Biomedical subjects

P R Joyce

Publications and source records attributed to P R Joyce.

At least 73 records · Page 4Linked to original sources

PubMed1996

Family history of depression in clinic and community samples.

Because most published family studies of depression ascertained subjects from treatment settings, the reported familial aggregation of depression could be an artifact if a family history of depression increased the likelihood of seeking treatment. To investigate this possibility, we compared the family history of depression in three groups of probands aged 18-44; 54 women randomly selected from the community with depression in the prior year, 41 women who entered a clinical trial for depression and 37 women randomly selected from the community who had not been depressed in the prior year. The presence of depression in the parents and siblings of the probands was assessed by the family history method and quantified via family history scores which took the age, gender and number of relatives into account. Depressed probands ascertained from clinical sources had markedly higher family history scores of depression than other two groups (P < 0.00005 in each instance). In the absence of direct interviews with relatives, we cannot exclude the impact of differential reporting. A family history of depression might be associated with an increased probability of treatment or the differential reporting of family history. It is thus possible that the familial aggregation of depression observed in probands from treatment settings is an artifact.

Adolescent↗

PubMed1996

Intimate bonds in depression.

There is considerable interest in the relationship between interpersonal relationships and mood disorders. The Intimate Bond Measure (IBM) assesses the respondent's perception of their partner over recent times. IBM care scores have been reported to be independent of depression severity and personality, to distinguish between melancholic and non-melancholic depressives, and to predict treatment outcome. In a sample of 105 depressed patients, IBM care measures were independent of depression severity and personality measures, but they did not distinguish between melancholic and non-melancholic depressives, and did not predict treatment outcome. When the sample was restricted to individuals who had been previously treated, IBM care measures did distinguish between melancholic and non-melancholic depressives, although they still did not predict treatment outcome. Possible implications of these findings are discussed.

Adolescent↗

PubMed1996

The effect of a history of conduct disorder in adult major depression.

This paper examines the impact of a history of conduct disorder on major depression in adulthood, including its symptomatology, comorbidity and response to tricyclic antidepressants. 103 subjects with DSM-III-R major depression were assessed for DSM-III-R axis I and II comorbidity, severity of depression, social functioning, general psychiatric symptomatology, early familial environment and family psychiatric history. 18 patients (17%) had a history of conduct disorder, 32 (31%) were subthreshold, and 53 (51%) had no childhood symptoms of conduct disorder. Depressed adults with a history of conduct disorder had significantly higher lifetime alcohol and drug dependence and virtually all (17/18, 94%) met criteria for a personality disorder. Despite this, the current episode of depression did not differ in severity, symptoms or response to treatment except that those with a history of conduct disorder were more likely to be agitated when depressed. The authors conclude that a history of conduct disorder is depressed patients predicts the presence of adult personality disorders and psychoactive substance dependence. In most other ways, depressed subjects with a history of conduct disorder were similar to other subjects.

Adolescent↗

PubMed1996

Correlates of severity in bulimia nervosa.

OBJECTIVE: We sought to clarify the correlates of severity in women with bulimia nervosa. METHOD: We studied 114 bulimic women at entry to a randomized clinical trial. We used eight definitions of severity that encompassed the DSM-III-R criteria set for bulimia nervosa (i.e., binging, purging, and body dissatisfaction in the current and worst lifetime time frames) and global functioning and symptomatology. We operationalized 28 possible correlates of severity that covered demographic, Axis I psychiatric, personality, family background, symptoms, and neuropsychological domains. We used regression techniques to investigate the associations between the correlates and severity indices. RESULTS: The regression models were all statistically significant and tended to account for a sizeable proportion of variance. In particular, earlier age of onset of bulimia and lower character scores (measured by the Temperament and Character Inventory) correlated with greater severity. Worse mean parental care (from the Parental Bonding Instrument), the absence of any lifetime anxiety disorder, and the presence of any lifetime mood disorder emerged as independent correlates in several models. CONCLUSIONS: As these were hypothesis-generating analyses, confirmation or refutation of these results awaits further study. In particular, age of onset of bulimia and personality traits related to character may be important modifiers of the severity of illness in bulimia nervosa.

Adolescent↗

PubMed1996

The significance of a prior history of anorexia in bulimia nervosa.

