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Biomedical subjects

R T Mulder

Publications and source records attributed to R T Mulder.

At least 55 records · Page 3Linked to original sources
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

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↗
PubMed1994

Total cholesterol and suicidality in depression.

There exists considerable controversy regarding an association between low total cholesterol and increased mortality from suicide. As suicide mortality is a crude marker for suicidal ideation and behavior, we investigated the association between total cholesterol and suicidality in a depressed sample. Ninety men and women meeting structured criteria for a major depressive episode of at least moderate severity participated in a study of predictors of treatment response. A three level variable codified the degree of suicidality in the previous month: no suicidal thoughts (39/90), suicidal ideation or plan (38/90), and a suicide attempt (13/90). There was a significant univariate association between lower cholesterol levels and increasing degrees of suicidality. In a multivariate analysis, this association was the only one that neared statistical significance (p = 0.068). Although it is premature to conclude that these variables are causally associated, data from a number of sources suggest that this association is worthy of further study.

Adult↗
PubMed1994

Temperament predicts clomipramine and desipramine response in major depression.

Clinical predictors of drug response in major depression have been weak and inconsistent. Eighty-four patients suffering from a current major depressive episode completed a 6-week double-blind trial of either clomipramine or desipramine. Temperament, as measured by the Tridimensional Personality Questionnaire, accounted for 35% of the variance in treatment outcome, compared with less than 5% predicted by clinical variables. In the more severely depressed patients, temperament predicted nearly 50% of the variance in treatment outcome, which is the first time that such a substantial predictor of drug response has been identified. Within depressed women, temperament also predicted response to different antidepressant drugs. The potential importance of temperament, and the need for replication of these findings is discussed.

Adult↗
PubMed1994

Borderline personality disorder in major depression.

The precise interrelationship between borderline personality disorder (BPD) and major depression (MD) remains unclear. To elucidate this further, we studied the characteristics of BPD in an unselected sample of 103 depressed subjects. All subjects were evaluated with structured diagnostic instruments. We contrasted three groups (MD plus BPD, MD plus a non-BPD, and MD plus no personality disorder) across several domains (characteristics of the depressive disorder, psychometric scales, axes I and II comorbidity, early environmental indices, family psychiatric history, and treatment response). Depressed subjects with BPD had significantly earlier onset of depression, dense axes I and II comorbidity, and higher prevalence of conduct disorder, and were characterized by elevated psychoticism and anger-hostility scores. In most other respects, however, depressed subjects with BPD were not strikingly distinct from other groups of depressed subjects.

Adult↗
PubMed1994

Temperament and hypercortisolemia in depression.

OBJECTIVE: The authors examined the relationships among depression severity, melancholia, and cortisol level and the relationship between temperament, as measured with the Tridimensional Personality Questionnaire, and cortisol level. METHOD: Morning and afternoon cortisol levels of 40 healthy comparison subjects and 96 patients with major depression were measured. The depressed patients were rated for depression severity and melancholia, and they completed the Tridimensional Personality Questionnaire. RESULTS: Temperament, especially dependence and extravagance, but not depressive symptoms, was the major determinant of the hypercortisolemia observed in the depressed patients. CONCLUSIONS: For research in biological psychiatry to advance, more attention needs to be paid to the individual differences in biology that underlie any state-dependent biologic dysfunction.

Adult↗
PubMed1994

Relationships of the Tridimensional Personality Questionnaire to mood and personality measures for depressed patients.

The relationships of Tridimensional Personality Questionnaire dimensions to mood and to the Eysenck personality dimensions and Barratt's impulsivity scores are presented. Some aspects of temperament appear to be mood related, but most are not. Correlations with the other personality measures were largely as predicted. However, Exploratory Excitability correlated negatively with Harm Avoidance rather than with Novelty Seeking. Factor analysis supported this relationship. Reward Dependence was weakly represented by the other personality measures and may be tapping unique behaviours.

Adolescent↗
PubMed1993

One hundred years of suicide in New Zealand.

Suicide rates were obtained for New Zealand from 1889 to 1988. The overall rate for women has been stable since the 1930s, and the male rate showed marked peaks in the early 1930s and in the 1980s. Analysis of rates by age group revealed that the 1930 male peak was due to increases among the middle-aged and elderly men, and the current peak is due to increases among young men. Possible explanations for fluctuations in suicide rates over the last century are discussed.

Adolescent↗
PubMed1993

Why study the history of psychiatry?

The history of psychiatry is being neglected. The major psychiatric textbooks no longer offer any overview of psychiatric history. Possible reasons for this indifference are discussed. It is suggested that a knowledge of our history is not only necessary in a general intellectual sense, but also specifically in enabling us to more easily tolerate the incompleteness and ambiguity of many of our concepts. Furthermore, it may help psychiatry to more convincingly explain the reality and consequences of mental illness to a sceptical public.

Curriculum↗
PubMed1992

Elevated levels of acute phase plasma proteins in major depression.

Levels of acute phase and other plasma proteins were measured in 21 men with major depression, 28 men with alcohol dependence, and 12 men who acted as controls. The depressed men had significantly elevated levels of the acute phase proteins, haptoglobin and alpha-1-antichymotrypsin, and of immunoglobulin G. The elevations in haptoglobin and alpha-1-antichymotrypsin were highly correlated with each other, and were correlated with the severity of depression and negatively correlated with the thyroid stimulating hormone response to thyrotropin. The alcoholic men had elevated haptoglobin levels, but significantly decreased levels of immunoglobulin G. These findings provide further evidence for an inflammatory response during depression.

Acute-Phase Proteins↗
PubMed1992

Diurnal profiles of thyroid hormones are altered in depression.

Free thyroxine index (FT4I), serum thyroxine (T4) and thyrotrophin concentrations were measured in 45 depressed subjects and 23 controls. The FT4I am/pm ratio was significantly higher in depressed subjects than in controls. This elevated diurnal ratio of thyroid hormones in depression adds to the literature on the chronobiology of affective disorders, and may help to explain differences in thyroid hormone levels in depressed patients in other studies, where time of sampling has seldom been reported.

Adolescent↗
PubMed1991

Personality disorders in New Zealand hospitals.

A survey was carried out of all patients admitted to New Zealand psychiatric hospitals over a 7-year period with a primary diagnosis of personality disorder. Despite a decrease in the total number of admissions, the relative totals for each personality disorder remained consistent. The personality categories differed significantly in terms of age, sex, marital status and committal status. These variables conformed closely to traditional clinical descriptions of the personality disorders, indicating that the reliability and utility of classical categorical systems may be greater than has been assumed in the literature. The DSM-III-R prototypical categories, which may possibly be a more natural representation of personality disorder syndromes, may be less useful than the traditional categories in clinical and research applications.

Adult↗
PubMed1990

Seasonality of mania in New Zealand.

This paper examines the seasonal variation in manic admissions over a five year period in New Zealand. There is a significant monthly variation in admission rates with a spring/summer peak. Breakdown by sex, age and admission status suggested that there is no particular subgroup responsible, but that young first admissions and older female readmissions do not follow this trend. Examination of the monthly admission rates revealed that this peak is not constant from year to year. Possible mechanisms, which link fluctuating environmental variables with an irregular spring/summer peak for manic admissions, are discussed.

Adult↗