Childhood Trauma and Premenstrual Symptoms: The Role of Emotion Regulation.

BACKGROUND: Women with Premenstrual Dysphoric Disorder (PMDD) are more likely to have a history of childhood trauma, and may experience more severe premenstrual symptomatology. However, the pathway in which childhood trauma affects the prevalence and severity of premenstrual symptoms remains largely unclear. OBJECTIVE: To determine whether childhood trauma is associated with increased premenstrual symptoms, and if so, whether emotional dysregulation mediates or moderates this relationship. PARTICIPANTS AND SETTINGS: A total of 112 women were recruited for the study among students at the Hebrew University of Jerusalem. METHODS: Participants completed the Premenstrual Symptoms Screening Tool (PSST), the Childhood Trauma Questionnaire (CTQ) and the Difficulties in Emotion Regulation Scale (DERS). To test the mediation hypothesis, direct and indirect effects of childhood trauma on premenstrual symptoms were calculated. To test moderation, we performed multiple regression, including the interaction term between childhood trauma and emotion dysregulation RESULTS: Twenty-two women (18.6%) met criteria for premenstrual syndrome (PMS) and sixteen (13.6 %) for PMDD. The number and severity of premenstrual symptoms increased with more childhood trauma (r = .282), and this relationship was completely mediated by emotion regulation difficulties. Specifically, exposure to Sexual abuse (r = .243) and Emotional neglect (r = .198) were significantly associated with premenstrual symptoms. Abuse predicted greater emotion dysregulation (r = .33), whereas, neglect did not. CONCLUSIONS: This study contributes to the current knowledge on the long-term effects of childhood trauma. Promoting use of adaptive emotion regulation strategies for women with a history of childhood trauma, could improve their capability to confront and adapt to premenstrual changes.

Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists.

OBJECTIVE: Psychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice liability that is not for the sole benefit of the patient's mental health and well-being. The objectives of this study were to assess the scope of DP practised by psychiatrists and to understand whether awareness of DP correlated with defensive behaviours. METHODS: A questionnaire was administered to 213 Israeli psychiatry residents and certified psychiatrists during May and June 2015 regarding demographic data and experience with malpractice claims, medicolegal literature and litigation. Four clinical scenarios represented defensive behaviours and reactions (feelings and actions) to malpractice claims. RESULTS: Forty-four (20.6%) certified psychiatrists and four (1.9%) residents were directly involved in malpractice claims, while 132 (62.1%) participants admitted to practising DP. Residents acknowledged the practice of DP more than did senior psychiatrists (p=0.038).Awareness of DP correlated with unnecessary hospitalisation of suicidal patients, increased unnecessary follow-up visits and prescribing smaller drug dosages than required for pregnant women and elderly patients. CONCLUSIONS: This study provides evidence that DP is well established in the routine clinical daily practice of psychiatrists. Further studies are needed to reveal whether DP effectively protects psychiatrists from malpractice suits or, rather, if it impedes providing quality psychiatric care and represents an economic burden that leads to more harm for the patient.

Deterioration of mental health in bariatric surgery after 10 years despite successful weight loss.

BACKGROUND/OBJECTIVE: The present study evaluated the mental health and psychological functioning of bariatric patients before surgery, and after 1 year and 10 year follow-ups, and compared them with participants in a dietary program. Such long follow-up is rare, but strongly recommended by the American Association of Bariatric Surgeons. SUBJECTS/METHODS: Thirty-six bariatric surgery patients and 34 participants of a weight loss program were weighed and assessed at all 3 points in time. Participants were administered the mental health inventory, neuroticism, sense of control and fear of intimacy scales. Along with these mental and psychological measurements, the medical outcome short form (SF-36) was used. RESULTS: The surgery group achieved successful weight loss outcomes (27% reduction of pre-operative weight) after 10 years and better than baseline health-related quality-of-life scores. However, their general mental health, neuroticism, sense of control and fear of intimacy scores showed significant deterioration in comparison to pre-operative levels after 10 years. The dietary group participants remained psychologically stable among all three points in time. CONCLUSIONS: This study highlights the importance of identifying a risk group among bariatric patients for which the dietary and psychological follow-up may be of special significance.

