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Biomedical subjects

P R Joyce

Publications and source records attributed to P R Joyce.

At least 55 records · Page 3Linked to original sources
PubMed1998

Psychiatric contacts among youths aged 13 through 24 years who have made serious suicide attempts.

OBJECTIVE: To compare the history of psychiatric contacts among young people who have made medically serious suicide attempts and control subjects. METHOD: Using a case-control design, the authors contrasted 129 young people who made serious suicide attempts with 153 randomly selected community controls on a series of measures of lifetime, prior year, and prior month contacts with psychiatric services. RESULTS: Of those who made serious suicide attempts, 78.3% had a lifetime history of contact with health services for psychiatric reasons, 72.1% reported contact within the year preceding the suicide attempt 58.9% reported contact within the month preceding the suicide attempt, and 29.5% had a lifetime history of psychiatric hospital admission. Within the year preceding the suicide attempt, 21.7% had been admitted to a psychiatric hospital and 67.4% had outpatient consultations for psychiatric problems. Multiple logistic regression suggested that the best psychiatric service predictors of risk of serious suicide attempt were admission within the preceding year (p < .005) and outpatient consultation within the preceding month (p < .0001). CONCLUSIONS: Young people making serious suicide attempts had vastly elevated rates of a range of psychiatric contacts including hospital admissions and outpatient consultations. These findings imply that the development of improved treatment and management strategies for young people with psychiatric morbidity may be a very effective approach to reducing youthful suicidal behaviors.

Adolescent↗
PubMed1998

No association between novelty seeking and the type 4 dopamine receptor gene (DRD4) in two New Zealand samples.

OBJECTIVE: In 1986 and 1987, Cloninger postulated the existence of the heritable behavioral trait of novelty seeking and its putative underpinnings in the dopaminergic systems of the ventral midbrain. Two widely reported studies found significant associations between novelty seeking and the type 4 dopamine receptor gene (DRD4), although a more recent study did not. The authors' objective was to investigate this association in two New Zealand samples. METHOD: The authors studied two nonoverlapping samples: subjects in a depression treatment trial (N = 86) and subjects from 14 pedigrees dense with alcoholism (N = 181). DRD4 genotyping was based on a standard protocol. RESULTS: Novelty seeking and DRD4 were not statistically associated. CONCLUSIONS: In these samples, there was no suggestion that the DRD4 polymorphism contributed to individual differences in the behavioral trait of novelty seeking.

Adult↗
PubMed1998

Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample.

OBJECTIVE: The aim of this study was to examine the relationship between childhood sexual abuse, childhood physical abuse, current psychiatric illness, and measures of dissociation in an adult population. METHOD: The authors used a randomly selected sample of 1,028 individuals. Each subject completed a semistructured face-to-face interview that included measures of childhood sexual abuse, childhood physical abuse, DSM-III-R psychiatric diagnoses, and selected items from the Dissociative Experiences Scale. RESULTS: Many individuals experienced occasional dissociative symptoms, and 6.3% of the population suffered from three or more frequently occurring dissociative symptoms. Among these individuals, the rate of childhood sexual abuse was two and one-half times as high, the rate of physical abuse was five times as high, and the rate of current psychiatric disorder was four times as high as the respective rates for the other subjects. Logistic regression modeling showed that physical abuse and current psychiatric illness were directly related to a high rate of dissociative symptoms but sexual abuse was not. The influence of sexual abuse was due to its associations with current psychiatric illness and with childhood physical abuse. Childhood physical abuse was not directly related to current psychiatric illness. Its association appeared to be mediated by its link to childhood sexual abuse. CONCLUSIONS: This study confirms that a small proportion (approximately 6%) of the general population suffer from high levels of dissociative symptoms. It calls into question the hypothesized direct relationship between childhood sexual abuse and adult dissociative symptoms.

Adolescent↗
PubMed1998

Youth suicide attempts: a social and demographic profile.

OBJECTIVE: The social and demographic characteristics of a New Zealand sample of young people making medically serious suicide attempts were examined and compared with those of a control sample of similar age. METHOD: Using a case control design, 129 young people making serious suicide attempts were contrasted with 153 randomly selected community controls on a series of social and demographic characteristics including educational achievement, socioeconomic status, income, occupation, religious affiliation and ethnicity. The age and gender distribution of the sample, and the methods of suicide attempt, were examined. RESULTS: Almost equal numbers of young males (45.7%) and females (54.3%) made medically serious suicide attempts. The clear majority of serious suicide attempts were by overdose or poisoning (78.3%), with tricyclic antidepressants (38.6%) and paracetamol (37.6%) together accounting for three-quarters (76.2%) of all drug overdoses. Young people who were less well educated and who were from lower socioeconomic backgrounds had elevated risk of serious suicide attempts. CONCLUSIONS: Young people from socially disadvantaged backgrounds have elevated risk of serious suicide attempt.

