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PubMed2001

Alcohol and gambling pathology among U.S. adults: prevalence, demographic patterns and comorbidity.

OBJECTIVE: This study was designed to determine the prevalence and demographic distribution of problem gambling, pathological gambling, alcohol abuse and alcohol dependence in the United States, and to examine the co-occurrence of gambling pathology and alcohol pathology in the United States. METHOD: A representative sample (N = 2,638) of U.S. adults age 18 and older was surveyed in the year 2000 using computer-assisted telephone interviewing. Respondents' gambling pathology and alcohol dependence were assessed by the South Oaks Gambling Screen (SOGS) and the Diagnostic Interview Schedule (DIS). RESULTS: Current pathological gambling had an overall prevalence of 1.3% as measured by the DIS and 1.9% as measured by the SOGS, with a higher prevalence among minorities and lower socioeconomic status (SES) respondents. Current and lifetime alcohol pathology was more common among males and young adults than among females and older adults. Current pathological gambling and alcohol dependence were correlated, and the highest correlation was found among higher SES respondents. CONCLUSIONS: The rate of current pathological gambling in the United States is higher than reported in past surveys. Minorities and lower SES Americans have higher than average rates of current pathological gambling. However, when higher SES persons are classified as current pathological gamblers, they are more likely than lower SES persons to be dependent on alcohol.

Adolescent↗
PubMed2006

Personality and substance dependence symptoms: modeling substance-specific traits.

Personality traits related to neuroticism and disinhibition have been consistently associated with substance use disorders (SUDs). It is unclear, however, whether different personality traits predict distinct forms of substance dependence. Additionally, it is unclear whether personality traits continue to predict alcohol, drug, and tobacco dependence after controlling for comorbid antisociality and other SUDs. The current study addresses these questions by characterizing relations between personality traits and substance dependence symptoms in a longitudinal sample of 3,720 college students. Results revealed that antisociality and certain core personality traits predicted multiple types of substance pathology. In addition, several personality traits were differentially associated with alcohol, drug, and tobacco symptomatology.

Adolescent↗
PubMed2005

The therapeutic alliance in the treatment of personality disorders.

Because personality disorders are associated with significant impairment in interpersonal relationships, special issues and problems arise in the formation of a therapeutic alliance in the treatment of patients with these disorders. In particular, patients with narcissistic, borderline, and paranoid personality traits are likely to have troubled interpersonal attitudes and behaviors that will complicate the patient's engagement with the therapist. While a strong positive therapeutic alliance is predictive of more successful treatment outcomes, strains and ruptures in the alliance may lead to premature termination of treatment. Therefore, clinicians need to consider the patient's characteristic way of relating in order to select appropriate interventions to effectively retain and involve the patient in treatment. Research has shown not only the importance of building an alliance but also that this alliance is vital in the earliest phase of treatment. The author first reviews several definitions of the therapeutic alliance with reference to how they apply to the treatment of patients with personality disorders. Issues relevant to forming a therapeutic alliance with patients with personality disorders are then discussed in terms of the three DSM-IV-TR personality disorder clusters. However, the author notes that these categories do not adequately capture the complexity of character pathology and that clinicians also need to consider which aspects of a patient's personality pathology are dominant at the moment in considering salient elements of the therapeutic alliance. In dealing with Cluster A personality disorders (schizotypal, schizoid, and paranoid personality disorders), what is most relevant for alliance building is the profound impairment in interpersonal relationships. The Cluster B "dramatic" personality disorders (antisocial, borderline, histrionic, and narcissistic) are all associated with pushing the limits. Consequently, clinicians need to exercise great care to avoid crossing inappropriate lines in a quest to build an alliance with patients with one of these disorders. Patients with Cluster C "anxious/fearful" personality disorders (avoidant, dependent, and obsessive-compulsive personality disorders) are emotionally inhibited and averse to interpersonal conflict. These patients frequently feel guilty and internalize blame for situations even when there is none, a tendency that may facilitate alliance building because the patients are willing to take some responsibility for their dilemma and may engage somewhat more readily with the therapist to sort it out, compared with patients with more severe Cluster A or B diagnoses. The author then reviews considerations relevant to treatment alliance that arise in the different treatment approaches that may be used with patients with personality disorders, including psychodynamic psychotherapy/psychoanalysis, cognitive-behavioral therapies, and psychopharmacology. The author also discusses issues, especially splitting, that arise in the alliance when patients with personality disorders are treated in inpatient psychiatric hospital settings.

