Schema Modes and Personality Disorder Symptoms in Alcohol-Dependent and Cocaine-Dependent Patients.

Substance use disorders (SUD) and personality disorders co-occur frequently. This relationship might be understood by studying schema modes (a key concept in Schema therapy), which explain the dysfunctions characterizing personality disorder patients. In the present study, we compared the schema modes and personality disorder symptoms between alcohol-dependent patients, cocaine-dependent patients and healthy controls. We found indications that specific schema modes are specific for SUD patients. However, no differences between specific subtypes of SUD patients (alcohol- vs. cocaine-dependent patients) could be found regarding schema modes. Further, it is suggested that borderline personality disorder symptoms are highly relevant for SUD patients. A first step is made in understanding the relationship between schema modes and SUD, which may contribute to the understanding of the problematic behaviour seen in patients with personality disorders and SUD (and may possibly contribute to the improvement of the treatment of this group of patients).

Optimal screening for increased risk for adverse outcomes in hospitalised older adults.

BACKGROUND: Screening for frailty might help to prevent adverse outcomes in hospitalised older adults. OBJECTIVE: To identify the most predictive and efficient screening tool for frailty. DESIGN AND SETTING: Two consecutive observational prospective cohorts in four hospitals in the Netherlands. SUBJECTS: Patients aged ≥70 years, electively or acutely hospitalised for ≥2 days. METHODS: Screening instruments included in the Dutch Safety Management Programme [VeiligheidsManagementSysteem (VMS)] on four geriatric domains (ADL, falls, undernutrition and delirium) were used and the Identification of Seniors At Risk, the 6-item Cognitive Impairment Test and the Mini-Mental State Examination were assessed. Three months later, adverse outcomes including functional decline, high-healthcare demand or death were determined. Correlation and regression tree analyses were performed and predictive capacities were assessed. RESULTS: Follow-up data were available of 883 patients. All screening instruments were similarly predictive for adverse outcome (predictive power 0.58-0.66), but the percentage of positively screened patients (13-72%), sensitivity (24-89%) and specificity (35-91%) highly differed. The strongest predictive model for frailty was scoring positive on ≥3 VMS domains if aged 70-80 years; or being aged ≥80 years and scoring positive on ≥1 VMS domains. This tool classified 34% of the patients as frail with a sensitivity of 68% and a specificity of 74%. Comparable results were found in the validation cohort. CONCLUSIONS: The VMS-tool plus age (VMS+) offers an efficient instrument to identify frail hospitalised older adults at risk for adverse outcome. In clinical practice, it is important to weigh costs and benefits of screening given the rather low-predictive power of screening instruments.

Differences in changes in health-related anxiety between Western and non-Western participants in a trauma-focused study.

Disaster victims from ethnic minorities manifest more health complaints and concerns than others following a medical investigation. The authors aimed at analyzing ethnicity as a proxy for risk factors predictive of changes in health-related anxiety, and mediators that explain ethnic group differences after participating in a medical investigation. Western (n = 406) and non-Western participants (n = 379) were assessed at baseline and 12-week follow-up. Education, unemployment, years of residence, and posttraumatic stress disorder symptoms were independent predictors of changes in health-related anxiety, excluding ethnicity. The predictive value of ethnicity was mediated mainly by changes in psychopathology, fatigue, and quality of life. Stronger responses to a trauma-related investigation by more vulnerable ethnic minority groups may explain their enhanced health-related anxiety.

Offering a medical examination following disaster exposure does not result in long-lasting reassurance about health complaints.