Adolescent↗
PubMed1998

Relationship between interpersonal psychotherapy problem areas with temperament and character: a pilot study.

OBJECTIVE: To examine the relationships between dimensions of personality assessed by using the Temperament and Character Inventory and presenting problem areas in Interpersonal Psychotherapy. METHOD: One hundred two depressed patients completed the Temperament and Character Inventory (TCI), and Interpersonal Psychotherapy (IPT) problem areas were assessed using a clinician-rated questionnaire. RESULTS: Following multiple regression analysis, patients rated as having problems with grief scored low on self transcendence, those with disputes had low cooperativeness, those with role transitions had low novelty seeking, and those with deficits had low reward dependence. CONCLUSIONS: Both temperament and character may be relevant to the nature of presenting problems related to Interpersonal Psychotherapy. An understanding of how personality is relevant to presenting interpersonal problems may provide both a framework and a focus with which to work in this form of psychotherapy.

Adult↗
PubMed1997

The cross-national epidemiology of panic disorder.

BACKGROUND: Epidemiological data on panic disorder from community studies from 10 countries around the world are presented to determine the consistency of findings across diverse cultures. METHOD: Data from independently conducted community surveys from 10 countries (the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand), using the Diagnostic Interview Schedule and DSM-III criteria and including over 40,000 subjects, were analyzed with appropriate standardization for age and sex differences among subjects from different countries. RESULTS: The lifetime prevalence rates for panic disorder ranged from 1.4 per 100 in Edmonton, Alberta, to 2.9 per 100 in Florence, Italy, with the exception of that in Taiwan, 0.4 per 100, where rates for most psychiatric disorders are low. Mean age at first onset was usually in early to middle adulthood. The rates were higher in female than male subjects in all countries. Panic disorder was associated with an increased risk of agoraphobia and major depression in all countries. CONCLUSIONS: Panic disorder is relatively consistent, with a few exceptions, in rates and patterns across different countries. It is unclear why the rates of panic and other psychiatric disorders are lower in Taiwan.

Adolescent↗
PubMed1997

The nutrient intake of women with bulimia nervosa.

OBJECTIVE: The objective of this study was to evaluate the meal patterns and nutrient intake of women with bulimia nervosa (BN), and to compare them to clinical variables and recommended dietary allowances (RDA). METHOD: The nutrient intake of 50 women with BN was analyzed from 14 day dietary records. The data were compared to the median intakes of a random sample of women and to the RDA. Clinical variables for the women with BN were also available. RESULTS: Compared to nonbinge episodes per day, binge eating was significantly higher in energy from sucrose, fat, saturated fatty acids (SFA), monounsaturated fatty acids (MUFA) and lower in protein. Compared to the population median, binge eating was significantly lower in percent energy from protein, and higher in percent carbohydrate (CHO), sucrose, SFA, and MUFA, while nonbinge eating was significantly lower in percent energy from fat, SFA, and MUFA. Total intakes were significantly higher in energy and percent energy sucrose compared to the population. Despite significantly lower nonbinge energy intake, calcium, vitamins A and C, iron, and folate were not significantly different to the population median. However, one half or more of the subjects had less than two-thirds the RDA for nonbinge calcium, iron, zinc and for total intake one fourth remained less than two-thirds the RDA for iron and zinc. CONCLUSION: Nonbinge eating was characterized by low energy intake and by low intake of iron, calcium, and zinc. Binge eating, characterized by high sucrose and SFA content, overcompensated for these low energy intakes. Where treatment reduces or eliminates binge eating, it should also encourage consumption of regular meals and in particular, consumption of foods rich in zinc and iron.

Adolescent↗
PubMed1997

Initial manifestations of disordered eating behavior: dieting versus binging.

OBJECTIVE: We examined the onset of binge eating and dieting in 108 women with bulimia nervosa to determine whether (1) dieting always preceded binge eating; (2) dieting always preceded the onset of bulimia nervosa; and (3) individuals who manifested early initial binge eating differed from those whose earliest manifestation of disordered eating behavior was dieting in terms of lifetime psychopathology and temperament. METHOD: One hundred eight women were assessed at entry to a randomized clinical trial of cognitive-behavioral therapy for bulimia nervosa using structured diagnostic methodology. Retrospective recall of the onset of disordered eating behavior was used to categorize individuals as initial binge eaters or initial dieters. We then compared lifetime psychopathology and temperament across the two groups. RESULTS: Seventeen percent of women reported early binge eating prior to any dieting behavior. The mean age of onset of binging in this group was approximately 10 years. Neither the clinical picture of bulimia nervosa nor lifetime psychopathology differed between initial binge eaters and initial dieters. Individuals with early binge eating endorsed higher novelty seeking and lower harm avoidance. CONCLUSION: In a minority of women with bulimia nervosa, binge eating precedes dieting. These women display markedly higher novelty seeking and lower harm avoidance. Possible links between the dopamine system, novelty seeking, and appetitive behavior are discussed.

