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Biomedical subjects

R T Mulder

Publications and source records attributed to R T Mulder.

At least 37 records · Page 2Linked to original sources
PubMed1998

Psychiatric illness in a New Zealand sample of young people making serious suicide attempts.

AIM: To examine the extent of psychiatric illness amongst young people making medically serious suicide attempts and control subjects. 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 measures of current and lifetime DSM-III-R diagnoses of mental disorders. RESULTS: Individuals making suicide attempts were characterised by high rates of current mental disorder (89.5%), current comorbidity (54.3%), lifetime histories of psychiatric disorder (90.7%) and previous suicide attempts (52.7%). At the time of the suicide attempt, those making serious attempts had elevated rates of the following disorders: affective disorders (70.5%), substance use disorders (38.8%), anxiety disorders (14.7%), eating disorders (8.5%) and antisocial disorders (34.9%). CONCLUSIONS: Young people who made medically serious suicide attempts had high rates of a range of mental disorders, and of comorbid disorders, at the time of the suicide attempt. They had high rates of lifetime histories of mental disorders and previous suicide attempts. The implications of these findings for the development of strategies to manage, treat and prevent suicidal behaviours in young people are discussed.

Adolescent↗
PubMed1998

Unemployment and serious suicide attempts.

BACKGROUND: This study used a case-control design to examine the association between unemployment and risk of medically serious suicide attempt. METHOD: A sample of 302 individuals who made serious suicide attempts was contrasted with 1028 randomly selected community control subjects. RESULTS: Individuals who made serious suicide attempts reported higher rates of current unemployment (OR = 4.2) than control subjects. This association was similar for males and females. However, even before adjustment for confounding factors it was evident that exposure to unemployment made only a small contribution to suicide attempt risk. The population attributable risk for exposure to unemployment was 7.3%. After adjustment for antecedent childhood, family and educational factors the association between unemployment and risk of serious suicide attempt was reduced but remained significant (OR = 2.1), suggesting that common antecedent factors made a large contribution to risks of both unemployment and serious suicide attempt. When both antecedent family and childhood factors, and psychiatric morbidity were taken into account, unemployment was not significantly related to risks of serious suicide attempt. CONCLUSION: The results of this study provide support for the contention that much of the association between unemployment and suicidal behaviour is non-causal, and reflects common or correlated factors that contribute to risks of both unemployment and suicidal behaviour. Any remaining association between unemployment and suicide attempt risk appears to arise from the correlation that exists between unemployment and psychiatric disorder.

Adolescent↗
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

Obsessive-compulsive disorder in post-streptococcal infection.

OBJECTIVE: We describe the sudden onset of obsessive-compulsive symptoms following a peritoneal infection with alpha-haemolytic streptococci. CLINICAL PICTURE: A 35-year-old woman with no past history or family history of obsessions or compulsions developed these symptoms 2 weeks after a peritoneal infection. TREATMENT: The patient received 80 mg fluoxetine daily. OUTCOME: She responded to treatment with a progressive reduction in symptoms. CONCLUSIONS: It is suggested that these obsessions and compulsions may be related to an autoimmune response to the streptococcal infection.

Adult↗
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

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

Temperament and substance abuse in schizophrenia: is there a relationship?

The influence of temperament on substance abuse in schizophrenia is poorly understood, whereas it is known to play an important role in other clinical populations. In a sample of 28 male schizophrenics, Cloninger's dimensions of temperament were measured with the use of the Tridimensional Personality Questionnaire (TPQ). Levels of four commonly used substances were recorded. There was a significant correlation between the novelty-seeking dimension and past use of alcohol, cannabis, and caffeine and current use of caffeine and nicotine. There was no relationship between substance use and clinical symptoms or demographic variables. The possible implications of abnormal mean TPQ scores in the sample as well as a weak correlation between symptom patterns and TPQ scores are discussed. The findings suggest that novelty-seeking type behaviors contribute to substance use in schizophrenia.

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

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↗
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↗