OBJECTIVE: This study tested the hypothesis that large-scale provision of individual medical examination will reduce persistent anxiety about health and subjective health complaints after involvement in an aviation disaster with alleged exposure to hazardous chemicals. METHOD: Three measurements were performed: during the medical examination, 6 weeks later during consultation with the physician and 12 weeks after the first examination. Rescue workers (n=1736) and residents (n=339) involved in the disaster participated. Standardized questionnaires on health complaints and concerns were administered. RESULTS: Both groups reported increased health anxiety and somatic sensitivity after 12 weeks. Residents reported more posttraumatic stress symptoms, whereas rescue workers seemed to have gained a better quality of life and were somewhat reassured. Participants who attended the consultation with the physician showed increased reassurance scores after 6 weeks, but their worries had increased again on follow-up. However, nonattendees reported more health anxiety on follow-up. More participants judged participation to have had a positive impact, instead of a negative impact, on their health. CONCLUSION: Our study does not indicate that a large-scale medical examination offered after involvement in a disaster has long-lasting reassuring effects and suggests that such examination may have counterproductive effects by sensitizing participants to health complaints.

Participation in a trauma-focused epidemiological investigation may result in sensitization for current health problems.

OBJECTIVES: Participation in health survey research may result in a worsening of self-assessed health status and enhanced service-use by increasing self-awareness of current health status. The present study investigated whether participation in a trauma-focused epidemiological study sensitized participants for health problems irrespective of trauma exposure. METHODS: A total of 1,019 rescue workers and 453 residents involved in varying degrees in a large scale aviation disaster participated. Data collection took place between December 2000 and April 2003. There were two measurements: one during the epidemiological investigation at a general hospital and one 12 weeks after the first measurement. Follow-up data were gathered in 80% of a randomly selected group of rescue workers and in 62% of the residents. Main outcome measures were: health anxiety, somatic sensitivity, the tendency to be reassured by a physician, psychopathology, post-traumatic stress symptoms, fatigue and quality of life. RESULTS: Both rescue workers and residents reported less reassurance, and increased health anxiety and somatic sensitivity 12 weeks after the investigation compared to the first measurement. Exposure to the aviation disaster was not predictive of these changes in health perception, but higher levels of psychological and physical symptoms at baseline were. Only 0.2-1.6% of the residents and rescue workers indicated at baseline that the investigation had had a very negative impact on their mental and/or physical well-being. No evidence for systematic trends or changes in baseline scores for anxiety about health or subjective complaints during the 15 months inclusion period were found. CONCLUSIONS: Participation in an epidemiological study of the long-term sequelae of disaster exposure does not lead to very strong negative reactions in most of the participants, but can result in an increased awareness of somatic sensations, enhancement of health worries and lowered reassurability by physicians, especially in participants with higher levels of psychological and physical symptoms at baseline. Future studies are needed to investigate the temporal stability of these inadvertent and unobtrusive negative consequences.

Predictors of fatigue in rescue workers and residents in the aftermath of an aviation disaster: a longitudinal study.

OBJECTIVES: Although medically unexplained physical symptoms such as fatigue are frequently observed after exposure to trauma, the vast majority of health outcomes studies in trauma and disaster research relates to the psychological and psychiatric problems met by victims. The objectives of this study were to investigate the prevalence of (persistent) fatigue in the aftermath of a disaster and to analyze the predictive value of sociodemographic and various health-related variables for fatigue among both rescue workers and residents. METHODS: A total of 1951 rescue workers and 753 residents involved in the Bijlmermeer aviation disaster participated in this study. Follow-up data were gathered in 70% of randomly selected rescue workers and 53% of the residents. Multiple regression analyses, multivariate logistic regression analyses, and crosslagged panel analyses examined sociodemographic variables and self-report measures for psychopathology, posttraumatic stress reactions, quality of life, somatosensory amplification, health anxiety, and tendency to be reassured by a physician as predictors of fatigue at baseline and fatigue from baseline to 13 to 28 months follow up. RESULTS: Elevated levels of fatigue are common after involvement in a disaster in rescue workers (20.6%) and residents (45.4%). Higher levels of psychopathology, lower quality of life, and the tendency to be less reassured were multivariate predictors of both elevated and persistent fatigue. Tendency to be reassured was the most important causal factor for fatigue. CONCLUSIONS: These results suggest that early identification, adequate reassurance, and treatment of individuals at risk may be worthwhile to prevent chronic fatigue.

