An assessment of the Standardized Assessment of Personality as a screening instrument for the International Personality Disorder Examination: a comparison of informant and patient assessment for personality disorder.

BACKGROUND: The International Personality Disorder Examination (IPDE) has been developed as a standardized interview for personality disorders. While it has good psychometric properties, its length makes it difficult to use in the community in population research, particularly outside psychiatric settings. The informant-based Standard Assessment of Personality (SAP), which has been in use since 1981, could serve as a valid screen to detect likely personality disordered individuals who would then receive a definitive diagnosis by IPDE. This study aimed to compare the two instruments in their capacity to detect personality disorder according to ICD-10 taxonomy and to estimate the efficiency of the use of the two together in a case-finding exercise. METHOD: Ninety psychiatric out-patients in Bangalore, India, were assessed for personality disorder using the two methods. Assessment was conducted by a pair of trained interviewers in random order and by random allocation to interviewer. RESULTS: Overall agreement between the two instruments in the detection of ICD-10 personality disorder was modest (kappa = 0.4). The level of agreement varied according to personality category, ranging from kappa 0.66 (dependent) to kappa 0.09 (dyssocial). The SAP proved to have a high negative predictive value (97%) for IPDE as the gold standard, suggesting its potential as a screen in samples where the expected prevalence of personality disorder is low. CONCLUSION: A two-stage approach to epidemiological studies of personality disorder may be practicable.

Awareness of diagnosis and psychiatric morbidity among cancer patients--a study from South India.

Awareness regarding cancer diagnosis and its relationship to psychiatric morbidity was studied in 294 newly admitted cancer patients at an oncology center in South India. Fifty-four percent of patients were aware that they had cancer and were able to discuss their diagnosis; 46% of patients reported nonawareness of diagnosis. Discriminant function analysis revealed that oral cancers and relatives' awareness of the cancer was more prevalent in the group aware of diagnosis. More patients in the "unaware" group refused treatment for psychological distress. There was no difference between the two groups in patterns and prevalence of psychiatric morbidity. The study emphasizes the complexities in assessing awareness in cancer patients and a need to study its various components and relationship to psychological distress.

Psychological well-being among cancer patients receiving radiotherapy--a prospective study.

The impact of cancer on the psychological well-being of newly diagnosed cancer patients before and during the course of radiotherapy was assessed in 70 consecutive cancer patients. Most of the patients were over 40 years of age, women, illiterate and from a lower socioeconomic group. During the course of treatment there was a decrease in the well-being scores on some dimensions such as perceived family and primary group support. Improvements were seen in the dimensions of positive feelings, coping, social support other than the family and spiritual well-being. There were no changes in the dimensions of negative feelings and perceived ill-health. The results give a profile on well-being and the changes observed during radiotherapy.

Subjective wellbeing among police personnel.

To study whether high job stress has 'spill over effect' on other dimensions of life, subjective well being inventory (SWBI) and GHQ were administered to 201 policeman selected randomly from Bangalore city, India. Policemen scored significantly high in all dimensions expect in social support when compared to urban middle class men working in factories. The police who scored low in GHQ had significantly higher scores in all dimensions of SWBI except in social contact. The results indicate that various dimensions of SWB of police are not affected. Psychosocial and job related factors buffering job stress have to be studied and further strengthened.

Neurobiological characterization of bipolar affective disorders : a focus on tardive dyskinesia and soft neurological signs in relation to serum dopamine Beta hydroxylase activity.

In this study, the prognostic determinants were investigated involving bipolar patients classified into two groups-one with favourable course and outcome, and the other with clearly unfavourable prognosis, based on certain recommended criteria, with intermediate prognosis were excluded. As compared to the poor prognosis group, the good prognosis group had lower social dysfunctions, lower ratings on psychopathotogy fewer indicators of neurodysfunction in form of neurological soft signs (NSS) and tardive dyskinesia (TD). The poor prognosis group was characterized by: (i) older age at onset; (ii) more manic than depressive episodes (5:1) and (HI) lower levels of serum dopamine-ß-hydroxylase activity (DBH). The association between poor prognosis bipolar disorder having neuroleptic intolerance (TD and NSS) with low serum DBH, suggests that it is genetically governed. Further research in this direction seems in order, particularly the follow up of first episode manic disorders.

