Biomedical subjects

D N Klein

Publications and source records attributed to D N Klein.

At least 55 records · Page 3Linked to original sources

PubMed1996

Hypomanic personality traits in a community sample of adolescents.

The distribution and correlates of hypomanic personality traits were examined in a representative sample of 1709 adolescents. Hypomanic traits were assessed with an abbreviated version of Eckblad and Chapman's (1986) Hypomanic Personality Scale. Hypomanic traits were normally distributed and were slightly but significantly higher among females. Test-retest stability over a mean 14-month interval was 0.54. High scores were associated with elevated lifetime rates of mood, disruptive behavior and substance use disorders. Among subjects with no history of mood disorder, hypomanic traits were associated with a broad range of indices of psychosocial dysfunction, both concurrently and at 1-year follow-up. In addition, hypomanic personality traits predicted increased levels of impairment in a number of areas, including depressive and internalizing symptomatology, over the course of the follow-up. Finally, among subjects with a past history of major depression, hypomanic traits were associated with a higher level of depression at the initial assessment, greater symptomatology and impairment during their worst episode, and higher rates of attempted suicide, comorbid disruptive behavior disorders and recurrent major depressive episodes.

Adolescent↗

PubMed1996

The subaffective-character spectrum subtyping distinction in primary early-onset dysthymia: a clinical and family study.

In 1983, Akiskal proposed that primary early-onset dysthymia should be divided into two subtypes: subaffective dysthymia, which is a subsyndromal form of major mood disorder; and character spectrum disorder, which is a form of personality disorder with secondary dysphoria. The present study attempted to validate this distinction. Akiskal's (1983) criteria were applied to a sample of 97 early-onset dysthymic outpatients, yielding groups of 41 subaffective and 56 character spectrum patients. Patients were evaluated using structured interviews for Axis I and II disorders, family history of psychopathology, and the early home environment, and a comprehensive battery of questionnaires. In addition, direct and family history interviews were conducted with their first-degree relatives. There was mixed support for Akiskal's typology. Consistent with the model, subaffectives exhibited higher rates of major depression, depressive symptoms, and a number of depressive personality and cognitive features. In addition, there was a higher rate of alcoholism among the relatives of character spectrum patients. However, contrary to Akiskal's model, the groups did not differ on gender, unstable personality disorders, family history of mood disorders, or the early home environment.

Adult↗

PubMed1996

Social adjustment in dysthymia, double depression and episodic major depression.

We contrasted the overall social functioning of pure dysthymics, double depressives, episodic major depressives and normal controls using both interview and self-report measures of social functioning and depression. In addition, we used hierarchical multiple regression to assess the differential impact of several variables (comorbid personality, anxiety and substance use disorders, life stress, duration of dysthymia and severity of depressive symptomatology) on social functioning in the dysthymics and double depressives. Participants included 41 outpatients with early-onset dysthymia alone, 56 outpatients with early-onset dysthymia and concurrent major depression, 45 outpatients with episodic major depression and 45 normal controls. All 3 patient groups were found to be significantly more impaired than normal controls in overall functioning, as well as in every specific role area. Double depression was found to be particularly impairing, both in overall functioning and in every specific role area. In dysthymic patients with and without concurrent major depression, current depressive symptomatology is the strongest predictor of impairment. Taken together, these data suggest that chronic, low-grade depressive symptoms and acute, moderate depressive symptoms have similar, significant and additive effects on social adjustment.

Activities of Daily Living↗

PubMed1996

Summary of the DSM-IV mood disorders field trial and issue overview.

The DSM-IV Mood Disorders Field Trial addressed several issues concerning the relationship among major depression, dysthymia, recurrent brief depression, minor depression, and depressive personality disorder. The Mood Disorders Field Trial is a naturalistic, multisite study that investigated the diagnostic criteria for dysthymia, the reliability and validity of longitudinal course modifiers, the nosology of minor and recurrent brief depression, and the relationship between depressive personality disorder and dysthymia. Research on the nosology of chronic depressive disorders will, it is hoped, contribute to a better understanding of pathophysiology, etiology, and treatment. This article presents findings from the Field Trial as well as brief reviews of the other nine articles in this issue.

