MMPI-2 personality profiles and suicidal ideation and behavior in victims of bullying at work: a follow-up study.

The main aim of this study was to investigate longitudinally the personality profile and suicidal ideation and behavior in victims of bullying at work in relation to the evolution of the victimization. Forty-eight victims were evaluated by means of medical and psychological assessment including the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). A follow up session was carried out after an average of 22 months. At first evaluation, the average MMPI-2 personality profile of victims showed abnormal elevations on scales Hs (Hypochondria), D (Depression), Hy (Hysteria), and Pa (Paranoia), which were strikingly similar to that found in previous studies. Furthermore, suicidal ideation and behavior were common among victims. At follow-up, 26 victims reported that the degree of bullying had remained the same or had even worsened, whereas 22 said that the situation had improved or had been resolved. Although there was a trend toward normalization in the MMPI-2 profile for all victims, the profile of the "static" group was still abnormal at follow up. On the contrary, the profile of the "improved" group was entirely within normal range. Suicidal ideation and behavior decreased in all victims, but only to a significant degree in the improved group. Results are discussed in the light of the bullying process.

[Mental disorders related to persistent negative working conditions]. / Disturbi psichici associabili a condizioni di lavoro negative persistenti.

BACKGROUND: Mental disorders are common in our industrialised society and inevitably affect the working population. Over the last few years greater attention has been focussed on work-related psychopathologies due to an increasing number of studies regarding workplace bullying. OBJECTIVES: This study reports our observations on patients with mental disorders who came to our Occupational Health Centre because they perceived themselves to be victims of negative working conditions. An indepth analysis of their working conditions led us to the conclusion that many of these disorders were to be attributed to the workplace. METHODS: Between 2004 and 2010, 449 workers attended our Occupational Health Centre, most suffering from mental disorders which they ascribed to negative working conditions. All patients had an initial consultation session with an occupational physician which focused on the environmental and relational characteristics of their place of work. Thereafter, patients underwent a second clinical evaluation with a psychologist including several psychological tests. At the end of diagnostic process, the occupational physician and the clinical psychologist drew their clinical conclusions and defined the possible relationship with the working condition. RESULTS: For 379 out of 449 patients/workers, a positive and causal relationship between medical disorders and working conditions was established. The mental disorders observed in these groups of workers were: mixed anxiety and depressive disorder (53.6%), depressive disorder (16.2%), adaptation disorder (15.9%), anxiety disorder (13%) and only 1.3% post-traumatic stress disorder. The working conditions favouring the mental disorders were: workplace bullying, such as person-related bullying (30.1%) and task-related bullying (14.8%), adverse situations causing work distress (38.2%) or non-specific work discomfort (16,9%). CONCLUSIONS: Our experience showed that not only workplace bullying can cause different psychiatric disorders but also adverse situations that favour work distress and non-specific work discomfort often give raise to the same disorders. Negative working conditions can play a significant role in the development of psychological-psychiatric disorders: such disorders related to occupational conditions are on the increase in many industrialised countries.

Assessment of cerebral blood volume in schizophrenia: A magnetic resonance imaging study.

Brain atrophy has consistently been observed in schizophrenia, representing a 'gross' evidence of anatomical abnormalities. Reduced cerebral blood volume (CBV) may accompany brain size decrement in schizophrenia, as suggested by prior small SPECT studies. In this study, we non-invasively investigated the hemisphere CBV in a large sample of patients suffering from schizophrenia with perfusion-weighted imaging (PWI). PWI images were obtained, following intravenous injection of paramagnetic contrast agent (Gadolinium-DTPA), for 54 DSM-IV patients with schizophrenia (mean age+/-SD=39.19+/-12.20 years; 34 males, 20 females) and 24 normal controls (mean age+/-SD=44.63+/-10.43 years; 9 males, 15 females) with a 1.5T Siemens magnet using an echo-planar sequence (TR=2160 ms, TE=47 ms, slice thickness=5mm). The contrast of enhancement (CE), a semi-quantitative parameter inversely estimating the CBV, were calculated pixel by pixel as the ratio of the maximum signal intensity drop during the passage of contrast agent (Sm) by the baseline pre-bolus signal intensity (So) (CE=Sm/Sox100) for right and left hemisphere on two axial images. Specifically, higher CE values correspond to lower CBV and viceversa Compared to normal controls, patients with schizophrenia had significantly higher bilateral hemisphere CE values (p=0.02) and inverse CE laterality index (p=0.02). This study showed abnormally reduced and inverse hemisphere CBV in a large population of patients with schizophrenia. Hypothetically, chronic low CBV may sustain neural hypoactivation and concomitant increase of free radicals, ultimately resulting in neuronal loss and cognitive impairments. Thus, altered intracranial hemodynamics may accompany brain atrophy and cognitive deficits, being a crucial factor in the pathophysiology of schizophrenia.

