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PubMed2006

Data from the VITA Study do not support the concept of vascular depression.

OBJECTIVE: Cerebrovascular lesions that are apparent in magnetic resonance scans and regioselective atrophy of the brain have been proposed as a causative or exacerbating factor in depression with late-life onset. The objective of this study was to investigate whether deep white matter or periventricular hyperintensities, small ischemic lesions, and brain atrophy contribute to late-onset depression in the nondemented elderly. METHOD: Based on a group of 606 individuals of identical age (75.8 years, standard deviation: 0.45 years) residing in two districts of Vienna, the authors built a case-control cohort (ratio: 1:4) consisting of 51 individuals with late-onset major or minor depression matched with 204 subjects of identical gender and education status without depression, resulting in two groups that were homogenous with respect to age, place of residence, gender, and education. Scores for focal brain lesions, mediotemporal lobe atrophy, and ventricular enlargement as well as risk factors for vascular disease were compared with cognition and depression status. RESULTS: Depressed individuals had significantly lower scores than nondepressed subjects in all measures of cognitive and executive function. No significant relation was found between a diagnosis of depression and any type of discrete brain lesions, but measures of brain atrophy (Cella Media indices, mediotemporal atrophy) showed a clear statistical relation to depression. No relationship was found between depression and lipid parameters. CONCLUSION: The authors found no indication that white matter hyperintensities or minor ischemic lesions played a role in our depressed cohort, casting doubt on the vascular hypothesis of late-onset depression.

Aged↗
PubMed2002

Show me the features! Understanding recognition from the use of visual information.

We propose an approach that allows a rigorous understanding of the visual categorization and recognition process without asking direct questions about unobservable memory representations. Our approach builds on the selective use of visual information in recognition and a new method (Bubbles) to depict and measure what this information is. We examine three face-recognition tasks (identity, gender, expressive or not) and establish the componential and holistic information responsible for recognition performance. On the basis of this information, we derive task-specific gradients of probability for the allocation of attention to the different regions of the face.

Adolescent↗
PubMed2002

Outcomes for children with lesbian or gay parents. A review of studies from 1978 to 2000.

Twenty-three empirical studies published between 1978 and 2000 on nonclinical children raised by lesbian mothers or gay fathers were reviewed (one Belgian/Dutch, one Danish, three British, and 18 North American). Twenty reported on offspring of lesbian mothers, and three on offspring of gay fathers. The studies encompassed a total of 615 offspring (age range 1.5-44 years) of lesbian mothers or gay fathers and 387 controls, who were assessed by psychological tests, questionnaires or interviews. Seven types of outcomes were found to be typical: emotional functioning, sexual preference, stigmatization, gender role behavior, behavioral adjustment, gender identity, and cognitive functioning. Children raised by lesbian mothers or gay fathers did not systematically differ from other children on any of the outcomes. The studies indicate that children raised by lesbian women do not experience adverse outcomes compared with other children. The same holds for children raised by gay men, but more studies should be done.

Adolescent↗
PubMed1993

Polycystic ovaries are a common finding in untreated female to male transsexuals.

OBJECTIVE: We studied the pretreatment hormone profile and ovarian ultrasound appearance of female-to-male transsexuals. DESIGN: Female-to-male transsexuals who were seen in the local Gender Identity Clinic were examined after psychiatric assessment. RESULTS: Sixteen patients were assessed. Approximately 50% had symptoms and signs of the polycystic ovary syndrome (PCOS) and 15 had a pelvic ultrasound diagnosis of polycystic ovaries. The endocrine profiles of the patients were not markedly abnormal and were compatible with the diagnosis of PCOS. CONCLUSIONS: Polycystic ovaries and the polycystic ovary syndrome are a common finding in female-to-male transsexuals who have had no previous exposure to exogenous androgen therapy.

Female↗
PubMed2004

Ignoring the evidence dictating the practice: sexual orientation, suicidality and the dichotomy of the mental health nurse.

International epidemiological studies demonstrate that gay and bisexual males are four times more likely to report a serious suicide attempt than their heterosexual counterparts. Data on completed suicides, usually derived from mortality statistics misrepresent the rate of suicides among homosexual populations. However, an increasing number of studies comparing representative samples of gay, lesbian and bisexual youths with heterosexual controls demonstrate increased rates of mental health problems and subsequent suicide among the homosexual population. Homosexual orientation must therefore be considered a risk factor for mental distress and as such should be a focus for any contemporary public health agenda. One of the difficulties of addressing the problem through a public health agenda is the juxtaposition proffered by our political and social environment. The Diagnostic and Statistical Manual of Mental Disorder ceased to define homosexuality as pathological in 1973 replacing it with a new 'illness' of 'gender identity disorder'. Until recently in England, Section 28 of the Local Government Act (1988), forbidding the promotion of homosexuality, further reinforced negativity towards this group of people. This compounded the negative mental health consequences for those developing a gay sexual orientation in a climate of heterosexism. Current health care policy in England concerns itself with the rising number of suicides among young people but fails to acknowledge the importance of the research findings relating to gay people by integrating them into the development of mental health policy. This paper reviews the literature relating to homosexual people and suicidality, and addresses the seriousness of a policy rhetoric which results from ignoring the evidence while dictating mental health nursing practice.

