A carbohydrate diet rich in sucrose increased insulin and WAT in macronutrient self-selecting rats.

In order to evaluate the influence of a carbohydrate (CHO) diet rich in sucrose (37%) on food choice and body composition, Wistar rats received a food selection diet (protein, CHO, fat) from the time of weaning to 13 weeks of age. Three groups of animals were examined: the first received a CHO diet containing 37% sucrose; the second, a diet containing only 10% sucrose; and the third, control group, received a complete standard diet (14% protein, 72% CHO including 10% sucrose). Food intakes and body weight (BW) were recorded four times a week. No differences in total food intake were observed between the two self-selecting groups and the control group, and no differences were observed between the two self-selecting groups in terms of their protein intake (about 45% of the total calorie intake). The latter groups modified their selections during the 10-week period, but the variations were similar. BW gain in the 37% group was lower but the white adipose tissue (WAT)/total BW ratio was significantly higher than those seen in the control and 10% groups. Insulinemia was higher in 37% and control groups. In conclusion, the high preferences for protein and fat were identical, whatever the CHO diet composition. The sucrose level in the diet was an essential factor for the development of hyperinsulinemia, leptin resistance and thus a higher prevalence of obesity. These results confirm the importance of the quality of CHO sources in the diet.

The psychology of gastric bypass surgery.

BACKGROUND: This article discusses the importance of psychological evaluation of gastric bypass (GBP) surgery candidates and post-surgical psychological support services, using the Center for Weight Reduction Surgery at Montefiore Medical Center as a model. The study of psychological predictors of post-operative outcome is in its beginning stages, and the small body of literature on this topic is reviewed. METHODS: 115 GBP surgery candidates completed a clinical interview and a self-report measure, the MMPI-2. RESULTS AND CONCLUSIONS: A high prevalence of psychopathology and personality disturbance was found in this population. The impact that psychological disturbance may have on post-operative outcome is discussed. The authors also provide a qualitative analysis of the psychological themes commonly found among this population, as well as psychosocial interventions that have been found helpful.

Passive-aggressive personality disorder: the demise of a syndrome.

This article presents an explanation and critique of the rationale for dropping passive-aggressive personality disorder (PAPD) from DSM-IV. The clinical and research literature on PAPD is reviewed along with the historical changes in definition, diagnostic criteria, and usage. PAPD can be reliably diagnosed, is fairly prevalent, and has good internal consistency. Because PAPD is no less valid than other personality disorders, and describes clinical phenomena that are unique among personality disorders, we recommend the reinstatement of PAPD in the official diagnostic nomenclature.

A new approach to managed care: the provider-run organization.

Behavioral managed care has been dominated by for-profit carve-out managed care organizations who deliver mental health and substance abuse services by reducing services and fees to the detriment of patients and providers. We offer a new model of managed care based on a provider-run, hospital-based approach in which provider groups contract directly with HMOs and eliminate the managed care organization intermediaries. This approach allows providers to maintain or regain control of the delivery of behavioral health services. A model is presented of an academically based organization which has achieved utilization patterns compatible with the demands of payors. Innovations in service delivery, network management and fiscal issues are reviewed.

Dissociative symptomatology and aggressive behavior.

The present study examined the relationship between dissociative symptomatology and a range of aggressive behavior in a general psychiatric outpatient population. Of the total sample (n = 122), 29% scored above 25 on the Dissociative Experiences Scale (DES). Patients with high DES scores (> 25) were significantly more likely than patients with lower DES scores (< 25) to report a history of childhood sexual abuse, to have attempted suicide, and to report more assaultive behavior, irritability, and negativism. There were no differences between the patients with high versus low DES scores on homicidal behavior. To better manage and treat outpatients with dissociative symptomatology, it is important to clarify the association between outwardly aggressive behavior and dissociative experiences.

The use of the MMPI-2 for the assessment of depressive and psychotic disorders.