Adolescent↗
PubMed1997

Food cravings in women with a history of anorexia nervosa.

OBJECTIVE: The objective of the present study was to determine the prevalence and characteristics of food cravings in women with a history of anorexia nervosa. METHOD: One hundred one control women selected at random and 64 women with a diagnosis of anorexia nervosa 10 to 14 years earlier (cases) completed the Diagnostic Interview for Genetic Studies, a food craving questionnaire, the Temperament and Character Inventory and the Three-Factor Eating Questionnaire. RESULTS: A similar proportion of cases and controls reported food cravings. A greater proportion of cases reported strong cravings with two or more features of intensity (p = .02). Cravings in the cases were more likely to be characterized by difficulty resisting the craved food (p = .0008), anxiety when the craved food was unavailable (p = .002), and a high frequency of occurrence (p = .001). The cases who craved were significantly more likely to have had lifetime BN (p = .02). CONCLUSION: A similar prevalence of food craving in cases as in controls suggests that successful control of food intake and/or denial of hunger overrides dietary restriction as a precondition for craving in anorexia nervosa. A dysfunction in the serotonergic system, the provision of intermittent reinforcement by binge episodes, and/or frustration due to unsuccessful attempts at dietary restraint may mediate the association of cravings with the presence of lifetime bulimia.

Adolescent↗
PubMed1997

Impact of definition on prevalence of food cravings in a random sample of young women.

The objective of this study was to determine the characteristics of food cravings in a random sample of young women and to evaluate the impact of the definition used in food craving research. The Diagnostic interview for Genetic Studies and a questionnaire about food craving experiences were completed by 101 women aged between 18 and 45 years. Of this sample, 58% of respondents reported having ever experienced food cravings. Of these, 7% had experienced food cravings only during pregnancy. Fewer women met criteria for craving as the definition narrowed; 28% reported moderate to strong cravings with two features of intensity; 6% reported moderate to strong cravings with three features of intensity and 4% reported strong cravings with three features of intensity. Features of intensity or "core features" were those that related to strength of craving and were difficulty resisting eating, feeling anxious when the craved food was unavailable and a change in speed of consumption. Of strong cravers, 86% experienced at least two core features, compared with 48% of moderate and 10% of mild cravers. These features may aid in defining the craving state and should be taken into consideration in studies on food cravings.

Adolescent↗
PubMed1997

What determines post-traumatic stress disorder symptomatology for survivors of childhood sexual abuse?

OBJECTIVE: The aim of this paper was to ascertain which childhood abuse experiences are associated with post-traumatic stress disorder (PTSD) symptomatology for women survivors of childhood sexual abuse (CSA). METHOD: Seventy-three women attending a Family Health Counselling Service's Sexual Abuse Program were invited to participate in a study looking at the effectiveness of sexual abuse counselling. Initially, the women completed a series of self-report questionnaires including a measure of PTSD symptoms, and were interviewed about childhood abuse experiences. RESULTS: PTSD symptoms were associated with higher levels of all psychopathology. However, more interestingly, the severity of PTSD symptoms was also associated with the extent of CSA which involved actual sexual intercourse. This association of repeated abuse involving sexual intercourse with PTSD symptoms was still significant (partial coefficient = .30, p, .000) even when controlling for general level of psychopathology. CONCLUSIONS: One of the long-term effects of child sexual abuse (CSA) is post-traumatic stress disorder (PTSD), and the women who reported multiple abusive episodes which involved sexual intercourse had increased symptoms of PTSD.

Adult↗
PubMed1997

Precipitating factors and life events in serious suicide attempts among youths aged 13 through 24 years.

OBJECTIVE: Precipitating factors and life events associated with medically serious suicide attempts were examined in young people making serious suicide attempts and control subjects. METHOD: Using a case-control design, the authors contrasted 129 young people making serious suicide attempts with 153 randomly selected community controls on a series of life event occurrences within the preceding year. Precipitating factors for serious suicide attempts were also examined. RESULTS: The most common precipitants of serious suicide attempts were relationship breakdowns, other interpersonal problems, and financial difficulties. However, one third of those attempting suicide were unable to describe any precipitating factor. Individuals who made serious suicide attempts had elevated rates of life events which were associated principally with interpersonal difficulties, work issues, financial difficulties, and legal problems. When due allowance was made for intercorrelations between life event measures and antecedent social, family, and personality factors, interpersonal losses and conflicts and legal problems remained significant risk factors for serious suicide attempts. CONCLUSIONS: Important proximal occurrences for serious suicide attempts among young people include a series of life events associated principally with interpersonal conflicts, relationship difficulties, and legal problems.

