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1.  Comparison of Memory Function and MMPI-2 Profile between Post-traumatic Stress Disorder and Adjustment Disorder after a Traffic Accident 
Differential diagnosis between post-traumatic stress disorder (PTSD) and adjustment disorder (AD) is rather difficult, but very important to the assignment of appropriate treatment and prognosis. This study investigated methods to differentiate PTSD and AD.
Twenty-five people with PTSD and 24 people with AD were recruited. Memory tests, the Minnesota Multiphasic Personality Inventory 2 (MMPI-2), and Beck's Depression Inventory were administered.
There were significant decreases in immediate verbal recall and delayed verbal recognition in the participants with PTSD. The reduced memory functions of participants with PTSD were significantly influenced by depressive symptoms. Hypochondriasis, hysteria, psychopathic deviate, paranoia, schizophrenia, post-traumatic stress disorder scale of MMPI-2 classified significantly PTSD and AD group.
Our results suggest that verbal memory assessments and the MMPI-2 could be useful for discriminating between PTSD and AD.
PMCID: PMC4022765  PMID: 24851120
Diagnosis, Differential; Post-traumatic stress disorders; Adjustment disorders; Memory deficits; MMPI-2
2.  Heterogeneity of Posttraumatic Stress Disorder Symptoms in Croatian War Veterans: Retrospective Study 
Croatian medical journal  2007;48(2):133-139.
To determine the relationship between the intensity of combat-related posttraumatic stress disorder (PTSD) and the intensity of predominating symptoms.
The study included 151 veterans from 1992-1995 war in Croatia with PTSD, aged 38.3 ± 7.3 years (mean ± standard deviation). The veterans were psychologically tested with the Mississippi Scale for Combat-related PTSD (M-PTSD), Questionnaire on Traumatic Combat and War Experiences (USTBI-M), and Minnesota Multiphasic Personality Inventory-version 201 (MMPI-201).
The discriminative analysis of the data revealed that the group with lower PTSD intensity had the highest scores on MMPI scales D (depression, T-score 95.7 ± 5.6), Hs (hypochondriasis, 87.6 ± 5.1), and Hy (hysteria, 85.6 ± 4.9), whereas the group with higher PTSD intensity, besides these three scales (D = 98.3 ± 5.3; Hs = 90.1 ± 4.3; Hy = 89.5 ± 4.7), also had clinically significantly elevated Pt (psychastenia, 80.6 ± 5.6), Sc (schizophrenia, 79.6 ± 4.8), and Pa (paranoia, 85.6 ± 5.4) scales, with the highest Pa scale.
It was possible to differentiate study participants with different PTSD intensity on the basis of their MMPI profile. More intense PTSD was associated with externalized symptoms, such as aggression, acting-out, hostility, and mistrust, whereas less intensive PTSD was associated with mostly depressive symptoms. Our study showed that different intensity of PTSD has different symptom patterns.
PMCID: PMC2080523  PMID: 17436377
3.  DSM-IV-TR “pain disorder associated with psychological factors” as a nonhysterical form of somatization 
Elevated Minnesota Multiphasic Personality Inventory (MMPI) scores on the hysteria (Hy) scale are reported in several forms of pain. Previous results were possibly biased by diagnostic heterogeneity (psychogenic, somatic and mixed pain syndromes included in the same index sample) or Hy heterogeneity (failure to differentiate Hy scores into clinically meaningful sub-scales, such as admission of symptoms [Ad] and denial of symptoms [Dn]).
To overcome this drawback, 48 patients diagnosed as having a Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision (DSM-IV-TR) diagnosis of “pain disorder associated with psychological factors” were compared with 48 patients experiencing somatic pain excluding psychological factors, and 42 somatic controls without pain.
MMPI Hy and hypochondriasis (Hs) scores were significantly higher in the pain disorder group than in control groups, who scored similarly. MMPI correction (K) scores and Dn scores were similar in the three groups, whereas Ad was significantly higher in the pain disorder group and lower and similar in the two control groups, respectively. In the pain disorder group, Ad and Dn were negatively correlated, whereas in control groups they were unrelated.
