Search

Background: Cognitive impairment is a core feature of Huntington's disease (HD), however, the onset and rate of cognitive decline is highly variable. Apathy is the most common neuropsychiatric symptom of HD, and is associated with cognitive impairment. The aim of this study was to investigate apathy as a predictor of subsequent cognitive decline over 2 years in premanifest and early HD, using a prospective, longitudinal design. Methods: A total of 118 premanifest HD gene carriers, 111 early HD and 118 healthy control participants from the multi-centre TRACK-HD study were included. Apathy symptoms were assessed at baseline using the apathy severity rating from the Short Problem Behaviours Assessment. A composite of 12 outcome measures from nine cognitive tasks was used to assess cognitive function at baseline and after 24 months. Results: In the premanifest group, after controlling for age, depression and motor signs, more apathy symptoms predicted faster cognitive decline over 2 years. In contrast, in the early HD group, more motor signs, but not apathy, predicted faster subsequent cognitive decline. In the control group, only older age predicted cognitive decline. Conclusions: Our findings indicate that in premanifest HD, apathy is a harbinger for cognitive decline. In contrast, after motor onset, in early diagnosed HD, motor symptom severity more strongly predicts the rate of cognitive decline. [ABSTRACT FROM AUTHOR]

Abstract: Personality disorder (PD) is common among psychiatric patients, and diagnosing such disorders is of great importance for the choice of treatment. Diagnosing PD is a demanding and time‐consuming process. The utilities of several PD screening instruments have been studied in different populations, but not in a population who receives long‐term group psychotherapy. In the current study, we investigate the predictive properties of the Iowa Personality Disorder Screen (IPDS) in a sample of 694 psychiatric outpatients with and without PD who were admitted for psychodynamic long‐term group therapy from 2012 to 2014. The definitive, reference diagnoses were defined according to the SCID‐II, by which 484 patients (68%) warranted a PD diagnosis. The IPDS correctly classified 67.4 percent of all participants. Sensitivity (0.75) and specificity (0.51) were lower than in previous validation studies of IPDS. We discuss possible explanations related to the general concept of PD and, more specifically, to our study sample. Because of the weaker predictive properties of IPDS, we advise caution in use of the IPDS in similar clinical settings. Copyright © 2018 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background/aims TRACK-HD is a multinational prospective, observational study of Huntington's disease (HD) that aims to examine longitudinal change in premanifest carriers of the mutant HTT gene and subjects with early stage disease (Tabrizi 2009). New data from the first follow-up assessment are reported here, and build on previous findings from baseline 3T MRI and novel clinical, cognitive, quantitative motor, oculomotor and neuropsychiatric assessments. Of 366 subjects enrolled at baseline, 345 (115 controls, 116 premanifest (preHD) and 114 early HD) completed 12 months of follow-up. Statistical analysis was performed to assess annualised change in all modalities. Methods/techniques Annualised rates of global and regional atrophy were higher in both the pre- and early HD groups than in controls (p≤0.007). Whole brain atrophy rates were 0.3%, 0.5% and 0.9%, and caudate atrophy rates 0.6%, 2.0% and 3.5%, in controls, pre and early HD, respectively, over 1 year. Whole brain image analysis techniques also revealed striking cortical and subcortical grey and white matter atrophy over just 1 year even in subjects furthest from predicted disease onset. Quantitative imaging showed significant associations with disease burden and total functional capacity, a widely used clinical measure of disease severity. Cognitive deterioration was detectable in both HD groups. However, rates of decline in cognitive, quantitative motor and oculomotor tasks were greater after onset of motor signs. Results/outcome HD is characterised by a long premanifest state, slow progression and a disease course of around 20 years. After 1 year, we have identified robust change in a range of measures across modalities in both premanifest and early stage HD. Quantitative imaging showed the greatest differentiation across the spectrum of the disease and a number of functional measures of decline were sensitive in early HD with cognitive impairment also detectable in the pre-HD group. Conclusions TRACK-HD is the first multi-site study to report whole brain, regional and subcortical atrophy in premanifest subjects many years from predicted disease onset using 3T MR imaging; and demonstrates the feasibility of obtaining quantifiable endpoints which show robust change over just 1 year thus showing potential as endpoints for future therapeutic trials. [ABSTRACT FROM PUBLISHER]

