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PubMed1992

Vulnerability to depressive symptomatology: a prospective test of the diathesis-stress and causal mediation components of the hopelessness theory of depression.

The diathesis-stress and causal mediation components of the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) were tested using a prospective methodology. Measures of the 3 vulnerability factors posited by the theory (cognitive diatheses about cause, consequences, and self) were completed by 152 Ss at Time (T) 1. Ss completed measures of depressive symptoms, anxious symptoms, and hopelessness at T1 and again at T2, 5 weeks later. Naturally occurring stressors were assessed at T2 (covering the T1-T2 interval). Consistent with the diathesis-stress component, each Cognitive Diathesis x Stress (CD x S) interaction predicted onset of depressive symptoms from T1 to T2. In contrast, the CD x S interactions predicted neither state nor trait anxiety. In addition, 2 of the 3 CD x S interactions (those involving cause and self, but not consequences) were partially mediated by hopelessness. Implications for future work on the hopelessness theory of depression are discussed.

Adaptation, Psychological↗
PubMed2003

Impaired skin barrier and atopic diathesis in perioral dermatitis.

BACKGROUND: Perioral dermatitis (PD) is a common dermatological disease whose aetiology and pathogenesis remain speculative. We investigated skin barrier function and various markers of the atopic diathesis to elucidate their impact on the development of perioral dermatitis. PATIENTS AND METHODS: Forty patients (24 to 69 years of age) with PD were evaluated. Transepidermal water loss was measured in three regions of the face (lateral chin, perinasal cheek and side of the nose) and the patients were assessed for clinical criteria for atopy. Prick tests were performed, and specific IgE against a mixture of aeroallergens (CAP SX1) was measured. The control group consisted of 62 individuals (20 to 68 years of age) without a history of PD or active disease. RESULTS: Transepidermal water loss was significantly increased (P < 0.001) on all regions of the face in the patient over the control group. Significantly (P < 0.001) higher values were also found for the patient group regarding history (52.5% vs. 17.7%) and clinical signs of atopic diathesis (> or = 4 features: 72.5% vs. 0%), prick test reactivity (> or = 2 reactive prick tests: 60% vs. 12.9%), and specific IgE against aeroallergens (CAP SX1 classes > or = 2: 60.0% vs. 17.7%). CONCLUSIONS: Our findings emphasize the relevance of impaired skin barrier function as a pathogenic factor in the causation of perioral dermatitis. The susceptibility of atopic skin to irritants increases as soon as the skin becomes eczematous. Therefore, we propose that atopic diathesis serves as an intensifier, supporting development and continued presence of perioral dermatitis after nonspecific irritant mechanisms have induced impaired skin barrier function.

Adult↗
PubMed2001

Arterial dimensions in the lower extremities of patients with abdominal aortic aneurysms--no indications of a generalized dilating diathesis.

PURPOSE: This study assessed whether there is a dilating diathesis in peripheral arteries of patients with abdominal aortic aneurysms (AAAs). METHODS: The anteroposterior diameters of the common femoral artery (CFA) and popliteal artery (PA) were measured in 183 consecutive patients with an AAA (158 men, 25 women; age range, 57-78 years) before elective surgery on the AAA and compared with that of healthy age-matched control subjects. The diameter registrations were performed on the right leg by using a noninvasive echo-tracking ultrasound scanning technique. RESULTS: Eight CFA aneurysms and four PA aneurysms were found in the male patients with AAAs. Of the patients with AAAs in the CFA and in the PA who were investigated, 46% and 49%, respectively, were affected by peripheral vascular occlusive disease (PVOD). The CFA diameters in the patients with AAAs were 97.8% of those in healthy control subjects (P = not significant [NS]). After exclusion of the CFA aneurysms, the diameters were 92.7% of those in healthy control subjects (P = .0003). If patients with PVOD were also excluded, the CFA diameters were 95.2% of those in healthy control subjects (P = .022). The PA diameters in the patients with AAAs were 97.8% of those in healthy control subjects (P = NS). If PA aneurysms were excluded, the diameters were 94.4% of those in healthy control subjects (P = .0003). If patients with PVOD were also excluded, the PA diameters were 96.1% of those in healthy control subjects (P = NS). CONCLUSION: After excluding the few patients with AAAs who had peripheral aneurysmal disease and the patients with PVOD, no dilating diathesis in CFAs and PAs was found. This supports the hypothesis that specific genetic, or other factors, not present in most AAAs are responsible for the occurrence of concomitant peripheral aneurysms. Furthermore, the generalized vascular dilating diathesis seen in some patients seems to be a specific entity that was not necessarily affiliated with AAA disease.