These findings suggest that whereas a pattern of high Hs and Hy scores together with a normal K score might characterize patients with a pain disorder associated with psychological factors, elevated Hy scores per se do not indicate hysterical traits. In the pain disorder group, elevated Hy scores reflected the Ad subscale alone, indicating a strikingly high frequency of distressing somatic symptoms. They tend not to repress or deny the emotional malaise linked to symptoms, as the hysterical construct expects. The pain disorder designation should be considered a nonhysterical form of somatization.
PMCID: PMC2670805  PMID: 18301811
Chronic pain; Hysteria; Idiopathic pain; Psychogenesis; Psychogenic pain; Somatoform pain
4.  Post-Traumatic Stress Disorder, Depression, and Heart-Rate Variability among North Korean Defectors 
Psychiatry Investigation  2011;8(4):297-304.
This study evaluated the symptoms of post-traumatic stress disorder (PTSD) among North Korean defectors and their level of suicidal ideation and the correlation between these and heart-rate variability (HRV) to explore the possibility of using HRV as an objective neurobiological index of signs of autonomic nervous system disorder.
A total of 32 North Korean defectors (nine men, 23 women) were selected as subjects, and their HRV was measured after they completed the Minnesota Multiphasic Personality Inventory-PTSD (MMPI-PTSD) scale and the Beck Depression Inventory (BDI).
1) Low-frequency (LF)/high-frequency (HF) ratios in the HRV index and MMPI-PTSD scores were correlated (r=0.419, p<0.05), as were BDI item 9 (suicidal ideation) and MMPI-PTSD scores (r=0.600, p<0.01). 2) A regression analysis of LF/HF ratios and MMPI-PTSD scores revealed an R-value of 13.8% (Adj. R2=0.138, F=4.695, p=0.041), and a regression analysis of BDI item 9 and MMPI-PTSD scores showed an R-value of 32.8% (Adj. R2=0.328, F=11.234, p=0.003). In other words, the LF/HF ratio (β=0.419) and BDI item 9 (β=0.600) appear to be risk factors in predicting MMPI-PTSD scores.
The LF/HF ratio, a standard index of autonomic nervous system activity, can be used as an objective neurobiological index to analyze PTSD among North Korean defectors presenting with various mental and physical symptoms, and the approximate level of suicide -ideation can act as a predicting factor for PTSD.
PMCID: PMC3246136  PMID: 22216038
North Korean defectors; Post-traumatic stress disorder; Suicide; Heart rate variability; Depression
5.  In-patient, short-term group psychotherapy – a therapeutic option for Bundeswehr soldiers? 
Objective: This study is to assess the efficacy of short-term group psychotherapy rooted in depth psychology for Bundeswehr soldiers suffering from depressive, neurotic, stress, or personality disorders.
Method: 103 participants in the in-patient, closed group setting were evaluated prospectively and compared with a non-randomized waitlisted control group.
Results: In all relevant SCL-90-R (Symptom-Check-List-90) and MMPI-K (Minnesota-Multiphasic-Personality-Inventory short-form) scales therapy resulted in significant improvements as compared with the initial values. The control group did not show any significant changes, the therapy group was significantly superior to the control group in the scales of MMPI-K and the GSI-Scale of the SCL-90-R. For soldiers with a stress-reactive disorder (F43), no differences in efficacy could be identified compared with the other diagnosis groups.
Conclusion: The results were considered to indicate that in-patient, short-term group psychotherapy may, in combination with additional setting components, be helpful in improving psychological symptoms in German soldiers. The indication range of group therapy offered to Bundeswehr soldiers should be expanded to also include primary prophylaxis and the treatment of mental-health problems following deployments abroad, if applicable.
PMCID: PMC2736515  PMID: 19742280
Bundeswehr soldiers; short-term group psychotherapy; efficacy; stress-reactive disorders
6.  Chronic daily headache: personality study by means of computerized MMPI-2 
The Journal of Headache and Pain  2000;1(Suppl 1):S67-S70.
