Psychologic aspects of patients with oral lichenoid reactions.

Psychologic aspects of 49 patients with oral lichenoid reactions (OLR) in contact with amalgam fillings were studied and compared with an age- and sex-matched control group. Psychologic factors such as personality, psychologic functioning, and quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a Quality of Life Scale (QLS). With regard to personality the OLR patients had significantly higher scores on the muscular tension and suspicion scales and significantly lower scores on the indirect aggression scale. In addition, the OLR patients were significantly more worried about their health and more helpful. With regard to psychologic functioning the OLR patients had significantly more sad thoughts, became dizzy more easily, found it harder to imagine themselves free from anxiety, and had more difficulty in concentrating. The results indicated that OLR patients had a tendency to be depressive. The need for a systemic investigation including odontologic, medical, and psychologic aspects was expressed.

Cognitive therapy in the treatment of patients with resistant burning mouth syndrome: a controlled study.

The effect of cognitive therapy (CT) on resistant burning mouth syndrome (BMS) was studied. Thirty patients with resistant BMS after odontological and medical treatment were randomly divided into two equal groups; a therapy group (TG) was treated with CT and an attention/placebo group (APG) served as a control group. The intensity of BMS, which was estimated by the use of a visual analogue scale, was significantly reduced in the TG directly after CT was completed and was further reduced in a 6-month follow-up. The APG did not show any decrease in intensity of BMS. The results of this study indicate that, in some cases, resistant BMS probably is of psychological origin.

Personality characteristics of patients with resistant burning mouth syndrome.

The personality characteristics in 32 patients with resistant burning mouth syndrome (BMS) after treatment of diagnosed medical and odontologic diseases were examined and compared with a sex- and age-matched control group. After evaluation of burning mouth symptoms, the personality, the psychologic functioning, and the quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a Quality of Life Scale (QLS). The result showed that, compared with a control group, the patients with resistant BMS had a significantly lower score in socialization scale and significantly higher scores in somatic anxiety, muscular tension, and psychasthenia scales. Furthermore, the patients with resistant BMS were significantly more easily fatigued and more sensitive and showed a tendency to be more concerned about their health. With regard to the psychologic functioning, the BMS patients had significantly more problems taking the initiative, more easily became dizzy, and had more sad thoughts. They also showed a tendency to report palpitations and/or indigestions more often. The observed significant differences in personality and psychologic functioning might suggest that the burning sensations are psychosomatic symptoms in these patients. We recommend that patients with resistant BMS should undergo psychologic investigation. If psychologic and/or psychosocial disturbances are diagnosed, adequate treatment should be offered.

Cross-national generalizability of dimensions of perceived parental rearing practices: Hungary and The Netherlands; a correction and repetition with healthy adolescents.

In a previous study, an attempt was undertaken to examine whether dimensions of parental rearing style as measured with the Egna Minnen Beträffande Uppfostran (EMBU) on dimensions of Rejection, Emotional Warmth, Overprotection, and Favoring Subject can be generalized from Dutch adult samples, for whom they were originally interpreted from factor analyses, to an Hungarian adult sample. The findings suggested either differences in the meaning of the constructs between Hungarians and the Dutch or the presence of errors of translation in the Hungarian version. To rule out the possibility of inadequate translation, the Hungarian item-content was cross-checked by our Hungarian coworkers and, after reformulating several items, used for obtaining new data with a sample of adolescents. On the whole, negative findings with the old version disappeared with the new; clear evidence was found here for qualitative similarity/identity of the Rejection, Emotional Warmth, and Overprotection dimensions across the Dutch and Hungarian samples. Further studies with Hungarian persons are needed to examine whether these dimensions generalize from (nonpatient) adolescent to adult samples.

The early family situation of Hungarian depressed patients.

In a series of fifty depressed patients and 258 controls possible differences in the early family situation as concerns parental rearing practices have been investigated by means of the Swedish EMBU inventory. The results show that the depressive experienced their parents as more "rejecting", more "overprotecting" and less "emotionally warm" as compared to their normal counterparts.

Age at onset of affective disorders in Italian and Swedish patients.

Variability of age at onset in affective disorder is a complex event where several variables play a role, resulting in a detectable observed distribution which can be viewed as related to the structural mechanism of the disease. To confirm previous results on factors affecting the distribution of onset in affective disorders, we studied its distribution pattern in two different populations, Italian and Swedish, with an analytic approach that does not require specifications of any a priori hypothesis. The findings in this study, however, tend to confirm the biological nature of the age of onset phenomenon and to exclude cultural determinants. On the other hand, it does not exclude that other factors, not considered in this study, may be operating. This result is very important under the hypothesis of a genetic ethiopathogenesis of affective disorders, and some of its implications are discussed.