Well being, psychopathology and coping strategies in psoriasis compared with atopic dermatitis: a controlled study.

BACKGROUND: There is a vast literature describing the association between psoriasis, atopic dermatitis (AD) and psychological distress. Some of these studies were uncontrolled and others used non-dermatological diseases as control, but only a few used chronic skin diseases as controls. OBJECTIVE: To compare well being, psychopathology and coping strategies of psoriatic, AD and healthy controls in a prospective case-control study. METHODS: Thirty-seven psoriatic patients and 31 AD patients were recruited from the Hadassah Ein Karem Hospital, Jerusalem, Israel, outpatient and inward clinic. The participants in the control group were 31 healthy workers and volunteers with no dermatological diseases from Kaplan Hospital, Rehovot, Israel. We used self-report questionnaires [Mental Health Inventory (MHI) and Adjustment to Chronic Skin Diseases Questionnaire (ACSD)], a projective technique (Hand Test) and assessment tools (Clinical Global Impression). RESULTS: Psoriatic patients experienced reduced well being (P = 0.007) and more anxiety and depression (P = 0.018) than normal controls. Psoriatic patients also displayed more severe psychopathology (P = 0.039) a more passive attitude towards life, and loss of meaning in life (P = 0.001) as measured by the projective technique compared with AD patients and normal controls. CONCLUSIONS: We propose two explanations, derived from the psychological and the psycho-neuro-immunological domains. First, greater mental distress in psoriasis is because of the greater stigma it bears compared with AD. Alternatively, we hypothesize that the psoriatic inflammatory process may possibly have a direct central nervous system effect.

Blood mononuclear cell gene expression signature of postpartum depression.

In sorrow thou shalt bring forth children (Genesis 3:16) seems as relevant today, with one of seven mothers afflicted by a depressive episode, constituting the most common medical complication after delivery. Why mothers are variably affected by mood symptoms postpartum remains unclear, and the pathogenesis and early molecular indicators of this divergent outcome have not been described. We applied a case-control design comparing differential global gene expression profiles in blood mononuclear cells sampled shortly after delivery at the time of inception of postpartum depression (PD). Nine antidepressant naive mothers showing high depressive scores and developing a persisting major depressive episode with postpartum onset were compared with 10 mothers showing low depressive scores and no depressive symptoms on prospective follow-up. A distinctive gene expression signature was observed after delivery among mothers with an emergent PD, with a significant overabundance of transcripts showing a high-fold differential expression between groups, and correlating with depressive symptom severity among all mothers. Early expression signatures correctly classified the majority of PD patients and controls. Those developing persisting PD exhibit a relative downregulation of transcription after delivery, with differential immune activation, and decreased transcriptional engagement in cell proliferation, and DNA replication and repair processes. Our data provide initial evidence indicating that blood cells sampled shortly after delivery may harbor valuable prognostic information for identifying the onset of persisting PD. Some of the informative transcripts and pathways may be implicated in the differential vulnerability that underlies depression pathogenesis.

Altered expression of genes involved in ATP biosynthesis and GABAergic neurotransmission in the ventral prefrontal cortex of suicides with and without major depression.

The prefrontal cortex is believed to play a major role in depression and suicidal behavior through regulation of cognition, memory, recognition of emotion, and anxiety-like states, with numerous post-mortem studies documenting a prefrontal serotonergic dysregulation considered to be characteristic of depressive psychopathology. This study was carried out to detect changes in gene expression associated with both suicide and major depression using oligonucleotide microarrays (Affymetrix HG-U133 chip set) summarizing expression patterns in primarily ventral regions of the prefrontal cortex (BA44, 45, 46 and 47). A total of 37 male subjects were included in this study, of which 24 were suicides (depressed suicides=16, nondepressed suicides=8) and 13 were matched controls. All subjects were clinically characterized by means of psychological autopsies using structured interviews. Unique patterns of differential expression were validated in each of the cortical regions evaluated, with group-specific changes highlighting the involvement of several key neurobiological pathways that have been implicated in both suicide and depression. An overrepresentation of factors involved in cell cycle control and cell division (BA44), transcription (BA44 and 47) and myelination (BA46) was seen in gene ontology analysis of differentially expressed genes, which also highlights changes in the expression of genes involved in ATP biosynthesis and utilization across all areas. Gene misexpression in BA46 was most pronounced between the two suicide groups, with many significant genes involved in GABAergic neurotransmission. The pronounced misexpression of genes central to GABAergic signaling and astrocyte/oligodendrocyte function provides further support for a central glial pathology in depression and suicidal behavior.

