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C R Cloninger

Publications and source records attributed to C R Cloninger.

At least 127 records · Page 7Linked to original sources
PubMed1987

A systematic method for clinical description and classification of personality variants. A proposal.

A systematic method for clinical description and classification of both normal and abnormal personality variants is proposed based on a general biosocial theory of personality. Three dimensions of personality are defined in terms of the basic stimulus-response characteristics of novelty seeking, harm avoidance, and reward dependence. The possible underlying genetic and neuroanatomical bases of observed variation in these dimensions are reviewed and considered in relation to adaptive responses to environmental challenge. The functional interaction of these dimensions leads to integrated patterns of differential response to novelty, punishment, and reward. The possible tridimensional combinations of extreme (high or low) variants on these basic stimulus-response characteristics correspond closely to traditional descriptions of personality disorders. This reconciles dimensional and categorical approaches to personality description. It also implies that the underlying structure of normal adaptive traits is the same as that of maladaptive personality traits, except for schizotypal and paranoid disorders.

Animals↗
PubMed1987

Etiologic heterogeneity in alcoholism.

Etiologic heterogeneity in alcohol abuse was evaluated in 195 extended pedigrees, comprising 288 nuclear families of 140 male and 55 female Caucasian American hospitalized alcoholics. Previous adoption studies in Sweden demonstrated differential heritability of two patterns of alcohol abuse in men: type-2 alcoholism exhibited early onset of abuse associated with criminal behavior, while type-1 abuse began at a later age, uncomplicated by antisocial traits. Alcohol abuse in female Swedish adoptees was relatively homogeneous and similar to the late-onset, type-1 abuse. The notion of etiologic heterogeneity, as suggested by the Stockholm Adoption Studies, was examined in the American pedigrees by contrasting the models of familial transmission of susceptibility to alcoholism obtained via segregation analyses of families of male versus female probands. Families of male probands demonstrated significant familial resemblance, accounted for by a multifactorial-polygenic background in addition to a major (gene) effect. In contrast, familial resemblance in the pedigrees of female probands was attributed solely to a multifactorial-polygenic effect. We considered whether some families of male alcoholics were similar to families of female probands, who expressed type-1 abuse predominantly. Pedigrees of male probands were separated in two groups: (1) "female-like" families had a better likelihood for the model obtained for families of female probands than the one for families of all male probands, (2) "male-like" families had a better likelihood for the model of familial transmission describing families of all male probands. A statistically significant difference in the pattern of familial transmission was observed between the "male-like" and "female-like" groups. Discriminant function analysis of alcohol-related symptoms showed that the familial subtypes differed in clinical features as well. Alcohol abuse by male relatives in "male-like" families was characterized by the early onset of inability to abstain entirely from alcohol or lack of desire to stop drinking; in contrast, abuse in "female-like" families was characterized by late onset of guilt feelings and loss of control over binge drinking.

Adolescent↗
PubMed1987

Neurogenetic mechanisms of learning: a phylogenetic perspective.

Common psychiatric disorders often involve abnormal patterns of adaptive response to environmental stimuli. Thus, an understanding of the pathophysiology and inheritance of such maladaptation requires specification of the underlying neural mechanisms involved in learning, which is broadly defined as the modification of behavior as a result of individual experience. The phylogenetic development of learning ability in animals is shown to proceed by a sequence of discrete steps in which non-associative learning is augmented successively by classical conditioning to aversive stimuli, followed by classical conditioning to food and other rewarding stimuli, then exploratory learning about novel habitats and operant conditioning of behavioral responses, and finally conceptual learning ability. As a result of this complex phylogenetic history, adaptive responses to the environment in mammals including human beings is multidimensional. A model of the structure of stimulus-response and cognitive-processing characteristics in human beings is described. The model is discussed in terms of its evolutionary advantages for survival and reproductive fitness as well as its importance in understanding susceptibility to psychiatric disorders, including personality and anxiety disorders.