Adolescent↗

PubMed1996

Symptomatology in dysthymic and major depressive disorder.

The lists of associated symptoms included in the DSM-III, DSM-III-R, and DSM-IV criteria for dysthymic disorder have been criticized for lacking content and discriminant validity. The literature on the content and discriminant validity of dysthymic symptoms was reviewed and relevant data from the DSM-IV Mood Disorders Field Trial were presented. These data indicate that cognitive and social-motivational symptoms are much more characteristic of dysthymic disorder than are vegetative and psychomotor symptoms. In addition, subjects with major depressive disorder exhibit higher rates of most depressive symptoms than do subjects with dysthymic disorder, but there is little evidence of qualitative distinctions in symptomatology between these conditions. Finally, after taking course and exclusion criteria into account, variations in the symptom criteria do not have a major effect on case definition.

Chronic Disease↗

PubMed1996

The relationship between age at onset and comorbidity in psychiatric disorders.

The Epidemiologic Catchment Area community sample data were analyzed to determine whether there is a general tendency for subjects with two or more disorders to have an earlier age of onset of the index disorder than subjects with only one disorder. DSM-III axis I disorders and antisocial personality were each used as index disorders in separate logistic regressions. The results show that an earlier age of onset is associated with greater comorbidity in major depression, with a similar trend for alcoholism. Schizophrenia and the phobias, however, showed significant results in the opposite direction. Overall, the results argue for specific rather than general effects of age of onset on comorbidity.

Adolescent↗

PubMed1996

Demographics, family history, premorbid functioning, developmental characteristics, and course of patients with deteriorated affective disorder.

OBJECTIVE: This exploratory study examined the characteristics of a group of unusual and previously undescribed patients with major affective disorder who not only had been continuously symptomatic for prolonged periods of time but were also so functionally impaired that they required years of continuous care in psychiatric facilities or by family members. METHOD: Twenty-seven inpatients with major mood disorders and 29 inpatients with schizophrenia were recruited from a large state hospital; 27 outpatients with major mood disorders were recruited from an affiliated outpatient facility. The research battery included the Structured Clinical Interview for DSM-III-R--Patient Version, the Premorbid Adjustment Scale, and a semistructured interview designed to assess demographic, family history, developmental, and course information. RESULTS: Inpatients with deteriorated affective disorder differed from outpatients with nondeteriorated affective disorder along several important dimensions, including family history of mental illness, birth-related problems, physical disorders in infancy, premorbid functioning, presence of mixed episodes and rapid cycling, and medication non-compliance between hospitalizations. Inpatients with deteriorated affective disorder differed from inpatients with schizophrenia on the Premorbid Adjustment Scale. Patients with bipolar affective disorder differed from those with unipolar disorder on many of the variables associated with deterioration of functioning. CONCLUSIONS: Birth-related problems, physical disorders in infancy, and poor premorbid adjustment in childhood and adolescence appear to play an important role in deterioration of functioning among patients with unipolar depression. Disruption in treatment because of medication noncompliance and the appearance of mixed episodes and rapid cycling are associated with functional decline in bipolar affective disorder. Several characteristics previously considered specific to deterioration of functioning in schizophrenia, such as a high rate of birth complications and poor premorbid adjustment, appear to be associated with functional deterioration among patients with major depression as well.

Adolescent↗

PubMed1996

Understanding the comorbidity between early-onset dysthymia and cluster B personality disorders: a family study.