Bisexuality↗
PubMed1988

Sibling influences on childhood development.

To summarize the main points concerning sibling influence: 1. That siblings play a causal role in the development of aggressive behavior, in children's style of conflict behavior and in cooperative fantasy play is strongly suggested by recent research. 2. Marked problems in the sibling relationship are indicative of other problems, but a causal role for siblings is not established, other than for aggressive behavior. 3. Family factors are closely involved in the quality of sibling relationships--and thus in sibling influence, namely differential parental behavior, and the emotional climate of the family. That is, it is important not to consider the sibling relationship in isolation from other family relationships. 4. Studies of families under stress indicate heightened importance of these family factors. 5. It is likely, but not yet established, that later-born siblings are influenced by first-born in socio-cognitive development and gender identity. 6. Finally it should be noted that an important theme in current research on siblings is a concern with the question of why siblings develop to be so different from one another. It has been shown that the major source of environmental influence on the development of individual differences is within-family rather than between-family differences in experience (Plomin & Daniels, 1987). The different experiences each sibling may have within their relationship is one potential source of such differential environmental influence. Thus documenting the influence of siblings upon each other takes on added significance: By clarifying the extent and nature of this influence we will gain not only useful clinical information but illumination on a developmental principle of very general significance.

Aggression↗
PubMed1993

Personality traits and disorders among transsexuals.

A group of transsexuals, 9 biological men and 10 women, was assessed according to clinical DSM-III-R diagnosis and a self-report instrument for Axis II diagnoses based on the Structured Clinical Interview for DSM-III-R (SCID screen). A control group of 133 individuals was assessed by the same instrument. Combined with a functional criterion according to the Global Assessment of Functioning, the SCID screen showed good agreement with clinical Axis II diagnoses. The overall proportion of Axis II criteria fulfilled, proportion of criteria fulfilled for every single personality disorder and number of personality disorders were calculated from the modified version of the SCID screen. Personality disorders, mainly within cluster B, were identified among 5 of 19 transsexuals, and a majority had multiple personality disorders. Among controls, no personality disorder was identified. Personality traits as measured by the SCID screen revealed significantly more subthreshold pathology among transsexuals than controls in 8 of 12 personality categories. The proportion of overall Axis II criteria fulfilled was 29% among transsexuals versus 17% among controls. Sex differences among transsexuals, the usefulness of the SCID screen and diagnostic problems in DSM-III-R with respect to gender identity disorders are discussed.

Adult↗
PubMed1997

Congenital adrenal hyperplasia in Turkey: a review of 273 patients.

In this study the clinical and epidemiological characteristics of congenital adrenal hyperplasia were evaluated retrospectively from the records of 273 patients managed in our clinic over a 25-year period. 21-Hydroxylase deficiency was present in 234 patients (85.7%), simple virilizing form in 134 (110 F, 24 M), salt-losing form in 85 (71 F, 14 M) and late on-set form in 15 girls. 11 beta-Hydroxylase deficiency was diagnosed relatively frequently (13.5%) among our patients with congenital adrenal hyperplasia; one girl had 17 alpha-hydroxylase deficiency and one boy had 3 beta-hydroxy steroid dehydrogenase deficiency. The median chronological age of diagnosis was 12 months (1 day-16.6 years) in patients with classical congenital adrenal hyperplasia. Chromosomal sex was 46, XX in a total of 221 patients and 46, XY in 52. Ninety-one girls were considered to be male before diagnosis was established and male sex was assigned in 31 of them due to development of male gender identity at diagnosis. Parental consanguinity rate among families of patients was higher than the general population in Turkey (56.4% vs 21%). Our overall figures show that the incidence of congenital adrenal hyperplasia is expected to be high due to a high rate of consanguinity in our populations and the patients remain frequently undiagnosed during the neonatal period. Therefore screening may be beneficial in our population.

Adolescent↗
PubMed2001

The acoustic bases for gender identification from children's voices.

