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AbstractSince clinical and biochemical observations point to much overlap between depression and aggression, both characterised by intolerance to frustration, a questionnaire was developed to test if different patterns of depressive and aggressive reactions elicited by exposure to negative events and deprivation from expected positive ones in human and nonhuman conditions, respectively, would result in specific response patterns in depressive and aggressive persons. The questionnaire was tested for internal consistency in a pilot healthy sample and for correlations of responses with the personality factors of Aggression and Depression in 60 abstinent male alcoholics.
Aggressive and depressive responses were highly correlated across all stimulus conditions, and not specifically but rather equally associated with the personality factors of Aggression and Depression, confirming the close association between these dimensions. IntroductionSince the present paper deals with aggression and depression in the context of a psychopathological disorder, the following consideration has to be addressed as a premise.It has already been claimed by Kretschmer and Eysenck that symptoms of psychiatric diseases may be observed on a milder level in nonclinical populations which suggests a continuum between disease and normal behavior. Psychologists used some of these symptoms as items to construct scales by factor analysis for specific pathology related personality traits like depression or aggression.
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Such scales nowadays usually form subscales of broader personality inventories like the NEO-PI-R used for assessment of the five factor model of personality. When applied to clinical samples, personality scales like those of the NEO-PI-R have been shown to be predictive of specific personality disorders ,. Scales of neuroticism, depression, and anxiety yield higher scores in depressed patients , , and scales measuring reactive or spontaneous aggression yield higher means in patients with impulse control disturbances, antisocial personality disorders or alcohol dependence than in nonclinical groups. Therefore, scores of depression and aggression on personality tests are conceived as models for respective psychopathological symptoms.Depression and aggression are considered to belong to different classes of diagnoses according to psychiatric classification systems (DSM-IV and ICD-10) and to different factors in personality inventories (e.g., NEO-PI-R). Gender differences in the subscales of the QDF (means, SD, SEM, and significance of differences ).
HAMILTON DEPRESSION RATING SCALE (HAM-D) (To be administered by a health care professional) Patient Name Today’s Date The HAM-D is designed.
ResultsIn order to test if gender could operate as a confounder, sex differences were tested for all 48 scales. They were found to be significant only in scales posh3 and posh4 (Table ), that is, males feel more anger and females are more relaxed or forgiving in conditions of being deliberately deprived from a positive reinforcement by another person. Since these were the only differences observed between the male and female sample and since the male sample was very small anyhow, further evaluations will not take gender into account. Internal Consistency of Scales (Question 1)Table shows the reliability analyses of the QDF scales.
Cronbach’s alpha of the QDF subscales “positive” and “negative” (legend, see Table ).For most of the scales, Cronbach’s Alpha reveals acceptable internal consistencies. For this analysis, also items with corrected item-total-correlations below were retained in order to keep the parallel structure of the questionnaire and for considering face validity.
They will, however, be eliminated for the validation of the questionnaire in a clinical sample. It is obvious that the shorter 4 item scales show lower reliabilities than the longer ones. Comparison between Deprivation from Positive and Encounter with Negative Reinforcements according to Stimulus Conditions (Question 2)Means of responses to the two types of frustration, separated according to nonhuman and human conditions are depicted in Figure. NegNH1negNH2negNH3negNH4negNH5negNH6negh+1negh+2negh+3negh+4negh+5negh+6negh1negh2negh3negh4negh5negh6negNH11.840.396.−.246.455.636.411.353.negNH21.850.826.negNH3. 484.1.380.748.−.413.265.349.685.271.245negNH4−. 2641−.283.394.587.−.266.290.390.negNH5.
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2771.314.645.271.627.negNH6. 337.1.472.−.255.261.431.424.273.314.negh+1.840.380.−.283.314.472.1.826.267.348.negh+2.850.394.1.829.238negh+3.396.748. 428.1.389.626.negh+4−.246−.413.587.−.255−. 335.1.388.negh+5.455.0.265−.266.645.261. 472.301.1.383.688.negh+6.431. 2761.253.259.661.negh1.636.349.271.424.826.389.383.2531negh2.826.290.829.1negh3.411.685.267.626.1negh4.390.238.388. 2691negh5.353.271.627.273.348.688.259.
