ABSTRACT
BACKGROUND: A dimensional approach of psychopathology focuses on features and risk factors that are shared across diagnoses. In support for this dimensional approach, studies point to a general psychopathology factor (GPF) associated with risk for multiple psychiatric disorders. It is, however, unknown how GPF relates to white matter integrity (WMI). In the current diffusion tensor imaging (DTI) study, we examined how GPF relates to abnormalities in a skeleton representation of white matter tracts, taking into account a trans-diagnostic risk factor: unresolved-disorganized attachment (Ud) resulting from loss or trauma. METHODS: Unique associations between GPF, Ud, and WMI were examined in a combined sample of adolescents (N = 63) with childhood sexual abuse-related posttraumatic stress disorder (N = 18), anxiety and depressive disorders (N = 26) and without psychiatric disorder (N = 19). WMI was measured using DTI. Ud was measured using the Adult Attachment Interview. We controlled for puberty stage, gender, age, and IQ. RESULTS: Controlling for GPF, Ud was associated with reduced fractional anisotropy (FA) in the splenium and inferior fronto-occipital fasciculus (IFOF). Controlling for Ud, GPF was associated with reduced FA in the genu and body of the corpus callosum. CONCLUSIONS: Decreasing WMI in the genu and body with increasing psychopathology across diagnoses suggests demyelinization in these areas and may underlie comorbidity and presence of symptoms that transcend psychopathological diagnoses. In contrast, trauma-related WMI reductions in the splenium and IFOF may account for heterogeneity within diagnostic categories as a function of childhood trauma. These findings support the importance of a dimensional approach in addition to traditional diagnostic classifications in clinical research and practice.
Subject(s)
Anxiety Disorders/diagnostic imaging , Depressive Disorder/diagnostic imaging , Diffusion Tensor Imaging , Object Attachment , Stress Disorders, Post-Traumatic/diagnostic imaging , White Matter/diagnostic imaging , Adolescent , Anxiety Disorders/etiology , Brain/diagnostic imaging , Child , Child Abuse, Sexual/psychology , Depressive Disorder/etiology , Female , Humans , Male , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Young AdultABSTRACT
BACKGROUND: Growing concern about how the neglect and abuse of children can be tackled and prevented has led to increased interest in the parent-child relationship and the concept of attachment. It is vitally important that the diagnostics relating to attachment are accurate. One of the main problems is that up till now the parent-child relationship has not been assessed and analysed in accordance with reliable, unambiguous standards.
AIM: To search the literature in order to identify the prerequisites for reliable diagnostics of attachment.
METHOD: PubMed articles concerning instruments for measuring attachment were reviewed. The found articles were based on more extensive search strategies used in English-language meta-analysis, and included reflections on possible implications of mental health care.
RESULTS: Accurate detailed analysis of attachment is particularly important in cases that involve cumulative risk factors. The task must be performed by trained professionals who used thoroughly tested, reliable measuring instruments.
CONCLUSION: The application of the concept of attachment in child and adolescent psychiatry is in its infancy. Those applying the concept need to have breadth of vision and evidence-based skills in applying relevant diagnostics.
Subject(s)
Mental Health , Parent-Child Relations , Child , Child Abuse/psychology , Humans , Risk FactorsABSTRACT
We studied fatigue and sleep in chronic headache sufferers in comparison to age- and sex-matched controls. We determined the prevalence and intensity of fatigue as well as several sleep features. The study was conducted in a headache center through the use of a questionnaire. One hundred thirteen headache sufferers (59 men and 54 women) and 110 controls (56 men and 54 women) were included in the analysis. Fatigue was found to be equally common in the headache sufferers (70.3%) and in the controls (60.0%). However, the headache sufferers rated the intensity of their fatigue significantly higher (4.1 versus 2.8 cm on a 10-cm visual analog scale). When the sexes were considered separately, the difference in intensity of the fatigue between the two groups was significant only for the women (5.1 versus 3.0 cm). With regard to sleep, the headache sufferers slept significantly shorter (6.7 hours) than the controls (7.0 hours). It also took them longer to fall asleep (31.4 versus 21.1 minutes) and longer to fall back asleep after waking up at night (28.5 versus 14.6 minutes). When the sexes were considered separately, the differences in sleep features between the two groups were significant only for the men. On the basis of these results, we conclude that chronic headache sufferers feel more tired, especially the women, and do not sleep as well at night, especially the men. Further study is necessary to determine the significance of these findings in relation to chronic headache suffering.