OBJECTIVE: A number of studies have documented significant comorbidity between dysthymia and axis II personality disorders, particularly those grouped in cluster B. However, the nature of this comorbidity is poorly understood. The purpose of this investigation was to use the family study method to test five competing models of the comorbidity between early-onset dysthymia and cluster B personality disorders. METHOD: Proband groups consisted of subjects with early-onset dysthymia and a co-occurring cluster B personality disorder (N = 28), subjects with early-onset dysthymia without a cluster B personality disorder (N = 69), and a comparison group of subjects who had never been psychiatrically ill (N = 45). The groups were compared on rates of dysthymia with a cluster B personality disorder, dysthymia without a cluster B personality disorder, and cluster B personality disorders without dysthymia in their first-degree relatives (N = 675). RESULTS: The relatives of both subgroups of dysthymic probands exhibited higher rates of dysthymia with a cluster B personality disorder, dysthymia without a cluster B personality disorder, and cluster B personality disorders without dysthymia than the relatives of the never ill probands. In addition, the relatives of probands with comorbid dysthymia exhibited higher rates of cluster B personality disorders without dysthymia than the relatives of probands with noncomorbid dysthymia. CONCLUSIONS: This pattern of results is consistent with the notion that dysthymia and cluster B personality disorders co-occur because of shared etiological factors. This was the only one of five models of the comorbidity between dysthymia and cluster B personality disorders that was supported by the family data.

Adolescent↗

PubMed1995

Reports of the childhood home environment in early-onset dysthymia and episodic major depression.

This study addressed 2 questions: (a) is early-onset dysthymia associated with reports of a disturbed childhood home environment; and (b) can adverse early experiences account, at least in part, for the differing clinical presentations of dysthymia and major depression? Participants included 97 outpatients with early-onset dysthymia, 45 outpatients with episodic major depression, and 45 normal controls. The early home environment was assessed blind to diagnosis using both interview and self-report measures. Early-onset dysthymia patients reported significantly more physical and sexual abuse and poorer relationships with both parents than normal controls. In addition, patients with dysthymia reported having received significantly poorer parenting than those with episodic major depression. The results could not be accounted for by mood state effects, comorbidity with borderline and antisocial personality disorder, or comorbid major depression.

Adolescent↗

PubMed1995

DSM-III-R axis II comorbidity in dysthymia and major depression.

OBJECTIVE: Dysthymia is generally believed to be associated with a high rate of DSM-III-R axis II comorbidity. However, it is unclear whether this rate is higher than that for other axis I disorders, how many dysthymic patients have personality disorders, and what the most common co-occurring axis II conditions are. METHOD: Ninety-seven outpatients with early-on-set dysthymia and 45 with episodic major depression were administered structured diagnostic interviews for axis I and II disorders. In addition, knowledgeable informants were independently interviewed about axis II conditions in the patients. RESULTS: A significantly greater proportion of dysthymic patients (60%) than patients with episodic major depression (18%) met criteria for a personality disorder. The most common axis II conditions among dysthymic patients were borderline, histrionic, and avoidant personality disorder. Informants' reports yielded similar results. CONCLUSIONS: These data indicate that early-onset dysthymia is associated with significantly greater axis II comorbidity than episodic major depression. Further work is necessary to elucidate the processes underlying this association.

Adult↗

PubMed1995

Results of the DSM-IV mood disorders field trial.

OBJECTIVE: The DSM-IV mood disorders field trial, a multisite collaborative study, was designed to explore the reliability of a course-based diagnostic classification system for major depression, evaluate the symptom criteria for dysthymia, and explore the need for additional diagnostic categories for milder forms of mood disorder (e.g., minor and recurrent brief depression). METHOD: Five hundred twenty-four depressed subjects were recruited from inpatient, outpatient, and community settings at five sites and evaluated with structured interviews according to DSM-III and DSM-III-R criteria, with careful attention to longitudinal course. Within- and across-site interrater reliability studies and 6-month test-retest reliability studies were also conducted on subsets of the sample. RESULTS: For evaluations of major depression and dysthymia, intrasite reliability was good to excellent and intersite reliability was fair to good; 6-month test-retest reliability was fair for dysthymia and poor to fair for major depression. Interrater reliability for six course of illness specifiers was fair to good, and almost all subjects could be assigned to a specific type of course. CONCLUSIONS: The results supported the use of a course-based classification system for major depression. They also suggested that the content validity of the DSM-III-R symptom criteria for dysthymia could be improved by emphasizing cognitive and social/motivational symptoms, although such changes are unlikely to sharpen the distinction between dysthymia and major depression. Finally, 91% of the subjects met the criteria for current or lifetime major depression or dysthymia, suggesting that additional categories for milder forms of depression are not needed.