336.1negh6.245.314.661.345.−. PosH1posH2posH3posH4posH5posH6negH1negH2negH3negH4negH5negH6posH11.892.426.393.posH21.823.328.posH3.529.1.401.815.285.posH4−.363.585.−.342.1−.329.581.626.−.297.−.248posH5.524.302.−.297.1.468.654.posH6.499.−.343.478.−.296.309.1.438.424.281.569.negH1.892.401.−.329.468.438.1negH2.823.581.1negH3.426.815.424.362.1negH4.328.626.340.1negH5.393.285.−.297.654.281.435.1negH6−.248.569.257.279.2551;.;. Intercorrelations between the reactions to scales of withdrawal from positive and encounter with negative reinforcers of the QDF. Conclusions (Study 1)The results reveal that although fair internal consistencies for the reaction scales to the four major categories, posNH, negNH, posH, and negH, have been achieved, some reactions are inappropriate for certain situations and have to be eliminated due to their low item-total-correlations (question 1). Moreover, although the situations can be significantly discriminated into frustrations due to deprivation from reward and application of punishment (“positive” and “negative frustrations) by the intensities of emotional reactions (question 2), the types of depressive and aggressive reactions do not form opposite emotional responses but are positively related (question 3).
They are not highly specific for the types of stimulus classes and are both negatively correlated or unrelated to being relaxed or inclined to active coping.The results reveal that although fair internal consistencies for the reaction scales to the four major categories posNH, negNH, posH, and negH have been achieved, some reactions are inappropriate for certain situations and have to be eliminated due to their low item-total-correlations (question 1). Rome total war patch 1.5 to 1.0 3. Moreover, although the situations can be significantly discriminated into frustrations due to deprivation from reward and application of punishment (positive and negative frustrations) by the intensities of emotional reactions (question 2), the types of depressive and aggressive reactions do not form opposite emotional responses but are positively related (question 3). They are not highly specific for the types of stimulus classes and are both negatively correlated or unrelated to being relaxed or inclined to active coping.Study 2Questions to be tested in this study are as follows. (1) Are correlations between the trait of depression higher with the depressive QDF responses than with the aggressive ones and is aggression more correlated to the aggressive QDF responses than to the depressive ones? (2) Do responses to nonreward (pos) show stronger associations with the trait of aggression than responses to punishment (neg) and do responses to punishment (neg) show stronger correlations with the trait of depression than responses to nonreward (pos)? (3) Do the results reveal higher responses to human than to nonhuman conditions of the QDF scales in depressive alcoholics and is this relationship absent in aggressive alcoholics?
Sample and Data CollectionThe sample of patients (age: mean = 47.93; SD = 9,00; range = 27–69) included in study 2 had to fulfill the following criteria: alcohol abuse as defined by the ICD-10 code F10.2 according to the WHO, diagnosed by an experienced psychiatrist, male gender, age 18 years, no additional substance dependence, sufficient knowledge of the German language. Patients who additionally suffered either from schizophrenia, schizotypal, or delusional disorder or from bipolar affective disorder according to the WHO ICD-10 classification were excluded. Patients were recruited on the one hand from two German psychiatric hospitals (University Hospital Giessen-Marburg and Vitos Hospital Giessen), after acute withdrawal, and on the other hand from two outpatient institutions for psychotherapy of alcohol addiction after withdrawal in one of the two psychiatric hospitals. They were asked to give informed consent and were rewarded by 20 Euro after completion of the session.
The study was approved by the ethics committee of the Medical Faculty of Giessen University, Giessen, Germany. Correlations of factors Depression and Aggression with QDF scales for human conditions; withdrawal from positive reinforcers: posH, (a); encounter with negative reinforcers: negH, (b) (.;.; +; after Bonferroni correction).Significant correlations between responses, in particular responses 1 (happens only to me) and 3 (get angry) with both, Depression and Aggression, can be found within all four conditions (Figures and left and right panel). The hypothesis would suggest that Depression should show higher correlations with the depressive responses 1 and 5 than Aggression, and Aggression should be more intensively related to responses 3 and 6 than Depression. Regarding the significant correlation coefficients, this is neither the case for the negative reinforcement condition nor for the condition of withdrawal from rewards in either human (H, Figure ) or nonhuman (NH, Figure ) sources of frustration. Even in the few instances in which pairs of correlations according to inspection would support the hypothesis (Figure response 3, pos NH, and response 5 both, pos and neg NH), no significant differences between the Aggression and Depression coefficients can be proven by z-tests.