OBJECTIVE: Some authors stratify women with current, normal-weight bulimia nervosa into groups defined by the presence or absence of a past history of anorexia nervosa. Unlike the distinction between current anorexia nervosa with or without bulimic symptoms, fewer studies have investigated the significance of stratifying bulimic women by a past history of anorexia. METHOD: One hundred and fourteen women with bulimia nervosa in a clinical trial were studied via structured clinical interviews covering Axis I and II disorders and measures of personality and symptomatology. Prospective, 14-day dietary analysis was available for a subset of subjects. RESULTS: Bulimic women with a past history of anorexia nervosa were significantly more likely to have a lifetime anxiety disorder, lower current body mass index, increased cooperativeness on the Temperament and Character Inventory, and increased mature and neurotic scores on the Defense Style Questionnaire. These women also reported lower scores on the bulimia subscale of the Eating Disorders Inventory, but these self-report data were not consistent with the numbers of objective binges or reported energy intake. The prevalence of other Axis I disorders, Axis II personality disorders, and bulimic symptomatology was quite similar across groups. CONCLUSIONS: Although bulimic women with a prior history of anorexia nervosa differed in limited respects from those without such a history, the differences were outweighed by the similarities. A past history of anorexia nervosa did not appear to define particularly meaningful subgroups of women with current, normal-weight bulimia nervosa.

Adolescent↗

PubMed1996

Risk factors for serious suicide attempts among youths aged 13 through 24 years.

OBJECTIVE: To examine associations between a series of sociodemographic factors, childhood experiences, and mental disorders and risk of serious suicide attempt in young people aged 13 through 24 years and to explore the joint relationship between these factors and vulnerability to serious suicide attempt. METHOD: The study used a case-control design in which a sample of 129 young people who had made serious suicide attempts was contrasted with 153 randomly selected community controls. Measures included sociodemographic factors (educational qualifications, annual income, residential mobility), childhood experiences (parental relationship, parental care, childhood sexual abuse), and psychiatric morbidity. RESULTS: On the basis of multiple logistic regression, those making serious suicide attempts reported elevated rates of sociodemographic disadvantage (p < .0001), higher rates of disadvantageous childhood experiences (p < .05), and elevated rates of psychiatric morbidity (p < .0001). CONCLUSIONS: Risks of serious suicide attempt among young people increased with extent of exposure to childhood adversity, social disadvantage, and psychiatric morbidity, with each of these factors making independent contributions to risk of serious suicide attempt.

Adolescent↗

PubMed1996

Towards an understanding of defense style in terms of temperament and character.

The aim was to investigate the relationships between a model of personality based on the concept of defense mechanisms, as articulated by Vaillant, with the psychobiological model of personality, as developed by Cloninger. A total of 128 adults from 11 family pedigrees with at least two alcohol-dependent members completed the self-report Defense Style Questionnaire and the Temperament and Character Inventory. Immature defenses were largely explained by low character scores, while neurotic defenses were part temperament and part character. Cluster A, B and C defenses were related to low reward dependence, high novelty-seeking and high harm avoidance respectively. In a regression analysis, cluster B and C defenses were more related to low character scores than to temperament but, for cluster A defenses, temperament and character both contributed. The results suggest that it is possible to integrate an ego defense model of personality with a psychobiological model of personality, thereby enriching both approaches.

Adolescent↗

PubMed1996

Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study.

OBJECTIVE: The aim of this study was to compare the prevalence and comorbidity patterns of psychiatric disorders in subjects making medically serious suicide attempts and in comparison subjects. METHOD: The association between mental disorders and the risk of a suicide attempt was examined in 302 consecutive individuals who made serious suicide attempts and 1,028 randomly selected comparison subjects. Each subject completed a semistructured interview, and a significant other underwent a parallel interview; best-estimate DSM-III-R diagnoses were then generated. RESULTS: Of those who made serious suicide attempts, 90.1% had a mental disorder at the time of the attempt. Multiple logistic regression showed that those who made suicide attempts had high rates of mood disorders (odds ratio = 33.4, 95% confidence interval = 21.9-1.2); substance use disorders (odds ratio = 2.6, 95% confidence interval = 1.6-4.3); conduct disorder or antisocial personality disorder (odds ratio = 3.7, 95% confidence interval = 2.1-6.5); and nonaffective psychosis (odds ratio = 16.8, 95% confidence interval = 2.7-105.8). The relationship between psychiatric morbidity and suicide risk varied with age and gender. The incidence of comorbidity was high: 56.6% of those who made serious suicide attempts had two or more disorders. The risk of a suicide attempt increased with increasing psychiatric morbidity: subjects with two or more disorders had odds of serious suicide attempts that were 89.7 times the odds of those with no psychiatric disorder. CONCLUSIONS: Individuals who made serious suicide attempts had high rates of mental disorders and of comorbid disorders. Subjects with high levels of psychiatric comorbidity had markedly high risks of serious suicide attempts.