Patterns of gene expression in the limbic system of suicides with and without major depression.

The limbic system has consistently been associated with the control of emotions and with mood disorders. The goal of this study was to identify new molecular targets associated with suicide and with major depression using oligonucleotide microarrays in the limbic system (amygdala, hippocampus, anterior cingulate gryus (BA24) and posterior cingulate gyrus (BA29)). A total of 39 subjects were included in this study. They were all male subjects and comprised 26 suicides (depressed suicides=18, non depressed suicides=8) and 13 matched controls. Brain gene expression analysis was carried out on human brain samples using the Affymetrix HG U133 chip set. Differential expression in each of the limbic regions showed group-specific patterns of expression, supporting particular neurobiological mechanisms implicated in suicide and depression. Confirmation of genes selected based on their significance and the interest of their function with reverse transcriptase-polymerase chain reaction showed consistently correlated signals with the results obtained in the microarray analysis. Gene ontology analysis with differentially expressed genes revealed an overrepresentation of transcription and metabolism-related genes in the hippocampus and amygdala, whereas differentially expressed genes in BA24 and BA29 were more generally related to RNA-binding, regulation of enzymatic activity and protein metabolism. Limbic expression patterns were most extensively altered in the hippocampus, where processes related to major depression were associated with altered expression of factors involved with transcription and cellular metabolism. Additionally, our results confirm previous evidence pointing to global alteration of gabaergic neurotransmission in suicide and major depression, offering new avenues in the study and possibly treatment of such complex disorders. Overall, these data suggest that specific patterns of expression in the limbic system contribute to the etiology of depression and suicidal behaviors and highlight the role of the hippocampus in major depression.

Psychometric properties of goal-attainment scaling in the assessment of mann's time-limited psychotherapy.

This study tested the reliability and validity of Goal-Attainment Scaling (GAS) in assessing outcome in Mann's Time-Limited Psychotherapy (TLP). Judges constructed GAS scales for 33 patients on five dimensions: severity of symptoms, self-esteem, same-sex friendships, romantic relationships, and work performance. Patients in the treatment group received 12 sessions of TLP, whereas controls were in a waiting list for the same period of time (12 weeks) before starting time-limited psychotherapy. Judges rated all patients on GAS before beginning therapy, at termination, and follow-up. Mean interrater reliability of scores between pairs of judges was r = .88. Convergent validity of the GAS was confirmed by moderate to high correlations with the Health-Sickness Rating Scale (r = .70, p < .001), the Target Complaints Scale (r = .50, p <.01), and the Brief Symptom Inventory (r = .38, p < .05). The findings are discussed and recommendations are made for the reliable and valid use of the GAS in psychotherapy outcome research.

The impact of parental death versus separation from parents on the mental health of Israeli adolescents.

Early research suggested that the loss of a parent during childhood can lead to depression and other psychopathology in children and adults. More recent research has differentiated between loss due to death and separation from parents and has questioned the link between early parental death and psychopathology. We examined the hypothesis that separation from parents has a more detrimental effect than the death of a parent on the mental health of adolescents in the community. Israeli adolescents (N = 844) with a mean age of 16.7 +/- 1.0 years (mean +/- SD) participated in this study. Seventy reported that a parent did not live at home during one of three 5-year periods until they reached the age of 15; 37 reported the death of a parent and 777 were from intact families. All participants completed the Brief Symptom Inventory (BSI), General Well Being Schedule (GWB), Parental Bonding Instrument (PBI), and Perceived Social Support Family/ Friends Scales (PSS-Fam and PSS-Fr). Adolescents who had experienced separation from parents had more psychiatric symptoms (BSI), expressed a lower sense of well-being (GWB), experienced less support from their family (PSS-Fam), and felt less cared for and more controlled by their parents (PBI) compared with those belonging to intact families. The death of a parent was not associated with significantly different scores on these variables. When we controlled for parental bonding (PBI) and perceived social support from family (PSS-Fam), the differences between the separation group and the intact family group were no longer significant. The psychological impact of separation from parents involves a greater risk for psychopathology than the death of a parent. The quality of the relationship with the parents moderates the negative impact of separation from them.

