Life-span Development and Behavior

Objective: To carry out a systematic review of the risk factors for, and incidence of, major depressive episode (MDE) related to antiviral therapy for chronic hepatitis C. Data Sources: The MEDLINE, PsycINFO, and Cochrane databases were searched to locate articles published from the earliest available online year until June 2011 using the keywords hepatitis C, interferon-alpha, peginterferon, pegylated interferon, depression, and mood and Boolean operators. Articles written in English, Spanish, and French were included. StudySelection: Prospective studies reporting incidence of interferon-alpha-induced MDE were included. At baseline, patients did not present a DSM-IV/ICD depressive episode, and evaluation was performed by a trained clinician. Twenty-six observational studies met the inclusion criteria. Data Extraction: Extracted data included authors, year of publication, design, characteristics of the population, viral coinfection, adjunctive psychopharmacology, instruments to assess depression, dose and type of interferon-alpha, adjunctive ribavirin treatment, and follow-up time. Outcome of incidence of MDE (primary outcome measure) was abstracted, as were potential predictive variables. Data Synthesis: A full review was performed. Meta-analysis of the cumulative incidence of induced MDE as a function of time was carried out. Odds ratios (ORs) and mean differences were used to estimate the strength of association of variables. Results: Overall cumulative incidence of depression was 0.25 (95% CI, 0.16 to 0.35) and 0.28 (95% CI, 0.17 to 0.42) at 24 and 48 weeks of treatment, respectively. According to our analysis, high baseline levels of interleukin 6 (mean difference=1 . 8 1; 95% CI, 1.09 to 2.52), female gender (OR= 1 . 4 0 ; 95% CI, 1.02 to 1.91), history of MDE (OR=3.96; 95 % CI, 2.52 to 6.21), history of psychiatric disorder (OR=3.18; 95% CI, 1.60 to 6.32), subthreshold depressive symptoms (mean difference = 0.96; 95% CI, 0.31 to 1.61), and low educational level (mean difference=―0.99; 95% CI, -1.59 to -0.39) were predictive variables of MDE during antiviral treatment. Conclusions: One in 4 chronic hepatitis C patients who start interferon and ribavirin treatment will develop an induced major depressive episode. Clinicians should attempt a full evaluation of patients before starting antiviral treatment in order to identify those at risk of developing interferon-induced depression.

Interferon-Induced Depression in Chronic Hepatitis C: A Systematic Review and Meta-Analysis

A statistical review of published data for 37 personality and psychopathology inventories was conducted to determine whether there are dimensional structure differences between clinical and nonclinical respondents. Correlation and factor-loading matrices from multiscale inventories and from specialized measures were tested for structural invariance across populations. There was relatively consistent evidence for high levels of similarity between normal and abnormal populations both in the number of factors that exist in the data matrices and in the factor patterns. The dimensional universes of normality and abnormality are apparently the same, at least according to data derived from contemporary assessment instruments. Categorical-taxonic differences between clinical and nonclinical populations, which were not examined, may nevertheless exist within contexts of dimensional structure similarity.

The search for dimensional structure differences between normality and abnormality: a statistical review of published data on personality and psychopathology.

Background Interpersonal psychotherapy and cognitive–behavioural therapy are widely accepted as effective treatments for major depression. There is little evidence on how personality disorder or personality traits affect treatment response.

Aims To determine whether personality disorder or traits have an adverse impact on treatment response to interpersonal psychotherapy or cognitive–behavioural therapy in people receiving out-patient treatment for depression.

Method The study was a randomised trial in a university-based clinical research unit for out-patients with depression.

Results Personality disorder did not adversely affect treatment response for patients with depression randomised to cognitive–behavioural therapy. Conversely, personality disorder did adversely affect treatment response for patients randomised to interpersonal psychotherapy.

Conclusions Despite the two therapies having comparable efficacy in patients with depression, response to interpersonal psychotherapy (but not cognitive–behavioural therapy) is affected by personality traits. This could suggest the two therapies are indicated for different patients or that they work by different mechanisms.

/pdf/temperament-character-and-personality-disorders-as-15er2aahe2.pdf

Temperament, character and personality disorders as predictors of response to interpersonal psychotherapy and cognitive–behavioural therapy for depression

Prevalence and predictors of pathological gambling: results from the St. Louis personality, health and lifestyle (SLPHL) study.

Objective

The aim of this study was to determine the prevalence of personality disorders in a group of elderly patients without an organic mental disorder and to examine the relationship between the Temperament and Character Inventory (TCI) and personality disorder symptoms in psychogeriatric clinical practice.

Method

A total of 91 subjects completed the Structured Clinical Interview for DSM-111-R personality questionnaire and the 125-item TCI.

Results

Of the 91 subjects, 34 individuals (31%) had at least one DSM-111-R personality disorder diagnosis, with avoidant, dependent and paranoid personality disorder being the most common. The trends and correlations between the temperament and character dimensions and the correlations between individual personality disorder symptoms and the dimensions were similar to those in the original model. The most significant findings were the strong negative correlations of the character scores of self-directedness and co-operativeness with the total number of personality disorder symptoms, and the fact that the self-directedness scores predicted the number of personality disorder diagnoses.

Conclusion

The reported prevalence rate is comparable to studies of both younger and older patient populations using similar methodology. The TCI provides a useful framework for further research on personality disorders in the elderly.

Personality disorder and the Temperament and Character Inventory in the elderly.

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Personality disorder and the Temperament and Character Inventory in the elderly.