Aged↗
PubMed2005

Main clinical manifestations of a bleeding diathesis: an often disregarded aspect of medical and surgical history taking.

A suitable clinical evaluation of a bleeding diathesis is often forgone. The young doctor is often unprepared to describe in an accurate way the different types of bleeding. An adequate classification and adequate clinical information about a bleeding diathesis are instead of paramount importance. Bleeding may be cutaneous, mucous, articular, muscular, parenchymal, intracavitary, orificial. Each of these sites and forms may have diagnostic implications. An accurate description of the several forms of cutaneous bleeding (petechiae, purpuric spots, ecchymosis, haematomas, etc.) is needed for referrals and for controls. The correct evaluation of cutaneous bleeding manifestations of children (battered child syndrome) is absolutely important for clinical and medico-legal purposes. The same is true for the battering syndrome seen in women abused by their spouses. The grading of haemarthrosis in haemophilia patients is important for the follow-up. A proper description of haematuria is essential in suggesting the probable site of bleeding (kidney or bladder or urethra). A proper evaluation of bleeding may give also useful information on the general health status of the patients (presence of anaemia, poor nutrition, renal insufficiency, etc.). The combination of bleeding and thrombosis in the same patient is also a clinical challenge. The relationship between haemorrhage and thrombosis may be sequential or concomitant. Sequential thrombosis may occur in a patient confined in bed for a brain haemorrhage. Concomitant thrombosis and bleeding occur in DIC and in patients with thrombosis being treated with anticoagulants. Finally, it should be kept in mind that a proper evaluation of the bleeding diathesis of a given patient may help the caring doctor in ordering appropriate laboratory tests (e.g. a platelet count for petechiae, a PTT for a patient with haemarthrosis, etc.).

Abdomen↗
PubMed2004

Presence of IgE antibodies to bacterial superantigens and increased IL-13-producing T cells in myelitic patients with atopic diathesis.

BACKGROUND: Superantigens are considered to exacerbate autoimmune inflammation through the expansion of autoreactive T cells; however, the immune response to bacterial superantigens has not been extensively studied in any type of myelitis. We recently reported the occurrence of a distinct type of myelitis in patients with atopic diathesis, which in a recent nationwide survey was reported to be widespread in Japan. The aim of this study was to investigate the presence of IgE antibodies to bacterial superantigens and the proportion of IL-13- or IL-5-producing CD4+ or CD8+ T cells in patients with myelitis and atopic diathesis. METHODS: Twenty-four myelitic patients with and 12 myelitic patients without hyperIgEemia, 28 patients with multiple sclerosis (MS) and 34 healthy controls were enrolled in this study. IgE antibodies to staphylococcal enterotoxins A (SEA) and B (SEB) in sera were measured using a liquid-phase enzyme immunoassay, and the intracellular production of IL-5 and IL-13 in peripheral blood CD4+ and CD8+ T cells was measured by flow cytometry. RESULTS: The myelitic patients with hyperIgEemia showed significantly higher positive rates of serum SEA/SEB-specific IgE antibodies (41.7 and 62.5%, respectively) than the healthy controls (5.9 and 8.8%), patients with MS (0 and 21.4%) and those with normoIgEemic myelitis (0 and 0%). Moreover, IL-13-producing CD4+ T cells and CD8+ T cells increased significantly in the myelitic patients with hyperIgEemia compared to the controls, while IL-5-producing CD4+ or CD8+ T cells did not. CONCLUSIONS: The IgE response to staphylococcal superantigens is heightened in myelitic patients with atopic diathesis, which might contribute to increases in IL-13-producing T cells and thus the development of myelitis.

Adult↗
PubMed2004

A test of integration of the activation hypothesis and the diathesis-stress component of the hopelessness theory of depression.

