Untreated depressive symptoms significantly worsen quality of life in old age and may lead to the misdiagnosis of dementia: a cross-sectional study.

BACKGROUND: Several studies demonstrated the role of depressive mood and cognitive impairment in the background of elevated mortality and decreased Quality of Life (QoL) in old age. Our aim was to assess depressive and cognitive symptoms among older people in order to determine if those are recognized and treated or not, to elucidate the association between them and to investigate their impact on QoL. METHODS: In the framework of the ICT4Life project self-administered questionnaires and clinical screening tools were used to assess QoL, depressive symptoms and cognitive functions of 60 older persons over the age of 65. RESULTS: Males found to be depressed (53.8 vs. 40.4%) and cognitively declined (53.8 vs. 48.9%) more frequently; and had higher scores on the depression (6.85 vs. 5.32) and lower on the QoL (47.38 vs. 50.19) scales. Depressed older persons had lower cognitive levels (24.39 vs. 21.52) and their QoL was significantly poorer (53.97 vs. 43.85) than that of the non-depressed subjects. Depressive symptoms were detected in almost half of the older adults (43.9%), and the majority (80.77%) did not receive antidepressant medication. CONCLUSIONS: Depressive and cognitive symptoms found to be common among older people, but were not recognized and treated in most cases. Close correlation between depression and cognitive impairment was also confirmed, as well as the key role of depression in the background of pseudo-dementia and QoL decline. Early recognition of depressive symptoms is important not only to treat the underlying mood disorder, but also to improve QoL of older persons.

Morningness-eveningness, relationship quality, and quality of life among couples living together.

Morningness-eveningness (chronotype) indicates the preferred time of intellectual and physical activity. This cross-sectional study had two main aims. The first aim was to explore associations among chronotype, quality of life, and relationship quality. The second aim of this study was to examine whether the similarities or discrepancies in chronotype between male and female members of the couples were linked to relationship quality. Both members of 143 couples (mean age = 39.44; SD = 10.11y) living together for at least 6 months completed measures of chronotype, marital stress, relationship satisfaction, dyadic coping, satisfaction with life, health-related quality of life, and quality of sleep. Variable-oriented (correlational) and person-oriented (cluster-analytic) analyses were conducted. Variable-oriented analyses showed that morningness was linked to better mental health, and fewer insomnia problems, but less frequent (self-perceived) stress communication for both genders. The discrepancy between the couple's chronotype scores was positively related to the women's sexual and general life satisfaction and more frequent (self-perceived) supportive dyadic coping by the partner. Moreover, ANOVA results showed that Evening-type (E-type) women had the highest mean score on sexual life satisfaction. According to cluster-analytic investigation, couples consisting of two morning-type members had the least frequent stress communication. On the other hand, these couples had better sleeping quality with less insomnia symptoms than couples with two E-type members. In summary, the present findings demonstrate that morningness holds both advantages and disadvantages for both general aspects of life and also the quality of relationships.

[The diagnosis and treatment of bipolar affective disorders].

No abstcarct available.

A study of affective temperaments in Hungary: internal consistency and concurrent validity of the TEMPS-A against the TCI and NEO-PI-R.

