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PubMed1991

Antisocial behavior and personality disorders.

Present classifications fall short of helping clinicians to systematically approach syndromes of antisocial (A-S) behavior. Various clinical forms of A-S behavior derive from different levels of personality organization (normal, neurotic, and borderline level) whereas certain personality disorders (PD) display specific antisocial "profiles" and form the horizontal continuum of antisocial behavior. The borderline level of personality and pathological narcissism stand behind A-S PD, Narcissistic PD, and Histrionic PD. The authors propose that the disorders should be regarded as spectrum disorders. Paranoid PD and "pure" Borderline PD complete the list of PDs manifesting A-S behaviors. Finally, diagnostic instruments for clinical approach to and research of A-S PD are presented.

Antisocial Personality Disorder↗
PubMed2003

Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients.

Our knowledge of longer term outcome in psychogenic nonepileptic seizures (PNESs) patients is limited; we know less still about factors predicting prognosis. This study was intended to describe outcome in a large cohort and to identify predictive clinical and psychological factors to generate new ideas for treatment. One hundred sixty-four adult patients with PNESs (66.7%) responded to outcome, personality, and psychosymptomatology questionnaires (Dimensional Assessment of Personality Pathology-Basic Questionnaire [DAPP-BQ], Dissociative Experiences Scale, and Screening Test for Somatoform Symptoms) a mean of 11.9 years after manifestation and 4.1 years after diagnosis of PNES. Additional clinical data were retrieved from hospital records. The responses showed that 71.2% of patients continued to have seizures and 56.4% were dependent on social security. Dependence increased with follow-up. Outcome was better in patients with greater educational attainments, younger onset and diagnosis, attacks with less dramatic features, fewer additional somatoform complaints, and lower dissociation scores. Better outcome was associated with lower scores of the higher order personality dimensions "inhibitedness," "emotional dysregulation," and "compulsivity" but not "dissocial behavior" (DAPP-BQ). Outcome in PNESs is poor but variable. Clinical and personality factors can be used to provide an individualized prognosis. By generating a patient-specific profile, they show particular maladaptive traits or tendencies that can identify goals for psychological therapy.

Adult↗
PubMed1992

Echocardiographic findings in strength- and endurance-trained athletes.

Assessment of echocardiographic measurements in athletes should take into account the specific sport and the quantity and quality of training. In addition, values corrected for body dimensions, especially the active body mass, should be used rather than absolute values. All parts of the athlete's heart are enlarged and its performance increases. Highly trained endurance athletes show the most enlarged hearts. Athlete's heart can be observed in athletes of all ages including the young. However, it is rarer than generally assumed. To differentiate between physiological and pathological myocardial changes, the relationship between heart size and ergometric performance as well as the echocardiographically measured ratio between left ventricular (LV) myocardial thickness and volume are useful; the latter remains unchanged, on the whole, in endurance- and strength-trained athletes. Concentric hypertrophy cannot be induced by strength training alone; additional factors, such as hypertension, aortic stenosis, cardiomyopathy or anabolic steroid use can play an important role. When corrected for body dimensions, non-endurance-trained, e.g. strength-trained, athletes have standard heart sizes even if considerable time is devoted to training. Findings in healthy untrained persons with large body dimensions also indicate no significant difference between the increase of echocardiographic measures caused by training and that caused by growth. An LV myocardial thickness of 13mm is seldom exceeded even in the highly endurance-trained or anabolic drug-free strength trained athletes under physiological conditions. However, the echocardiographic differentiation of cardiomyopathy can be difficult if an individual is highly trained and has large body dimensions. In such cases, LV end-diastolic diameter may be up to 66 to 70mm. The upper normal value of LV muscle mass is 170 g/m2 for a physiological heart enlargement. Future areas of investigation should include: adaptative changes; of the right ventricle; differences in the regression of the athlete's heart after cessation of training; the differentiation between echocardiographic changes; in highly endurance-trained or combined strength-endurance-trained persons and pathological changes; the importance of heart size and endurance sports performance; and finally the influence of genetic factors.

Cardiomegaly↗
PubMed1992

Personality inventory responses of males with medically intractable seizures.

The psychosocial adjustment of 50 male patients to intractable seizures was assessed by comparing their responses to a combined version of the Minnesota Multiphasic Personality Inventory (MMPI) and the California Psychological Inventory (CPI) to the responses of 50 medical, psychiatric, or nonclinical controls who denied seizures. The two groups were significantly different (p < .01) on one MMPI and 10 CPI scales. Significant (p < .01) between-group differences were also reflected in 29 of the 704 personality inventory items. Those items were rationally clustered according to content into six conceptually identifiable subscales; 30 additional items with similar content that were significant at the .05 level were added to those subscales. Comparison of subscale scores of an additional 30 seizure and 30 nonseizure subjects using analysis of variance revealed F values that reached statistical significance (p < .05) in four cases and approached significance (p = .07) in another. Applying coefficients derived from discriminant analysis of the first samples correctly classified 99% of the original patients and 85% of the validation subjects. Results reveal a logical, understandable, and largely adaptive response to intractable seizures and offer little support for the concept of a dysfunctional or pathological interictal personality style.

Adaptation, Psychological↗
PubMed1996

The problem of assessing brain damage in psychiatric samples: use of personality variables in prediction of WAIS-R scores.