OBJECTIVES: This prospective study tested the integration of the diathesis-stress component of the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) and Persons and Miranda's (1992) activation hypothesis (i.e. depressogenic inferential styles are typically latent cognitive processes that must be primed in order to be accurately assessed). DESIGN: In order to test the diathesis-stress component of the hopelessness theory, we used a short-term longitudinal design. In order to test the activation hypothesis, inferential styles were assessed both before and after a negative cognitive priming questionnaire. METHODS: A group of 165 university students completed measures of inferential styles about the self, consequences, and causes before and after completing a negative cognitive priming questionnaire (Time 1). Participants also completed measures of depressive symptoms prior to completing the cognitive priming questionnaire and 5 weeks later (Time 2). Finally, negative events occurring between Time 1 and Time 2 were assessed. RESULTS: Contrary to the diathesis-stress component of the hopelessness theory, none of the unprimed inferential styles interacted with negative events to predict increases in depressive symptoms. In line with the integration of the hopelessness theory and the activation hypothesis, however, each of the primed inferential styles interacted with negative events to predict increases in depressive symptoms even after controlling for the proportion of variance in depressive symptoms accounted for by the unprimed inferential style stress interactions. CONCLUSION: Individuals with depressogenic inferential styles are likely to show increases in depressive symptoms following the occurrence of negative events. At the same time, these depressogenic inferential styles are typically latent cognitive processes that must be primed in order to be accurately assessed.

Adult↗
PubMed1998

Autopsy study of patients dying of bleeding diathesis.

Ten thousand & thirty seven autopsies performed from the year 1982 to 1992 were studied retrospectively, to find out the number of deaths due to bleeding diathesis. Eighty-seven (0.87%) patients died due to bleeding diathesis, out of which haemolytic uraemic syndrome (HUS) was seen in 9 cases (10.34%), disseminated intravascular coagulation (DIC) in 67 cases (77.01%) & 11 cases were grouped as miscellaneous. Martius scarlet blue stain was carried out to demonstrate fibrin & depending on the number of thrombi in the glomerulus & blood vessels, the lesions were graded as mild, moderate or severe. Kidney was the most common organ involved in all groups of bleeding diathesis. In DIC kidney & lung involvement was almost equal.

Autopsy↗
PubMed2002

A longitudinal study of the hopelessness theory of depression: testing the diathesis-stress model within a differential reactivity and exposure framework.

A ten-week prospective longitudinal study was conducted to test the diathesis-stress component of the hopelessness theory and to test whether negative attributional style leads to an increased exposure to stressors. Participants completed initial measures of attributional style and depressive symptoms followed by weekly assessments of depressive symptoms and daily hassles. Consistent with the diathesis-stress hypothesis, Hierarchical Linear Modeling revealed that attributional style moderated the impact of daily hassles on depressive symptoms. Negative attributional style predicted greater depressive symptom reactivity in response to stress. The results also indicated that attributional style was not predictive of the number of subsequent daily hassles. Thus, the data were supportive of a differential reactivity to stress model, but not supportive of a differential exposure to stress model. Implications for understanding the mechanisms involved in the hopelessness theory are discussed.

Activities of Daily Living↗
PubMed1997

Brain dopamine receptor plasticity: testing a diathesis-stress hypothesis in an animal model.

A wealth of clinical data supports a major role of genetic liability as well as of altered brain dopamine (DA) functioning in different types of behavioural disturbances. Genetic influence on behaviour involves multiple genes, rather than one or two major genes, as well as non-genetic sources of variance. Thus, in recent years, increasing attention has been devoted to the involvement of stressful experiences (life events) in the development and expression of psychopathology. Moreover, a diathesis-stress hypothesis has been proposed, which suggests that the environmental factors (stress) are not specific for a given pathology, whereas genetic factors (diathesis) are. Results obtained in an animal model offer support to this hypothesis. Indeed, mice of the C57BL/6 and DBA/2 inbred strains are equally susceptible to stress but develop different behavioural disturbances related to different alterations of brain DA receptors. Moreover, quantitative trait loci (QTL) associations in the C57 (B) x DBA (D) recombinant inbred (RI) strains indicate a number of provisional QTLs influencing the behavioural effect of stress. Finally, the results of this analysis suggest the involvement of regulatory factors related to stress response and neural or synaptic plasticity in the control of brain DA receptor plasticity.

Animals↗
PubMed2005

Diathesis stress model for panic-related distress: a test in a Russian epidemiological sample.

To investigate a cognitive diathesis-stress model, the present study evaluated the main and interactive effects of anxiety sensitivity (AS) and exposure to aversive conditions (past month) in predicting theoretically relevant panic vulnerability variables in an epidemiologically defined sample from Russia (N = 390). Consistent with expectation, findings suggested that the combination of high levels of exposure to aversive conditions and high AS physical concerns predicted panic attacks (past week) and agoraphobic avoidance above and beyond the variance accounted for by negative affect. These findings are discussed in relation to biopsychosocial theories of panic disorder, which emphasize the importance of both a cognitive diathesis and stress component in the pathogenesis of the disorder.