Adolescent↗

PubMed1996

Does depression predict relapse in the 6 months following treatment for men with alcohol dependence?

OBJECTIVE: To investigate whether depression measured at the time of treatment predicts relapse of alcohol dependence in the 6 months following treatment of alcohol-dependent men. METHOD: Ninety-three subjects with moderate-severe alcohol dependence (DSM-III-R), recruited from a 3-week, abstinence-focused therapeutic program, were assessed for current and lifetime major depression using the SCID-P and baseline depressive symptoms using the SCL-90, and then followed up for 6 months. Drinking outcomes were based on multiple sources of data. RESULTS: Relapse was not associated with either lifetime major depression, or baseline depressive symptoms; inadequate numbers of subjects with a current major depression precluded statistical analysis of this variable. CONCLUSIONS: Neither lifetime major depression, nor the degree of depressive symptoms in alcohol-dependent men at the time of treatment, compromise drinking outcomes in the 6 months following treatment.

Adult↗

PubMed1996

Access to firearms and the risk of suicide: a case control study.

OBJECTIVE: This study examined the association between access to a firearm and risk of suicide in a consecutive sample of individuals who had made serious suicide attempts. METHOD: The study used a case control design in which a sample of 197 individuals who died by suicide and 302 individuals who made medically serious suicide attempts was contrasted with 1028 randomly selected community control subjects. RESULTS: Suicide attempts by gunshot accounted for 1.3% of all serious suicide attempts (with non-fatal outcome) and 13.3% of suicides. However, among those making serious suicide attempts, gunshot had a high rate of fatality (83.3%). While access to a firearm was associated with increased risks that gunshot would be chosen as the method of suicide attempt (OR = 107.9; CI = 24.8-469.5), this access was not associated with significant increases in the risk of suicide (OR = 1.4; CI = 0.96-1.99). CONCLUSIONS: For this sample, access to a firearm was not associated with a significant increase in the risk of suicide, although such access was associated with an increased probability that gunshot would be chosen as the method of suicide attempt.

Adolescent↗

PubMed1996

Phobic disorders are associated with temperament in alcoholic men.

OBJECTIVE: To investigate whether in a sample of men with alcohol dependence those with comorbid phobic disorders had higher persistence scores than those without. METHOD: Ninety-nine men with moderate-severe alcohol dependence recruited from an alcohol treatment programme were interviewed using the Structured Clinical Interview (SCID) and completed a Tridimensional Personality Questionnaire (TPQ). RESULTS: Subjects with a comorbid phobic disorder had significantly higher persistence scores compared to those without. CONCLUSIONS: The temperament dimension, persistence, is associated with phobic disorder.

Adult↗

PubMed1995

Adverse parenting and other childhood experience as risk factors for depression in women aged 18-44 years.

65 women who had experienced a recent major depressive disorder, and 81 women who had never been depressed, were recruited from a community probability sample. The two groups of women were compared with regard to a number of childhood experiences, including parenting style, which was assessed with the Parental Bonding Instrument (PBI). When all the childhood factors were considered simultaneously in a logistic regression analysis, only low maternal care was significantly associated with recent depressive episodes. Low maternal care increased the risk of recent major depression approximately 4-fold and the estimate of the population attributable risk was 35%. These findings give further weight to the contention that adverse parenting in childhood, particularly a maternal parenting style typified by low care, is a significant risk factor for adult depression.

Adolescent↗

PubMed1995

Urinary catecholamines and plasma hormones predict mood state in rapid cycling bipolar affective disorder.

Over the course of 1 year, a patient with a rapid cycling bipolar affective disorder was followed at weekly intervals to examine whether plasma hormones and urinary catecholamines could predict current or future mood. Higher cortisol levels were found to predict depressed mood 3 days after blood sampling, higher urinary dopamine predicted a manic mood 3 days after blood sampling, urinary norepinephrine was associated with severity of current mood and prolactin was lower with concurrent depressed mood. In multivariate analyses of mood against cortisol, prolactin and three urinary catecholamines, > 50% of the variance in mood state in 3 days was explained by combinations of these biologic measures, especially cortisol and urinary dopamine, while all five biologic variables contributed to explaining 50% of the variance in current mood state. Based on the interrelationships between urinary dopamine, norepinephrine and mood, we postulate the existence of an overcompensating mechanism which is reflected in opposing correlations between urinary dopamine and norepinephrine with mood, despite the two urinary catecholamines being positively correlated.

Adult↗

PubMed1995

Temperament, character, and personality disorder in bulimia nervosa.