Background Huntington's disease (HD) is a progressive, inherited neurodegenerative condition, with onset usually in mid-life, affecting motor, cognitive and neuropsychiatric functions. Not surprisingly, studies have suggested that HD has a detrimental effect on the quality of life (QoL) of individuals with the HD gene expansion and also by association their families. The present literature exploring the impact for spouses predominantly investigates the later stages of HD. This study, however, uses clearly defined groups of both premanifest and early-stage symptomatic gene-carriers and their spouse/partners. Methods/techniques Self-report measures of quality of life and neuropsychiatric domains (SF-36; Quality of Life Index; Frontal Systems Behaviour Inventory (FrSBe)), clinical rating of motor function (UHDRS motor), Cognitive measures (Emotion Recognition, Trails-B) and the Short version of Problem Behaviours Assessment for HD (PBA-s) were completed by 86 participants from the TRACK-HD study. This included 23 pre-manifest gene carriers, 20 early, clinical stage 1 and 2, HD patients and 43 gene-negative spouse controls. Between-group differences and relationships between neuropsychiatric and cognitive data from the premanifest and symptomatic participants and QoL for their spouses were examined. Results/outcomes Largest between-group differences were evident between spouses and their partners with early stage disease; and different QoL domains were impacted in the different participant groups. The data presented shows the QoL domains affected in each group; and the impact of specific neuropsychiatric, cognitive and motor symptoms on spouse partners. Identification of the specific domains impacted in spouse/partners at an early stage of disease is crucial for establishing appropriate and long-term support. [ABSTRACT FROM PUBLISHER]

Background TRACK-HD is a multi-centre, longitudinal study investigating a range of motor, cognitive, neuropsychiatric and imaging measures as potential biomarkers for clinical trials in Huntington's disease (HD). The neuropsychiatric battery includes the Frontal Systems Behaviour Scale (FrSBe), a 46-item scale measuring behaviours associated with damage to the frontal lobes of the brain. In addition to subjects rating their own behaviour on the FrSBe, companions also rated subjects' behaviour. This provided an opportunity to investigate HD patients' insight into their behaviour by studying discrepancies between subject and companion ratings. Method 225 TRACK-HD subjects (62 premanifest gene carriers far from onset, 52 near to onset, 70 stage 1 HD and 41 stage 2 HD) completed the FrSBe. In addition, 164 companions (77 of premanifest subjects and 87 of early HD subjects) rated subjects' behaviour with the FrSBe. Results Companion ratings indicate a worsening of FrSBe scores with disease progression, especially in subjects with manifest HD. In contrast, subjects' self ratings did not show the same deterioration in FrSBe scores across the pre-HD and stage 1 subgroups, with the biggest discrepancy between subject and companion ratings at stage 1 HD. Surprisingly, self-ratings of stage 2 subjects were markedly worse than those at stage 1, almost eliminating this discrepancy between companion and self-ratings. Companion FrSBe ratings correlated more strongly with objective measures of cognitive and behavioural function than did subjects own ratings. Conclusion The existence of a discrepancy between companion and subjects' own ratings using the FrSBe in stage 1 HD but not in those with more advanced disease suggests that denial (as a psychological defence mechanism) is a more likely explanation than a loss of insight secondary to cognitive impairment. [ABSTRACT FROM PUBLISHER]

To examine the nature and extent of personality dysfunction related to somatization, the authors administered the Structured Interview for DSM-IV Personality and the NEO Five-Factor Inventory to a series of somatizing and nonsomatizing patients in a general medicine clinic. A greater percentage of somatizers met criteria for one or more DSM-IV personality disorders, especially obsessive-compulsive disorder, than did control patients. Somatizers also differed from control patients with respect to self-defeating, depressive, and negativistic personality traits and scored higher on the dimension of neuroticism and lower on the dimension of agreeableness. In addition, initial and facultative somatizers showed more personality pathology than true somatizers. These findings suggest that certain personality disorders and traits contribute to somatization by way of increased symptom reporting and care-seeking behavior.

DSM antisocial personality disorder (ASPD) requires a retrospective diagnosis of conduct disorder-historical behavior not present in everyone with adult ASPD criteria. Using adoption study data, we examined the impact of this requirement on biological and environmental risk associations. We also compared clinical correlates of adult antisocial behavior with and without prior conduct disorder. We defined three subgroups: DSM-III ASPD (n = 30), adult antisocials without conduct disorder (n = 25), and controls (n = 142). By design, the sample had a high incidence of biological parent ASPD, which was partially confounded with fetal alcohol exposure. We compared the associations of both of these putative risk factors with subgroup membership after controlling for gender and adverse adoptive environment. We also examined differences in two sociopathy scales and the incidence of co-occurring affective, alcohol, and other substance use disorders. Finally, we explored differences in individual antisocial symptoms. Having an antisocial biological parent was a specific risk factor for ASPD. In contrast, fetal alcohol exposure, male gender, and adverse environment were associated with the adult antisocial syndrome, regardless of conduct disorder history. The two antisocial groups were similar with respect to sociopathy scales, co-occurring diagnoses, and the incidence of most individual symptoms. However, several adult and conduct disorder symptoms had significant specific associations with biological or environmental background or their interaction. Phenotypic expression of the biological-possibly genetic-risk for ASPD appears to be manifest before adulthood. The influence of other risk factors may not depend on antecedent conduct disorder. Despite this, we could not detect clinically important differences between the two sociopathic groups. The conduct disorder requirement therefore may be more relevant to etiological than clinical understanding of adult antisocial behavior., (Copyright 2001 by W.B. Saunders Company)

Relationships between service satisfaction, life satisfaction, and self-reported mental health status were examined for Iowa Medicaid mental health service recipients. Of the 16,579 persons who received services in 1993, a mail-out survey was sent to 2,520 persons and returned by 815 (32.3 percent). Persons with schizophrenia reported greater service satisfaction and life satisfaction than persons with other diagnoses, and their ratings of their mental health were higher. A relationship between service satisfaction and current life satisfaction was observed for persons with schizophrenia, affective disorder and adjustment disorder, but not for persons with anxiety disorder.