Unresolved questions in headache research are the roles of drug abuse and psychopathology in headache disorder, especially in chronic daily headache. We investigated the utility of the revised version of the Minnesota Multiphasic Personality Inventory (MMPI-2) for assessing psychopathology in chronic daily headache patients. Chronic headache sufferers gave characteristic responses on Hy (hypochondria), D (depression) and Hs (hysteria) scales which are known as the “neurotic triad”. Although our data suggest that the MMPI profile types do not discriminate between different diagnosis groups and fail to determine whether psychopathological traits predispose to drug abuse, they nonetheless confirm the importance of psychological assessment as an essential step in the decision to seek medical help for headache.
PMCID: PMC3611794
Key words MMPI-2; Chronic daily headache; Personality inventory
7.  Evidence Against a Link Between Hyperemesis Gravidarum and Personality Characteristics from an Ethnically Diverse Sample of Pregnant Women: A Pilot Study 
Journal of Women's Health  2011;20(1):137-144.
Hyperemesis gravidarum (HG), a pregnancy-related condition marked by extreme nausea and vomiting, has been considered a psychosomatic illness associated with long-standing personality characteristics (e.g., hysteria). In this pilot study, we examined personality, somatic, and psychological variables with ethnically diverse samples of women with HG and women with typical levels of nausea and vomiting of pregnancy (NVP).
Personality (Minnesota Multiphasic Personality Index-2 [MMPI-2] and MMPI-2RF), somatic (MMPI-2RF), and psychological (Beck Depression Inventory-II [BDI-II] and NVP-related quality of life) variables collected during the first trimester of pregnancy were compared between 15 women with HG and 15 women with normal levels of NVP matched for age, education, marital status, insurance source, and race/ethnicity. A secondary analysis was performed comparing these variables among a group of 9 asymptomatic pregnant women to the HG and NVP groups.
No significant differences were found between the HG and NVP groups on any personality, somatic, or psychological variables. Both groups had clinically significant elevations on the MMPI-2 hypochondriasis scale, which incorporates somatic symptoms. The NVP group had a clinically significant elevation on the MMPI-2RF gastrointestinal complaints scale. Both groups had significantly higher means on the MMPI-2 and MMPI-2RF scales than the asymptomatic group. Predominantly Spanish speakers appeared particularly vulnerable to psychological distress associated with somatic complaints.
The results of this pilot study suggest that research with HG patients is feasible and that psychological distress expressed by women with HG and NVP may reflect reactions to somatic symptoms. No evidence was found to support an association between HG and personality characteristics. Recommendations for future research are provided, such as examining the potential benefits of translation services for Spanish-speaking HG patients.
PMCID: PMC3026647  PMID: 21194308
8.  Personality traits in chronic daily headache patients with and without psychiatric comorbidity: an observational study in a tertiary care headache center 
Previous studies suggest that patients with Chronic Daily Headache (CDH) have higher levels of anxiety and depressive disorders than patients with episodic migraine or tension-type headache. However, no study has considered the presence of psychiatric comorbidity in the analysis of personality traits. The aim of this study is to investigate the prevalence of psychiatric comorbidity and specific personality traits in CDH patients, exploring if specific personality traits are associated to headache itself or to the psychiatric comorbidity associated with headache.
An observational, cross-sectional study. Ninety-four CDH patients with and without medication overuse were included in the study and assessed by clinical psychiatric interview and Mini International Neuropsychiatric Interview (M.I.N.I.) as diagnostic tools. Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Hamilton Depression Rating Scale (HAM-D) were afterwards administered. Patients with and without psychiatric comorbidity were compared. Further analyses were made by splitting the whole group according to the headache diagnosis and the presence or not of medication overuse.
Psychiatric comorbidity was detected in 44 patients (46.8%) (group A) and was absent in the remaining 50 patients (53.2%) (group B). Mood and anxiety disorders were the most frequently diagnosed (43.6%).
In the overall group, mean scores of MMPI-2 showed a high level in the so-called neurotic triad; in particular the mean score in the Hypochondriasis subscale was in the pathologic area (73.55 ± 13.59), while Depression and Hysteria scores were moderate but not severe (62.53 and 61.61, respectively). In content scales, score in Health Concern was also high (66.73).
