Psychiatry 1999 Aug;175:141-6
ABSTRACT BACKGROUND: There are concerns that memories recovered during therapy are likely to be the result of inappropriate therapeutic techniques. AIMS: To investigate systematically these concerns. METHOD: One-hundred and eight therapists provided information on all clients with recovered memories seen in the past three years, and were interviewed in detail on up to three such clients. RESULTS: Of a total of 690 clients, therapists reported that 65% recalled child sexual abuse and 35% recalled other traumas, 32% started recovering memories before entering therapy. According to therapists' accounts, among the 236 detailed client cases very few appeared improbable and corroboration was reported in 41%. Techniques to aid recall were used in 42%, but only in 22% were they used before memory recovery started. CONCLUSIONS: Some of the data are consistent with memories being of iatrogenic origin, but other data clearly point to the need for additional explanations.
Arntz, A. ; Weertman, A. (1999)
Treatment of childhood memories: theory and practice
Behaviour Research and Therapy ISSN 0005-7967: Vol. 37 (1999), no. 8 (aug), pag. 715-740.
ABSTRACT With the growing interest of cognitive behaviour therapy in early developed psychopathology like personality disorders there is an increased need for therapeutic methods for more directly treating pathogenic schemas. Exploring and reinterpreting memories of early childhood experiences that are assumed to have contributed to the pathogenesis are more and more viewed as a promising way to modify core schemas. Experiential methods seem to be the most effective. This article discusses two main forms of these methods: (i) imagery with rescripting and (ii) role play, both of childhood interactions with key figures. For both, protocols are provided as guidelines for clinicians and to stimulate standardization so that this new field can be opened for experimental research. Theoretical views are discussed as to why these methods might be so effective in treating chronic problems that originated in childhood.
Awas, M., Kebede, D., Alem, A. (1999)
Major mental disorders in Butajira, southern Ethiopia
Acta Psychiatrica Scandinavica, Supplementum, 100, 56-64.
ABSTRACT Determined the lifetime and 1-mo prevalence rates of specific International Classification of Diseases (ICD)-10 mental disorders and associated socio-demographic factors using the Amharic version of the Composite International Diagnostic Interview. 501 rural community residents aged 15 yrs and over were randomly selected and interviewed by lay interviewers. Diagnoses included cognitive disorders, substance (alcohol, tobacco, khat) dependence, schizophrenia, schizoaffective disorders, mood disorders (bipolar, depressive), neuroses, somatoform disorders, phobia, and anxiety and dissociative disorders. The lifetime prevalence of psychiatric morbidity was 31.8% (26.7% when substance dependence was not included). The most frequent specific diagnoses were: dissociative disorders (6.3%), mood disorders (6.2%), somatoform disorders (5.9%), and anxiety disorders (5.7%). Female sex was shown to have a statistically significant association with mood and somatoform disorders. Severe cognitive and mood disorders were significantly associated with being 60 or more yrs of age. Khat dependence was associated with being Muslim and with earning a low income. It is concluded that psychiatric morbidity is a major public health problem in the rural Butajira community.