Adult↗

PubMed1995

Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course.

OBJECTIVE: The purpose of this study was to examine the prevalence, clinical characteristics, and mental health treatment services utilization of adolescents with bipolar disorders and manic symptoms. METHODS: Structured diagnostic interviews were administered to a representative community sample of 1,709 older adolescents (aged 14 through 18 years). RESULTS: The lifetime prevalence of bipolar disorders (primarily bipolar II disorder and cyclothymia) was approximately 1%. An additional 5.7% of the sample reported having experienced a distinct period of abnormally and persistently elevated, expansive, or irritable mood even though they never met criteria for bipolar disorder ("core positive" subjects). The rate of manic symptoms in these subjects was similar to that reported in clinical samples, and the course of bipolar disorder was relatively chronic. Compared with adolescents with a history of major depression (n = 316) and a "never mentally ill" group (n = 845), the bipolar and core positive subjects both exhibited significant functional impairment and high rates of comorbidity (particularly with anxiety and disruptive behavior disorders), suicide attempts, and mental health services utilization. CONCLUSIONS: These data highlight the clinical and public health significance of even the milder and subthreshold cases of bipolar disorder in adolescence.

Adolescent↗

PubMed1995

Family study of early-onset dysthymia. Mood and personality disorders in relatives of outpatients with dysthymia and episodic major depression and normal controls.

BACKGROUND: The nosological status of dysthymia has generated considerable controversy. The major issues include whether dysthymia should be classified as a form of mood or personality disorder and, if dysthymia is classified as a mood disorder, whether it is sufficiently distinct from major depression to warrant a separate category. METHODS: We conducted a family study of 97 outpatients with early-onset dysthymia, 45 outpatients with episodic major depression, and 45 normal controls, and their 882 first-degree relatives. Axis I and II disorders were assessed in relatives using direct and informant interviews and all available medical records. RESULTS: The rate of major depression in the relatives of early-onset dysthymic probands was significantly greater than in the relatives of normal controls and non-significantly greater than in the relatives of episodic major depressive probands. The rate of dysthymia was significantly greater in the relatives of dysthymic probands than in relatives of both major depressive probands and normal controls. Rates of most personality disorders were increased in the relatives of the dysthymic and major depressive probands compared with relatives of normal controls. In addition, the relatives of dysthymic probands had significantly higher rates of any personality disorder and any cluster B disorder than those of episodic major depressive probands, although these differences disappeared after controlling for Axis II comorbidity in the probands. Finally, dysthymic probands with and without a lifetime history of major depression did not differ on rates of psychiatric disorders in relatives. CONCLUSIONS: There is a strong familial relationship between dysthymia and major depression. However, dysthymia is also somewhat distinct in that it aggregates specifically in the families of patients with dysthymia. Finally, dysthymia and episodic major depression both appear to have a familial association with the personality disorders, although the link appears to be somewhat stronger for dysthymia.

Adolescent↗

PubMed1994

Relationship of sociotropy/autonomy and dependency/self-criticism to DSM-III-R personality disorders.

Relationships between Beck's constructs of sociotropy/autonomy and Blatt's constructs of dependency/self-criticism and the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) Axis II personality disorders were examined. Two measures of personality styles and a structured diagnostic interview for personality disorders were administered to 138 outpatients. Significant relationships were found between both sets of constructs and a number of personality disorders using both categorical and dimensional measures of Axis II psychopathology. These relationships were consistent with previous theory, supporting recent conceptualizations extending the range of psychopathology associated with these personality styles from depression to the personality disorders. However, the autonomy/self-criticism dimension was correlated with a broader range of personality disorder traits and diagnoses than anticipated.

Adult↗

PubMed1994

Depressive disorders: distinctions in children.