Group A presented higher scores compared to Group B in the following MMPI-2 subscales: Hypochondriasis (p = .036), Depression (p = .032), Hysteria (p < .0001), Hypomania (p = .030). Group B had a high score only in the Hypochondriasis subscale. No significant differences were found between chronic migraine (CM)-probable CM (pCM) plus probable medication overuse headache (pMOH) and chronic tension-type headache (CTTH)-probable CTTH (pCTTH) plus pMOH patients or between patients with and without drug overuse.
The so-called “Neurotic Profile” reached clinical level only in CDH patients with psychiatric comorbidity while a high concern about their general health status was a common feature in all CDH patients.
PMCID: PMC3620450  PMID: 23566048
Chronic daily headache; Medication overuse headache; Psychiatric comorbidity; MMPI-2
9.  Effect of preoperative iodine in patients with Graves' disease controlled with antithyroid drugs and thyroxine. 
Thirty-four patients with Graves' disease, first rendered euthyroid with antithyroid drugs (ATD) then given supplementary thyroxine (T4), were randomly allocated to three treatment groups. In Group I ATD and T4 were stopped 10 days before partial thyroidectomy and the patients were treated with Lugol's iodine alone. In Group II the patients were treated up to the time of operation with ATD and T4 alone. In Group III ATD and T4 were continued until the day of operation, but the patients also received 10 days' treatment with Lugol's iodine. Analysis of the results showed that pre-operative iodine therapy in patients with Graves' disease, already rendered euthyroid with ATD and T4, made no difference to the vascularity of the gland, operative blood loss or thyroid follicular size. Over a third of patients in Group I, treated with Lugol's iodine alone for 10 days pre-operatively, had subnormal levels of thyroid hormones at the time of operation and this was also the Group in which the complications of partial thyroidectomy tended to occur. It is concluded that the addition of iodine preoperatively is unnecessary in the patient who is already euthyroid on ATD and T4.
PMCID: PMC2498739  PMID: 2457351
10.  The MMPI-2 in women with headache or facial pain. A comparative study 
The Journal of Headache and Pain  2000;1(2):105-110.
Our purpose was to apply the Minnesota Multiphasic Personality Inventory (MMPI-2) to groups of women with different types of headache and facial pain. 117 women with tension-type headache (TTH), migraine (M), facial pain disorder as somatoform disorder (FP), myogenous facial pain (MP), or temporomandibular joint disorder (TMJ) were given in the Italian version of the MMPI-2. The level of pain was assessed with the visual analogue scale (VAS). A configural analysis of the MMPI profiles was also performed. Data were analysed with one-way ANOVA, chi-square analysis and Pearson's correlation coefficient. FP and TH patients showed the highest scale elevation and TMJ patients the lowest. The TMJ group had the highest prevalence of “coper” configuration and the FP group the lowest. A correlation was found between VAS and MMPI-2 scores for hypochondria, hysteria and paranoia. We conclude that: chronic pain may alter the patient's personality characteristics; patients with facial pain disorder show the highest tendency to neurotism and psychoticism; and in patients with migraine, TTH and MP, the psychological component may vary conspiquously. These factors should be taken into account when selecting the treatment options.
PMCID: PMC3611779
Key words MMPI-2; Headache; Facial pain; Personality traits
11.  Can bone loss be reversed by antithyroid drug therapy in premenopausal women with Graves' disease? 
Hyperthyroidism can lead to reduced bone mineral density (BMD) and increased fracture risk particularly in postmenopausal women, but the mechanism behind is still unclear.
Prospective examination of the influence of thyroid hormones and/or thyroid autoantibodies on BMD in premenopause.
We have examined 32 premenopausal women with untreated active Graves' disease from time of diagnosis, during 18 months of antithyroid drug therapy (ATD) and additionally 18 months after discontinuing ATD. Variables of thyroid metabolism, calcium homeostasis and body composition were measured every 3 months. BMD of lumbar spine and femoral neck were measured at baseline, 18 ± 3 and 36 ± 3 months. Data were compared to base line, a sex- and age matched control group and a group of patients with Hashimoto's thyroiditis treated with non-suppressive doses of levothyroxine.