Animals↗
PubMed1987

Genetic principles and methods in high-risk studies of schizophrenia.

Recent advances in genetic epidemiology present excellent opportunities for future high-risk studies of schizophrenia. Improved methods are now available for specifying the natural boundaries of the schizophrenia spectrum and evaluating the mode of inheritance of schizophrenia and its biosocial risk factors. Path-analytic techniques permit the derivation of multifactor indices of both biological and social antecedents of schizophrenia. Powerful advances have been made in segregation analysis of pedigree data and in the power of linkage tests with DNA markers to confirm the presence of putative major loci that influence susceptibility to complex phenotypes like schizophrenia. The yield of information from high-risk samples is greatly increased when both longitudinal and pedigree analyses are combined.

Genetic Markers↗
PubMed1987

Structure and stability of childhood personality: prediction of later social adjustment.

Four hundred and thirty-one children (233 boys, 198 girls) born in Stockholm, Sweden had detailed behavioral assessments at 11 and 15 yrs of age, including a detailed interview with their school teachers and at age 27 yrs were re-evaluated to identify convictions for violent or property crimes. Three dimensions of childhood personality variation were identified and rated without knowledge of later outcome. These three dimensions (novelty-seeking, harm-avoidance and reward-dependence) were largely uncorrelated with one another and each was moderately predictive of later personal and social adjustment, including type of adult criminality. Factor and correlational analyses confirmed predictions that the number and structure of personality dimensions based on teacher ratings throughout childhood is similar to that observed in self-reports by adults.

Adolescent↗
PubMed1986

Symptom patterns and causes of somatization in men: I. Differentiation of two discrete disorders.

Two distinct patterns of somatization were identified in 807 Swedish adopted men, using comprehensive lifetime psychiatric and sick-leave records. "Diversiform" somatizers had a high frequency of brief sickness occasions for a wide diversity of complaints, particularly pain in the head, joints, and abdomen. "Asthenic" somatizers had a lower frequency and diversity of complaints. They recuperate more slowly, however, and were more often disabled by fatigue, weakness, and minor illnesses such as upper respiratory infections. Both types of somatizers had associated psychosocial maladjustment, but they had discrete clinical patterns, with infrequent overlap. Diversiform somatizers had a higher risk of alcohol abuse, psychiatric hospitalization, and substandard income than either asthenic somatizers or non-somatizers. Asthenic somatizers had a higher risk of divorce than either diversiform somatizers or non-somatizers. Men with prominent somatization had an excess of psychiatric treatment for alcoholism or anxiety disorders, but, unlike female somatizers, no excess of criminality. These clinical differences suggest that the psychiatric processes associated with somatization may be qualitatively different in men and women. The method used here is generally applicable in genetic epidemiology to identify natural clinical subtypes within a heterogeneous phenotype.

Absenteeism↗
PubMed1986

Symptom patterns and causes of somatization in men: II. Genetic and environmental independence from somatization in women.

The genetic and environmental antecedents of clinically distinct disorders leading to somatization were compared in 807 Swedish men and 859 Swedish women adopted at an early age by non-relatives. Asthenic somatization, the predominant form in men, was a neurotic disorder associated with a lower incidence of criminality in the somatizers' biological parents than in the biological parents of non-somatizers of either sex. In contrast, most female somatizers and a minority of men with diversiform somatization had disorders that were associated with a higher incidence of criminality in their biological parents than in other biological parents. Likewise, female somatizers, but not male somatizers, had an excess of alcoholic biological fathers when compared to other adoptees. In addition, different postnatal environmental background factors contributed to the risk for somatization in each sex. These findings support the distinctions among the different types of somatizers and show that the usual causes of somatization are fundamentally different in men and women. This illustrates the utility of the adoption paradigm in resolving genetic and environmental contributions to the familial aggregation of developmentally complex phenotypes.