Adult↗
PubMed2005

Systemic dilation diathesis in patients with abdominal aortic aneurysms: a role for matrix metalloproteinase-9?

INTRODUCTION: Accumulating evidence suggests that patients with abdominal aortic aneurysm (AAA) suffer from a systemic dilating condition affecting all arteries. Matrix metalloproteinases (MMPs) and their natural inhibitors, the tissue inhibitors of metalloproteinases (TIMPs), appear to be involved in aneurysm formation, as evidenced by increased aortic tissue MMP activity and plasma MMP levels in patients with AAA. Hypothesizing that an imbalance in plasma MMP/TIMP level might be associated with a systemic dilation diathesis, we studied mechanical vessel wall properties of non-affected arteries of patients with either AAA or aorto-iliac obstructive lesions in association with plasma MMP-9 and TIMP-1 levels. METHODS: Twenty-two patients with AAA and 12 with aorto-iliac occlusive disease (AOD) were included. Diastolic diameter (d) and distension (Deltad) were measured at the level of the common carotid artery (CCA) and suprarenal aorta (SA) using ultrasonography. Distensibility (DC) and compliance (CC) were calculated from d, Deltad and brachial pulse pressure. Plasma MMP-9 and TIMP-1 were determined with specific immunoassays. RESULTS: The average (+/-SD) age was 72.3+/-5.6 and 65.0+/-8.2 years for the AAA and AOD patients, respectively, (P=0.005). CCA diameter was 9.1+/-1.3mm in AAA patients and AOD 7.8+/-1.4mm in AOD patients, P=0.009. This difference persisted after correction for age. Plasma MMP-9 and TIMP-1 did not differ significantly between AAA and AOD patients. In the total 34 patients, the MMP-9/TIMP-1 ratio was correlated inversely with distensibility (r=-0.74, P=0.002) and to compliance (r=-0.58, P=0.024) of the suprarenal aorta. CONCLUSIONS: The CCA diameter was larger in AAA patients compared to AOD patients. MMP-9/TIMP-1 ratio was associated with decreased distensibility and compliance of the suprarenal aorta. These data support the idea that AAA patients exhibit a systemic dilation diathesis, which might be attributable to MMP/TIMP imbalances.

Aged↗
PubMed2006

Toward a definition of a cyclothymic behavioral endophenotype: which traits tap the familial diathesis for bipolar II disorder?

BACKGROUND: Although the cyclothymic temperament appears to be related to the familial diathesis of bipolar disorder, exhibiting high sensitivity for bipolar II (BP-II) disorder, it is presently uncertain which of its constituent traits are specific for this disorder. METHODS: In a sample of 446 major depressive patients (BP-II and unipolar), in the French National EPIDEP study, the cyclothymic temperament was assessed by using clinician- and self-rated scales. We computed the frequency of individual traits and relative risk for family history of bipolarity. RESULTS: From both clinician- and self-rated scales, four items related to mood reactivity, energy, psychomotor and mental activity were significantly highly represented in the subgroup with positive family history of bipolarity. The item "rapid shifts in mood and energy" obtained the highest relative risk (OR=3.42) for positive family history of bipolarity. CONCLUSION: These findings delineate those cyclothymic traits which are most likely to tap a familial-genetic diathesis for BP-II, thereby identifying traits which can best serve as a behavioral endophenotype for this bipolar subtype. Such an endophenotype might underlie the cyclic course of bipolar disorder first described in France 150 years ago by Falret and Baillarger.

Bipolar Disorder↗
PubMed2006

Treatment resistance in unipolar depression: Is it an iatrogenic phenomenon caused by antidepressant treatment of patients with a bipolar diathesis?

Major depressive disorder is a common psychiatric illness that is considered generally treatable; however, there are some patients who fail to respond in spite of adequate trials of antidepressants. Clinical factors known to contribute to treatment resistance include psychiatric and physical comorbidity, undiagnosed bipolarity, and treatment non-adherence. There is also emerging evidence that the use of antidepressants in some 'unipolar' patients may lead to a pattern of progressive diminution of therapeutic response and ultimately treatment resistance. A large number of these patients may have a bipolar diathesis even though there are no symptoms of hypomanic, manic or mixed episodes. It is hypothesized that the widespread and injudicious use of antidepressants in patients with a bipolar diathesis might result in treatment-induced resistant depression. Furthermore, attempts to manage the antidepressant-led mood instability might cause increased utilisation of other psychotropic drugs including sedative/hypnotics, neuroleptics and mood stabilisers and contribute to polypharmacotherapy.