The authors designed an instrument, the Health Attitude Survey, to assess somatization, and administered it to over 1,000 patients attending a general medicine clinic. Within this population, a series of somatizing patients and control patients were identified for purposes of developing and testing the instrument. The 27-item scale was rapidly administered and acceptable to the patients. Based on comparisons with other measures of somatization, the instrument appeared to be a valid measure of the attitudes and perceptions of somatizing patients, and it distinguished these patients from the control subjects. The measure showed acceptable predictive value and may prove useful in clinical settings, where rapid screening is desired.

The length and expense of comprehensive personality disorder interviews makes them unwieldy for routine use. A brief but sensitive screen could eliminate administration of longer instruments in many instances. We describe the development of the Iowa Personality Disorder Screen (IPDS)--a mini-structured interview which can be completed in less than 5 minutes. Retrospective analyses using 1,203 SIDP-R interviews suggested that the IPDS items should provide good sensitivity and specificity. We present results from a prospective validation study, using a mixed group of 52 nonpsychotic inpatients and outpatients who were diagnosed using the SIDP-IV. Blind administration of the IPDS yielded excellent sensitivity (92%) and good specificity (79%), using a subset of five screening items. Addition of two more items leads to an estimated sensitivity of 79% and specificity of 86%. The IPDS shows promise as a quick personality disorder screen for use in research settings or standard clinical interviews.

Background: We conducted an exploratory multivariate analysis of juvenile behavior symptoms in an adoption data set. One goal was to see if a few DSM-interpretable symptom dimensions economically captured information within the data. A second goal was to study the relationships between any such dimensions, biological and environmental background, and eventual adult antisocial behavior., Methods: The data originated from a retrospective adoption study. Probands with a biological background for parental antisocial personality or alcoholism were heavily oversampled. Symptoms were ascertained by proband and adoptive parent interview. We performed, by gender, orthogonal rotated principal component analyses of juvenile behavior disturbance symptoms (females, n = 87; males, n = 88). We used structural equation modeling to examine the relationships hypothesized above., Results: For both genders, an oppositional defiant disorder (ODD) component and at least 1 conduct component emerged. Regardless of the conduct component scores, the ODD components were significant predictors of adult antisocial behavior. For males, the ODD component was predicted by an antisocial biological background, but not by scores on the Adverse Adoptive Environment Scale. The conduct components were predicted by adoptive environment alone. For females, biological background or biological-environmental interactions predicted each of the components., Conclusions: There has been little previous distinction between conduct disorder and ODD in studies of genetic and environmental influences on juvenile behavior. The study suggests that adolescent ODD symptoms may be a distinct antecedent of adult antisocial personality. In males, adolescent ODD symptoms may represent early expression of genetic sociopathic personality traits.

Many clinical decision-making rules are equivalent to linear discriminant functions that involve the unweighted sum of binary variables (SBV). We briefly consider the geometry of this restriction and then propose a number of methods for forward stepwise selection of SBV models. Using a simulation study, we compare the performance of these methods under a wide range of plausible conditions and show that no single method is uniformly superior for selecting models of a fixed size. Factors of general importance in relative method performance are the ratio of sample size to the number of candidate variables and the class-conditional moment structure of the data. We conclude by offering some practical strategies for SBV model construction.

The charts of 660 consecutive admissions to a university psychiatric hospital were examined. After excluding those with mental retardation, 32 patients who had mutilated themselves and 88 patients admitted for unsuccessful suicide attempts were identified. Women were significantly overrepresented among the mutilators, but the groups did not differ with respect to age. Most analyses were restricted to women, of whom 27 were self-mutilators and 51 were nonmutilating suicide attempters. Mutilators were less likely to receive diagnoses of major depression or adjustment disorder but were more likely to have a history of substance abuse and receive Axis II diagnoses. The mutilative behavior was generally repetitive. The most common form was superficial cutting of the arms and wrists. Reports of lifetime sexual or physical abuse were more common among mutilators. Mutilators also had frequent histories of suicide attempts distinct from their mutilation behavior, multiple hospitalizations, and transfer to state hospitals for longer-term care. These findings suggest a chronic course with significant morbidity and associated features which may be of clinical significance.