Also on a descriptive level from the 6 significant correlation coefficients between depressive responses 1 or 5 and Depression, three showed higher correlations with Depression and three with Aggression. Even more surprising was that out of the 6 significant correlations of the aggressive responses 3 and 6 with the personality factors, five showed higher correlations with Depression than with Aggression indicating that Depression seems to be more responsible for both types of responses to frustration than Aggression, and that aggressives do not seem to be more inclined to respond by aggressive reactions than depressives. It seems that neither Depressive nor Aggressive types prefer their trait congruent reactions. So, the hypothesis of specific trait-state relationships has to be rejected.
The Relations between Punishment and Depression versus Nonreward and Aggression (Question 2)For testing the hypothesis derived from Gray’s theory that depressives are more sensitive to punishment than to withdrawal of reward corresponding correlations of Depression and Aggression, respectively, with the QDF response items of the left (pos) and right panel (neg) of each figure compared by z-tests. Although no significant differences between corresponding Items of the left and right panel could be detected, on a descriptive level correlations with Depression with each of the relevant responses 1, 3, 5, 6 were higher for responses to negative reinforcers than for denial of positive events, particularly in the nonhuman conditions of frustration (Figure ), so that this part of the hypothesis gets some support.
For Aggression, no clear pattern emerged since only half of the correlations with the responses were higher for denial of positive reinforcers than for encounter with negative events. Surprisingly, aggressives even tended to accuse themselves (reaction 5) and not the other person (reaction 6) when being insulted or attacked by other persons (Figure, negH). Taken together, the situation by personality interaction expected for the two stimulus conditions according to question 2 could not be found in our data.
Differences in Correlations between Frustrations Caused by Humans and NonHuman Conditions (Question 3)It was hypothesized that depressives as opposed to aggressives might be more sensitive to frustrations caused by humans than to frustrations by external inanimate obstacles. Although this seems to apply to getting angry (reaction 3) which was higher with Depression in frustrations caused by humans than in the nonhuman conditions, statistical comparisons between correlations of Depression with corresponding responses to person induced as opposed to inanimate frustrations, did not yield significant differences by z-tests. Rather, it becomes evident that in particular reaction 6 (blaming others) is less associated with both personality factors Depression and Aggression when elicited by frustrations caused by humans (Figure ) than by inanimate frustrations (Figure ). So, there is no convincing evidence for a specific affinity of depressives to frustrations by humans.Since the traits of Aggression and Depression are positively correlated with each other ( ), partial correlations with Depression were computed controlling for Aggression and partial correlations with Aggression partialling out Depression (see Table ). QDF reactionsAggression (contr. For depression)Depression (contr. For aggression)posNHnegNHposNHnegNH1 (“always happens to me”).29.27.26.30.2 (make the best of it).06−.05−.02.123 (become angry).35.28.28.32.4 (“such things just happen”)−.14−.16−.07−.175 (blame yourself).13.12.21.26.6 (blame everybody else).29.26.42.47.posHnegHposHnegH1 (“always happens to me”).31.28.26.35.2 (make the best of it).09.08.09.043 (become angry).23.22.31.39.4 (“such things just happen”)−.02−.06−.04−.075 (blame yourself)−.05.25.19.236 (blame everybody else).19.10.15.17;.;.
