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.