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PubMed1993

Mental health status of Cambodian refugees ten years after leaving their homes.

The mental health status of a general population sample of Cambodian refugees living in the United States was assessed ten years after they had left their homes in Cambodia. Subjects were found to be experiencing extremely high levels of post-traumatic stress disorder, dissociation, depression, and anxiety. Ninety percent of these refugees exhibited marked symptomatology in one or more of these categories.

Acculturation↗

PubMed1993

[Multiple personality disorder: old concepts presented as new].

The rapid increase in numbers of MPD patients in the Anglo-American literature requires discussion of the diagnostic concept. The classification of MPD as Dissociative Disorders by DSM-III-R and ICD-10 follows the traditional conceptualization of hysteria and hypnosis. In the view of the majority of modern authors child abuse appears as a new etiological issue. This theme highly sensitive is critically discussed against the background of older psychopathological concepts of forgetting. A careful analysis of personality traits and motivation in the individual case help to avoid overuse of the new diagnostic label.

Child↗

PubMed1991

An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder.

Chronic complex dissociative symptoms can be readily inquired about in the diagnostic interview leading to a clinical diagnosis of MPD in many cases. It is most useful to begin with inquiry about amnesia, autohypnotic, posttraumatic, pseudopsychotic, and passive-influence symptoms, and childhood abuse or traumatization. As this proceeds, overt dissociation is commonly noted including spontaneous trances, age-regression, blending or overlap of states, or frank switching. When this occurs, the interviewer can pursue more detailed information about the patient's experiences. Tracking these processes may readily lead to the clear appearance of an alter personality or will help make the patient sufficiently comfortable that he or she will allow the full emergence of an alter if this is directly requested. In other cases, however, methods such as use of ideomotor signals, formal induction of trance, and even barbiturate-facilitated interviews may be necessary to permit the full emergence of an alter. The symptom-cluster method is a useful clinical diagnostic tool to elicit dissociative symptoms for the diagnosis of MPD. Combined with diagnostic tools such as the DES, the DDIS, and the SCID-D, this method can help the clinician make the diagnosis of MPD in a far more expeditious and rigorous fashion. In addition, all psychiatric patients should be screened for a history of blackouts, time loss, trance experiences, childhood trauma, and PTSD symptoms. This will improve case finding to help clinicians begin to treat the single largest preventable cause of mental illness: the sequelae of childhood abuse, trauma, and family violence.

Dissociative Disorders↗

PubMed2006

Psychiatric problems of heart transplant candidates with left ventricular assist devices.

Most heart transplant candidates are equipped with left ventricular assist devices (LVADs). LVAD therapy is associated with characteristic psychiatric and psychosocial problems. To investigate the mental states of heart transplant candidates, psychiatric diagnosis, psychological or behavioral problems, and the need for treatment were evaluated around the time of registration to the waiting list and during follow-up. Saitama Medical University Hospital has been designated a hospital for heart transplantation since October 2002. The subjects were 14 heart transplant candidates (9 male candidates and 5 female candidates, mean age 29 years) at the hospital from September 1997 to October 2005. These 14 candidates were equipped with LVADs. The waiting periods on LVAD support were from 119 days to 1028 days, and the average waiting period was 313 days. Six candidates among the 14 had more than one DSM-IV diagnosis. Seven candidates were diagnosed with adjustment disorder, which was the most frequent diagnosis. Three candidates had depressive disorder, one had psychotic disorder, and one had dissociative disorder. Three candidates had acute cognitive dysfunction (delirium) due to their general medical condition. All three had other disorders with mainly psychological elements. Nine candidates (64%) were diagnosed with disorders with mainly psychological elements. Antipsychotics were used for the candidates in psychotic states and with delirium, and there was a need for crisis intervention. Antidepressants and antianxiety drugs were used for the candidates with depressive disorder; they needed intensive observation. Four candidates (28%) needed some attention and some antianxiety drugs or hypnotics. Psychiatric interventions were not necessary in five candidates (36%).