Considering the normative changes incorporated into the MMPI-2 and the introduction of content scales, this study examined its usefulness for the diagnosis and assessment of depression and psychosis in a heterogeneous sample of 264 psychiatric inpatients. We examined the mean group profiles and diagnostic efficiency of single scales at specified cutoff scores for these conditions. We also conducted cross-validated stepwise regression using all the basic and content scales as well as hierarchical regression examining the incremental validity of the basic and content scales. In general, the MMPI-2 profiles were found to be sensitive to group differences and the derived regression equations proved to be stable and fairly good at classification; but single scales were less useful for diagnosis. Changes in norms made the MMPI-2 more specific than the MMPI, and the introduction of new content scales offered considerable additional clinical information and incremental validity.

Manic indices on the Rorschach.

This study examined signs of mania on the Rorschach, specifically whether manic inpatients (n = 24) produce different thematic content and thought disorder than comparison groups of paranoid schizophrenic (n = 27) and schizoaffective (n = 25) inpatients. Rorschach protocols were scored by a trained rater for the Thought Disorder Index and the Schizoid-Affective Rating Scale. Results indicated that all 3 groups had moderate levels of thought disorder, but the manic inpatients produced significantly more combinatory thinking and affective content responses than the other 2 groups. The paranoid schizophrenic and schizoaffective patients did not produce significantly more schizoid content and were not different on any other types of thought disorder than the manic patients. These findings are discussed in terms of the contribution of thought disorder and affective thematic content in making the diagnosis of mania on the Rorschach.

Academic psychiatry and managed care: a case study.

An academic department of psychiatry in New York City eliminated the need for behavioral managed care intermediaries by transforming itself from a fee-for-service system to a system able to engage in full-risk capitation contracts. The first step was to require health maintenance organizations to contract directly with the department. The department formed two legal entities, a behavioral management services organization for utilization management and a behavioral integrated provider association. The authors describe these entities and review the first year of operation, presenting data on enrollees, capitation rates, and service utilization for the first three contracts. The fundamental differences in the treatment model under managed care and under a fee-for-service system are highlighted. The authors conclude that by contracting directly with insurers on a full-risk capitation basis, departments of psychiatry will be better able to face the economic threats posed by the cost constraints inherent in managed care and maintain or re-establish their autonomy as care managers as well as high-quality care providers.

Serotonin function in panic disorder: intravenous administration of meta-chlorophenylpiperazine.

A placebo-controlled study of the direct serotonin receptor agonist meta-chlorophenylpiperazine (MCPP), intravenously infused over 90 s in a 0.06 mg/kg dose, was conducted in 10 patients with panic disorder and 9 normal control subjects. Cortisol, MCPP serum levels, and behavioral responses in both groups. Differences between intravenous and oral administration of MCPP are discussed, and the present findings are related to the serotonergic hypothesis of panic disorder.

Atypical depression among psychiatric inpatients: clinical features and personality traits.

OBJECTIVE: This study investigates the frequency and characteristics of Atypical Depression (AD) among depressed inpatients. METHOD: Twenty-one depressed inpatients received DSM-IV diagnoses, were rated on the Hamilton Depression Rating Scale (HAMD), and assessed for AD using the Atypical Depressive Disorder Scale. AD was defined as the presence of mood reactivity and two of four associated features: hyperphagia, hypersomnia, leaden paralysis, rejection sensitivity. Mood reactivity was defined as the ability to reach 50% of a non-depressed mood. All subjects completed the SCL-90, MCMI-II, and a suicide survey. RESULTS: Seven patients (33%) met criteria for AD. AD and non-AD patients did not differ in terms of severity of depression, history of suicide attempts, levels of clinical symptomatology, age of onset of depression, prior hospitalizations, and most personality characteristics. However, AD patients scored significantly higher than non-AD patients on the SCL-90 Interpersonal Sensitivity and MCMI-II Avoidant scales, and were more likely to be single. CONCLUSION: AD is fairly prevalent on an inpatient service, comparable to the frequency found in outpatient settings. AD is not a milder form of depression. The only differences between AD and non-AD patients reflect the personality trait of rejection sensitivity which is a defining feature of AD.