Associations among homesickness, anger, anxiety, and depression.

The study investigated the association of homesickness with the related concepts of anxiety, depression, and anger. Two conceptualizations of homesickness were used, one considering homesickness as a state, characterized by severe symptoms of a depressive episode, and the other one as a self-reported tendency to experience homesickness in times of separation from the familiar environment. The latter conceptualization can rather be considered as an enduring trait and does not specifically refer to actual feelings of depression. We compared these two conceptualizations of homesickness in a random sample from the Dutch population (n=485) by assessing their uni- and multivariate associations with anger, anxiety, depression, and anxiety-sensitivity. Both conceptualizations of homesickness were associated with anxiety and depression and with the externalization of anger. No association was found between internalization of anger or control over internalized and externalized anger for either conceptualization of homesickness. The pattern of multivariate associations between homesickness and its emotional correlates was similar for both conceptualizations, although homesickness as a state appeared to have a stronger association with depression, whereas the tendency to develop homesickness showed a particularly strong association with anxiety. It is concluded that homesickness can be considered as a mixed emotion of anxiety and depression ("Cothymia"), but that depression is more characteristic of homesickness as a state, whereas anxiety is more important if homesickness is conceptualized as an enduring tendency.

Testimony method to ameliorate post-traumatic stress symptoms. Community-based intervention study with Mozambican civil war survivors.

BACKGROUND: The effectiveness of the testimony method has not been established in rural communities with survivors of prolonged civil war. AIMS: To examine the effectiveness and feasibility of a testimony method to ameliorate post-traumatic stress symptoms. METHOD: Participants (n=206) belonged to former war zones in Mozambique. They were divided into a case (n=137) and a non-case group (n=69). The case group was randomly divided into an intervention (n=66) and a control group (n=71). Symptoms were measured during baseline assessment, post-intervention and at an 11-month follow-up. RESULTS: Post-intervention measurements demonstrated significant symptom reduction in both the intervention and the control group. No significant differences were found between the intervention and the control group. Follow-up measurements showed sustained lower levels of symptoms in both groups, and some indications of a positive intervention effect in women. CONCLUSIONS: A remarkable drop in symptoms could not be linked directly to the intervention. Feasibility of the intervention was good, but controlling the intervention in a small rural community appeared to be a difficult task to accomplish.

Anxiety sensitivity profile: dimensional structure and relationship with temperament and character.

BACKGROUND: Anxiety sensitivity (AS), the belief that bodily sensations have harmful consequences, is a reliable predictor of panic attacks in both clinical and nonclinical populations. Recently, a new measure of AS has been proposed. The AS profile (ASP) was designed to be a more comprehensive measure of AS, and to be more suitable for the measurement of different AS dimensions. Preliminary evidence (college student sample) suggests that the ASP has 4 dimensions. In the present study, the dimensional structure of the ASP was further investigated, as well as its relationship with temperament and character traits. METHODS: Exploratory and confirmatory factor analysis of ASP scores in two large samples of psychiatric outpatients and nonclinical controls (combined n = 742). Correlations and partial correlations of ASP with temperament and character. RESULTS: Exploratory factor analysis yielded a single AS factor. However, confirmatory factor analysis showed that the 6-dimensional structure, as Taylor and Cox had originally intended it, might be a defendable solution. However, the number of items is much too high, with many subscales consisting of semantic clusters. ASP scores were found to be weakly related to the temperament dimension harm avoidance, corroborating earlier findings that were not statistically significant because of small sample sizes. CONCLUSIONS: The ASP may be shortened from 60 to 24 items without loss of reliability or content. Future studies using challenge paradigms and studies with general hospital patients may further investigate the usefulness of a shortened version of the ASP.