Adult↗
PubMed1989

[Echography in the diagnosis of pathology of the gallbladder and bile ducts. Personal experience].

We evaluated the echographic findings in gallbladder and bile duct disease in 300 patients. These findings were correlated with those obtained after surgery and post-mortem study. The literature was reviewed to compare our results with those of other authors. In some pathologies, mainly those involving distension of the choledochus, echography must be accompanied by other diagnostic techniques, endoscopy and conventional radiology, to determine the cause of the obstruction responsible for distension. Finally, we conclude that echography is very efficient in this kind of exploration because of its high diagnostic reliability, its innocuousness and the fact that barium contrast is not required.

Bile Duct Diseases↗
PubMed1994

The pathological extensions of love.

BACKGROUND: Clarification is still required of the nature of pathological love. METHOD: A series is presented of 16 personally assessed cases with pathologies of love (erotomania). RESULTS: The pathologies of love usually involve a mixture of morbid infatuation and a morbid belief in being loved. They occur both in a symptomatic form, as part of an underlying mental illness, as well as in a pure form, where their emergence is to some extent understandable in a vulnerable personality. These disorders often go unrecognised to the detriment of clinical management. CONCLUSIONS: Pathologies of love create distress and disruption to the patient, and place the objects of their unwarranted affection at risk of at best harassment and at worst violence. Although this series of cases, which is drawn predominantly from forensic practice, overemphasises the risk of overt violence, the distress occasioned by pursuit and harassment alone should not be underestimated.

Adult↗
PubMed2003

Deliberate self-harm in a nonclinical population: prevalence and psychological correlates.

OBJECTIVE: Research on deliberate self-harm (intentionally injuring oneself without suicidal intent) has focused on clinical and forensic populations. Studying only these populations, which typically have serious psychopathology, may lead to inflated estimates of the association between self-harm and psychiatric disorder, as well as of the prevalence of deliberate self-harm. The present study investigated the prevalence and correlates of deliberate self-harm in a large group of nonclinical subjects. METHOD: Participants were 1,986 military recruits, 62% of whom were men, who were participating in a study of peer assessment of personality traits and pathology. Individuals who did and did not report a history of self-harm were compared on measures of personality and psychopathology. RESULTS: Approximately 4% of the participants reported a history of deliberate self-harm. Compared with participants without a history of deliberate self-harm, self-harmers scored higher on self- and peer-report measures of borderline, schizotypal, dependent, and avoidant personality disorder symptoms and reported more symptoms of anxiety and depression. Item-level analyses indicated that peers viewed self-harmers as having strange and intense emotions and a heightened sensitivity to interpersonal rejection. CONCLUSIONS: About one of every 25 members of a large group of relatively high-functioning nonclinical subjects reported a history of self-harm. Self-harmers had more symptoms of several personality disorders than non-self-harmers, and their performance across measures suggested that anxiety plays a prominent role in their psychopathology. Future research should investigate whether psychotherapies or psychiatric medications known to reduce symptoms of anxiety can be effective in treating deliberate self-harm.

Adult↗
PubMed1999

Chronic pain: the need for a "second-person" account.

Clinicopathological correlation between first-person patient complaints and third-person objective tissue pathology often fails for patients with chronic pain. It is, in fact, difficult to reconcile first- and third-person perspectives on much of clinical pain. One root for this problem is our belief in the privacy of pain. The idea of private pain is critiqued using the work of Ludwig Wittgenstein who contends that pain and pain behavior are inextricably linked. This allows us to appreciate the essentially social nature of human pain. A second-person theory of pain is sketched, which sees pain as intersubjective action. This theory allows us to escape our current dualistic, and often damaging, notions about chronic pain.

Chronic Disease↗
PubMed1991

The comorbidity of multiple personality disorder and DSM-III-R axis II disorders.