Investigation of corpus callosum in schizophrenia with diffusion imaging.

BACKGROUND: Corpus callosum (CC) is the main white matter commissure between the two cerebral hemispheres. Abnormalities of CC have been shown in schizophrenia patients by magnetic resonance imaging (MRI) studies. We here further investigated CC organization with diffusion imaging (DWI) in a sample of schizophrenia patients recruited from the epidemiologically defined catchment area of South Verona, Italy. METHODS: Sixty-seven patients with schizophrenia and 70 normal controls were studied. Regions of interests (ROIs), standardized at 5 pixels, were placed in CC on the non-diffusion weighted echoplanar images (b = 0) and were then automatically transferred to the corresponding maps to obtain the apparent diffusion coefficient (ADC) of water molecules. RESULTS: ADC measures for all callosal subregions in schizophrenia patients were significantly greater compared to normal controls (ANCOVA, p < 0.05). Positive symptoms significantly correlated with anterior callosal ADC measures (partial correlation analyses, p < 0.05). CONCLUSIONS: These findings support the existence of widespread microstructure disruption of CC in schizophrenia, which may ultimately lead to inter-hemispheric misconnection, and also suggest a specific role of anterior transcallosal disconnectivity in underlying positive symptoms. Future longitudinal MRI studies in high risk and first-episode patients together with neurophysiological tests are indicated to further examine CC anatomical abnormalities and inter-hemispheric transmission in schizophrenia.

Cerebral atrophy and white matter disruption in chronic schizophrenia.

Several magnetic resonance imaging (MRI) studies have shown cerebral atrophy in established schizophrenia, although not in all reports. Discrepancies may mostly be due to population and postprocessing differences. Recently, disruption of cortical white matter integrity has also been reported in chronic patients with schizophrenia. In this study we explored tridimensional (3D) cerebral volumes and white matter microstructure in schizophrenia with structural and diffusion magnetic resonance. Twenty-five patients with established schizophrenia and 25 1:1 matched normal controls underwent a session of MRI using a Siemens 1.5T-scanner. 3D brain volume reconstruction was performed with the semi-automatic software Amira (TGS, San Diego, CA), whereas the apparent diffusion coefficients (ADCs) of cortical white matter water molecules were obtained with in-house developed softwares written in MatLab (The Mathworks-Inc., Natick, MA). Compared to controls, patients with schizophrenia had significantly smaller gray matter intracranium and total brain volumes, increased 4th ventricle volumes, and greater temporal and occipital ADCs. Patients treated with typical antipsychotic medication (N = 9) had significantly larger right lateral and 4th ventricles compared to those on atypical antipsychotic drugs. Intracranial volumes significantly inversely correlated with left temporal ADC in patients with schizophrenia. Also, age correlated directly with right, left, and 3rd ventricle volumes and inversely with gray matter intracranium volumes in individuals with schizophrenia. This study confirmed the presence of cortical atrophy in patients with schizophrenia, especially in those on typical antipsychotic drugs, and the existence of white matter disruption. It also suggested that physiological aging effects on brain anatomy may be abnormally pronounced in schizophrenia.

Three-dimensional MRI perfusion maps: a step beyond volumetric analysis in mental disorders.

A new type of magnetic resonance imaging analysis, based on fusion of three-dimensional reconstructions of time-to-peak parametric maps and high-resolution T1-weighted images, is proposed in order to evaluate the perfusion of selected volumes of interest. Because in recent years a wealth of data have suggested the crucial involvement of vascular alterations in mental diseases, we tested our new method on a restricted sample of schizophrenic patients and matched healthy controls. The perfusion of the whole brain was compared with that of the caudate nucleus by means of intrasubject analysis. As expected, owing to the encephalic vascular pattern, a significantly lower time-to-peak was observed in the caudate nucleus than in the whole brain in all healthy controls, indicating that the suggested method has enough sensitivity to detect subtle perfusion changes even in small volumes of interest. Interestingly, a less uniform pattern was observed in the schizophrenic patients. The latter finding needs to be replicated in an adequate number of subjects. In summary, the three-dimensional analysis method we propose has been shown to be a feasible tool for revealing subtle vascular changes both in normal subjects and in pathological conditions.