In a sample of 76 women participating in a clinical treatment trial for bulimia nervosa, we examined the clinical differences between subjects with and without concurrent personality disorders and the ability of "self-directedness" (a character scale of Cloninger's Temperament and Character Inventory) to predict the presence of personality disorder. Sixty-three percent of the sample had at least one personality disorder diagnosis. Fifty-one percent of personality disorders were in cluster C, 41% were in cluster B, and 33% were in cluster A. The presence of personality disorder was associated with greater depressive symptoms, worse global functioning, laxative use, greater body dissatisfaction, higher harm avoidance, and lower self-directedness. As hypothesized, low self-directedness scores were associated with a markedly increased probability of a personality disorder.

Adult↗

PubMed1995

The effects of alcoholism on the hypothalamic-pituitary-adrenal axis: interaction with endogenous opioid peptides.

BACKGROUND: Abnormal baseline hypothalamic-pituitary-adrenal axis function and dexamethasone suppressibility seen in withdrawing alcoholics returns to normal on abstinence, but some studies report blunting of the ACTH response to CRH persisting during the early abstinence phase. Reduced central levels of endogenous opioid peptides have been postulated to have an aetiological role in alcohol addiction. AIMS: To evaluate hypothalamic-pituitary-adrenal axis function in a group of recently abstinent alcoholics using basal hormone data, naloxone (an opioid receptor antagonist), and ovine CRH. SUBJECTS: Nine alcoholics (age 41.4 +/- 3.1 years) studied more than one week after the acute withdrawal period but within 6 weeks of cessation of drinking, and nine age and sex matched non-alcoholic controls. PROTOCOL: Cortisol, ACTH, CRH and AVP levels were measured every 20 minutes for 2 hours between 0900 and 1100h Twenty mg naloxone i.v. was administered at 1100h (0 minutes) and further samples for the above hormones were taken at 15, 30, 45, 60, 90 and 120 minutes. On a separate occasion, again at 1100h, oCRH 1 microgram/kg (n = 7 alcoholics, n = 6 controls) was administered, with samples for cortisol, ACTH and AVP taken at the same times. STATISTICS: Results were examined by analysis of variance for repeated measures (ANOVA), while incremental hormone response and area under the secretory curve (AUC) in alcoholics versus controls were compared by the two-tailed Student's t-test. Linear regression analysis was carried out to examine the relation between basal cortisol and hormone responses to naloxone and oCRH. RESULTS: Basal hormone levels did not differ between the groups. The alcoholics had a blunted ACTH incremental response to naloxone (11.4 +/- 3.0 vs 21.1 +/- 2.5 pmol/l, P < 0.05) but the cortisol response was not significantly different (205 +/- 51 vs 305 +/- 42 nmol/l, P = 0.15). The alcoholics also had a blunted ACTH incremental response to oCRH (28.7 +/- 4.2 vs 41.2 +/- 3.7 pmol/l, P = 0.052) and by ANOVA a significant main effect of group (alcoholic vs control) was seen (P < 0.02) for the ACTH response to oCRH. There was no difference between the groups in the cortisol incremental response to oCRH. In the control subjects, a negative correlation was found between basal cortisol and the cortisol increment (r = -0.82, P < 0.05) and ACTH increment (r = -0.81, P = 0.052) following oCRH, while in contrast, basal cortisol correlated positively with cortisol increment (r = 0.72, P < 0.05) following naloxone. There was also a trend for basal cortisol to correlate positively with ACTH increment following naloxone in the controls (r = 0.63, P < 0.07). In the alcoholics, the normal negative effect of basal cortisol on the cortisol increment after oCRH was reversed, with a positive correlation between basal cortisol and cortisol increment (r = 0.75, P = 0.05). CONCLUSIONS: Recently abstinent alcoholics with normal basal HPA axis hormone levels have a blunted ACTH response to naloxone and oCRH. While reduced levels of central endogenous opioid peptides may be a factor in the blunted ACTH response to naloxone in the alcoholics, it is proposed that the alcoholics have reduced pituitary responsiveness to CRH. This may be via a direct pituitary effect of the chronic ethanol exposure or by a reduction in hypothalamic-hypophyseal vasopressin levels.

Adrenocorticotropic Hormone↗

PubMed1995

The acute effects of oral ethanol on the hypothalamic-pituitary-adrenal axis in normal human subjects.