The study showed significantly (p < 0.002) lower BMD in the thyrotoxic state compared to the control group with subsequent significant improvement during 18 ± 3 months of ATD compared to baseline (p < 0.001). However, during the following 18 months after stopping ATD femoral neck BMD decreased again unrelated to age (more than 0.4% per year, p < 0,002). The wellestablished effect of thyrotoxicosis on calcium homeostasis was confirmed. The positive predictor for best BMD was TSH receptor antibodies (TRAb) while free T4 correlated negatively in the thyrotoxic female Graves' patients (p < 0.02 and p < 0.003). In healthy controls and patients with treated Graves' disease both TSH and T4 correlated negatively to the bone mass (BMC) (p < 0.003).
The results indicated a clinically relevant impact of thyroid function on bone modulation also in premenopausal women with Graves' disease, and further indicated the possibility for a direct action of TRAb on bones.
PMCID: PMC2936437  PMID: 20807449
12.  Associations of Preexisting Depression and Anxiety With Hospitalization in Patients With Cardiovascular Disease 
Mayo Clinic Proceedings  2011;86(11):1056-1062.
OBJECTIVE: To determine the risk of hospitalization and death in relation to preexisting depression and anxiety among patients with cardiovascular disease (CVD).
PATIENTS AND METHODS: The cohort consisted of 799 Olmsted County, MN, residents diagnosed with CVD (myocardial infarction or heart failure) from January 1, 1979, to December 31, 2009, who completed a Minnesota Multiphasic Personality Inventory (MMPI) prior to their event. The MMPI was used to identify depression and anxiety, and participants were followed up for hospitalizations and death during an average of 6.2 years.
RESULTS: Depression and anxiety were identified in 282 (35%) and 210 (26%) participants, respectively. After adjustment, depression and anxiety were independently associated with a 28% (95% confidence interval [CI], 8%-51%) and 26% (95% CI, 3%-53%) increased risk of being hospitalized, respectively. Depression also conferred an increased risk of all-cause mortality of similar magnitude, whereas the hazard ratio for anxiety was not statistically significant. The combined occurrence of depression and anxiety led to a 35% (95% CI, 8%-71%) increase in the risk of hospitalizations.
CONCLUSION: Among patients with CVD, both preexisting depression and anxiety, occurring on average 17 years before the CVD event, independently predict hospitalizations. In addition, the 2 conditions may act synergistically on increasing health care utilization in patients with CVD.
PMCID: PMC3202995  PMID: 22033250
13.  Does levodopa alter depression and psychopathology in Parkinsonism patients?1 
Twenty-seven Parkinsonism patients and 31 controls, matched for age and verbal IQ, were tested on an objectively scored personality test (Minnesota Multiphasic Personality Inventory) at the beginning of the patients' levodopa therapy and three months later. Patients, but not the controls, were retested after 15 months of levodopa treatment. The patients, all of whom were intact intellectually, obtained MMPI scores indicating moderate depression before beginning levodopa treatment. There was no test evidence to indicate that levodopa significantly increased or decreased the amount of depression in the patients after three or 15 months of levodopa. The patient group, however, significantly increased their Index of Psychopathology (Ip) score after 15 months of levodopa but not after three months.
PMCID: PMC1083592  PMID: 4149286
14.  Hemispheric asymmetries of affective processing as determined by the Minnesota Multiphasic Personality Inventory. 
Patients with left hemisphere disease have been noted to be depressed while those with right hemisphere disease appear indifferent. While patients with left hemisphere disease frequently have a greater cognitive deficit, patients with right hemisphere disease have difficulty in expressing affectively intoned speech. The Minnesota Multiphasic Personality Inventory (MMPI) can demonstrate underlying affective experience and is not dependent on affectively intoned speech. The purpose of this study was to determine whether a difference in affective moods, as assessed by the MMPI, was related to laterality of lesion in patients matched for severity of cognitive and motor dysfunction. Seven of the 16 subjects with left hemisphere dysfunction and none of the eight subjects with right hemisphere dysfunction showed an elevation on the depression scale. This observation not only confirms previous clinical observations but also demonstrates that these asymmetries cannot be ascribed completely to hemisphere-related differences in cognitive deficits or expressive abilities.
