Depressive personality and dysthymia: Evaluating symptom and syndrome overlap

Background: Depressive Personality (DP) is being evaluated for future inclusion in DSM. One recurring issue has been conceptual and empirical redundancy with Dysthymia (i.e., Dysthymic Disorder; DD). Methods: The symptom and syndrome overlap of DP and DD were tested in a clinical sample (N = 125) using both self-report and clinician ratings. Results: Confirmatory factor analyses of the DP and DD symptoms indicated that models which separate these two syndromes had a better fit than a model in which all symptoms were classified together, particularly for the clinician-rated data. At the same time, the syndromes were highly correlated. Binary diagnostic analysis showed that over 80% of the individuals meeting criteria for DP also met criteria for DD. As predicted, the best fit was obtained when the 'psychological' symptoms of DD - low self-esteem and feelings of hopelessness - were allowed to be part of both syndromes, and 82% of patients who met criteria for both DP and DD endorsed these two symptoms. Limitations: Clinical ratings rather than structured diagnostic interviews were used. As well, some models required modification to improve fit. Conclusions: Depressive personality traits can be empirically separated from DD symptoms, but including DP as a categorical diagnosis would lead to a high degree of diagnostic overlap. Much of this overlap is due to sharing psychological features in common. Revisions in the diagnostic system should find a way to incorporate depressive personality traits without insisting that they be diagnosed in a categorical manner. © 2006 Elsevier B.V. All rights reserved

Cognitive change in cognitive-behavioural therapy

BACKGROUND: Although cognitive-behavioural therapy (CBT) is a well-established treatment for adult depression, its efficacy and efficiency may be enhanced by better understanding its mechanism(s) of action. According to the theoretical model of CBT, symptom improvement occurs via reductions in maladaptive cognition. However, previous research has not established clear evidence for this cognitive mediation model. METHODS: The present study investigated the cognitive mediation model of CBT in the context of a randomized controlled trial of CBT v. antidepressant medication (ADM) for adult depression. Participants with major depressive disorder were randomized to receive 16 weeks of CBT (n = 54) or ADM (n = 50). Depression symptoms and three candidate cognitive mediators (dysfunctional attitudes, cognitive distortions and negative automatic thoughts) were assessed at week 0 (pre-treatment), week 4, week 8 and week 16 (post-treatment). Longitudinal associations between cognition and depression symptoms, and mediation of treatment outcome, were evaluated in structural equation models. RESULTS: Both CBT and ADM produced significant reductions in maladaptive cognition and depression symptoms. Cognitive content and depression symptoms were moderately correlated within measurement waves, but cross-lagged associations between the variables and indirect (i.e. mediated) treatment effects were non-significant. CONCLUSIONS: The results provide support for concurrent relationships between cognitive and symptom change, but not the longitudinal relationships hypothesized by the cognitive mediation model. Results may be indicative of an incongruence between the timing of measurement and the dynamics of cognitive and symptom change

The role of outcome expectancy in therapeutic change across psychotherapy versus pharmacotherapy for depression.

BACKGROUND: Patient outcome expectancy - the belief that treatment will lead to an improvement in symptoms - is linked to favourable therapeutic outcomes in major depressive disorder (MDD). The present study extends this literature by investigating the temporal dynamics of expectancy, and by exploring whether expectancy during treatment is linked to differential outcomes across treatment modalities, for both optimistic versus pessimistic expectancy. METHODS: A total of 104 patients with MDD were randomized to receive either cognitive behavioral therapy (CBT) or pharmacotherapy for 16 weeks. Outcome expectancy was measured throughout treatment using the Depression Change Expectancy Scale (DCES). Depression severity was measured using both the Hamilton Depression Rating Scale and Beck Depression Inventory-II. RESULTS: Latent growth curve models supported improvement in expectancy across both treatments. Cross-lagged panel models revealed that both higher optimistic and lower pessimistic expectancy at mid-treatment predicted greater treatment response in pharmacotherapy. For CBT, the associative patterns between expectancy and depression differed as a function of expectancy type; higher optimistic expectancy at pre-treatment and lower pessimistic expectancy at mid-treatment predicted greater treatment response. LIMITATIONS: The sample size limited statistical power and the complexity of models that could be explored. CONCLUSIONS: Results suggest that outcome expectancy improved during treatment for depression. Whether outcome expectancy represents a specific mechanism for the reduction of depression warrants further investigation

On the Convergence Between PSY-5 Domains and PID-5 Domains and Facets: Implications for Assessment of DSM-5 Personality Traits

The DSM-5 Personality and Personality Disorders workgroup and their consultants have developed the 220-item, self-report Personality Inventory for the DSM-5 (PID-5) for direct assessment of the proposed personality trait system for DSM-5; however, most p

Psychometric properties of a revised Spanish 20-item Toronto Alexithymia Scale adaptation in multiple sclerosis patients