Our ability to differentiate MPD from DSM-III-R Axis I disorders has become increasingly refined. Differentiation of MPD from the Axis II personality disorders is an area of more recent clinical investigation. MPD can be found comorbidity with many other psychiatric conditions. It is found in association with each of the DSM-III-R personality disorders. At the present time, however, we lack research data that define the prevalence of the comorbidity of MPD with the personality disorders. Objective study of this area is complicated by the paucity of instruments available to assess personality dimensions in the presence of a DD. In addition, the currently available personality inventories tend to overdiagnose BPD in patients with a high level of distress and acuity of symptoms. The diagnosis of a personality disorder in a patient with MPD is made on the basis of the assessment of the "whole" human being. It is based on the presence of a pervasive and relatively inflexible pattern of behaviors that reflects the individual predominant mode of being. The diagnosis of a personality disorder is not made on the basis of personality traits contained within any single alternate personality or groups of personalities. The personality disorders defined by DSM-III-R are a heterogeneous group of conditions whose individual etiologies reflect a complex interplay of constitutional, genetic, environmental, interpersonal, and psychodynamic factors. The interplay is variable and diverse between these determinants of the personality disorders and the traumatic forces that result in the development of a DD. For the Cluster A personality disorders (schizoid, schizotypal, paranoid), there is evidence supporting a relationship with specific psychotic illnesses. The combination of dissociative pathology with these personality disorders commonly results in a greater impairment of reality testing than in either condition alone. The Cluster B personality disorders (histrionic, narcissistic, borderline, antisocial) and Cluster C personality disorders (avoidant, compulsive, dependent, passive-aggressive) are believed to be primarily developmental disturbances. Comorbidity of these personality disorders with MPD involves consideration of the interaction of many developmental processes with the psychological impact of severe childhood trauma. Many MPD patients present with an apparent mixed personality profile consisting of an array of avoidant, compulsive, borderline, narcissistic, dependent, and passive-aggressive features. Although this article explores comorbidity of MPD with each of the personality disorders defined in DSM-III-R individually, it seems likely that a number of posttraumatic personality organizations can be defined that commonly coexist with MPD.(ABSTRACT TRUNCATED AT 400 WORDS)

Borderline Personality Disorder↗
PubMed2001

Peripheral microcirculation during pregnancy and in women with pregnancy induced hypertension.

During pregnancy the cardiovascular system undergoes several changes so as to adapt the maternal organism to the strains of pregnancy. These adaptations can assume a pathological development in persons with a previous history of cardiovascular problems. On the other hand the absence of these adaptations may lead to a pathological course of pregnancy. Pregnancy induced hypertension (PIH) may be such a pathological development due to maladaptation. The causes are for the most part unknown. For some time it has been assumed that it is due to microcirculatory disorders. Using periungual capillary microscopy the present study prospectively investigated the changes in peripheral microcirculation during pregnancy focussing on pregnancy induced hypertension. Sixty-seven women with a normal course of pregnancy and 28 women with pregnancy induced hypertension were evaluated. Throughout the prospective study 3 examinations were performed during pregnancy and one during childbed. The women who developed a PIH were registered during the third trimester. Erythrocyte velocity at rest and vascular reagibility of capillaries following a 3 minute ischaemia were evaluated. In the course of pregnancy a significant increase of approximately 30% in erythrocyte velocity could be observed. Interpolation to obtain the best strait line result demonstrates that it is a continuous increase. Erythrocyte velocity returns to normal in the course of 14 weeks post partum. Due to a physiological vasodilatation during pregnancy, vascular reaction to ischaemic stress significantly decreases. During childbed these changes return to normal. Examinations on women with pregnancy induced hypertension not only showed a significant reduction of microcirculation under resting conditions but also a different pattern of reaction to ischaemic stress. Erythrocyte velocity under resting conditions lies 36% below normal values. Furthermore the distinctly shortened hyperaemic period indicates a hightened sensitivity to vasoconstrictive substances in women with PIH. While taking into account the clinical data a positive correlation with the severity of the illness was able to be established.

Adult↗
PubMedDate not supplied

[Isolation and purification of an unspecific component from human serum albumin, typical for pathology].