Adoption↗
PubMed1986

Excess medical care of women with somatization disorder.

We compared 50 women with somatization disorder to 25 women with major depression. The somatizers had three times as many operations and hospitalizations as the depressed women. Hospitalizations for headache and backache, abdominal and pelvic operations, and radiologic studies for abdominal complaints occurred frequently in the somatizers. Important factors in the excess medical care of these women were the difficulty in diagnosis and the unwillingness of physicians to use the diagnosis of somatization disorder to limit medical care. Even though somatization disorder has been well described in the medical literature for 30 years, somatizers still receive excess medical care.

Adult↗
PubMed1986

A prospective follow-up and family study of somatization in men and women.

The authors evaluated alternative criteria for somatization disorder in 277 female and 129 male psychiatric outpatients. In women, the diagnosis of somatization disorder based on DSM-III criteria was highly concordant with the diagnosis of Briquet's syndrome based on Guze's original criteria. There was familial aggregation for Briquet's syndrome in women but none among individuals of either sex who had somatization disorder without the full Briquet's syndrome. In men, the diagnosis of somatization disorder was rarer and less stable than in women. The findings show that somatization usually has a different clinical picture and different familial antecedents in men than in women.

Ambulatory Care↗
PubMed1986

A follow-up and family study of Briquet's syndrome.

The study began with the systematic clinical evaluation of a cross-section of 500 of the clinic's patients. This was followed by a 'blind' follow-up of the index subjects and a 'blind' study of first-degree relatives. The present report deals with the diagnosis of Briquet's syndrome (hysteria, somatisation disorder) at index, at follow-up, and among first-degree relatives. The data indicate that the criteria used for the diagnosis of Briquet's syndrome select patients who show a high degree of diagnostic consistency over many years, although not all patients who meet these criteria at follow-up receive the diagnosis of Briquet's syndrome initially. Most importantly, the diagnostic criteria select cases associated with a strong familial increase in the risk of Briquet's syndrome and in the risk of antisocial personality. Both are increased among first-degree female relatives, while only antisocial personality is increased among first-degree male relatives.

Antisocial Personality Disorder↗
PubMed1986

A unified biosocial theory of personality and its role in the development of anxiety states.

A general theory of heritable personality traits and their neurobiological basis is described. Three independent dimensions of personality are defined and related to heritable variation in patterns of response to specific types of environmental stimuli: 'novelty seeking' is due to a heritable tendency toward frequent exploratory activity and intense excitement in response to novel stimuli; 'harm avoidance' is due to a heritable tendency to respond intensely to aversive stimuli and to learn to avoid punishment, novelty, and non-reward passively; and 'reward dependence' is due to a heritable tendency to respond intensely to reward and succorance and to learn to maintain rewarded behavior. Evidence suggests that variation in each dimension is strongly correlated with activity in a specific central monoaminergic pathway: novelty seeking with low basal dopaminergic activity, harm avoidance with high serotonergic activity, and reward dependence with low basal noradrenergic activity. These neurobiological dimensions interact to give rise to integrated patterns of differential responses to punishment, reward, and novelty. The combination of high novelty seeking, high reward dependence, and low harm avoidance (histrionic personality) or the combination of high harm avoidance, low reward dependence, and low novelty seeking (obsessional personality) are each associated with information-processing patterns that lead to unreliable discrimination of safe and dangerous situations and hence to chronic anxiety. In individuals with high novelty seeking, chronic anxiety is characterized by global uneasiness or alarm without specific premonitory cues, frequent bodily pains due to low pain and sensation thresholds, low sedation threshold, and slow fatigability. In contrast, in individuals with high harm avoidance, chronic anxiety is characterized by frequent anticipatory worries based on specific cues, high pain and sedation thresholds, and easy fatigability. In response to frustrative non-reward, individuals with high reward dependence are susceptible to compensatory noradrenergic hyperactivity and hence acute or recurrent states of agitated dysphoria associated with reward-seeking behaviors such as overeating and increased sexual activity. Specific predictions are made about normal personality development as well as the development and familial aggregation of anxiety, somatoform, depressive and personality disorders. These predictions are compared with available information, and recommendations are made for future research.

