Gene/Protein Disease Symptom Drug Enzyme Compound
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Recent exploratory [Taylor, S., Kuch, K., Koch, W. J., Crockett, D. J., & Passey, G. (1998). The structure of posttraumatic stress symptoms. Journal of Abnormal Psychology, 107, 154-160.] and confirmatory [Buckley, T. C., Blanchard, E. B., & Hickling, E. J. (1998). A confirmatory factor analysis of posttraumatic stress symptoms. Behaviour Research and Therapy, 36, 1091-1099; King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD scale: evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment, 10, 90-96.] factor analytic investigations suggest that the three symptom clusters of posttraumatic stress disorder (PTSD) as defined in the Diagnostic and Statistical Manual [4th ed.; DSM-IV; American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.] may not provide the best conceptualization of symptom dimensionality. However, the alternative models have not been in agreement, nor have they been compared against each other or models based on the DSM-IV. The purpose of the present investigation was to test a series of dimensional models suggested by these recent factor analytic investigations and the DSM-IV. Using data collected with the PTSD Checklist--Civilian Version [Weathers, F. W., Litz, B. T., Huska, J. A., & Keane, T. M. (1994). PCL-C for DSM-IV. Boston: National Center for PTSD--Behavioral Science Division.] from 349 referrals to a primary care medical clinic, we used confirmatory factor analysis to evaluate a: (1) hierarchical four-factor model, (2) four-factor intercorrelated model, (3) hierarchical three-factor model, (4) three-factor intercorrelated model, and (5) hierarchical two-factor model. The hierarchical four-factor model (comprising four first-order factors corresponding to reexperiencing, avoidance, numbing, and hyperarousal all subsumed by a higher-order general factor) provided the best overall fit to the data; although, all models met some standards specified for good model fit. More research is needed to establish the dimensional nature of PTSD symptoms and to assess whether identified dimensions differ as a function of the trauma experience. Implications for assessment, diagnosis, and treatment are also discussed.
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PMID:Dimensionality of posttraumatic stress symptoms: a confirmatory factor analysis of DSM-IV symptom clusters and other symptom models. 1066 Oct 4

The aim was to investigate associations of a history of features of DSM-III-R conduct disorder (CD) with features of DSM-III-R personality disorders (PDs) and psychopathy, in inpatient psychiatric practice. Fifty-six psychiatric inpatients, without a history of specified 'psychoses', were assessed by the SCID structured interview for DSM-III-R PDs and the 'Psychopathy Checklist Revised' (PCL-R). In a sample in which 59% had borderline PD, significant associations between a history of CD criteria and the adult features of antisocial PD (APD) were relatively specific compared with other PDs, but were weaker in women. However, significant correlations between the number of positive CD criteria and PCL-R scores were similar in both genders. The relatively specific associations between CD and adult features of APD are likely to be relevant to psychiatric patients who show various presentations of PD, if these include some adult features of APD. The findings inform the understanding of the development and classification of PDs.
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PMID:Associations of past conduct disorder with personality disorders in 'non-psychotic' psychiatric inpatients. 1124 92

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist--Revised (PCL-R). Male prison inmates (N = 313) were assessed using the PCL-R and DSM-III-R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL-R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both.
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PMID:Psychopathy, antisocial personality, and suicide risk. 1150 89

The relationship between suicide attempts and different vulnerability factors was investigated in 61 male subjects during forensic psychiatric examination. Personality traits and psychopathy were determined by means of the Karolinska Scales of Personality (KSP) and the Psychopathy Checklist-Revised (PCL-R). Clinical diagnoses were determined by the use of Structured Clinical Interview for DSM-III-R (SCID). Platelet monoamine oxidase (MAO) activity was investigated in 58 subjects. Suicide attempters had extremely low socialization and high impulsive aggression. This was independent of a history of repeatedly criminal violence or not. They had higher PCL-R scores and lower levels of platelet MAO activity than non-attempters. No relationship was found between suicide attempts and repeated violent criminality. However, among the subjects with repeated criminal violence there was a highly significant difference between suicide attempters and non-attempters, indicating different personality profiles in violent offenders with and without suicidal behavior. Suicidal behavior was significantly associated with borderline personality disorder, but not with any other single DSM-III-R disorder. The results show a far more severe personality disturbance in suicide attempters than in other violent patients in this type of population. Suicidal behavior should therefore be evaluated and treated per se.
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PMID:Relationships between attempted suicide, temperamental vulnerability, and violent criminality in a Swedish forensic psychiatric population. 1172 50