PMCID: PMC493058  PMID: 660213
15.  Depression after myocardial infarction. 
The Minnesota Multiphasic Personality Inventory was completed by 101 patients 16 to 18 months after a proved myocardial infarction. The data suggested a bimodal distribution of patients. One class of patients had a relatively "normal" personality score apart from a tendency to hypomania. The second class had severe depression, with associated hysteria, hypochondriasis and psychasthenia. The severely depressed patients were older, with a greater tendency to hypertension and angina, and a tendency to smaller gains in aerobic power despite an equal intensity of endurance training. The distinction between "normal" and "depressed" postinfarction patients seems of some clinical importance, for the two classes of patients require opposite supportive techniques--restraint and encouragement, respectively.
PMCID: PMC1956314  PMID: 1148970
16.  The MMPI-2 Restructured Clinical Scales in the Assessment of Posttraumatic Stress Disorder and Comorbid Disorders 
Psychological assessment  2008;20(4):327-340.
This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Clinician Administered Scale for PTSD. The utility of the RCSs was compared to that of the Clinical Scales (CSs) and the Keane PTSD (PK) scale. The RCSs demonstrated good psychometric properties along with patterns of associations with other measures of psychopathology that corresponded to current theory regarding the structure of comorbidity. A notable advantage of the RCSs compared to the MMPI-2 CSs was their enhanced construct validity and clinical utility in the assessment of comorbid internalizing and externalizing psychopathology. The PK scale demonstrated incremental validity in the prediction of PTSD beyond that of the RCSs or CSs.
PMCID: PMC2605647  PMID: 19086756
Minnesota Multiphasic Personality Inventory-2; Restructured Clinical Scales; posttraumatic stress disorder; internalizing; externalizing
17.  Comparison of methimazole/hydrocortisone ointment with oral methimazole in patients with graves disease: A prospective, randomized, open-label, parallel-group, 18-month study 
Background: Thionamide antithyroid drugs (ATDs) have certain disadvantages and are associated with some adverse events (AEs). To overcome the problems associated with ATDs, a compound antithyroid ointment (CATO) containing methimazole (MMI) and hydrocortisone has been developed for use as a local thyroid treatment (LTT).
Objective: The aim of this study was to assess the clinical effectiveness and tolerability of CATO LTT in patients with Graves disease (GD).
Methods: This was a prospective, randomized, open-label, parallel-group clinical trial conducted at the Provincial Hospital Affiliated to Shandong University (Jinan, China). Patients with GD aged 19 to 65 years were randomized to receive either CATO LTT 0.3 g/d or oral MMI 37.5 mg/d (control group) treatment for 18 months, with a 4-year follow-up period. Hyperthyroid symptoms, thyroid function, granulocyte count, liver function, and AEs were assessed at baseline and every 2 weeks until serum thyroid hormone (TH) concentration normalized, at which point patients were assessed monthly. The primary efficacy end points were the duration of treatment required for serum TH concentration to normalize and the remission rate after completing the 18-month treatment regimen.
Results: A total of 154 patients (133 women, 21 men; mean [SD] age, 39.6 [11.8] years; all Han Chinese) participated in the study; all patients completed the 18-month treatment period. Compared with the MMI group (n 76), the CATO- treated group (n 78) had a significantly shorter median (range) time to restoration of normal serum thyroid hormone concentration (43 [12–150] vs 22 [7–60] days; P < 0.001), a significantly lower rate of recurrence of hyperthyroidism (309/1520 [20.3%] vs 193/1368 [14.1%] person-time; P < 0.001), a significantly lower drug hypothyroidism rate (185/1520 [12.2%] vs 54/1368 [3.9%] person-time; P < 0.001), and a higher remission rate (year 1:46/69 [66.7%] vs 65/72 [90.3%] patients, P 0.001; year 2:40/69 [58.0%] vs 60/72 [83.3%] patients, P - 0.001; year 3:34/69 [49.3%] vs 57/72 [79.2%] patients, P < 0.001; and year 4:30/69 [43.5%] vs 55/72 [76.4%] patients, P < 0.001). Systemic AEs occurred in 6 patients (7.9%) in the MMI group (drug neutropenia, 2 patients [2.6%]; epistaxis, 1 [1.3%]; hepatopathy, 1 [1.3%]; and other systemic AEs, 2 [2.6%]), while no systemic AEs were observed/reported in the CATO group.