Affect↗
PubMed1992

Retrospective search for bleeding diathesis among premature newborn infants with pulmonary hemorrhage after synthetic surfactant treatment. The American Exosurf Neonatal Study Group I, and the Canadian Exosurf Neonatal Study Group.

In an across study analysis of five multicenter, placebo-controlled trials of the synthetic surfactant, Exosurf Neonatal, involving infants with birth weights 700 gm or greater the incidence of clinical pulmonary hemorrhage was 1.9% in treated infants and 1.0% in control infants. To determine whether this apparent increase in pulmonary hemorrhage was the result of a bleeding diathesis, we retrospectively reviewed charts for 39 of 41 infants with clinical pulmonary hemorrhage. The incidence of nonpulmonary bleeding was the same in control- and surfactant-treated infants. Platelet counts, hematocrit values, and the number of transfusions with platelets or red blood cells did not differ between the two groups. There was no evidence that surfactant treatment was specifically associated with a generalized bleeding diathesis.

Double-Blind Method↗
PubMed1988

Gouty diathesis and sarcoidosis in patient with recurrent calcium nephrolithiasis.

We describe a patient who initially formed calcium-containing renal stones owing to gouty diathesis and hypocitraturia. On therapy with 300 mg. allopurinol and 60 mEq. potassium citrate daily serum uric acid decreased from 9.2 to 5.8 mg. per dl., urinary pH increased from less than 5.5 to 6.6 and urinary citrate increased from 223 to 1,005 mg. per day. Four months later while still on this medical regimen, the patient presented with hypercalcemia (13.4 mg. per dl.), high serum 1,25-dihydroxyvitamin D (65 pg. per ml.) and hypercalciuria (598 mg. per day), which subsequently were found to result from sarcoidosis. Prednisone therapy normalized the disturbances in calcium metabolism. During 33 months of combined treatment with 7.5 to 10 mg. prednisone a day, allopurinol and potassium citrate, the patient was free of stones and he had normal urinary calcium, pH and citrate. However, a calcium stone formed 1 month after discontinuation of prednisone therapy, although treatment with allopurinol and potassium citrate was continued. The patient had marked hypercalciuria of 447 to 465 mg. per day, despite normal urinary pH, citrate and uric acid. This case represents calcium stone formation in a patient with 2 separate etiologies for stone disease, that is gouty diathesis and sarcoidosis. Therapeutic regimens directed at the correction of both metabolic disturbances were required to control renal stone formation.

Allopurinol↗
PubMed1999

[A patient with isolated prolongation of aPTT without hemorrhagic diathesis anamnesis: severe, hereditary factor XII deficiency].

By virtue of a severely prolonged aPTT with a normal thromboplastin time (prothrombin time) and a normal thrombin time, severe FXII deficiency has been diagnosed in a woman without a bleeding diathesis or a history of thromboembolic complications. A deficiency of a factor of the contact activation system (FXII, prekallikrein, high molecular weight kininogen) is usually diagnosed during routine coagulation tests demonstrating a prolonged aPTT. The severe and partial deficiency of FXII, of prekallikrein or high molecular weight kininogen is not associated with a bleeding tendency. In contrast, severely factor XI deficient subjects may suffer from a mild hemorrhagic diathesis, whereas FVIII deficiency (hemophilia A, autoimmune "hemophilia", von Willebrand disease) and FIX deficiency (hemophilia B) are associated with a bleeding tendency of varying severity, depending on the clotting activity of FVIII or FIX, respectively. An isolated prolongation of the aPTT due to a lupus anticoagulant, however, is frequently associated with arterial and/or venous thrombosis. Therefore, in case of a prolongation of the aPTT, its cause has to be determined.

Adult↗
PubMed1993

Evaluating the hopelessness model of depression: diathesis-stress and symptom components.

The hopelessness model of depression posits that latent attributional diatheses combine with stressors to produce a specific subtype of depression characterized by a specific set of symptoms. Associations between attributional diathesis, stress, and symptoms were examined to test the prediction that hopelessness depressions are characterized by a specific symptom profile. Fifty-seven depressed outpatients were categorized into subgroups on the basis of whether or not they met the criteria of L. Y. Abramson, L. B. Alloy, and G. I. Metalsky's (1988) hopelessness depression, defined as a match in content domain between attributional diathesis and negative stressor. Support for hopelessness depression was mixed. The hopelessness subtype differed from other major depressions with respect to symptom profile. However, the differences in symptomatology were not wholly consistent with the predictions of the hopelessness model.

Adult↗