Animals↗
PubMed1985

Diagnosis and prognosis in schizophrenia.

We showed that schizophrenia was a discrete disorder by using a quantitative clinical scale that discriminated schizophrenics from other subjects in a prospective follow-up and family study of 500 psychiatric outpatients. Four symptoms tended to occur together as a stable syndrome throughout the six- to 12-year follow-up: persecutory delusions, delusions of control, firmly fixed mood-incongruent delusions, and auditory hallucinations. Scale scores were computed as the number of these four symptoms that was present less one if there was a history of spending sprees with marked elation. More than 68% of the schizophrenics and fewer than 2% of nonschizophrenics had scores of +2 or greater. The distribution of scores was bimodal: persons with scores of +1 were relatively rare. Also, there was familial resemblance for the presence or absence of schizophrenia, but no additional resemblance for the number of schizophrenic symptoms. Despite this relative discreteness, scale scores were valuable for quantifying the certainty of diagnosis and predicting outcome.

Adult↗
PubMed1985

Mortality in a follow-up of 500 psychiatric outpatients. I. Total mortality.

Total or all-cause mortality data were determined from a prospective study of 500 randomly selected psychiatric outpatients during a mean follow-up period of seven years. With the use of age-, sex-, and race-adjusted methods, a mortality nearly twice that expected from reference population rates was observed. Mortality was excessive among younger, but not older, patients; and among white men and women and black men, but not among black women. Certain psychiatric diagnoses (based on structured personal interviews performed at index and using explicit criteria) were associated with excess mortality: alcoholism, antisocial personality, drug addiction, homosexuality, organic brain syndrome, and schizophrenia. Excess mortality was not observed among patients with primary affective disorders, ie, disorders not antedated by nonaffective psychiatric illness.

Adolescent↗
PubMed1985

Mortality in a follow-up of 500 psychiatric outpatients. II. Cause-specific mortality.

In a six- to 12-year follow-up study of 500 psychiatric outpatients, death from natural causes occurred 11/2 times the expected rate, although the excess was not significant. Death from unnatural causes occurred 31/2 times the expected rate, a significant elevation. Suicide and homicide rates were particularly excessive. Unnatural mortality was excessive among younger, but not older, patients, and among all sex-race groups except black women, none of whom died unnaturally. Initial psychiatric diagnoses highly predictive of unnatural death included alcoholism, antisocial personality, drug addiction, and homosexuality. Secondary affective disorder was predictive of excess unnatural mortality, but in all cases of such death one of the four disorders associated with excess mortality antedated the affective disturbance. No patient with an index diagnosis of primary affective disorder died of an unnatural cause. Despite a frequent history of suicide attempts, hysteria was not associated with excess unnatural mortality.

Adolescent↗
PubMed1985

Psychopathology in adopted-out children of alcoholics. The Stockholm Adoption Study.

The inheritance of alcohol abuse and other psychopathology was studied in 862 men and 913 women adopted by nonrelatives at an early age in Sweden. Both male and female adoptees had a greater risk of alcohol abuse if their biologic, but not adoptive, parents were alcoholic. We distinguished two types of alcoholism that have distinct genetic and environmental causes and that differ in frequency of alcohol abuse and somatoform disorders in women. The combination of both genetic and environmental risk factors is required for development of alcoholism in the most common type. In contrast, in families with the less common type of susceptibility, alcohol abuse is highly heritable in the men, but the women have multiple somatic complaints without alcohol abuse. The implications of these findings of genetic heterogeneity and gene-environment interaction are discussed in relation to research, prevention, and treatment.

Adoption↗