Adolescent↗
PubMed1997

Temperament and the structure of personality disorder symptoms.

This paper attempts to construct a simplified system for the classification of personality disorders, and relates this system to normally distributed human personality characteristics. One hundred and forty-eight subjects with a variety of psychiatric diagnoses were evaluated using the SCID-II structured clinical interview for personality disorders. A four-factor solution of personality disorder symptoms was obtained and we labelled these factors 'the four As': antisocial, asocial, asthenic and anankastic. The factors related to the four temperament dimensions of the Tridimensional Personality Questionnaire (TPQ), but less closely to Eysenck Personality Questionnaire (EPQ) dimensions. The four factors were similar to those identified in a number of studies using a variety of assessment methods and this lends some credibility to our findings. It suggests that a more parsimonious set of trait descriptors could be used to provide simpler, less overlapping categories that retain links with current clinical practice. In addition, these factors can be seen as extremes of normally distributed behaviours obtained using the TPQ questionnaire.

Adolescent↗
PubMed1997

The hypothalamic-pituitary-thyroid axis in major depression.

We investigated the capacity of several thyroid-axis measures to distinguish between depressed and control subjects and determined whether these variables were related to antidepressant treatment response. We studied 105 subjects who fulfilled the DSM-III-R criteria for a current major depressive episode and 41 volunteers with no current mental disorder. The following thyroid-axis variables were measured: difference between T4 levels at 09.00 hours and 13.00 hours; baseline TSH; maximal TSH response to 400 micrograms TRH (delta max TSH); and presence of a blunted delta max TSH. The T4 difference variable alone distinguished between depressed and control subjects. In multivariate analyses, T4 difference and delta max TSH were independently related to antidepressant-treatment outcome, and predicted a modest proportion (14%) of the variance in outcome. The relationship between these two variables and treatment outcome was particularly strong in depressed male subjects who were receiving desipramine, for whom they accounted for 36% of the variance in treatment outcome. The T4 difference variable both distinguished between depressed and control subjects and was related to treatment outcome. Although this finding requires replication, it is consistent with other reports of the usefulness of thyroid-axis indices measured at different times of day in depressed patients.

Adolescent↗
PubMed1997

Eating disorders and antecedent anxiety disorders: a controlled study.

We compared the prevalence and age of onset of adult and childhood anxiety disorders relative to the primary diagnosis in 68 women with anorexia nervosa (AN), 116 women with bulimia nervosa (BN), 56 women with major depression with no eating disorder (MD) and 98 randomly selected controls (RC) in order to determine whether antecedent anxiety disorders are plausible risk factors for AN and BN. Comorbid anxiety disorders were common in all three clinical groups (AN, 60%; BN, 57%; MD, 48%). In 90% of AN women, 94% of BN women and 71% of MD women, anxiety disorders preceded the current primary condition (P = 0.01), although panic disorder tended to develop after the onset of AN, BN or MD. In multivariate logistic regressions, the odds ratios (ORs) for overanxious disorder (OR = 13.4) and obsessive-compulsive disorder (OR = 11.8) were significantly elevated for AN. The ORs for overanxious disorder and social phobia were significantly elevated for BN (OROAD = 4.9; ORSP = 15.5) and MD (OROAD = 6.1; ORSP = 6.4). These data suggest that certain anxiety disorders are non-specific risk factors for later affective and eating disorders, and others may represent more specific antecedent risk factors.

Adolescent↗
PubMed1997

Low persistence predicts relapse in alcohol dependence following treatment.

OBJECTIVE: To investigate the relationship between personality measures and alcohol dependence relapse in a treatment sample of men with alcohol dependence. METHOD: Alcohol dependent men (N = 87) without a primary diagnosis of antisocial personality disorder, recruited consecutively from a 3-week abstinence-focused therapeutic program, along with informants, completed the Structured Clinical Interview for DSM-III-R Personality Disorders (self-report questionnaire) (SCID-PQ) and the Tridimensional Personality Questionnaire (TPQ) and were followed-up for 6 months. Drinking outcomes were based on multiple sources of data and subjects categorized as relapsed or not. Personality was investigated according to traditional DSM-III-R/DSM-IV clusters, as well as conduct disorder and obsessionality separately, in addition to the four major temperament dimensions of the TPQ. RESULTS: Cluster B personality disorder symptoms, conduct disorder symptoms and novelty seeking were not associated with relapse. However, the temperament trait of persistence predicted relapse. CONCLUSIONS: Personality features associated with onset of alcohol dependence do not appear to be the same as those associated with relapse in a sample of alcohol dependent men that excludes severe antisocial personality disorder. It is speculated that what might be considered low motivation when applied to alcohol dependent patients who relapse following treatment, may in part reflect low persistence, a personality trait.

Adult↗