Albumin from blood serum of healthy persons and from patients with various pathologies and different severity of diseases was characterized using isoelectric focusing in borate-polyol system. In all the pathologies studied a new component occurred, which had an isoelectric point at pH 5.5 and which was not found in fresh albumin preparations isolated from healthy persons. This fraction was isolated and purified. Its isoelectric point was near pH 4.5-4.6 in isoelectrofocusing with ampholines. The divergences were due to complex formation of albumin with ampholines. The modified protein corresponded immunochemically to the human blood serum albumin, did not contain polymers, had a decreased amount of alpha-helix structures as shown by dispersion of optic rotation and its molecular mass was similar to the mass of native albumin.

Clinical Laboratory Techniques↗
PubMed1997

Psychological aspects of chronic pelvic pain.

Chronic pelvic pain (CPP) is a common gynecological problem which is poorly understood. A physical cause for the pain often cannot be established and, consequently, it has been difficult to treat successfully. In the absence of an identifiable physical cause for pain, researchers have attempted to identify a psychopathological causation. Associations have been reported between CPP and factors including personality and mood disturbance, childhood events, particularly sexual abuse, and sexual and relationship difficulties. However, evidence that women with CPP without discernible pathology differ in personality, psychological state, or life experiences from women with an identifiable cause for the pain, or those without chronic pelvic pain, is inconclusive. This review highlights methodological flaws inherent in many of the studies. It suggests areas and approaches for future research adopting a broader biopsychosocial perspective, which may generate findings of greater clinical utility.

Causality↗
PubMed1986

[Management of a clinical pathology laboratory using a record system on personal computer data base].

Data collection and processing via a Report System Data Base (dBASE III) is a new method recently implemented on Personal or Microcomputer. The major advantage compared to other systems lies in the possibility of working simultaneously with several open files that interact amongst themselves practically in real time. Procedures and programmes can also be created without the need to convert them to machine language. Management of the Clinical Pathology Laboratory via dBASE III is described. The Data Base Record files were specially created. Data on the necessary alteration in mass storage dimensions are supplied on the basis of the number of tests to be carried out. Preliminary information on the possibility of translating currently used statistical equations through the keyboard are also given. The package produced is absolutely interactive and does not require special training. It may therefore be used easily both by the laboratory doctor and personnel responsible for input and reference.

Clinical Laboratory Techniques↗
PubMed2000

Personality assessment of homeless adults as a tool for service planning.

The psychiatric status of homeless adults has been described primarily in terms of Axis I disorders. By adding a subset of the Personality Assessment Inventory, this study tests the feasibility and usefulness of a brief, self-administered questionnaire to obtain scores on several dimensions of personality. Cluster analysis sorted 112 tested subjects into four groups characterized by distinct profiles. Two of these were characterized by extreme scores on pathological dimensions of personality (borderline features, antisocial traits, and aggressivity) and differed primarily on the dimension of suicidality. The third reflected moderate levels of personality dysfunction and the fourth did not deviate from adult nonclinical norms. The validity of the clusters was supported by demographic, background, and diagnostic subgroup differences. Brief personality assessment can be a cost-effective approach to matching services with clinical needs of homeless adults by attending to interpersonal dimensions that will likely affect service provision.

Adult↗
PubMedDate not supplied

[Lipolysis in fatty tissue of patients with adrenohypercorticism].

Lipolytic activity was studied in subcutaneous and peripheric adipose tissue of patients with adrenohypercorticism (25 patients with Itsenko-Cushing disease and 4 patients with Cushing syndrome caused by corticosteroma of adrenal gland) and in 11 persons without this pathology. The lipolytic activity of the both adipose tissues in the patients with Itsenko-Cushing disease was similar to that of healthy persons and decreased in the patients with Cushing syndrome. The receptor-enzymatic system, responsible for lipolysis in adipose tissue, was not impaired in Itsenko-Cushing disease; differences found in lipolytic effects of corticotropin and somatotropin were caused by deteriorations in secretion of endogenous hormones in the disease. This system was inhibited in Cushing syndrome. Antilipolytic effect of insulin (especially in presence of glucose) was more distinct in subcutaneous adipose tissue of patients with Itsenko-Cushing disease as compared with controls.

Adipose Tissue↗
PubMed2001

Early gastric cancer in young, asymptomatic carriers of germ-line E-cadherin mutations.