BACKGROUND: TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego - Autoquestionnaire) is a new self-assessed temperament 110-item scale with depressive (D), cyclothymic (C), hyperthymic (H), irritable (I) and anxious (A) subscales. To date, it has been translated into 25 languages, and validated in 10. The present Hungarian version provides the most complete external validation across the Beck Depression Scale (BDI), Profile of Mood States (POMS), the BarOn Emotional Quotient Inventory (BarOn EQ-i), Temperament and Character Inventory (TCI), and the NEO Personality Inventory - Revised (NEO-PI-R). We were particularly interested in concurrent validation against the TCI and the NEO-PI-R, the most important of the new personality instruments. METHODS: 1132 clinically-well subjects (27% male) from the general population and university students (16-81 years) were administered the above scales and instruments. The data were tested with standard psychometric batteries. RESULTS: Factor analysis revealed 5 factors approximating the original D, C, I, H, and A subscales, which in their superfactor confirmed an Emotional (D, C, I, A) vs. Hyperthymic structure. Except for the D (a=0.65), the Cronbach alpha for the remainder temperaments ranged from 0.75-0.81. Dominant temperaments ranged from the I (2.7%) to the C (4.2%); the highest prevalence was observed among men with C=6% and H=5.4%. The BDI and POMS correlated significantly with the relevant subscales, as did the BarOn. Of the many significant possible correlations with the TCI, the most noteworthy were novelty seeking and harm avoidance with D, A, C, as well as C, and persistence with H. As for the NEO-PI-R, we were struck by the positive correlation of openness with C, and conscientiousness negatively with C; most other positive correlations such as neuroticism with all temperaments but the hyperthymic were expected and strongly supportive of concurrent validity. LIMITATIONS: Higher educational background of the subjects studied relative to that of the general population of Hungary. The distribution of the data may have in some instances deviated somewhat from the underlying assumptions for the standard psychometric tests for normality. We did not conduct test-retest reliability. CONCLUSIONS: The factorial structure of the TEMPS-A shows good reliability and internal consistency. Although the superstructure is reminiscent of neuroticism-extraversion, within it are embedded discernible classical affective temperaments. A provocative finding is the high prevalence of cyclothymia in Hungarian males (6%), which is rather unique when compared with the other 10 countries studied to date. This finding, coupled with high male hyperthymia (5.4%), may explain the high lifetime prevalence of bipolar disorders reported from Hungary. Inter alia, our psychometric data along with the foregoing epidemiologic considerations, are very much in line with the cyclothymic-bipolar spectrum model proposed by the senior author [Akiskal, H.S., Djenderedjian, A.H., Rosenthal, R.H., Khani, M.K., 1977. Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. Am. J. Psychiatry 134, 1227-1233].

[Affective temperaments: psychometric properties of the Hungarian TEMPS-A]. / Az affektív temperamentum: a TEMPS-A kérdöívvel szerzett hazai tapasztalatok.

The study examines the psychometric properties of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) based on 717 (438 females and 279 males) healthy subjects in a Hungarian normative sample. The questionnaire is a self-report 110-item tool that postulates five affective temperaments: depressive, cyclothymic, irritable, hyperthymic, and anxious. Most of the TEMPS-A scales have excellent internal consistencies (0.78-0.84), except for the Depressive Temperament Scale, which had a Cronbach's alfa coefficient of 0.63. The item-analyses have identified a few deficient items which do not fit into the scale. In line with the literary data, women had higher mean scores on the depressive, cyclothymic, and anxious subscales, whereas men scored higher on the cyclothymic subscale. Cut-offs for each temperament were based on z-scores higher than + 2S.D. Dominant nervous-anxious (4.3%), depressive (3.8%), cyclothymic (3.2%), and irritable (3.2%) temperaments were the most common in this normative population, whereas dominant hyperthymic (1.8%) temperament was relatively uncommon. Factor analyses of the TEMPS-A items yielded considerable overlap between depressive and cognitive anxiety traits. The strongest correlation was observed between the anxious and the depressive temperament subscales in line with some international findings (r=0.62**). To test construct validity, we administered the Beck Depression Inventory, Profile of Mood States (shortened version) and the Cloninger Temperaments and Character Inventory, which all supported the validity of TEMPS-A subscales. Based on the results obtained with the Hungarian normative sample, the TEMPS-A is a reliable and valid instrument in personality psychology, and further refinement on clinical samples opens new and interesting research avenues.

[The role of mother-child relationship in development of self-image, dysfunctional attitudes and coping strategies]. / Interakciódinamika evészavarban szenvedo fiatalok és édesanyjuk kapcsolatában.

