State and trait measures in the affective disorders

Sammanfattning: Background: Personality 'traits' refer to stability, consistency and repeated occurrence of actions while psychiatric 'states' concern the varying part of human behaviour. States are often associated with matter and body, and with biological causes, and 'traits' and 'personality' with 'mind', and with psychological and social causes. In a semantic, conceptual meaning, the concepts of 'states' and 'traits', and 'body' and 'mind' are opposites, and mutually exclusive. However, derived from a 'mind-body unity' approach to the 'mind-body problem', the basic idea in this thesis is that states and traits, body and mind are aspects of the same thing, and therefore inextricably interconnected. Results: 19 variables from the Comprehensive Psychopathological Rating Scale (CPRS), covering depressive, anxiety and OCD-symptoms were rephrased into self-rating format. In a sample of 30 patients with affective and anxiety disorders, the concordance for two CPRS subscales, the Montgomery Åsberg Depression Rating Scale (MADRS) and the Brief Scale for Anxiety (BSA), and their corresponding self-rating versions was found to be high (r=0.87-0.91, and r=0.80-0.91, respectively). In a larger sample of patients (N=101), the influence of maladaptive personality traits on concordance between these self-assessed and expert rated measures was investigated. In general, concordance between the measures was high (MADRS; r=0.83, BSA; r=0.76), but it tended to decline in patients with personality disorders, particularly for patients with cluster B personality traits. In a sample of 86 in- and outpatients, two self-rating scales for depression, the self-assessment version of the MADRS (MADRS-S) and the Beck Depression Inventory (BDI) were compared with regard to concordance and state and trait validity. The state measures BDI and MADRS-S were highly intercorrelated (r=0.87), but the BDI tapped more maladaptive personality traits compared to the MADRS, resulting in a tendency for the BDI to be less capable to discriminate between mild and moderate degrees of illness. A commonly accepted definition of 'maladaptiveness' of personality traits is lacking. In order to empirically investigate the meaning of the concept, the Karolinska Scales of Personality (KSP) and expert and self-rated state measures from the CPRS were assessed in a sample of 94 outpatients. One of four factors of the scores of the KSP subscales, 'Interpersonal aversiveness', and depressive symptoms, were related to degree of maladaption, indicating high KSP Detachment, Suspicion, Irritability, low Socialization, respectively, and dysphoria as core features of maladaptiveness. Particularly low KSP Socialization was associated with maladaptiveness, most strongly for patients with cluster B traits. In order to ascertain which variables psychodynamic therapists consider important when they recommend psychodynamic psychotherapy or other treatment forms, psychiatric states, the GAF, and personality traits as defined by the DSM-III-R Axis II and the Karolinska Psychodynamic Profile (KAPP), were retrospectively assessed in 80 patients applying for psychotherapy. Therapy recommendation was predicted by the absence of a personality disorder, and by high GAF scores, but not by the presence of a psychiatric syndrome. In 101 psychiatric outpatients the associations between personality states and traits, and biological measures, such as peptide hormones (glucagon and insulin) and fasting plasma glucose were explored. For males, low fasting glucose was associated with maladaptive cluster B personality traits, e.g., extrovert, impulsive, and acting-out behaviour. For females high glucose values were associated with histrionic personality traits, but not with maladaptive functioning.