Risperidone in Indian patients with schizophrenia.

Conventional antipsychotic agents are not effective against negative symptoms of schizophrenia and are also noted for their extrapyramidal side effects. Risperidone is a noval antipsychotic agent whose dual antagonism of dopamine and serotonin receptors is believed to underlie its efficacy against negative symptoms and the low incidence of extrapyramidal side effects. An open, non-comparative study of seven weeks duration was performed to evaluate risperidone in the treatment of schizophrenia in Indian patients. Previous antipsychotic therapy was discontinued for a week before risperidone therapy was initiated. At the end of six weeks of risperidone therapy, clinical improvement (≥ 20% reduction in total score on positive and negative syndrome scale for schizophrenia (PANSS;; was shown by 128 (87.7%) of the 146 evaluable patients. Statistically significant reduction (p < 0.05) occurred in the total score of this scale and in the subscale scores for positive, negative and general psychopathology symptoms and in the clinical global impression severity score. The number of patients with adverse experiences were 108 (65.5%) at baseline and 120 (72.7%) at the end of risperidone therapy. Extrapyramidal symptoms, seen in 65 (39.4%) patients compared to 22 (13.3%) patients at baseline, were largely mild to moderate in intensity.

Cerebrospinal fluid viral antibodies in obsessive-compulsive disorder in an Indian population.

Immunoglobulin G viral antibodies for herpes simplex virus type 1, varicella zoster virus, cytomegalovirus, measles, and mumps were studied in 76 subjects with obsessive-compulsive disorder and compared with a control population. There was a significantly higher titer for herpes simplex virus type 1 antibodies. Sera: cerebrospinal fluid ratios were suggestive of intrathecal synthesis.

Therapy with amineptine, a dopamine reuptake inhibitor, in patients with major depression.

The original tricyclic antidepressant drugs are consistently underused in major depression because of side effects, delayed onset of action, and potential for overdose. In an open study of 6 weeks' duration, we studied the efficacy and acceptability of amineptine, a dopamine reuptake inhibitor, at fixed dose of 200 mg per day in 50 patients with major depression.Intention-to-treat analysis showed a patient response rate of 64% (95% CI 77-50) in HDRS, 62% (95% CI 75-48) in MADRS, 46% (95% CI 59-32) in ZUNG scale, 52% (95% CI 66-38) in Social Activity scale, and 26% ("95% CI 38-14) in CGI-severity of illness after 7 days treatment. Response in CGI-global improvement was 38% (95% CI 51-25), and in CGI-efficacy index 48% (95% CI 62-34) after 14 days of treatment. With continued therapy, only CGI-severity of illness showed a significant increase in response rate after 42 days. The treatment effect of amineptine was reflected in a significant and progressive improvement in all depression, social activity, and CGI rating scale scores throughout the study period. Somatic symptoms and side effects assessed by AMDP-5 showed significant improvement at each assessment.The clinically useful response in depression which occurred by the first week of treatment, favourable side effect profile, and the convenience of a fixed dose could make amineptine a suitable first line alternative for the treatment of major depression.

Viral antibodies in blood in obsessive compulsive disorder.

IgG viral antibodies for herpes simplex virus -1, varicella zoster virus, cytomegalovirus, measles and mumps were studied in 76 subjects with obsessive compulsive disorder and compared with a control population. There was a significantly higher titre for some of the antibodies, most specifically for herpes simplex virus type 1 and mumps. This suggests a possible role for these viral infections in the pathogenesis of obsessive compulsive disorder.

Stigma, depression, and somatization in South India.