Early starting, lifetime criminal persistence has been called sociopathy, antisocial personality disorder, and psychopathy. There is, however, disagreement about its core features and which measure is best for identifying such individuals. In the 1st of 2 studies of male offenders (n = 74), we found a large association between scores on the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) and the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) antisocial personality disorder criteria scored as a scale. The second study (n = 684) replicated this finding and found that, as previously shown for PCL-R scores, a discrete class (or taxon) also underlies scores on items reflecting antisocial personality disorder. The high association among these sets of items and their similarity in predicting violence suggested that the same natural class underlies each. Results indicated that life-course-persistent antisociality can be assessed well by measures of psychopathy and antisocial personality disorder.
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PMID:Identifying persistently antisocial offenders using the Hare Psychopathy Checklist and DSM antisocial personality disorder criteria. 1191 Oct 46

Over the last few years, there has been a growing tendency for opioid addicts to abuse multiple drugs, although many patients are in substitution therapy with methadone. Abuse of multiple drugs leads to a more complicated withdrawal syndrome; it is therefore necessary to investigate new drug strategies as a treatment for detoxification. Buprenorphine appears to be an effective and safe drug in opioid-addicted patient detoxification. In this study, we have compared the short-term efficacy of an 11-day low-dose buprenorphine/14-day carbamazepine regime [BPN/CBZ] (n = 14) to an 11-day methadone/14-day carbamazepine regime [MET/CBZ] (n = 12) in a double-dummy, randomized 14-day inpatient detoxification treatment study. Twenty-six inpatients met the DSM-IV criteria for opioid dependence and were included in this study. All patients abused various additional drugs. Fourteen of 26 patients (53.8 %) completed the study. Seven non-completers (seven of 12 = 58.3 %) were treated with methadone/carbamazepine and five non-completers (five of 14 = 35.7 %) received buprenorphine/carbamazepine, but the difference in the dropout rate was not significant. However, patients with buprenorphine/carbamazepine showed significantly fewer withdrawal symptoms after the first two weeks of treatment. The present study supports the hypothesis that buprenorphine/carbamazepine is more effective than methadone/carbamazepine in detoxification strategies for opioid addict with additional multiple drug abuse. No severe side effects occurred during treatment in either group.
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PMID:Detoxification of opiate addicts with multiple drug abuse: a comparison of buprenorphine vs. methadone. 1223 86

The results of 2 validation studies for an assessment tool designed specifically for quality improvement and outcomes assessment efforts in mental healthcare are presented in this paper. The studies evaluated a new tool to assess the patient outcomes for major depressive disorder following treatment in routine clinical settings called the Depression-Arkansas Scale (D-ARK). Study 1 included 54 patients recruited from 3 hospital-based clinics (2 mental health clinics and 1 primary care clinic). Study 2 includes 827 patients from 5 clinical settings including a university based outpatient clinic, a VA based mental health clinic, and a managed-care program. These 2 very different studies provide preliminary evidence that the D-ARK may be a useful tool for quality improvement efforts in the mental healthcare setting. Specifically, they indicate that the D-ARK has strong validity when compared to 2 different research assessments, the Structured Clinical Interview for DSM-III-R, Patient Edition (SCID-P) and the Inventory to Diagnose Depression (IDD), and compared to clinical assessments using both the clinical diagnosis and a clinician checklist.
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PMID:Validity of the Depression-Arkansas (D-ARK) Scale: a tool for measuring major depressive disorder. 1238 69