Characteristics of suicidality among adolescents.

The identification of high-risk adolescent suicide attempters in a population of depressed and suicidal adolescents is of crucial importance. This retrospective study examined characteristics of suicidality (recent and lifetime, active and passive) and psychopathology (depression, aggression, impulsivity, stressful life events, SCL-90 dimensions) among four groups of depressed adolescent outpatients: (1) suicide attempters who required medical treatment (n = 84), (2) suicide attempters who did not require medical treatment (n = 57), (3) suicidal ideators who had never made a suicide attempt (n = 40), and (4) nonsuicidal patients (n = 44). Results indicate that the nonsuicidal group could be differentiated from the three suicidal groups on the basis of suicidality and psychopathology, and that the three suicidal groups could be differentiated from one another on the basis of suicidality but not psychopathology. These findings are discussed in terms of the usefulness of certain self-report measures of suicidality for identifying suicidal adolescents and for differentiating among them. Furthermore, the findings suggest that psychopathological factors do not determine which suicidal adolescents make a medically dangerous suicide attempt and which do not.

The psychological assessment of depression: unipolars versus bipolars.

Psychological test differences between unipolar (UD) and bipolar (BD) depressed inpatients were examined using the Minnesota Multiphasic Personality Inventory (MMPI, Hathaway and McKinley, 1943; MMPI-2, Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), Millon Clinical Multiaxial Inventory (MCMI, Millon, 1983; MCMI-II, Millon 1987), and Symptom Checklist-90 (SCL-90-R, Derogatis, 1983). One hundred fifty-eight UD patients and 26 BD patients took these self-report tests at the beginning of their hospitalization. Results indicate that there were few consistent findings across the three tests (or versions of tests). Contrary to some previous studies, the BD patients did not exhibit a "social desirability" response set, nor did they produce "normal" test profiles. Although the tests were not able to identify depressed patients with past manic episodes, BD patients were more narcissistic, driven, and willing to engage in antisocial practices than were UD patients. These findings are discussed in terms of the clinical similarities between UD and BD patients during a depressive episode as well as the limitations of cross-sectional self-report measures to evaluate historical information regarding course of illness.

Assessment of depression: using the MMPI, Millon, and Millon-II.

The analysis examined how the MMPI, original Millon, and Millon-II may be used for the assessment of clinical and personality characteristics of depressed patients. High-point code-type analysis of data from 133 depressed inpatients yielded seven MMPI personality profiles (incapacitated-depressive, intropunitive-depressive, caught psychopath, hysteroid-dysphoric, schizotypal-depressive, ruminative-depressive, and psychotic-depressive) and eight Millon personality profiles (avoidant-depressive, conforming-depressive, hostile-depressive, hysteroid-depressive, disenfranchised-depressive, guilty-depressive, passive aggressive-depressive, and anaclitic-depressive). These profiles reflect important similarities in the personalities of the tested depressed inpatients and differences among them as well. Our interpretive framework is speculative but offers a basis for clinical hypothesis generation.

Effects of alprazolam on increases in hormonal and anxiety levels induced by meta-chlorophenylpiperazine.

The effects of alprazolam, a triazolobenzodiazepine, on hormonal and behavioral responses induced by meta-chlorophenylpiperazine (MCPP), a serotonin receptor agonist, were investigated in 10 healthy men. Alprazolam (0.5 mg) or placebo was given 1 hour before MCPP (0.5 mg/kg) or placebo. Cortisol, prolactin, and growth hormone (GH) release, MCPP and alprazolam plasma levels, anxiety level, and panic symptoms were measured over 210 minutes. MCPP was found to increase cortisol, prolactin, GH, and anxiety levels. Alprazolam decreased cortisol and GH levels but had no effect on prolactin. When used in combination with MCPP, alprazolam blunted MCPP-induced cortisol and GH release, and it blocked the anxiogenic effects of MCPP.

