Factors that predict infant disorganization in mothers classified as U in pregnancy.

The unresolved (U) state of mind in parents has been validated by its association with infant attachment disorganization (D), yet all studies show a transmission gap, and a proportion of individuals classified as U have infants who are not D. This paper reports on 31 mothers who showed the characteristic lapses in thinking and reasoning of the unresolved/disorganized state of mind in relation to stillbirth (U(sb)), when assessed with the Adult Attachment Interview (AAI) in the pregnancy after stillbirth. Seventeen (55%) of their infants were D at 1 year old. We evaluate social, attachment, and psychiatric variables to establish whether there are differences in U(sb) individuals that will predict infant D. In this population of U mothers, social and attachment factors did not predict infant D, but U(sb) mothers of non-D infants showed significantly higher levels of depression and of intrusive thoughts on the posttraumatic stress disorder (PTSD) scale in pregnancy, and showed higher levels of intrusive thoughts when the infant was 1 year old. We discuss possible interpretations of these findings.

Factors associated with the unresolved classification of the Adult Attachment Interview in women who have suffered stillbirth.

The "unresolved" state of mind with respect to loss or trauma as assessed in the Adult Attachment Interview is common in clinical and forensic groups, as well as in mothers whose infants are classified as disorganized in their attachment relationship to them. However, questions remain about what the unresolved state represents and what factors predict the unresolved state. This case controlled study reports on 64 women who had suffered stillbirth and who were pregnant with their next child. The study explores attachment, psychiatric, and social factors associated with the unresolved state or higher unresolved scores with respect to stillbirth. Women who had experienced stillbirth were more likely to be unresolved than control women. Although a similar number of stillbirth and control women had experienced childhood trauma, only women who had experienced stillbirth were unresolved with respect to this trauma, suggesting the unresolved state may be evoked or reevoked by subsequent traumatic loss. Higher unresolved scores in relation to stillbirth were predicted by childhood trauma, poor support from family after the loss, and having a funeral for the infant. The results are discussed in terms of the woman's sense of being causal in the loss.

Disorganised attachment behaviour among infants born subsequent to stillbirth.

There is limited evidence that siblings of stillborn infants are more vulnerable to psychological problems. This case-controlled study examines the relationship between previous stillbirth and the next child's pattern of attachment and explores factors in the mother which may be associated with and which may explain the pattern of infant attachment. We examined 53 infants next-born after a stillbirth, and 53 control infants of primigravid mothers. Maternal demographic, psychiatric, and attachment data were collected in pregnancy, and self-report measures of depression collected in the first year. Infant attachment patterns to the mothers were assessed when the infants were 12 months old using the Ainsworth Strange Situation Procedure. Infants next-born after stillbirth showed significant increase in disorganisation of attachment to the mother compared with control infants (p < .04). The difference was not accounted for by differences in psychiatric symptoms or demography. It was strongly predicted by maternal unresolved status with respect to loss as measured in the Adult Attachment Interview, and less strongly by maternal experience of elective termination of pregnancy and by the mother having seen her stillborn infant. The study adds weight to previously reported clinical observations, that infants born after stillbirth may be at risk of an increase in psychological and behavioural problems in later childhood. The strong association between disorganisation of infant attachment and maternal state of mind with respect to loss suggests that the mother's state of mind may be causal, and raises interesting questions about the mechanism of intergenerational transmission. Given the existing evidence of later developmental problems, longer-term follow-up of these children would be valuable.

The adult attachment interview: rating and classification problems posed by non-normative samples.

Non-normative samples can pose major procedural and coding challenges to interviewers and raters of the Adult Attachment Interview (AAI). With reference to interview transcripts drawn from a population of personality disordered offenders detained in a high-security hospital, specific difficulties are identified and discussed. These difficulties have their roots in three separate but overlapping areas: extreme attachment-related experience; interviewees' psychological or psychiatric state; and factors relating to the context in which the interview is conducted. They raise questions about whether and when the use of the interview should be restricted, the rating rules elaborated and/or the rating system expanded. Suggestions are made as to how some of the difficulties might be addressed.

The psychological consequences and quality of life in adults with growth hormone deficiency.

It is now recognized that adults with pituitary disease and growth hormone (GH) deficiency have impaired physical and psychological functioning, including decreased quality of life. Research on quality of life continues to develop with reference to this patient group. In particular, disease-specific measures of quality of life have been developed, and data on long-term follow-up are now becoming available. Although the majority of studies investigating the effects of GH replacement show that quality of life improves with treatment, the results are not consistent. The relationship between quality of life and depressed mood in GH-deficient adults is complex and needs further study.

The effects of two doses of replacement growth hormone on the biochemical, body composition and psychological profiles of growth hormone-deficient adults.