Partial correlations of reactions in QDF scales with the personality factors of aggression and depression, controlling for depression and aggression, respectively, (legend see Table ).All correlations were lower than the original ones, but mostly still significant, although partly only on the.05 level. This demonstrates that in spite of some common variance each of the two constructs contributes special variance to the response variables which were significantly related to the traits.In reply to question 1, partial correlations between depressive responses 1 and 5 and aggressive responses 3 and 6 on the one hand and the corresponding personality factors on the other were compared across all stimulus conditions on a descriptive level. No clear relationship between corresponding trait and state variables could be observed, since from the eight correlation coefficients between depressive responses 1 or 5 and Depression, three showed higher correlations with Depression and three with Aggression (two were not significant). Even more surprising was that out of the 6 significant correlations of the aggressive responses 3 and 6 with the personality factors, five showed higher correlations with Depression than with Aggression indicating that Depression seems to be more responsible for both types of responses to frustration than Aggression, and that aggressives do not seem to be more inclined to respond by aggressive reactions than depressives.
AbstractFibromyalgia syndrome is a clinically well-characterized chronic pain condition of high socio-economic impact. Although the pathophysiology is still unclear, there is increasing evidence for nervous system dysfunction in patients with fibromyalgia syndrome. In this case-control study we investigated function and morphology of small nerve fibres in 25 patients with fibromyalgia syndrome. Patients underwent comprehensive neurological and neurophysiological assessment. We examined small fibre function by quantitative sensory testing and pain-related evoked potentials, and quantified intraepidermal nerve fibre density and regenerating intraepidermal nerve fibres in skin punch biopsies of the lower leg and upper thigh. The results were compared with data from 10 patients with monopolar depression without pain and with healthy control subjects matched for age and gender.
Neurological and standard neurophysiological examination was normal in all patients, excluding large fibre polyneuropathy. Patients with fibromyalgia syndrome had increased scores in neuropathic pain questionnaires compared with patients with depression and with control subjects ( P.
Patients with fibromyalgia syndrome had a higher NPSI-G median sum score (0.3; range 0.1–0.8) than patients with depression (0; range 0–0.3; P. The boxplots give ( A) the NPSI-G discriminative score for the assessment of neuropathic pain and ( B) the ADS assessing depressive symptoms. ( A) Patients with fibromyalgia syndrome have higher NPSI-G discriminative scores compared to patients with depression and to healthy control subjects.
The median and range values are as follows: fibromyalgia syndrome = 58 (44–79), patients with depression = 42 (42–56), healthy control subjects = 42 (40–66). The higher score in patients with fibromyalgia syndrome points towards neuropathic pain. Dots above the bar graphs indicate outlier values. ( B) Patients with fibromyalgia syndrome and patients with depression have elevated scores in the ADS compared with healthy control subjects. The median and range values are as follows: fibromyalgia syndrome = 20 (2–44), patients with depression = 29 (4–50), healthy control subjects = 6 (0–31). The boxplots give ( A) the NPSI-G discriminative score for the assessment of neuropathic pain and ( B) the ADS assessing depressive symptoms.
( A) Patients with fibromyalgia syndrome have higher NPSI-G discriminative scores compared to patients with depression and to healthy control subjects. The median and range values are as follows: fibromyalgia syndrome = 58 (44–79), patients with depression = 42 (42–56), healthy control subjects = 42 (40–66). The higher score in patients with fibromyalgia syndrome points towards neuropathic pain. Dots above the bar graphs indicate outlier values.
( B) Patients with fibromyalgia syndrome and patients with depression have elevated scores in the ADS compared with healthy control subjects. The median and range values are as follows: fibromyalgia syndrome = 20 (2–44), patients with depression = 29 (4–50), healthy control subjects = 6 (0–31). Sensory profiles measured with QST at the left foot of patients with fibromyalgia syndrome ( A) and depression ( B) compared with age- and gender-matched control subjects (blue zero-line in A and B).
( A) Patients with fibromyalgia syndrome have elevated warm and cold detection thresholds (WDT, CDT) and impaired ability to distinguish temperature changes (i.e. Increased thermal sensory limen, TSL). Also the mechanical detection threshold (MDT) is elevated, while mechanical pain sensitivity (MPS) and pressure pain thresholds (PPT) are decreased. ( B) Patients with depression do not differ from healthy control subjects. Sensory profiles measured with QST at the left foot of patients with fibromyalgia syndrome ( A) and depression ( B) compared with age- and gender-matched control subjects (blue zero-line in A and B). ( A) Patients with fibromyalgia syndrome have elevated warm and cold detection thresholds (WDT, CDT) and impaired ability to distinguish temperature changes (i.e.