Conclusion: This study suggests that CATO LTT was well tolerated and more effective than oral MMI treatment in controlling thyrotoxicosis and promoting remission of GD in these Han Chinese patients.
PMCID: PMC3969956  PMID: 24692808
hyperthyroidism; treatment; antithyroid drugs; transdermal administration; ointment
18.  A System for Evaluating and Treating Chronic Back Disability 
Western Journal of Medicine  1976;124(5):370-376.
Five methods of personality assessment are evaluated to provide guidance for the psychological treatment of patients with chronic back pain. Patient pain drawings, pentothal pain studies, stress score index, psychological testing with the Minnesota Multiphasic Personality Inventory (MMPI) and response to treatment challenge are used as measurements for evaluation. This evaluation gives the treating staff guidelines for individual treatment programs utilizing operant conditioning techniques. Using this approach, three fourths of the severely disabled patients seen have been successfully treated.
PMCID: PMC1130072  PMID: 132014
19.  A Pessimistic Explanatory Style is Prognostic for Poor Lung Cancer Survival 
Several studies have demonstrated the importance of personality constructs on health behaviors and health status. Having a pessimistic outlook has been related to negative health behaviors and higher mortality. However, the construct has not been well explored in cancer populations.
Survival time of 534 adults, who were diagnosed with lung cancer and had a pessimistic explanatory style, was examined. The patients had completed the Minnesota Multiphasic Personality Inventory (MMPI) approximately 18.2 years prior to receiving their lung cancer diagnosis. MMPI Optimism-Pessimism (PSM) scores were divided into high (60 or more) and low scores (less than 60), and log-rank tests and Kaplan-Meier curves were used to determine survival differences. Multivariate Cox models were used for assessing prognostic values of pessimism along with other known predictors for lung cancer survival outcome. Booting strapping of the survival models was used as a sensitivity analysis.
At the time of lung cancer diagnosis, patients were on average 67 years old; 48% were female; 85% had non-small cell lung cancer (NSCLC); 15% had small cell lung cancer (SCLC); 30% were stage I; 4% were stage II; 31% were stage III/limited; and 35% were stage IV/extensive. Patients who exhibited a non-pessimistic explanatory style survived approximately six months longer than patients classified as having a pessimistic explanatory style.
Among lung cancer patients, those having a pessimistic explanatory style experienced less favorable survival outcome, which may be related to cancer treatment decisions. Further research in this area is warranted.
PMCID: PMC2854019  PMID: 20139778
Explanatory Style; Optimism; Pessimism; Lung Cancer; MMPI; Survival
20.  Indefinite antithyroid drug therapy in toxic Graves’ disease: What are the cons 
Existing treatment modalities for Graves’ disease includes antithyroid drugs (ATDs), radioactive iodine, and surgery. There has been a lack of general agreement as to which therapy is the best as none is ideal since all effectively restore euthyroidism, but with some limitations. Previously, therapies were selected with the goal of achieving euthyroidism. Instead, hypothyroidism is now the goal of treatment, to ensure that hyperthyroidism does not recur. Current evidences suggest that high relapse rate and not so rare fatal side effects seen with ATD therapy compel one to consider other definite modes of treatment like radiotherapy and surgery for toxic Graves’ disease after discussing this with the patient.
PMCID: PMC3830376  PMID: 24251229
Antithyroid drugs; definitive therapy; graves’ disease
21.  The MMPI Assistant: A Microcomputer Based Expert System to Assist in Interpreting MMPI Profiles 
The Assistant is an MS DOS program to aid clinical psychologists in interpreting the results of the Minnesota Multiphasic Personality Inventory (MMPI). Interpretive hypotheses are based on the professional literature and the author's experience. After scores are entered manually, the Assistant produces a hard copy which is intended for use by a psychologist knowledgeable about the MMPI. The rules for each hypothesis appear first on the monitor, and then in the printed output, followed by the patient's scores on the relevant scales, and narrative hypotheses for the scores. The data base includes hypotheses for 23 validity configurations, 45 two-point clinical codes, 10 high scoring single-point clinical scales, and 10 low scoring single-point clinical scales. The program can accelerate the production of test reports, while insuring that actuarial rules are not overlooked. It has been especially useful as a teaching tool with graduate students. The Assistant requires an IBM PC compatible with 128k available memory, DOS 2.x or higher, and a printer.