OBJECTIVE: The present study examined the distinctions between major depression without dysthymia, dysthymia without major depression, and double depression in child psychiatry inpatients. METHOD: Sixty-two child inpatients, with current diagnoses of major depression and/or dysthymia, and their mothers were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version and the Social Adjustment Inventory for Children and Adolescents. RESULTS: Results suggest that the relationship between the three disorders is complex and varies according to the informant and the domain under examination. Externalizing disorders were present more often in the dysthymic group compared to the major depression and double depression groups. On the other hand, the major depression and double depression groups reported higher rates of depressive symptoms. Regarding social functioning, children with major depression appeared least impaired. Child report was found to be more sensitive to distinguishing between depressive syndromes, and parents reported the most depressive symptomatology. CONCLUSION: It appears that the presence of major depression plays an important role in the expression of depressive symptomatology and comorbidity, whereas chronicity seems to be the determining factor in social functioning.

Adolescent↗

PubMed1994

Concordance between patients and informants on the personality disorder examination.

OBJECTIVE: Difficulties in the assessment of personality disorders and the burgeoning interest in axis II have led to increased use of informants when studying these conditions. The present study sought to evaluate the correspondence between patients and their informants on symptoms of personality disorders. METHOD: A total of 105 outpatients and knowledgeable informants were independently interviewed by using the Personality Disorder Examination, a widely used instrument for the full range of personality disorders. RESULTS: Diagnostic concordance between interviews was low (median kappa = -0.01), while correlations between dimensional scores were somewhat higher (median kappa = 0.36). Overall, patient interviews showed more pathology than interviews with informants. However, many of the symptoms obtained from informants were not reported by patients. CONCLUSIONS: These data suggest that patient-informant concordance for axis II disorders is poor for diagnoses but somewhat better for dimensional scores. There was no evidence that low agreement can be explained by patients attempting to present themselves in a favorable light. Further work is necessary to elucidate the reasons for discordance and determine which data source provides the most valid information.

Adult↗

PubMed1994

Test-retest reliability of team consensus best-estimate diagnoses of axis I and II disorders in a family study.

OBJECTIVE: The present study examined the test-retest reliability of team consensus best-estimate diagnoses of axis I and II disorders. METHOD: As part of a series of family studies of outpatients with depressive and personality disorders, best-estimate diagnoses of relatives were derived in team diagnostic conferences held regularly over 4 years. Diagnoses were based on all available information, including direct interviews, family history data, and treatment records, and explicit guidelines were developed to resolve discrepancies between data sources. To evaluate the reliability of the team best-estimate diagnoses, 92 relatives were independently rediagnosed after a 2-year interval. RESULTS: The reliability of both axis I and II disorders was good to excellent. The results were similar for cases in which diagnoses were based on direct interviews plus informant data and cases in which diagnoses were based on informant data alone. CONCLUSIONS: These data indicate that the team consensus best-estimate diagnostic method can be applied consistently, even over an interval of several years.

Actuarial Analysis↗

PubMed1993

Depressive personality in nonclinical subjects.

OBJECTIVE: This study explored the reliability and clinical correlates of the depressive personality in nonclinical subjects. In particular, the authors were interested in determining the relationship between depressive personality and mood disorders. METHOD: The subjects were 185 college students who were selected by using a battery of screening inventories assessing a variety of psychopathological symptoms and traits. The subjects were given structured diagnostic interviews that included a section on depressive temperament. RESULTS: There were significant relationships between depressive personality and lifetime. DSM-III diagnoses of major depression and dysthymia. However, the magnitude of the associations was modest, indicating that these are distinct, although overlapping constructs. In addition, the subjects with depressive personality (N = 36) had significantly greater impairment and a higher rate of mood disorders in their first-degree relatives than did the subjects without depressive personality (N = 149). Moreover, these results were evident even after the subjects with a lifetime history of mood disorder were excluded. CONCLUSIONS: These data suggest that depressive personality is a clinically important condition that is not subsumed by existing mood disorders categories but can be viewed as falling within the affective spectrum.

Adolescent↗