Increased thermal sensory limen, TSL). Also the mechanical detection threshold (MDT) is elevated, while mechanical pain sensitivity (MPS) and pressure pain thresholds (PPT) are decreased. ( B) Patients with depression do not differ from healthy control subjects. Summarizes the median values of the measured PREP parameters. PREP in patients with fibromyalgia syndrome, depression and in healthy control subjects.
( A, C and E) N1 and P1 latencies of patients with fibromyalgia syndrome are not different after eliciting PREP at the face and the hand; N1 latencies are prolonged in patients with fibromyalgia syndrome compared with patients with depression and to healthy control subjects when elicited at the foot. ( B, D and F) Peak-to-peak amplitudes of PREP are reduced in patients with fibromyalgia syndrome when PREP is elicited at the face, the hand, or the feet. PREP in patients with fibromyalgia syndrome, depression and in healthy control subjects. ( A, C and E) N1 and P1 latencies of patients with fibromyalgia syndrome are not different after eliciting PREP at the face and the hand; N1 latencies are prolonged in patients with fibromyalgia syndrome compared with patients with depression and to healthy control subjects when elicited at the foot. ( B, D and F) Peak-to-peak amplitudes of PREP are reduced in patients with fibromyalgia syndrome when PREP is elicited at the face, the hand, or the feet.
FMS ( n = 25)Monopolar depression ( n = 10)Controls ( n = 55)P-value (FMS versus controls)FMS + depression ( n = 16)FMS no depression ( n = 9)FacePREP obtained: 22/25PREP obtained: 7/10PREP obtained: 43/55N1 latency (ms)135.0 (49.3–179.3)132.3 (109.2–155.3)135.5 (44.7–173.3)ns134.1 (49.3–179.3)135.9 (58.1–144.2)P1 latency (ms)183.4 (95.4–267.7)203.7 (175.1–241)193.1 (90.8–269.6)ns182.9 (95.4–267.7)183.9 (111.5–249.3)Amplitude (µV)8.7 (2.6–35.6)40.3 (18.7–74.7)32.0 (5.3–74.2). FMS ( n = 25)Monopolar depression ( n = 10)Controls ( n = 55)P-value (FMS versus controls)FMS + depression ( n = 16)FMS no depression ( n = 9)FacePREP obtained: 22/25PREP obtained: 7/10PREP obtained: 43/55N1 latency (ms)135.0 (49.3–179.3)132.3 (109.2–155.3)135.5 (44.7–173.3)ns134.1 (49.3–179.3)135.9 (58.1–144.2)P1 latency (ms)183.4 (95.4–267.7)203.7 (175.1–241)193.1 (90.8–269.6)ns182.9 (95.4–267.7)183.9 (111.5–249.3)Amplitude (µV)8.7 (2.6–35.6)40.3 (18.7–74.7)32.0 (5.3–74.2). FMS ( n = 25)Monopolar depression ( n = 10)Controls ( n = 55)P-value (FMS versus controls)FMS + depression ( n = 16)FMS no depression ( n = 9)FacePREP obtained: 22/25PREP obtained: 7/10PREP obtained: 43/55N1 latency (ms)135.0 (49.3–179.3)132.3 (109.2–155.3)135.5 (44.7–173.3)ns134.1 (49.3–179.3)135.9 (58.1–144.2)P1 latency (ms)183.4 (95.4–267.7)203.7 (175.1–241)193.1 (90.8–269.6)ns182.9 (95.4–267.7)183.9 (111.5–249.3)Amplitude (µV)8.7 (2.6–35.6)40.3 (18.7–74.7)32.0 (5.3–74.2).