OBJECTIVE: The relationships of stigma to both depression and somatization were studied in psychiatric patients in South India to test the hypothesis that stigma is positively related to depressive symptoms and negatively related to somatoform symptoms. METHOD: Illness experience, symptom prominence, and indicators of stigma for 80 psychiatric outpatients were addressed with the Explanatory Model Interview Catalogue. Stigma scores and ratings of symptom prominence were derived. The Structured Clinical Interview for DSM-III-R and the Hamilton Depression Rating Scale were administered to assess psychiatric diagnoses and symptoms of depression. Clinical narratives were analyzed to clarify the nature of relationships between stigma and symptom prominence. RESULTS: The mean stigma scores were 18.2 (SD = 13.0) for patients with somatoform disorders only, 36.0 (SD = 19.0) for patients with depressive disorders only, and 26.8 (SD = 16.0) for those with mixed depressive and somatoform disorders. The stigma scores were positively related to depressive symptoms, as indicated by Hamilton scale scores and prominence ratings for depressive symptoms, but stigma was inversely related to somatoform symptoms, as indicated by ratings of symptom prominence. Although both depressive and somatic symptoms were distressing, qualitative analysis clarified meanings of perceived stigma, showing that depressive symptoms, unlike somatic symptoms, were construed as socially disadvantageous. CONCLUSIONS: The tendency to perceive and report distress in psychological or somatic terms is influenced by various social and cultural factors, including the degree of stigma associated with particular symptoms. This study with the Explanatory Model Interview Catalogue demonstrates how quantitative and qualitative methods can be effectively combined to examine key issues in cultural psychiatry.

Erythrocyte aldehyde dehydrogenase = a potential marker for alcohol dependence.

The present study explored the utility of erythrocyte aldehyde dehydrogenase (ALDH) as a peripheral marker in alcoholism. The ALDH levels in aocoholics, their first degree nonalcholic relative and controls were compared. ALDH was found to be significantly lower in alcoholics (3.38±1.70 mU p< 0.001) and their first degree relatives (4.04±1.55 mU p< 0.05) compared to controls (5.06±1 55mU). Low ALDH levels among alcoholics persisted despite abstinence. The levels did not correlate with indices of hepatic dysfunction or with severity of alcoholism. These findings indicate that low erythrocyte ALDH may be considered as a biochemical trait marker associated with alcoholics, and the alcohol abuse would further decrease enzyme activitiy. To evaluate this proposition, logitudinal studies involving high risk progeny of alcohol dependents is being planned.

Cultural dimensions of psychiatric diagnosis. A comparison of DSM-III-R and illness explanatory models in south India.

BACKGROUND: Cross-cultural research to examine the cultural validity of diagnostic categories and underlying concepts requires methods that integrate epidemiological and anthropological frameworks. METHOD: The Explanatory Model Interview Catalogue (EMIC) and Structured Clinical Interview for DSM-III-R (SCID) were used to study 80 psychiatric out-patients with depressive neurosis at a clinic in south India. RESULTS: Summary kappa values of 0.75 for the EMIC and 0.68 for the SCID confirmed interrater reliability. Comparison of patient explanatory models and SCID diagnoses showed that patients emphasised somatic experience while clinicians emphasised depressive diagnoses. More than half the patients (55%) received a non-specific or dual diagnosis. CONCLUSIONS: These findings raise questions about the distinctiveness of depressive, anxiety, and somatoform (DAS) disorders for this population.

Family pathology and anorexia in the Indian context.

Frequent associations have been found between family interaction and anorectic behaviour. Family theorists have viewed anorexia as a manifestation of a dysfunctional family system. We report three families of cases of anorexia (one male and two female) where the symptom was a reflection of family pathology and was being maintained by it. The cases emphasize the need to assess families of anorectics in detail and view them in the cultural context of eating.

P300 amplitudes vary inversely with continuum of risk in first degree male relatives of alcoholics.