Childhood imaginary companionship and mental health in adolescence.

An imaginary companion (IC) is a frequently encountered childhood fantasy, invisible to anyone but the child, who may be named, addressed or played with. Whether the presence of an IC is a normal developmental feature has not been determined. We examined psychometric measures and the presence/absence of childhood IC in a sample of 850 mentally healthy adolescents. 17.6% of our subjects, more often females, reported having had such a companion. Subjects who reported having had an IC in childhood exhibited higher levels of distress and emotional discontrol, displayed prolonged transitional object attachment and immature modes of coping with stress. Thus, although childhood imaginary companionship is not indicative of psychopathology, it may denote a vulnerability for adolescent perturbation and difficulty in coping with emotionally laden situations.

Childhood vs. adolescence transitional object attachment, and its relation to mental health and parental bonding.

871 participants, 375 boys and 496 girls, mean age 16.7 + 1, were administered the Parental Bonding Instrument (P.B.I.), the Brief Symptom Inventory (B.S.I.), the General Well-Being Questionnaire (G.W.B.) and the Chestnut Lodge Transitional Object Scale. Results supported Winnicott's theory: participants reporting attachment to a Transitional Object (T.O.) in their childhood reported significantly more optimal maternal bonding than participants who were not attached to a T.O. Participants reporting attachment to a T.O. in adolescence had significantly more psychiatric symptoms and less general well-being. Adolescence T.O. attachment might be considered a marker of mental distress in the general, normal population.

Word Association Test and psychosexual cues in assessing persons with eating disorders.

The present study aimed to detect psychosexual conflicts in patients with eating disorders using the Word Association Test which tests the perceptual sensitivity of the subject to conflictual words. We also expected patients to show concern about food and eating. 19 anorexic patients, 21 bulimic patients, and 20 control subjects without eating disorders provided associations to four groups of words: psychosexual words, food words, emotionally loaded words, and neutral words. Reaction times were recorded. Analysis showed that anorexic patients were slower than controls in responding to food-related words but bulimic patients were not significantly different from controls. Anorexic patients reacted more slowly than controls to psychosexual words. Bulimic patients were also somewhat slower than controls but faster than anorexic patients; however, these differences were not statistically significant. Results are congruent with research that points to sexual problems and delays in the psychosexual development of anorexic patients and to a lesser extent of bulimic patients.

Pre-adolescent chumship as a buffer against psychopathology in adolescents with weak family support and weak parental bonding.

This study examines the degree to which the existence of a pre-adolescent "chum" interacts with family and social environments to buffer mental distress in adolescents. 831 high school students participated in this study, (male: 355; female: 476; mean age 16.7 +/- 1.0). Subjects were administered questionnaires assessing psychopathology and support systems. A pathway analyses model was used to investigate pathways and their interrelationships from chum to psychopathology and from social and family support to psychopathology. Only when adolescents experience weak parental bonding does chumship have a role in buffering distress.

Parental bonding and mental health in adolescence.

Attachment between parent and child plays a crucial role in the healthy development of the child. Accordingly disturbances in parental bonding will be linked with the development of mental disorders later in life. The present study examines the relationship between parental bonding and mental health in healthy adolescents. Participants were 847 Israeli high school students who completed the Parental Bonding Instrument (PBI), the Brief Symptom Inventory (BSI), the General Well-Being (GWB), the Perceived Social Support (PSS), and the Social Desirability scale (SDS). In general, Israeli adolescents reported more parental care and less control than did Australian adolescents and adults. Female subjects reported more maternal care than did males. Subjects who reported high care and low control (optimal bonding) reported less distress, better general well-being and better social support that did all other groups. In contrast, those who reported low care and high control (affectionless control bonding) had the highest BSI scores and the lowest GWB and PSS scores. These results are in line with Bowlby's theory of attachment. They also show that specific configuration of parental bonding are linked with distress and isolation in adolescents.