Depressive symptomatology at admission in Hungarian and Swedish depressed patients.

Within the framework of an ongoing cross-national study of hospitalized depressed patients the symptomatology of age, sex and diagnosis matched depressives consecutively admitted to a University Department of Psychiatry in Budapest, Hungary and in Umeå, Sweden has been compared. Only minor differences in symptomatology were detected between the two groups.

Cross-national invariance of dimensions of parental rearing behaviour: comparison of psychometric data of Swedish depressives and healthy subjects with Dutch target ratings on the EMBU.

A psychometric study on Swedish and Dutch samples used the EMBU, a self-report instrument designed to assess memories of parents' rearing behaviour. Of the four primary factors identified previously with Dutch individuals (Rejection, Emotional Warmth, Over-protection, and Favouring Subject), the first three were retrieved in a similar form in the two Swedish groups (depressives and healthy, non-patients). Examination of the metric equivalence of the scales and the strength of the factors for each group indicated that comparisons of patterns and levels between groups from the respective countries on the three factors showing cross-national constancy would be warranted. Scale-level factor analyses of these dimensions produced identical two-factor compositions (CARE and PROTECTION) across national groups which further supported this conclusion.

Parental loss by death in the early childhood of depressed patients and of their healthy siblings.

The incidence of parental loss by death before the age of 15 was investigated in a series of 200 depressed patients, sub-divided into unipolars, bipolars and neurotic-reactive depressives, and in their healthy siblings at risk. The age of onset of illness of patients who had lost a parent before 15 was compared with that of depressed controls. No excess of parental loss at any age was found in any of the patient sub-groups, as compared with their healthy siblings, nor did parental loss affect the age of onset of later depression. The results do not support the assumption that the loss of either parent by death in early childhood is significantly associated with depression in adult life, though parental death may be an important variable for individual patients.

Perceived depriving parental rearing and depression.

Four groups of depressed patients 47 unipolars, 21 bipolars, 34 with neurotic-reactive depression, and 39 with unspecified depressive disorder completed, after recovery, the EMBU, a Swedish instrument aimed at assessing the experience of parental rearing practices. The results for three factors: "rejection", "emotional warmth" and "over-protection" and the global judgement scores of "severity" and "consistency" in rearing attitudes were compared with those obtained from 205 healthy individuals. Depressed patients, particularly in the unipolar unspecified groups rated both parents lower than the controls on emotional warmth. Patients tended also to rate their parents as less consistent in their rearing attitudes. The variables emotional warmth and overprotection allowed 64% of the patients and 72 of the unipolar depressives to be classified correctly. These results, like those of previous studies, support the hypothesis that deprivation of love during childhood represents an important psychological risk factor in the background of depressive disorders.

Cross-national study of perceived parental rearing behaviour in healthy subjects from Australia, Denmark, Italy, The Netherlands and Sweden: pattern and level comparisons.

Samples of healthy subjects from Australia, Denmark, Italy, The Netherlands and Sweden completed the EMBU, a Swedish questionnaire aimed at assessing the experience of parental rearing practices. For the purpose of comparison three factors - "emotional warmth", "rejection" and "overprotection" - obtained in a previous factor analytic study, have been used. The most pronounced differences occurred between the Dutch and the Swedish sample on the one hand, and the Italian and Australian sample on the other, with the Danish sample in between. Differences in perceived parental rearing should be considered when comparing personality characteristics and/or psychopathological conditions in subjects from different countries.

Morbidity risk for psychiatric disorders in families of probands with affective disorders divided according to levels of platelet MAO activity.

In a series comprising 166 subjects with affective disorders, the lowest and highest quartiles in the male and female platelet monoamine oxidase (MAO) distribution, respectively, were included. The morbidity risk in the first-degree relatives (parents and siblings) of these low and high platelet MAO subjects was determined. First-degree relatives of low platelet MAO probands were found to have an increased morbidity risk for neurotic-reactive depressions and for alcoholism. The results seem to be in line with the biological high-risk paradigm, indicating that platelet MAO could be a biological marker for increased vulnerability. First-degree relatives of high platelet MAO probands were found to have an increased morbidity risk for bipolar affective disorders.

Perceived parental rearing behaviour in unipolar and bipolar depressed patients. A verification study in an Italian sample.

Two groups of former depressed Italian patients comprising 54 bipolars and 52 unipolars completed the Italian version of the EMBU, a Swedish instrument aimed at assessing the experience of parental rearing behaviour. As in a previous study of Swedish depressives, three factors, "rejection", "emotional warmth", and "over-protection", have been taken into account. The results obtained in the patient group have been compared with those obtained in Italian healthy controls. Depressed patients rated both parents significantly lower than the controls on the factor "emotional warmth". The present results cross-validate those obtained previously in the Swedish depressives and strengthen, together with other findings in the literature, the assumption that the lack of emotional warmth in the parents' rearing practices might be a crucial variable in the pathogenesis of depressive illnesses.