Detection of IQ decrements due to brain injury in patients with preexisting psychiatric disorders was examined. Subjects included 280 male and female adult psychiatric patients who were free of identified neurological disorders. Subjects were administered the MMPI and WAIS-R. Original (Barona, Reynolds, & Chastain, 1984) and revised (Barona & Chastain, 1986) Barona formulae were used to calculate premorbid IQ based on demographic variables. Multiple regression analyses were utilized to predict Wechsler IQ scores from the predicted Barona (original and revised) IQ scores along with MMPI clinical and validity scale raw scores for the experimental group (N = 186). The Barona equations overpredicted current IQ scores. The addition of MMPI variables when predicting current IQs resulted in significant increments in R(2)(p <.01). Cross-validation on a second sample (N = 94) yielded similar results when MMPI variables were added to all the original Barona formulae and the Barona PIQ revised formula. The MMPI may provide a means of incorporating pathology and personality characteristics into the detection of brain damage in psychiatric patients.

Journal Article↗
PubMed2003

Clinical significance of recurrent psychogenic nonepileptic seizure status.

To explore the clinical significance of a history of recurrent psychogenic nonepileptic seizure status (PNES-status), this study describes the frequency of PNES-status in 85 consecutive PNES patients and examines whether there are relevant differences between patients with a history of recurrent PNES-status and other PNES-patients. PNES patients were also compared with 64 patients with epilepsy. Data were extracted from hospital records and a postal questionnaire (Dimensional Assessment of Personality Pathology-Basic Questionnaire; Screening for Somatoform Symptoms; Dissociative Experience Scale). Of the PNES-patients, 77.6% reported at least one seizure > 30 minutes (PNES-status), 27 % admission to intensive care with status. 38.8% reported recurrent hospital admissions with status (PNES-status group), the remaining patients served as PNES-controls. The only clinical difference between the two PNES groups was that status patients were younger than PNES-controls (mean age 20.3 vs. 30.3 years, p = 0.001). Our results suggest that PNES status is common and often unrecognised. There were no substantial psychometric differences between patients with recurrent PNES-status and other PNES patients although both PNES-groups had more abnormal somatisation, dissociation and personality scores than patients with epilepsy.

Adolescent↗
PubMed2006

The Dutch DAPP-BQ: improvements, lower- and higher-order dimensions, and relationship with the 5DPT.

After modifying 53 items in a previous Dutch translation of the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; Livesley & Jackson, 2002), the present DAPP-BQ scales (with or without Self-Harm included) were subjected to a principal components analysis with oblimin or varimax rotation in a general population sample of 478 subjects, retaining four factors. All four (higherorder) factors (Emotional Dysregulation, Dissocial, Inhibition, and Compulsivity) proved identical to the factors originally derived in Canada, with Tucker coefficients of factor similarity approaching unity. Particularly the (unexpected) finding that the present Dutch version of the DAPP-BQ also resulted in an Inhibition factor (and not, like the former Dutch version, in an Intimacy Problems factor) was considered positive. In addition, a principal components analysis with oblimin rotation was conducted on the 282 items contained in the 18 DAPP-BQ scales, investigating the lower-order structure of the DAPP-BQ; in this case, 18 factors were retained. Although the structure originally derived by Livesley and colleagues could not be recovered completely, the degree of similarity was of such a magnitude that the 18 DAPP-BQ scales were considered to give a dependable account of the "true" lower-order structure of disordered personality. Moreover, based on the finding that the 18 scales are sufficiently reliable (Cronbach's alpha) and correlate as predicted in a subsample of 284 subjects with the normal personality scales of Van Kampen's 5DPT (or, Five-Dimensional Personality Test), the DAPP-BQ appears to be a valuable instrument.

Adolescent↗
PubMed2006

Cerebral information processing in personality disorders: I. Intensity dependence of auditory evoked potentials.

Patients with personality disorders such as the histrionic type exaggerate their responses when receiving external social or environmental stimuli. We speculated that they might also show an augmenting pattern of the auditory evoked potential N1-P2 component in response to stimuli with increasing levels of intensity, a response pattern that is thought to be inversely correlated with cerebral serotonin (5-HT) activity. To test this hypothesis, we collected auditory evoked potentials in 191 patients with personality disorders (19 patients with the paranoid type, 12 schizoid, 14 schizotypal, 18 antisocial, 15 borderline, 13 histrionic, 17 narcissistic, 25 avoidant, 30 dependent and 28 obsessive-compulsive) and 26 healthy volunteers. Their personality traits were measured using the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). Compared with healthy subjects and other patient groups, the histrionic group scored higher on the basic traits Affective Instability, Stimulus Seeking, Rejection and Narcissism, and on the higher traits Emotional Dysregulation and Dissocial, than the other groups, and the schizoid group scored lower on most of the DAPP-BQ basic and higher traits. In addition, the histrionic group showed steeper amplitude/stimulus intensity function (ASF) slopes at three midline scalp electrodes than the healthy controls or the other patient groups. The ASF slopes were not correlated with any DAPP-BQ traits in the total sample of 217 subjects. However, the DAPP-BQ basic trait Rejection was positively correlated with the ASF slopes at all three electrode sites in the histrionic group. The increased intensity dependence of the auditory N1-P2 component might indicate that cerebral 5-HT neuronal activity is, on average, weak in the histrionic patients.

Adult↗