There have been a small number of investigations of alexithymia in multiple sclerosis (MS) using the 20-item Toronto Alexithymia Scale (TAS-20). However, the TAS-20 factor structure has not yet been evaluated in a MS patient sample, and earlier Spanish translations of this instrument require some improvement. We aimed to evaluate the factorial validity and reliability of an improved Spanish translation of the TAS-20 (the TAS-20-S). The TAS-20-S was completed by 221 MS patients. Confirmatory factor analysis was used to compare the fit of six different factor models. Internal consistency and retest reliability coefficients were also computed. The correlated three-factor model and the higher-order factor model made up of Difficulty Identifying Feelings, Difficulty Describing Feelings, and Externally Oriented Thinking achieved the best fit. Alpha coefficients ranged between .87 and .67; mean inter-item correlations ranged between .48 and .20; and retest correlations after 6 months ranged between .61 and .52. A high degree of alexithymia was present in 18.1% of the sample. Reliability and the traditional three-factor structure were demonstrated for the TAS-20-S, which can now be recommended for assessing an aspect of emotional processing in MS patients.En la esclerosis múltiple (EM) son escasas las investigaciones centradas en evaluar la alexitimia con la Escala de Alexitimia de Toronto (TAS-20). A pesar de ello, no se ha evaluado aún su estructura factorial en dicha población y, además, las anteriores traducciones al español necesitan modificaciones. Los objetivos del presente estudio fueron evaluar la validez factorial y la fiabilidad de una traducción mejorada en español de la TAS-20 (la TAS-20-S), la cual fue administrada en una muestra de 221 pacientes con EM. Se realizaron análisis factoriales confirmatorios para comparar el ajuste de seis modelos factoriales. También se calcularon coeficientes de consistencia interna y de fiabilidad test-retest. Los modelos trifactorial correlacionado y el de orden superior conformados por Dificultad en Identificar Sentimientos, Dificultad en Describir Sentimientos y Pensamiento Externamente Orientado lograron el mejor ajuste. Los coeficientes alfa oscilaron entre 0,87 y 0,67; las correlaciones medias inter-ítem entre 0,48 y 0,20; y las correlaciones test-retest tras 6 meses oscilaron entre 0,61 y 0,52. El 18,10% de la muestra presentó niveles elevados de alexitimia. La TAS-20-S presentó una adecuada fiabilidad así como la tradicional estructura trifactorial, por lo que su uso es ahora recomendable para evaluar un aspecto del procesamiento emocional en EM.Ministerio de Educación, Cultura y Deporte de España Programa FPU (Formación del Profesorado Universitario

The Development of Preliminary HiTOP Internalizing Spectrum Scales

As part of a broader project to create a comprehensive self-report measure for the Hierarchical Taxonomy of Psychopathology consortium, we developed preliminary scales to assess internalizing symptoms. The item pool was created in four steps: (a) clarifying the range of content to be assessed, (b) identifying target constructs to guide item writing, (c) developing formal definitions for each construct, and (d) writing multiple items for each construct. This yielded 430 items assessing 57 target constructs. Responses from a heterogeneous scale development sample (N = 1,870) were subjected to item-level factor analyses based on polychoric correlations. This resulted in 39 scales representing a total of 213 items. The psychometric properties of these scales replicated well across the development sample and an independent validation sample (N = 496 adults). Internal consistency analyses established that most scales assess relatively narrow forms of psychopathology. Structural analyses demonstrated the presence of a strong general factor. Additional analyses of the 35 nonsexual dysfunction scales revealed a replicable four-factor structure with dimensions we labeled Distress, Fear, Body Dysmorphia, and Mania. A final set of analyses established that the internalizing scales varied widely—and consistently—in the strength of their associations with neuroticism and extraversion

Towards comprehensive understanding of bacterial genetic diversity:large-scale amplifications in Bordetella pertussis and Mycobacterium tuberculosis

Bacterial genetic diversity is often described solely using base-pair changes despite a wide variety of other mutation types likely being major contributors. Tandem duplication/amplifications are thought to be widespread among bacteria but due to their often-intractable size and instability, comprehensive studies of these mutations are rare. We define a methodology to investigate amplifications in bacterial genomes based on read depth of genome sequence data as a proxy for copy number. We demonstrate the approach with Bordetella pertussis , whose insertion sequence element-rich genome provides extensive scope for amplifications to occur. Analysis of data for 2430 B. pertussis isolates identified 272 putative amplifications, of which 94 % were located at 11 hotspot loci. We demonstrate limited phylogenetic connection for the occurrence of amplifications, suggesting unstable and sporadic characteristics. Genome instability was further described in vitro using long-read sequencing via the Nanopore platform, which revealed that clonally derived laboratory cultures produced heterogenous populations rapidly. We extended this research to analyse a population of 1000 isolates of another important pathogen, Mycobacterium tuberculosis . We found 590 amplifications in M. tuberculosis , and like B. pertussis , these occurred primarily at hotspots. Genes amplified in B. pertussis include those involved in motility and respiration, whilst in M. tuberuclosis, functions included intracellular growth and regulation of virulence. Using publicly available short-read data we predicted previously unrecognized, large amplifications in B. pertussis and M. tuberculosis . This reveals the unrecognized and dynamic genetic diversity of B. pertussis and M. tuberculosis , highlighting the need for a more holistic understanding of bacterial genetics