Alprazolam blockade of CO2-provoked panic in patients with panic disorder.

The primary aim of this study was to determine if pretreatment with a single dose of alprazolam reduces anxiety and panic provoked by the inhalation of 35% carbon dioxide (CO2) in patients with panic disorder. Ten panic disorder patients participated in a CO2 challenge test after pretreatment with a single dose of alprazolam (1 mg p.o.) or placebo in a randomized, double-blind, within-subjects design. Seventy percent of the subjects had a panic attack with placebo, compared to only 10% with alprazolam. Alprazolam reduced the number and severity of panic symptoms and baseline anxiety significantly more than placebo. This study demonstrates the efficacy of the acute administration of alprazolam to block panic attacks and supports the usefulness of the CO2 challenge as an analogue method to study panic disorder.

Contributions of discriminant analysis to differential diagnosis by self-report.

We used discriminant function analyses of the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1983), Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983), MCMI-II (Millon, 1987), and Symptom Checklist Ninety-Revised (SCL-90-R; Derogatis, 1983) profiles from a heterogenous group of 272 psychiatric inpatients to classify patients as depressed, manic, and/or psychotic. Most functions generated from these tests significantly discriminated depressed, manic (not MCMI-II), and psychotic (not MCMI) subjects from psychiatric controls. However, there was little improvement in diagnostic efficiency over the use of single scale elevations at specified cut scores. Functions derived from the MCMI for mania and the MCMI-II for psychosis show the most promise but require replication. The difficulty of using group profile differences for the diagnosis of individual psychiatric patients is discussed.

Prevalence of personality disorders among patients with anxiety disorders.

Outpatients with a principal diagnosis of an anxiety disorder (n = 347) were administered the Structured Clinical Interview for DSM-III-R/Axis II Disorders (SCID-II) during their intake evaluation. At least one personality disorder was found in 35% of these patients. Patients with social phobia (61%) and generalized anxiety disorder (49%) were most often diagnosed with a personality disorder. Patients with simple phobia were rarely diagnosed with a personality disorder (12%). The most commonly diagnosed personality disorders were from the "anxious/fearful" cluster (27% received at least one diagnosis from cluster C), most notably avoidant and obsessive-compulsive personality. Our findings suggest that personality disorders, in general, are less prevalent among anxious patients than among depressive patients.

Expressive characteristics of anxiety in depressed men and women.

This study was aimed at identifying the expressive, movement, and social behaviors associated with anxiety in the syndrome of major depression. The sample consisted of 97 hospitalized male and female depressed patients. Expressive and social behaviors were evaluated prior to treatment in a structured videotaped interview. Anxiety was measured using a multi-vantaged approach including doctor's rating, nurse's rating, patient self-report, and a separate video rating. Results indicate that anxiety was significantly associated with agitation, distressed facial expression, bodily discomfort, and poor social interaction in both sexes. Men and women differed in certain respects: anxiety was highly related to motor retardation in women only, and to hostility in men only. Differences in the pattern of expressive behavior between high and low anxious, depressed patients were clearly significant, and several were large enough to serve as clinical indicators. These findings help to characterize the expressive features of anxiety in the context of severe depression, and add to the growing literature on sex differences in depression.

The diagnosis and assessment of depression, mania, and psychosis by self-report.

We examined the usefulness of the Minnesota Multiphasic Personality Inventory (MMPI), the original and revised versions of the Millon Clinical Multiaxial Inventory (MCMI and MCMI-II), and the Symptom Checklist-90-R (SCL-90-R) for the diagnosis and assessment of depression, mania, and psychosis in a heterogeneous group of 272 psychiatric inpatients. We examined the following: diagnostic efficiency of single scales at specified cutoff scores for these conditions, multidimensional test profiles, MMPI high-point codes, and associated MCMI and MCMI-II personality disorders. The reported findings are discussed in terms of how these tests may and may not be used to answer particular assessment questions and what the self-report vantage contributes to the entire clinical assessment process.