The purpose of this study was to examine the acoustic characteristics of children's speech and voices that account for listeners' ability to identify gender. In Experiment I, vocal recordings and gross physical measurements of 4-, 8-, 12-, and 16-year olds were taken (10 girls and 10 boys per age group). The speech sample consisted of seven nondiphthongal vowels of American English (/ae/ "had," /E/ "head," /i/ "heed," /I/ "hid," /a/ "hod," /inverted v/ "hud," and /u/ "who'd") produced in the carrier phrase, "Say /hVd/ again." Fundamental frequency (f0) and formant frequencies (F1, F2, F3) were measured from these syllables. In Experiment II, 20 adults rated the syllables produced by the children in Experiment I based on a six-point gender rating scale. The results from these experiments indicate (1) vowel formant frequencies differentiate gender for children as young as four years of age, while formant frequencies and f0 differentiate gender after 12 years of age, (2) the relationship between gross measures of physical size and vocal characteristics is apparent for at least 12- and 16-year olds, and (3) listeners can identify gender from the speech and voice of children as young as four years of age, and with respect to young children, listeners appear to base their gender ratings on vowel formant frequencies. The findings are discussed in relation to the development of gender identity and its perceptual representation in speech and voice.

Acoustics↗
PubMed1983

Testicular feminization syndrome. An experimental model for the study of hormone action on sexual behavior.

Truly feminine consciousness of gender identity, normal extragenital erotogenic sensitivity, suppressed or very reduced clitoris sensitivity and reaction, normal reaction of the labia minora and the vagina which deepens with the renewal of intercourse, realization of pleasure climax without clonicotonic orgasm and followed by resolution, and a normal maternal attitude seem to characterize sexual behavior in a complete or almost complete testicular feminization syndrome. These features allow one to clearly distinguish, without ignoring multiple psychologic mechanisms, the factors related to androgens and to estrogens in normal feminine sexual behavior.

Adult↗
PubMed1976

Transsexualism in two male triplets.

The authors present clinical and case material on two male triplets with aberrant gender identity. Their findings coincide with those of the few family studies reported in which there were two or more transsexual members; they also reveal patterns generally in keeping with the psychological determinants of transsexualism suggested by Stoller.

Adult↗
PubMed1984

Narcissism and aggression.

Many of the phenomena we associate with violence and rage seem to be connected with narcissistic wounding. In this study, the narcissistic dimension of personality is regarded as a phylogenetic derivative of a territorial instinct. The establishment of a self-territory is experienced as a form of personal space, and an effort is made to distinguish various regions in this space. In particular, there is envisaged a narcissistic core consisting of the multiplicity of affiliations to which a given person belongs. These include gender identity, body self, religion, patriotism, lineage, profession, and other such self-defining attachments. In addition, there is a periphery to this space, a point of contact with the boundaries of others where much vulnerability can develop in people with narcissistic problems. It is in connection with such vulnerabilities and the immense reactivity to the invasion of core narcissistic territory that the nature of violence in interpersonal reactions needs to be studied.

Aggression↗
PubMed1988

Freud's three theories of love in the light of later developments.

Evidence is presented that Freud developed three very different theories on love. These theories were not integrated into a coherent theory. In subsequent developments each theory had its own history. The paper discusses the history of the controversy on the genital character, the relation between love and gender identity, between love and narcissism, the hierarchical structure of the capacity to love, and the relation between love and object loss. The impact of some concepts such as symbiosis and the rapprochmente subphase on the understanding of conflicts in loving is raised. While at present differences in emphasis make it difficult to build a coherent psychoanalytic theory of love, it is productive to bring divergent views in touch with each other. A unified theory of love based on psychoanalytic observations is suggested.

Freudian Theory↗
PubMed2002

Cricothyroid approximation to elevate vocal pitch in male-to-female transsexuals: results of surgery.

Functional changes in voice production, including pitch elevation, may help male-to-female transsexuals assume a new gender identity. To date, there has been a paucity of objective data on the effectiveness of pitch-raising methods. Acoustic data were gathered with regard to preoperative and postoperative changes in pitch, pitch range, and perturbation in 20 patients after cricothyroid approximation. Subjective data were gathered by means of a mailed questionnaire. The mean follow-up time was 22 months. The speaking fundamental frequency was raised by half an octave without any significant changes in perturbation. The lower and upper limits of pitch range both increased by an average of 4 semitones. There was some decline over time of the lower pitch range toward preoperative levels, but the upper pitch range remained elevated. The majority of the patients were satisfied with the results of surgery and felt their voices to be more feminine.

Adult↗
PubMed2001

The neurobiology, neuropharmacology, and pharmacological treatment of the paraphilias and compulsive sexual behaviour.