Reduced serotonergic (5-HT) neurotransmission has been reported in impulsive and aggressive personality disordered and offender samples. What is not clear is the relationship between 5-HT function and the North American construct of psychopathy assessed using the Psychopathy Checklist and its derivatives, which emphasizes the core interpersonal/affective as well as behavioural components of this syndrome. Fifty-one DSM-III-R personality disordered offenders who had a dynamic assessment of 5-HT function (prolactin response to 30 mg d-fenfluramine challenge) were rated on the Psychopathy Checklist: Screening Version based on interview and file data. The Psychopathy Checklist: Screening Version (PCL: SV) mean score in the sample was similar to other reports in European forensic samples. A three-factor structure best explained the PCL: SV data: arrogant/deceitful, callous-unemotional and impulsive-antisocial behaviour factors. 5-HT function did not correlate with psychopathy as a unidimensional phenomenon. The impulsive-antisocial component correlates negatively with 5-HT function while the arrogant/deceitful component correlates positively with 5-HT. In line with previous research findings, impulsive-antisocial conduct shows an inverse relationship with 5-HT function. Arrogant/deceitful traits correlate positively with 5-HT function and may be an adaptive component of psychopathy.
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PMID:The relationship between serotonergic function and the Psychopathy Checklist: Screening Version. 1287 May 70

The authors examined the construct of psychopathy as applied to 130 adolescent offenders using 3 psychopathy measures and a broad range of DSM-TV Axis I diagnoses and psychosocial problems. Measures used in the study included the following: (a) Psychopathy Checklist-Youth Version, (b) Antisocial Process Screening Device, (c) a modified version of the Self-Report Psychopathy-II scale, and (d) the Adolescent Psychopathology Scale. Results from this study offer incremental support for the construct validity of psychopathy in youth. Psychopathy evidenced better convergent and discriminant validity results than did the disruptive behavior disorders (DBDs) such as oppositional-defiant disorder (ODD) and conduct disorder (CD). Despite this finding, psychopathy scales nonetheless correlated with other forms of psychopathology at a higher rate than was expected, suggesting that comorbidity is high even when psychopathy is used as a classification scheme. Also, hierarchical multiple regression was used to determine whether psychopathy offered an improvement in the prediction of previous violent and nonviolent offenses. The results for the current study were mixed, with only the PCL-YV significantly predicting previous violent and nonviolent offenses beyond the DBDs. The findings indicate that psychopathy may offer incremental improvement over DBDs with regard to level of comorbidity and perhaps even prediction. However, simply extending the adult construct of psychopathy to youth without considering the array of psychopathology that may accompany adolescent psychopathy could be misleading.
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PMID:Psychopathy and comorbidity in a young offender sample: taking a closer look at psychopathy's potential importance over disruptive behavior disorders. 1531 87

The catechol-O-methyltransferase (COMT) is a major degrading enzyme in the metabolic pathways of catecholaminergic neurotransmitters such as dopamine and norepinephrine. This study investigated whether the functionally relevant Val(108/158)Met gene variant is associated with differential antidepressant response to mirtazapine and/or paroxetine in 102 patients with major depression (DSM-IV criteria) participating in a randomized clinical trial with both drugs. In patients treated with mirtazapine, but not paroxetine, allelic variations in the COMT gene were associated with differential response. COMT(VAL/VAL) and COMT(VAL/MET) genotype carriers showed a better response than COMT(MET/MET)-bearing patients in the mirtazapine group. Moreover, carriers of the COMT(VAL/VAL) or COMT(VAL/MET) genotype had significantly greater HAMD-17 (Hamilton Rating Scale for Depression 17 item version) score reductions than COMT(MET/MET) homozygotes from week 2 to 6, respectively, in the mirtazapine group. Time course of response and antidepressant efficacy of mirtazapine, but not paroxetine, seem to be influenced in a clinically relevant manner by this allelic variation within the COMT gene.
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PMID:The catechol-O-methyltransferase Val108/158Met polymorphism affects short-term treatment response to mirtazapine, but not to paroxetine in major depression. 1552 Aug 43


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