INTRODUCTION: Our study consisted of two interrelated work stages. In stage one, we set the goal to investigate coping styles and dysfunctional attitudes in patients with eating disorders. In stage two we studied the relationship between coping styles of the patients and mother-child interactional patterns, considering the role of communication in development of stress handling and problem management. PURPOSES: 1. Revealing characteristic coping patterns of the patients, comparing the coping styles to conrtrol subjects; 2. identifying dysfunctional attitudes in patients' thinking; 3. testing the hypothesis about existence of relationship between dysfunctional attitudes and coping; 4. finding out whether any dysfunctional attitudes or coping styles can be related to processes in mother-child communication. SUBJECTS: There were 28 participants in the first stage (9 subjects with anorexia nervosa, 10 subjects with bulimia nervosa and 9 control subjects). In stage two, 20 subjects (5 patients with anorexia, 5 with bulimia together with their mothers) were studied. METHODS: We used two questionnaires: Anxiety Handling Questionnaire and the Beck-Weissman Dysfunctional Attitudes Scale (DAS), shortened version. The Consensus Rorschach was administered in order to reveal interactional dynamics. In summary, 1769 code units were analyzed. RESULTS: Our subjects, primarily subjects with bulimia nervosa, used more self-punishing coping compared to control subjects. Dysfunctional attitudes were found to have an effect on coping style. The present results indicate some possibilities for explanation hov fragile self-image, dysfunctional attitudes and self-punishing coping patterns may develop in the patients as a possible effect of mother-child interaction dynamics.

[Communication deviance and thought disorder in schizophrenia: a case study]. / A kommunikációs és gondolkodási zavar megnyilvánulásai egy szkizofrén páciens családjának interakciómintáiban.

INTRODUCTION: Communication deviance (CD) means forms of communication that are hard to follow and that make difficult the consensual sharing of attention and meaning, and it has been hypothesized as a contributor to psychopathology of offspring, including schizophrenia. There is increasing evidence that CD may also trigger relapse of symptomatic illness in remission. We present a case with detailed sequence analysis, where we demonstrate disordered functioning in a family of a 27-year-old male patient with schizophrenia. METHOD: The patient and his parents participated in the Consensus Rorschach (CR) situation, a common problem solving task. Behaviour during the interaction was coded and analysed on different levels, including relational and symbolic level; and also, focusing on specific patterns of thought disorder. Results are in accordance with former findings that CD level is high in families of patients with schizophrenia. This type of communication was found to initiate transactional processes which resemble "games" aimed at gaining control over other family members. The content level of communication was frequently immature, and communication reflected pseudo-dependence as an only form of conflict resolution. CONCLUSIONS: Findings from the present study may be important from the perspective of secondary and tertiary prevention, and they reflect need for intervention focusing on the whole family.

[Interaction patterns in male and female suicide attempters]. / Interakciós minták öngyilkosságot megkísérelt férfiaknál és noknél.

UNLABELLED: The present study aimed to assess the interaction dynamics of suicidal patients' close relationships using the Consensus Rorschach method. Our sample consisted of 24 male and 8 female patients and their spouses as well as 30 control couples. We have analysed the couples' behavior in situations where communication difficulties ("communication crisis") have arisen, comparing communication of female and male patients to controls. Results have shown that couples with suicide history expressed more passive and passive emotional messages, with evident signs of problem solving difficulties. Male patients frequently expressed helplessness, while female patients showed poor emotional control. CONCLUSIONS: difficulties in communication and conflict management as well as lack of empathy and perspective taking observed in the relationships of these couples can be explained by disturbances in the bonding process (probably both in patients and partners); which indicates the need for individual and family therapy.

Possible effect of gender and season on the length of hospitalisation in unipolar major depressives.

BACKGROUND: Seasonal variation as well as gender differences of several phenomena of affective disorders are a common topic of interest. METHODS: The authors analysed the possible effect of season and gender on the length of hospital stay in 529 in-patients with unipolar major depressive episode. RESULTS: Age and menopausal status alone did not influence the length of hospitalisation but there was a statistical tendency (only for females) for the shortest hospital stay in summer, that reached significance in females younger than 50 years. CONCLUSIONS: The results suggest a possible seasonal and gender effect on recovery from major depression. LIMITATIONS: Retrospective nature of the study, lack of systematic assessment of clinical response and no data collection about marital status and living conditions, that also can influence the time of discharge.