Psychological well-being and ratings of psychiatric symptoms in bereaved Israeli adolescents: differential effect of war-versus accident-related bereavement.

Eight hundred seventy-one Israeli adolescents, 375 boys and 496 girls, mean age 16.7 +/- 1, participated in this study. Twenty-three of them lost relatives in war and 19 in road accidents. All participants were administered the Brief Symptom Inventory (BSI), the General Well-being Scale (GWB), the Parental Bonding Instrument (PBI) and the Perceived Social Support-Family/Friend (PSS-Fa and PSS-Fr) measures. War-bereaved adolescents showed significantly higher scores in psychological well-being (GWB) and significantly lower scores in reported psychiatric symptoms (BSI) than accident-bereaved adolescents. War-bereaved adolescents also had significantly better BSI and GWB scores than the general nonbereaved adolescent population. These results persisted after controlling for family socio-economic status, gender, and the degrees of closeness of the deceased relative. War-bereaved adolescents did not differ either from accident-bereaved adolescents or from the nonbereaved general adolescent population in social and family support systems (PSS-Fr, PSS-Fa) and did not experience different basic parental attitudes (PBI). Results are discussed in terms of the different meanings ascribed to death in battle versus death in a road accident.

Physical punishment and signs of mental distress in normal adolescents.

Adolescents (375 males and 496 females) were administered the Brief Symptom Inventory (BSI), the General Well-Being Scale (GWB), the Parental Bonding Instrument (PBI), and two questions about each parent, supplementing the PBI, tapping violent punitive behavior. Signs of mental distress in adolescents and reported physical punishment from parents were analyzed. Results indicated that greater physical punishment was associated with higher levels of psychiatric symptoms and lower general well-being. These results persisted after controlling for parental attitudes, as quantified by the PBI, and socioeconomic status. The findings of this study can contribute to efforts to raise public awareness of the negative consequences of physical punishment on the mental health of children.

Predictors of PTSD in injured trauma survivors: a prospective study.

OBJECTIVE: The aim of this study was to prospectively examine the relationship between immediate and short-term responses to a trauma and the subsequent development of posttraumatic stress disorder (PTSD). METHOD: All patients consecutively admitted to a general hospital were screened for the presence of physical injury due to a traumatic event. Fifty-one eligible subjects were assessed 1 week and 6 months after the trauma. The initial assessment included measures of event severity, peritraumatic dissociation, and symptoms of intrusion, avoidance, depression, and anxiety. The follow-up assessments added the PTSD module of the Structured Clinical Interview for DSM-III-R--Non-Patient Version and the civilian trauma version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. RESULTS: Thirteen subjects (25.5%) met PTSD diagnostic criteria at follow-up. Subjects who developed PTSD had higher levels of peritraumatic dissociation and more severe depression, anxiety, and intrusive symptoms at the 1-week assessment. Peritraumatic dissociation predicted a diagnosis of PTSD after 6 months over and above the contribution of other variables and explained 29.4% of the variance of PTSD symptom intensity. Initial scores on the Impact of Event Scale predicted PTSD status with 92.3% sensitivity and 34.2% specificity. Symptoms of avoidance that were initially very mild intensified in the subjects who developed PTSD. CONCLUSIONS: Peritraumatic dissociation is strongly associated with the later development of PTSD. Early dissociation and PTSD symptoms can help the clinician identify subjects at higher risk for developing PTSD.

Israeli adolescents' norms of the Brief Symptom Inventory (BSI).

The internal consistency and concurrent validity of a Hebrew version of Derogatis' Brief Symptom Index (BSI) were assessed in a sample of 840 high school students from three different towns in Israel. The results show high levels of internal consistency and good concurrent validity of the Hebrew version. The type of high school and the country of origin of the subjects' parents had no significant effect on BSI scores. Differences between Israeli and US subjects are reported. BSI norms presented in this study might be used in further studies in Israel.