FMS ( n = 25)Monopolar depression ( n = 10)Controls ( n = 55)P-value (FMS versus controls)FMS + depression ( n = 16)FMS no depression ( n = 9)FacePREP obtained: 22/25PREP obtained: 7/10PREP obtained: 43/55N1 latency (ms)135.0 (49.3–179.3)132.3 (109.2–155.3)135.5 (44.7–173.3)ns134.1 (49.3–179.3)135.9 (58.1–144.2)P1 latency (ms)183.4 (95.4–267.7)203.7 (175.1–241)193.1 (90.8–269.6)ns182.9 (95.4–267.7)183.9 (111.5–249.3)Amplitude (µV)8.7 (2.6–35.6)40.3 (18.7–74.7)32.0 (5.3–74.2). Skin innervation and regenerating fibres are reduced in patients with fibromyalgia syndromeMedian IENFD as quantified through PGP9.5 immunofluorescence was reduced at the lower leg in patients with fibromyalgia syndrome compared with healthy control subjects (fibromyalgia syndrome: 5 fibres/mm, range 0.3–11.3, control subjects: 9.5 fibres/mm, 3.2–17.4; P 0.05). IENFD at the lower leg ( A) and the proximal thigh ( B) of patients with fibromyalgia syndrome, depression, and of healthy control subjects investigated with the pan-axonal marker PGP9.5. Patients with fibromyalgia syndrome have lower PGP9.5-positive IENFD compared with healthy control subjects at both biopsy sites.
Density of regenerative intraepidermal nerve fibres immunoreacted with GAP43 at the lower leg ( C) and the proximal thigh ( D) of patients with fibromyalgia syndrome, depression, and of healthy control subjects. Patients with fibromyalgia syndrome have lower immunoreactivity for GAP43 compared with healthy control subjects at both biopsy sites.
IENFD at the lower leg ( A) and the proximal thigh ( B) of patients with fibromyalgia syndrome, depression, and of healthy control subjects investigated with the pan-axonal marker PGP9.5. Patients with fibromyalgia syndrome have lower PGP9.5-positive IENFD compared with healthy control subjects at both biopsy sites. Density of regenerative intraepidermal nerve fibres immunoreacted with GAP43 at the lower leg ( C) and the proximal thigh ( D) of patients with fibromyalgia syndrome, depression, and of healthy control subjects. Patients with fibromyalgia syndrome have lower immunoreactivity for GAP43 compared with healthy control subjects at both biopsy sites.
P 0.05).The mean number of PGP9.5 immunoreactive dermal nerve fibre bundles was reduced in patients with fibromyalgia syndrome compared with healthy control subjects (fibromyalgia syndrome: 2.9 ± 1.3 bundles/mm 2; healthy control subjects 4.4 ± 1.5 bundles/mm 2; P = 0.018), while patients with depression (3.4 ± 1.6 bundles/mm 2) did not differ from control subjects (A–C). The mean number of MBP immunoreactive dermal nerve fibre bundles (i.e.
Myelinated nerve fibres) was not different between groups (fibromyalgia syndrome: 1.1 ± 0.6 bundles/mm 2; depression 1.2 ± 0.9 bundles/mm 2; healthy control subjects 1.6 ± 1.1 bundles/mm 2; D–F). Also the mean percentage of PGP9.5 immunoreactive nerve bundles containing MBP immunoreactive myelinated nerve fibres did not differ between groups (fibromyalgia syndrome 36%, depression 32%, healthy control subjects 37%). These results underline that patients with fibromyalgia syndrome have a reduction in PGP9.5 immunoreactive unmyelinated nerve fibres, while the MBP immunoreactive myelinated nerve fibre population is spared. Representative photomicrographs of PGP9.5 stained skin punch biopsies of a patient with fibromyalgia syndrome ( A and D), a patient with depression ( B and E), and of a healthy control subject ( C and F). ( A–C) PGP9.5 stain for dermal nerve fibre bundles; ( D–F) MBP stain for myelinated nerve fibres.
The thin arrows indicate PGP9.5 immunoreactive dermal nerve fibre bundles ( A–C); arrowheads indicate MBP immunoreactive myelinated nerve fibres ( D–F); the thick arrows ( A–C) indicate the respective nerve fibre bundle that is shown in the inset. The inset illustrates a double-stain of PGP9.5 (red) and MBP (green) immunoreactive fibre bundles.
FMS = fibromyalgia syndrome; GAP43 = growth-associated protein 43; PGP9.5 = protein-gene product 9.5. Scale bar = 200 µm.
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