This study examined the effects of growth hormone (GH) replacement on the insulin-like growth factor-I (IGF-I), body composition and psychological profiles of GH-deficient adults. We assessed whether two doses of GH produced different effects on these variables and whether patients who, at the end of the study chose to remain on long-term GH replacement responded differently to those who chose to abandon therapy. Forty-two adults (aged 42.9 +/- 1.9 years (mean +/- S.E.M.)) with documented GH deficiency entered two studies (24 in study 1, 18 in study 2). Biochemical, body composition and psychological profiles were assessed at baseline, and after 6 months and 1 year. Psychological assessments were performed using well-established, independent, validated 'Quality of Life' questionnaires (Nottingham Health Profile (NHP) and the Psychological General Well-Being Schedule (PGWB)). The study protocols differed only in the doses of growth hormone (0.024 mg/kg per day and 0.012 mg/kg per day respectively). Comparison between studies and between patients eventually continuing and abandoning GH therapy was performed. GH replacement was associated with significant changes in IGF-I levels (P < 0.001), body composition (P < 0.01) and self-perceived well-being (NHP, P < 0.01; PGWB, P < 0.01). The higher dose of GH produced a greater IGF-I response than the lower dosage (44.6 +/- 7.3 vs 26.2 +/- 3.6 nmol/l, P < 0.05), but no better psychological response (NHP, P = 0.22; PGWB, P = 0.23). Those deciding to continue replacement therapy did not respond differently to those choosing to abandon therapy with respect to IGF-I (P = 0.72), body composition (P = 0.38) and psychological assessment (NHP, P = 0.29; PGWB, P = 0.24). GH replacement in GH-deficient adults was associated with significant improvements in self-perceived well-being as well as changes in body composition and other variables. This improvement was similar at two different doses of replacement GH. Those patients electing to continue on long-term replacement did not achieve a demonstrably different psychological, body composition or biochemical benefit to those patients deciding to discontinue replacement.

Growth hormone deficiency and quality of life.

Quality of life research in adults with growth hormone deficiency (GHD) is a developing field. It has been recognised that adults with childhood onset GHD suffer social and psychological disadvantages. The effects of GHD of adult onset have only been shown relatively recently. Assessment of these patients, using measures of physical and psychological well-being, has demonstrated that adults with GHD perceive themselves as much less healthy compared with matched controls. The majority of studies investigating the effects of growth hormone replacement therapy indicate that quality of life improves with treatment, although this is not a consistent finding.

Psychological well-being before and after growth hormone treatment in adults with growth hormone deficiency.

The effect of recombinant-DNA human growth hormone treatment on psychological well-being and quality of life was studied in adults with GH deficiency (GHD). 24 adults who satisfied strict criteria for GHD took part in a double-blind, placebo-controlled, 6-month trial. Quality of life assessments were performed at entry, 1 and 6 months by means of self-rating questionnaires. This study reports significantly lower scores on quality of life assessment in the GH-deficient patients at entry compared with matched controls, indicating that this population may be psychologically compromised. Preliminary analysis of treatment results shows that after 6 months, those patients receiving active treatment experienced less perceived illness than the placebo group. Significant psychological improvements were noted in the patients' perception of their energy level and mood.

The dexamethasone suppression test and negative symptoms of schizophrenia.

The dexamethasone suppression test (DST) was administered to 28 subjects who met DSM-III criteria for chronic schizophrenia and shared similar environments. Samples were assayed for both plasma cortisol and dexamethasone levels. After controlling for other factors, the mean postdexamethasone cortisol level (MPDC) was correlated with the patients' score on the Scale for the Assessment of Negative Symptoms (SANS). A significant relationship emerged between these 2 parameters, suggesting that the social deterioration seen in chronic schizophrenia is at least partly related to a biological disease process as reflected by the DST. The importance of quantifying the level of dexamethasone in the DST is discussed.

Quality of life assessment before and after growth hormone treatment in adults with growth hormone deficiency.

The effect of recombinant human growth hormone (rhGH) treatment on the quality of life was studied in adults with growth hormone deficiency (GHD). Twenty-four adults who satisfied strict criteria for GHD took part in a double-blind, placebo-controlled, 6-month trial. 'Quality of life' assessment was performed at entry into the trial and after 1 month and 6 months, by means of self-rating questionnaires. Entry data were also compared with a control group of healthy subjects matched for age, gender, ethnic origin, socio-economic class and area of residence. Significantly lower scores on 'quality of life' assessment in the growth hormone (GH) deficient patients were reported at entry into the trial compared with matched controls, indicating that patients with GHD may be psychologically compromised. Preliminary analysis of the results shows that after 6 months patients receiving human growth hormone (hGH) treatment experienced less perceived illness than the placebo group. Significant psychological improvement was noted in the hGH-treated patients' perception of their energy level and mood compared to the placebo group.