First degree relatives of alcoholics show significantly reduced P300 amplitudes. This phenomenon is though to be a vulnerability marker of alcoholism. Relatives of alcoholics with higher family loading and early onset alcoholism are at greater risk for developing alcoholism. The high risk population may comprise subtypes differentiated by family history and/or age at onset of alcoholism, with differing risks, measurable in terms of the expression of the vulnerability marker. Four groups of alcohol-naive sons/male siblings of alcoholics (n = 64) were studied. The groups were constructed on the permutation of two defining characteristics: high family loading (two or more first degree alcoholic relatives) and early onset alcohol dependence (before 25 years) in the relatives. Comparison of P300 amplitude in an auditory paradigm showed significant inter-group differences as well as progressive increase/normalization of amplitudes from the high loading-early onset group (HR1) to the low loading-late onset group (HR4), with the latter being indistinguishable from a separate group of (control) normals. There were no significant differences of P300 latency among the groups. We conclude that P300 amplitudes vary inversely with the presumed continuum of risk in those at high risk for developing alcoholism.

Mental health delivery system in general hospitals attached to medical colleges.

The psychiatric patient care facilities and services of fifty seven general hospitals attached to medical colleges in India were studied based on data pertaining to 1988. The average bed strength was 25 beds while the average length of stay was 21 days. Functional psychotics formed 62% of the discharged patients. On the average, 2914 new psychiatric outpatients were registered per hospital and follow up attendance was 3.2 times more than the number of new cases. The implications of these findings and the method of obtaining average length of stay are discussed.

The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders.

BACKGROUND: One of the aims of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration joint program on psychiatric diagnosis and classification is the development and standardization of diagnostic assessment instruments for use in clinical research worldwide. The International Personality Disorder Examination (IPDE) is a semistructured clinical interview compatible with the International Classification of Diseases, Tenth Revision, and the DMS-III-R classification systems. This is the first report of the results of a field trial to investigate the feasibility of using the IPDE to assess personality disorders worldwide. METHODS: The IPDE was administered by 58 psychiatrists and clinical psychologists to 716 patients enrolled in clinical facilities at 14 participating centers in 11 countries in North America, Europe, Africa, and Asia. To determine interrater reliability, 141 of the IPDEs (20%) were independently rated by a silent observer. To determine temporal stability, 243 patients (34%) were reexamined after an average interval of 6 months. RESULTS: The IPDE proved acceptable to clinicians and demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. CONCLUSION: It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.

Interhemispheric electroencephalographic coherence as a biological marker in alcoholism.

Electroencephalographic coherence scores in 21 teetotaler first-degree relatives of alcoholics, 27 subjects with alcohol dependence and 21 healthy subjects without a family history of alcohol abuse were compared. The relatives had significantly higher coherence scores in the frontal and parietal leads than the alcoholics and in the frontal and centroparietal leads than in the healthy subjects. This might represent a trait marker of resilience in subjects at high risk for the development of alcoholism.

Diazepam- and chlordiazepoxide-mediated increases in erythrocyte aldehyde dehydrogenase activity and its possible implications.

Erythrocyte ALDH activity was assayed in alcoholic (n = 70) and nonalcoholic (n = 40) subjects. In general, alcoholics without any prior medications (n = 57) were found to have a decreased ALDH activity (mean +/- SD: 3.38 +/- 1.7 mU; p less than 0.001) as compared to control group (5.10 +/- 1.57 mU). However, a group of alcoholics who were detoxified with benzodiazepines (n = 13) prior to blood collection for enzyme assay were found to have higher ALDH activity (4.92 +/- 2.46 mU; p less than 0.05) as compared to alcoholics who were not detoxified. In vitro experiments demonstrated that both diazepam (DZM) and chlordiazepoxide (CDP) could activate the ALDH. The magnitude of enzyme activation by DZM and CDP appear to correlate with their relative potency of tranquilizing effect. Further, the observed ability of DZM to reverse the inhibition of ALDH mediated by disulfiram may explain the biochemical basis of the reported ability of benzodiazepines (BDZ) to reduce the intensity of disulfiram ethanol reaction (DER).