Adjustment Disorders↗

PubMed1995

Hypnotizability and dissociativity in sexually abused girls.

Research on the relation between hypnotizability and clinical dissociation has led to contradictory findings. Measures of hypnotizability and dissociation are only weakly correlated in general population samples, but studies of posttraumatic stress and dissociative disorders patients have found elevated levels of clinical dissociation and hypnotizability respectively. This study assesses the relationships among hypnotizability, clinical dissociation and traumatic antecedents in 54 sexually abused girls, ages 6-15 years, and 51 matched controls. Hypnotizability was assessed on initial evaluation and again in matched subsamples at one year using the Stanford Hypnotic Clinical Scale for Children. Clinical dissociation was assessed using the Child Dissociative Checklist. Abuse variables were extracted from Child Protective Services reports. There were no significant differences in hypnotizability between abuse and control subjects. There were significant differences in clinical dissociation initially and on 1-year retest. Hypnotizability and clinical dissociation were only weakly correlated (r(105) = .118, p = NS). However, in the abuse group, highly hypnotizable subjects were significantly more dissociative. Higher levels of clinical dissociation were associated with abuse by multiple perpetrators and co-presence of physical abuse independent of the sexual abuse. A small subgroup of "double dissociative" subjects, high in both hypnotizability and dissociativity, was identified. Double dissociation was associated with multiple perpetrators and earlier onset of sexual abuse.

Adolescent↗

PubMed2004

[Emotional processing in patients with a dissocial personality disorder subtype "psychopathy" according to PCL-R].

OBJECTIVE: Functional MRI was used to test the effects of the deficient emotional responsiveness of psychopathic patients on cognitive processes. METHOD: We used a Simon-paradigm, in which ten healthy volunteers and ten patients with a diagnosis of "psychopathy" (defined by Hare Psychopathy Checklist Revised) have to select their spatially defined responses on the basis of a nonspatial stimuli feature. For the emotion induction pictures from the International Affective Picture System (IAPS) were selected. At the beginning and intermediated by the Simon-paradigm blocks of positive, negative or neutral pictures were presented. RESULTS: Patients with "psychopathy" exhibited untypical activation patterns in amygdala and prefrontal regions during interferences between negative or positive stimulations and cognitive tasks. CONCLUSIONS: These results demonstrated disturbed regulation of emotion-cognition-interaction in "psychopathy" according to PCL-R.

Adult↗

PubMed2003

Pathways to dissociation: intrafamilial versus extrafamilial trauma in juvenile delinquents.

Dissociation is postulated to occur as a function of particular types of child abuse or chronic abuse. Additionally, there is an ongoing controversy examining the perpetrator's relationship to the victim in the development of dissociation. In this study, reports of traumatic events experienced both in the family environment and in the community were used to examine the relationship between dissociative disorder as defined by DSM-IV (pathological dissociation), and dissociation as a defense mechanism. The first objective was to identify whether the site of the trauma or the quantity of trauma correlated more significantly with symptoms of dissociation. The second objective was to explore a potential correlation between topics that participants choose to disclose during a standardized Stress Inducing Speech Task (SIST), and symptoms of dissociation. The third objective was to examine the relationship between the age of occurrence, the duration of trauma, and symptoms of dissociation. Fifty-two delinquent juveniles completed measures (including the SCID-D, REM-71, CTQ, CTI, SIST) assessing traumatic experiences, psychopathological dissociation, and dissociation as defense mechanism. Blind raters scored the SIST for intrafamilial and extrafamilial trauma. The perpetrator's relationship to the victim, site of the trauma, quantity of the trauma, age of occurrence, and duration of the trauma were analyzed by descriptive statistics and Pearson partial correlations. Significant correlations were found between symptoms of pathological dissociation and intrafamilial trauma. Significant correlations were not found between extrafamilial trauma and pathological dissociation and dissociation as defense mechanism. All these correlations held constant the chronicity of traumas reported. The results obtained in this study through blind and independent assessment suggest that special trauma characteristics (i.e., childhood trauma perpetrated by a family member) rather than sheer cumulative effects of trauma may have greater implications for the development of pathological dissociation. The relationships to dissociation as a defense were much weaker.