Perceived parental rearing practices in depressed patients in relation to social class.

The occurrence of possible differences in rearing practices related to social class has been investigated in a series of 125 depressed patients by means of a special inventory - the EMBU - constructed by our group. Three factors derived from the EMBU in the course of previous studies: "rejection", "emotional warmth", "overprotection" have been taken into account. The rearing practices experienced by subjects belonging to different social classes did not differ concerning "emotional warmth". On the other hand, subjects belonging to the higher social classes scored their parents higher on the variables "rejection" and "overprotection". Since "emotional warmth" proved in an earlier study to discriminate between depressives and healthy controls, it is concluded that the difference cannot have been biased by possible differences in social class.

Presentation of a subscale for the rating of depression and some additional items to the Comprehensive Psychopathological Rating Scale.

From the Comprehensive Psychopathological Rating Scale (CPRS) a subscale for depression has been derived in the course of a study of depression in which 209 patients took part. The subscale presented in this article comprises 28 items from the original pool and two additional items constructed later. The scale has a high degree of internal consistency and is satisfactorily reliable also among previously unskilled raters who have undergone a minimum of training. It is able to significantly differentiate between ill and recovered patients and among patients with syndromes of different severity according to various classification principles. Reported symptoms rated by the subscale correlated significantly with self-ratings of depression. Since the original CPRS pool also comprises items for the rating of manic manifestations, the scale is particularly suitable for the study of patients suffering from affective disorders, also when a switch from depression to mania could occur in the course of treatment.

Life events and depression. Part 2. Results in diagnostic subgroups, and in relation to the recurrence of depression.

Although there is evidence that the occurrence of stressful life events might be important for the onset and development of depression, it is still unclear whether differences occur in diagnostic subgroups of depressed patients, or in relation to type of episode, i.e., whether the first event or a relapse in a depression with a recurrent course. The present study has been carried out to investigate these issues more closely. Two hundred and six depressed patients have been classified into bipolar, unipolar, neurotic-reactive, and unspecified subgroups according to given definitions. The patients have also been classified into those suffering from a first episode and those suffering from recurrent depression. Each patient, when sufficiently improved, was given a semistructured interview, based on a specially constructed 56-item life events inventory. Unipolar and bipolar patients proved to have experienced significantly fewer events, even of the 'fateful' type (i.e., independent of depression) than the neurotic-reactive patients. However, this difference appeared to be due to difference in age among the groups and not to diagnosis. No difference occurred between uni- and bipolar patients. Patients with recurrent depression showed only small differences compared with patients in their first episode. These differences were consistently in the direction of fewer events in patients with recurrent depression. The implications of these results are discussed in relation to findings published by other authors.

Life events and depression. Part 1. Effect of sex, age and civil status.

This is the first of three articles dealing with some basic aspects of the relationship between life events and depression, and is also one part of a larger study in which the possible impact of stressful events has been studied from a multifactorial point of view. Two-hundred and four patients suffering from a depressive disorder, consecutively admitted to the Department of Psychiatry of the Umeå University have participated in a study of life events carried out by means of a specially constructed life events inventory that was used as a guideline for a semistructured interview. The results of this part of the study show that there are no pronounced differences in the occurrence, or appraisal of life events between male and female patients. The more vulnerable, older patients have experienced significantly fewer life events, even of the fateful type, prior to the onset of depression. No difference was found between patients who were married or lived together with a partner and patients who were unmarried, separated, divorced or widowed except in the categories of events (e.g. 'conflict' events) which might have been the very reason for a separation or a divorce. The results are discussed in relation to other findings in the literature.

Life events and depression. Part 3. Relation to severity of the depressive syndrome.

Two hundred and six depressed patients, consecutively treated at the Department of Psychiatry, Umeå University were investigated both concerning the occurrence of life events within defined time limits and the severity of their depressive syndrome. Three different criteria were used to divide the patients according to severity: whether they were in- or out-patients, whether or not they were psychotic according to a classification model (MACM) used at Umeå and, finally, according to the clinical ratings received by those admitted to the hospital. The average number of events experienced by the patients within the time limits set by the study was similar in each of the subgroups taken into account. A weak, but still statistically significant, relation was found between a negative experience of the events and the total score obtained at the ratings. The occurrence of events 'independent' of depression did not distinguish between the groups. Thus, the results of this study do not support the opinion maintained by some authors that there is a sizeable positive relation between magnitude of life events and seriousness of illness.