OBJECTIVE: To evaluate the acute effects of oral ethanol on the hypothalamic-pituitary-adrenal axis in normal human subjects and, in particular, to examine the effect of background alcohol intake and gastrointestinal side-effects on this response. DESIGN: Plasma ethanol, cortisol, ACTH, corticotrophin-releasing hormone (CRH) and AVP were measured half-hourly for 4 hours following 1.1 ml/kg of 95% ethanol or placebo in a cross-over study. At least one week elapsed between each procedure. SUBJECTS: Twelve healthy non-alcoholic volunteers with a wide range of background alcohol intakes. MEASUREMENTS: Peptide hormones were measured by radioimmunoassay, cortisol by ELISA and blood ethanol by headspace gas chromatography. Results are expressed as mean +/- SEM. RESULTS: Blood ethanol levels peaked at one hour post ethanol ingestion. Three subjects developed significant gastrointestinal (GI) side-effects, with two vomiting and one experiencing moderate to severe nausea. There was no difference between peak blood ethanol levels in the groups with and without GI side-effects (34.5 +/- 2.4 mmol/l vs 34.3 +/- 1.7 mmol/l respectively). ACTH and cortisol rose in those subjects who experienced GI side-effects (P < 0.0001 for each). The remaining subjects had a tendency for ACTH and cortisol to be higher on the placebo day. The group with GI side-effects following ethanol administration had a significant rise in AVP (P < 0.02) that was synchronous with ACTH and cortisol. No consistent alcohol related changes were seen in peripheral CRH levels, although there was a significant increase over time on both active and placebo days (P < 0.0001). In the group with no GI side-effects, AVP did not significantly fall in the first half hour following ethanol, while a significant fall did occur following placebo (P < 0.05). Plasma renin activity was, however, increased by ethanol (P < 0.05). The background alcohol intake of the group with GI side-effects was significantly lower than the group without (18 +/- 7 vs 235 +/- 51 g/week, P < 0.05), but no hormonal response was seen in two subjects with a relatively low alcohol intake (< 100 g/week) who did not experience GI side-effects. CONCLUSION: Intoxicating levels of ethanol per se do not result in activation of the hypothalamic-pituitary-adrenal axis in humans. However, gastrointestinal side-effects induced by the ethanol do result in such activation, which appears to be mediated by AVP as the dominant ACTH secretagogue. One of the factors which influences the blood ethanol level at which GI side-effects occur appears to be background alcohol intake.

Adrenocorticotropic Hormone↗

PubMed1995

The significance of a history of childhood sexual abuse in bulimia nervosa.

BACKGROUND: Childhood sexual abuse (CSA) is found to have occurred to a substantial minority of women with bulimia nervosa. Its clinical significance is unclear. METHOD: We studied 87 bulimic women in a clinical trial. Structured interviews determined the presence of CSA, DSM-III-R disorders, global functioning, and depressive and bulimic symptoms. RESULTS: Forty-four per cent reported a history of CSA. Bulimic women with CSA reported earlier onset of bulimia, greater depressive symptoms, worse global functioning and more suicide attempts, and were more likely to meet criteria for bipolar II disorder, alcohol and drug dependence, conduct disorder and avoidant personality disorder. CONCLUSIONS: Although those with CSA had greater comorbidity, it was not an important modifier of bulimic symptoms.

Adolescent↗

PubMed1995

Disruptions in childhood parental care as risk factors for major depression in adult women.

OBJECTIVE: The aim of this study was to examine the influence of different types of disruptions in childhood parental care before the age of 15 years as risk factors for major depression in women aged 18 to 44 years. The types of disruptions studied were parental death, parental separation or divorce, other types of loss (i.e. adoption, foster-care, etc.), and prolonged separation from both parents. Potential confounding factors were also examined. METHOD: The data were obtained from a community probability sample. Caseness was determined by the use of the Diagnostic Interview Schedule (DIS) and both the current (one month) and lifetime prevalence periods were considered. Logistic regression was used to model the influence of each factor, singly and adjusted for the influence of other factors, on the risk for major depression. RESULTS: It was found that in this population 17% had experienced some type of parental loss (parental death 4%, separations/divorce 10% and other types of loss 3%) and 11% had experienced prolonged separation from both parents. Parental loss was significantly associated with lifetime depression, but this effect was no longer significant when adjusted for other factors. However, prolonged separation from both parents was associated with an increased risk of current and lifetime depressive episodes of approximately three to fourfold, even when the risk was adjusted for other factors. CONCLUSIONS: The results of this study suggest that prolonged separation from both parents has a stronger association with current or lifetime depression in women than do parental death, separation/divorce and other types of loss. Prolonged separation may be a marker for other risk factors and may not be a risk factor on its own.

Adolescent↗