Adolescent↗

PubMed2004

Does dissociation offer a useful explanation for psychopathology?

BACKGROUND: Dissociation is often conceptualised as an altered state of consciousness, a trance-like state in which normal barriers between conscious and unconscious memories, desires and beliefs break down and other amnestic barriers emerge. This review explores whether it is likely that there is a neurophysiology of pathological dissociative processes that will elucidate management. METHOD: A critical reading of current research, sourced through Medline and Psychinfo searches from 1990 to 2002, using subject headings: dissociative disorders, hypnosis and stress disorder (post-traumatic), as well as keywords: dissociation, hypnosis and trance. RESULTS: Current knowledge does not support the notion of dissociation as a discrete brain state or process. CONCLUSIONS: Psychiatric and neurophysiological research and theory development are better directed towards individual components that contribute to dissociative experience.

Brain↗

PubMedDate not supplied

[Prevalence of dissocial conduct disorder in adolescents using an epidemiological diagnostic questionnaire].

INTRODUCTION: Prevalence of Conduct Disorder has been calculated between 4 to 10%. OBJECTIVE: To estimate the prevalence CD in Colombian adolescents, using a rating scale by self report. PATIENTS AND METHODS: 190 male adolescents from secondary school population, 12 to 16 year-old, were stratified and selected in a randomizing procedure, from Medellín, Colombia. A checklist including 14 diagnostic symptoms taken from the DSM-IV Criterion A for CD was constructed, with a scale of 0 = never to 3 = almost always (Reliability alpha coefficient: 0.86). Prevalences were calculated as follow: (1) codifying as 'Probable TDC' a T score over 60; (2) codifying as Adolescent Antisocial Behavior (AAB) having three or more answers qualified with 1 or more points, and (3) codifying as CD obtaining three or more answers qualified with 2 or 3 points. RESULTS: The most prevalent CD symptoms were 'staying out at night before 13 year-old' (10.5%), 'having been cruel to animals' (8.4%), 'having been cruel to people' (7.4%), 'having broken into someone else's house or car' (7.3%), and 'using weapon or other objects that can cause serious physical harm to others' (6.9%). The prevalence of 'Probable CD' was 13.7%; prevalence of AAB was 56.8% and prevalence of CD was 8.4%. It was not found significant differences between socioeconomic strata. CONCLUSION: The prevalence of CD in the studied sample was 8.4%, independent of the socioeconomic strata.

Adolescent↗

PubMedDate not supplied

[Prevalence of mental retardation in teenagers with dissocial conduct disorder].

INTRODUCTION: Prevalence of adolescents with conduct disorder (CD) has been calculated between 4 y 10%. OBJECTIVE: To estimate the prevalence of mental retardation in Colombian adolescent offenders, using the Wechsler Intelligence Scales for Children Revised (WISC R). PATIENTS AND METHODS: 106 male adolescent offenders with CD, aged 12 to 16 years, and attending to institutions of re education in Medell n Colombia were selected in a randomized approach. WISC R Hispanic version was administered to the sample, using 4 verbal (information, vocabulary, similarities and arithmetic) and 4 performance (Picture completion, block design, picture arrangement, and digit symbol) subtests for calculating verbal, performance and full scale IQs (VIQ, PIQ, and FSIQ), according to the manual instructions. RESULTS: 43 participants (40.6%) obtained a FSIQ < 70, then they were categorized as mild mental retardation. 34 offenders (32.1%) had a FSIQ between 70 and 84, then they were classified as people with borderline intellectual functioning, only 29 participants (27.4%) obtained a FSIQ over 85. CONCLUSION: 72.7% of the institutionalized adolescents offenders had low intellectual functioning, which may be interfere with the re education programs.

Adolescent↗

PubMed1954