BACKGROUND: Germ-line truncating mutations in the E-cadherin (CDH1) gene have been found in families with hereditary diffuse gastric cancer. These families are characterized by a highly penetrant susceptibility to diffuse gastric cancer with an autosomal dominant pattern of inheritance, predominantly in young persons. We describe genetic screening, surgical management, and pathological findings in young persons with truncating mutations in CDH1 from two unrelated families with hereditary diffuse gastric cancer. METHODS: Mutation-specific predictive genetic testing was performed by polymerase-chain-reaction amplification, followed by restriction-enzyme digestion and DNA sequencing in Family 1 and by heteroduplex analysis in Family 2. A total gastrectomy was performed prophylactically in five carriers of mutations who were between 22 and 40 years old. In each case, the entire mucosa of the stomach was extensively sampled for microscopical analysis. RESULTS: Superficial infiltrates of malignant signet-ring cells were identified in the surgical samples from all five persons who underwent gastrectomy. These early diffuse gastric cancers were multifocal in three of the five cases, and in one person infiltrates of malignant signet-ring cells were present in 65 of the 140 tissue blocks analyzed, representing in aggregate less than 2 percent of the gastric mucosa. CONCLUSIONS: We recommend genetic counseling and consideration of prophylactic gastrectomy in young, asymptomatic carriers of germ-line truncating CDH1 mutations who belong to families with highly penetrant hereditary diffuse gastric cancer.

Adenocarcinoma↗
PubMedDate not supplied

Deaths from ischemic heart disease in persons aged 65 or younger in Helsinki in 1970 with special reference to patho-anatomic findings in hearts.?211.

Deaths from ischemic heart disease(IHD) occurring during a period of one year in Helsinki in persons aged 65 years or younger have been investigated by the Ischaemic Heart Disease Register. Altogether 526 fatalities were registered. Autopsy data were collected in 432 cases, the autopsy rate being 82 percent. The results are presented separately for persons autopsied in the pathologic departments, representing mostly delayed deaths in hospitals, and for medico-legally autopsied persons representing sudden deaths outside hospitals. The diagnosis of IHD death was either based on the positive patho-anatomic or clinical evidence of an acute heart attack or supported by a history of clinical IHD in 92 percent of all registered fatal cases. In the remaining fatalities the possibility of other causes of death had been more or less definitely excluced. All persons with an acute attack of IHD and all autopsied cases showed a division into four socio-economic groups very similar to that of the population of Helsinki. Men belonging to the lowest social group were over-represented among medico-legally autopsied cases. A history of a previous heart disease, visits to a doctor and the use of digitalis were less common in persons autopsied medico-legally than in those autopsied in the pathologic departments. In the former an acute infarction was most often located in the posterior wall and in the latter in the anterior wall of the left ventricle. The prevalence of an occlusion was highest in the right coronary artery in the former and in the left anterior descending coronary artery in the latter; In medico-legally autopsied cases in which a recent myocardial infarction was observed the interventricular septum was involved in 81 percent, but in cases with an old infarction the septum was involved in only 52 percent. No difference in the size of the hearts, the frequency of an old infarction or the prevalence of coronary occlusions was found between persons autopsied in the pathologic and forensic departments. Although a previous angina was about equally common in both sexes, old infarctions were more common in men. The increase in heart weight had occurred proportionally to the same extent in both sexes.

Acute Disease↗
PubMedDate not supplied

[AIDS and the central nervous system: correlations between clinical, radiological and anatomo-pathological aspects. A critical review of 40 personal cases].

The authors review the cases of 40 patients with AIDS who died in 1989, in order to establish the relationships between clinical picture, neuroradiological features and neuropathological findings. Neurological involvement was present in over 75% of the patients, with HIV-related encephalopathy and toxoplasmosis as the most frequent diseases (52.5% and 20.0%). With regard to the cases of AIDS dementia complex (ADC) the authors observed a good correlation between the severity of the clinical manifestations, central nervous system atrophy as observed on computed tomography scan and pathological findings. The survival of AIDS patients with ADC was higher when compared to patients without ADC, suggesting the time-relationship of ADC. AS in the case of toxoplasma encephalitis, a strong relationship between radiological and pathological findings was observed. The presence of toxoplasma encephalitis in patients with radiologic features of healed lesions confirms the need for life-long prophylaxis.

AIDS Dementia Complex↗