Archive for the ‘Annals of General Psychiatry’ Category

Shared psychological characteristics that are linked to aggression between patients with Internet addiction and those with alcohol dependence

February 26, 2014 Comments off

Shared psychological characteristics that are linked to aggression between patients with Internet addiction and those with alcohol dependence
Source: Annals of General Psychiatry

Internet addiction (IA) is considered as one of behavioral addictions. Although common neurobiological mechanisms have been suggested to underlie behavioral addiction and substance dependence, few studies have directly compared IA with substance dependence, such as alcohol dependence (AD).

We compared patients with IA, AD, and healthy controls (HC) in terms of the Five Factor Model of personality and with regard to impulsiveness, anger expression, and mood to explore psychological factors that are linked to aggression. All patients were treatment-seeking and had moderate-to-severe symptoms.

The IA and AD groups showed a lower level of agreeableness and higher levels of neuroticism, impulsivity, and anger expression compared with the HC group, which are characteristics related to aggression. The addiction groups showed lower levels of extraversion, openness to experience, and conscientiousness and were more depressive and anxious than the HCs, and the severity of IA and AD symptoms was positively correlated with these types of psychopathology.

IA and AD are similar in terms of personality, temperament, and emotion, and they share common characteristics that may lead to aggression. Our findings suggest that strategies to reduce aggression in patients with IA are necessary and that IA and AD are closely related and should be dealt with as having a close nosological relationship.

The relationship between drive to thinness, conscientiousness and bulimic traits during adolescence: a comparison between younger and older cases in 608 healthy volunteers

November 1, 2013 Comments off

The relationship between drive to thinness, conscientiousness and bulimic traits during adolescence: a comparison between younger and older cases in 608 healthy volunteers
Source: Annals of General Psychiatry

Adolescence represents one of the critical transitions in the life span and is characterized by a tremendous pace in growth and change that is second only to that of infancy. Both biological and psychological changes occurring during early adolescence may also influence the definition of subsequent late adolescence or early adulthood physiological or (psycho)-pathological features, including bulimia nervosa (BN) whenever occurring. Therefore, a pre-emptive assessment of suggestive psychological traits, including bulimic ones, during early and late years of adolescence, is recommended and represents the goal of the present study.

Six hundred and eight healthy volunteers attending mid- or high school, aged 14–19 years, were consecutively enrolled at multiple sites in Eastern Sicily, Italy. A systematic psychological assessment was performed, including McCrae and Costa’ BigFive, the Eating Disorders Inventory (EDI), Bisantis’s Assertivity test and the Liebowitz Social Anxiety Scale for Children and Adolescents. Demographic and general characteristics, including the body mass index, were also recorded. Based on hierarchical considerations, cases were then divided into ‘younger’ (‘early’ years, 14–16) and ‘older’ (‘late’ years, 17–19) adolescents.

Upon descriptive and Pearson’s correlation analyses, the following EDI constructs ‘drive to thinness’ and ‘bulimia’ scored significantly higher (both p = <.001) in 'early' vs. 'late' cases. Conversely, BigFive 'conscientiousness' was higher in older subjects vs. early cases (p = <.003). As expected, 'drive to thinness' positively correlated with BN both in early (r = .31) and late (r = .50) cases. In the 'late' group, age correlated with conscientiousness (r = .206) while BN correlated with drive to thinness (r = .505); finally, a negative correlation was observed with regard to consciousness and BN (r = -.19).

Despite intrinsic methodological limits, our preliminary findings confirm that the transition between early and late years of adolescence is a critical phase of life span, with the consolidation of 'conscientiousness' eventually playing a protective role towards the onset of bulimic traits. If confirmed by replication studies, ideally providing long-term follow-ups too, an early acknowledgement of bulimic traits may play a major predictive role for subsequent BN, ultimately contributing to more effective pre-emptive interventions as well.

No role for initial severity on the efficacy of antidepressants: results of a multi-meta-analysis

August 14, 2013 Comments off

No role for initial severity on the efficacy of antidepressants: results of a multi-meta-analysis
Source: Annals of General Psychiatry

During the last decade, a number of meta-analyses questioned the clinically relevant efficacy of antidepressants. Part of the debate concerned the method used in each of these meta-analyses as well as the quality of the data set.

Material and methods
The Kirsch data set was analysed with a number of different methods, and eight key questions were tackled. We fit random effects models in both Bayesian and frequentist statistical frameworks using raw mean difference and standardised mean difference scales. We also compare between-study heterogeneity estimates and produce treatment rank probabilities for all antidepressants. The role of the initial severity is further examined using meta-regression methods.

The results suggest that antidepressants have a standardised effect size equal to 0.34 which is lower but comparable to the effect of antipsychotics in schizophrenia and acute mania. The raw HDRS difference from placebo is 2.82 with the value of 3 included in the confidence interval (2.21–3.44). No role of initial severity was found after partially controlling for the effect of structural (mathematical) coupling. Although data are not definite, even after controlling for baseline severity, there is a strong possibility that venlafaxine is superior to fluoxetine, with the other two agents positioned in the middle. The decrease in the difference between the agent and placebo in more recent studies in comparison to older ones is attributed to baseline severity alone.