There has been increasing interest in the treatment of sexual disorders in recent years. Sexual disorders are classified in DSM-IV as sexual dysfunctions, paraphilias, and gender identity disorders. The sexual dysfunctions are nondeviant or nonparaphillic. The sexual dysfunction disorders should include "hyperactive sexual desire disorder" under sexual desire disorders. Further, there should be a specifier for paraphilias of "with hypersexuality" or "without hypersexuality." There is still incomplete understanding of the neurobiology of sexual disorders although functional neuroanatomy and neoropharmcological research has exposed the neurotransmitters, receptors, and hormones that are involved in sexual desire. Various pharmacological agents including serotonin reuptake inhibitors, antiandrogens, LHRH agonists, and others have been documented as reducing sexual desire. An algorithm for the use of these drugs in the treatment of the paraphilias as well nonparaphilic hypersexuality is outlined. The modes of action, dosages, aims of treatment, and usual methods of prescribing these agents is reviewed in this article. Some future directions of research in pharmacological treatment is also discussed.

Androgen Antagonists↗
PubMed1979

Family studies and changing concepts of personality development.

Many of the most significant changes in concepts of personality development and maldevelopment derive simply from belated appreciation that the child grows up in a family; and that the child requires considerable positive input from those who raise him to grow into a reasonably integrated person. Only recently have psychiatrists and psychoanalysts begun to focus on the influence of the family transactions throughout the formative years. The paper briefly presents the requisites a family must provide to assure the integrated development of its offspring and groups them under four headings: the parental nurturant functions that change with each phase of the offspring's development; the influence of the dynamic organization of the family on the offspring's intrapsychic structure, affecting self-boundaries, gender identity, superego directives, and so forth; conveying through family transactions the basic social roles and societal institutions to the child; transmitting the instrumental techniques of the culture, and particularly its language with its system of meanings and logic upon which virtually all ego functioning depends. The paper considers the evidence that the "choice of the neurosis" -- or more correctly, the choice of the psychiatric syndrome -- does not depend only upon fixation at various phases of pre-genital development, but also, and perhaps primarily, upon the panphasic influence of the intrafamilial environment. It is of particular importance to recognize that there is a very direct relationship between the family transactions, the separation-individuation process, bounary formation, the attainment of various degrees of object constancy, problems of splitting, superego directives, and what can be conscious and what need be repressed into the unconscious. The failure to recognize the import of the family has interfered with the formation of an integrated developmental theory that can unite various aspects of the developmental process that have remained more or less isolated from one another -- drive theory, object relations, ego psychology, separation-individuation, and cognitive development. Finally the question is raised if in providing guidance to parents we have been amiss in not focusing on such matters as who the parents are, how they relate to one another as well as to the child, the values they communicate by their behaviour -- matters that are fundamental and to which almost all else is secondary, but about which relatively little has been said or taught.

Adolescent↗
PubMed2004

Circulating nucleic acids and proteomics of plasma/serum: clinical utility.

Circulating tumor-specific nucleic acids have been identified in plasma, serum, and other body fluids from cancer patients with tumors originating in almost any organ site. Polymerase chain reaction provides a highly sensitive and specific technique for the detection of these genetic changes in a limited amount of tissue/fluid. The presence of elevated levels of free DNA/RNA in many medical conditions, malignancy, and infectious processes is being investigated for screening, diagnosis, prognosis, surveillance for occult disease progression, identifying potential therapeutic targets, and monitoring treatment response. Additionally, elevated fetal DNA/RNA in maternal blood is being used to determine gender identity, assess chromosomal abnormalities, and monitor pregnancy-associated complications. Questions remain on the etiology, characteristics, stability, and potential pathologic consequences of cell-free DNA/RNA in the circulation. Nevertheless, nucleic acid-based assays that monitor plasma, serum, and body fluids provide a noninvasive, facile, and practical method for assessing patients. Proteomic profiling may prove complementary to a total functionality approach in providing a comprehensive evaluation of the patient's disease.

Biomarkers, Tumor↗
PubMed1975

Female homosexuals' concepts of self, men, and women.

Twenty-four female homosexuals and 24 female heterosexuals matched for age and education were given the Draw-A-Person Test (DAP) and, on the Gough-Heilbrun Adjective Check List (ACL), were asked to describe themselves, men in general, and women in general. Results indicated that homosexuals, relative to the heterosuxual controls: (a) sexualized their drawings (p smaller than .02) and embellished the female figure more (p smaller than .05); (b) showed no evidence of confusion in gender identity on the DAP or ACL; (c) scored sifnigicantly higher on Autonomy, Change, and Exhibition on the ACL; and (d) scored significantly lower on Abasement, Defensiveness, Deference, Endurance, Order, Personal Adjustment and Self-control on the ACL. It was concluded that the female homosexual may be more independent, changeable, and sexually preoccupied and less well adjusted than her heterosexual counterpart.

Adult↗