The results reported here conclude the debate on the efficacy of antidepressants and suggest that antidepressants are clearly superior to placebo. They also suggest that baseline severity cannot be utilized to dictate whether the treatment should include medication or not. Suggestions like this, proposed by guidelines or institutions (e.g. the NICE), should be considered mistaken.

The media and intellectuals’ response to medical publications: the anti-depressants’ case

April 24, 2013 Comments off

The media and intellectuals’ response to medical publications: the anti-depressants’ case

Source: Annals of General Psychiatry

During the last decade, there was a debate concerning the true efficacy of anti-depressants. Several papers were published in scientific journals, but many articles were also published in the lay press and the internet both by medical scientists and academics from other disciplines or representatives of societies or initiatives. The current paper analyzes the articles authored by three representative opinion makers: one academic in medicine, one academic in philosophical studies, and a representative of an activists’ group against the use of anti-depressants. All three articles share similar gaps in knowledge and understanding of the scientific data and also are driven by an ‘existential-like’ ideology. In our opinion, these articles have misinterpreted the scientific data, and they as such may misinform or mislead the general public and policy makers, which could have a potential impact upon public health. It seems that this line of thought represents another aspect of the stigma attached to people suffering from mental illness.

Toxoplasma gondii Infection and Self-directed Violence in Mothers

July 10, 2012 Comments off

Toxoplasma gondii Infection and Self-directed Violence in Mothers
Source: Archives of General Psychiatry

Two studies based on clinical samples have found an association between Toxoplasma gondii infection and history of suicide attempt. To our knowledge, these findings have never been replicated in a prospective cohort study.

To examine whether T gondii–infected mothers have an increased risk of self-directed violence, violent suicide attempts, and suicide and whether the risk depends on the level of T gondii IgG antibodies.

Register-based prospective cohort study. Women were followed up from the date of delivery, 1992 to 1995 until 2006.


A cohort of 45,788 women born in Denmark whose level of Toxoplasma-specific IgG antibodies was measured in connection with child birth between 1992 and 1995.

Main Outcome Measures
Incidence rates of self-directed violence, violent suicide attempts, and suicide in relation to T gondii seropositivity and serointensity.

T gondii–infected mothers had a relative risk of self-directed violence of 1.53 (95% CI, 1.27-1.85) compared with noninfected mothers, and the risk seemed to increase with increasing IgG antibody level. For violent suicide attempts, the relative risk was 1.81 (95% CI, 1.13-2.84) and for suicide, 2.05 (95% CI, 0.78-5.20). A similar association was found for repetition of self-directed violence, with a relative risk of 1.54 (95% CI, 0.98-2.39).

Women with a T gondii infection have an increased risk of self-directed violence.

See: Women Infected With Common Parasite Have Increased Risk of Attempting Suicide, Study Finds (Science Daily)

Psychiatric comorbidities in asperger syndrome and high functioning autism: diagnostic challenges

July 2, 2012 Comments off

Psychiatric comorbidities in asperger syndrome and high functioning autism: diagnostic challenges

Source: Annals of General Psychiatry

Several psychiatric conditions, both internalizing and externalizing, have been documented in comorbidity with Asperger Syndrome (AS) and High Functioning Autism (HFA). In this review we examine the interplay between psychiatric comorbidities and AS/HFA. In particular, we will focus our attention on three main issues. First, we examine which psychiatric disorders are more frequently associated with AS/HFA. Second, we review which diagnostic tools are currently available for clinicians to investigate and diagnose the associated psychiatric disorders in individuals with AS/HFA. Third, we discuss the challenges that clinicians and researchers face in trying to determine whether the psychiatric symptoms are phenotypic manifestations of AS/HFA or rather they are the expression of a distinct, though comorbid, disorder. We will also consider the role played by the environment in the manifestation and interpretation of these symptoms. Finally, we will propose some strategies to try to address these issues, and we will discuss therapeutic implications.

Development of the Global Disability Scale (GloDiS): preliminary results

May 23, 2012 Comments off
Source:  Annals of General Psychiatry
The assessment of functioning and disability is an important part of clinical evaluation, since it measures disease burden and reflects the effectiveness of therapeutic planning and interventions. The aim of the current study was to develop a self-report instrument on the basis of a review of the literature, compatible with the World Health Organization (WHO) approach.
The review of the literature led to the development of the Global Disability Scale (GloDiS), with 25 items assessing different aspects of disability. The study sample included 728 persons from vulnerable populations (homeless, jobless, very low income, single parent families and so on (29.12% males and 70.88% females; age 55.96 +/- 15.22 years). The protocol also included the State-Trait Anxiety Inventory (STAI) and the Center for Epidemiologic Studies Depression Scale (CES-D). The statistical analysis included factor analysis, item analysis and analysis of covariance (ANCOVA).
The factor analysis revealed the presence of four factors explaining 71% of total variance (everyday functioning, social and interpersonal functioning, severity and mental disability). The Cronbach alpha value for the whole scale was 0.95 and for subscales the range of values was 0.74 to 0.94.
The results of the current study suggest that the GloDiS has the potential to serve as a reliable and valid tool for assessing functioning and disability. Further research is needed to prove that it could be useful across countries, populations and diseases, and on whether it provides data that are culturally meaningful and comparable. It can be used in surveys and in clinical research settings and it can generate information of use in evaluating health needs and the effectiveness of interventions to reduce disability and improve health.

Full Paper (PDF)