PMCID: PMC2245731
22.  A Prospective Study on Changes in Health Status Following Flood Disaster 
Psychiatry Investigation  2008;5(3):186-192.
We examined changes in general health status, the prevalence of depression and post-traumatic stress disorder (PTSD) symptoms, and the existence of pre-trauma contributing factors in an agricultural population following a massive flood.
Eighty-three of 160 residents of Garisan-ni, Inje-gun, Gangwon-do, were assessed using the Korean version of the 36-Item Short-Form Health Survey (SF-36-K) between April and June 2006, just prior to a massive flood. Among those initially assessed, 58 residents were available for follow-up 18 months after the flood. Participants completed the SF-36-K, Beck Depression Index (BDI), Minnesota Multiphasic Personality Inventory (MMPI)-PTSD, and the Korean version of the Impact of Event Scale-Revised (IES-R) to detect depression and PTSD. Trauma experiences were also assessed. Factors related to changes in health status were then analyzed.
SF-36-K total scale scores decreased significantly, suggesting a significant reduction in health-related quality of life. The largest reductions were noted in physical and social functioning. Fifty-three percent of the subjects were at least mildly depressed, and 17% had severe depression. In addition, 22% had PTSD on both the IES-R and MMPI-PTSD. Factors that contributed to the deterioration of health status following the flood were the number of disaster events and existence of depression (as assessed by the BDI).
The flood was found to lead to deterioration of health status and to provoke depression and PTSD among the agricultural population in the mountainous region. We suggest that the number of disaster event experiences and existence of depression contriuted to changes in health status after the flood.
PMCID: PMC2796032  PMID: 20046364
Disaster; Flood; Depression; Post-traumatic stress disorder
23.  Pessimistic, Anxious, and Depressive Personality Traits Predict All-Cause Mortality: The Mayo Clinic Cohort Study of Personality and Aging 
Psychosomatic medicine  2009;71(5):491-500.
To study the association between several personality traits and all-cause mortality.
We established a historical cohort of 7216 subjects who completed the Minnesota Multiphasic Personality Inventory (MMPI) for research at the Mayo Clinic from 1962 to 1965, and who resided within a 120-mile radius centered in Rochester, MN. A total of 7080 subjects (98.1%) were followed over four decades either actively (via a direct or proxy telephone interview) or passively (via review of medical records or by obtaining their death certificates). We examined the association of pessimistic, anxious, and depressive personality traits (as measured using MMPI scales) with all-cause mortality.
A total of 4634 subjects (65.5%) died during follow-up. Pessimistic, anxious, and depressive personality traits were associated with increased all-cause mortality in both men and women. In addition, we observed a linear trend of increasing risk from the first to the fourth quartile for all three scales. Results were similar in additional analyses considering the personality scores as continuous variables, in analyses combining the three personality traits into a composite neuroticism score, and in several sets of sensitivity analyses. These associations remained significant even when personality was measured early in life (ages 20 to 39 years).
Our findings suggest that personality traits related to neuroticism are associated with an increased risk of all-cause mortality even when they are measured early in life.
PMCID: PMC3087200  PMID: 19321849
personality; mortality; pessimism; anxiety; depression; neuroticism; MMPI
24.  Association between TSH-Receptor Autoimmunity, Hyperthyroidism, Goitre, and Orbitopathy in 208 Patients Included in the Remission Induction and Sustenance in Graves' Disease Study 
Journal of Thyroid Research  2014;2014:165487.
Background. Graves' disease may have a number of clinical manifestations with varying degrees of activity that may not always run in parallel. Objectives. To study associations between serum levels of TSH-receptor autoantibodies and the three main manifestations of Graves' disease (hyperthyroidism, goiter, and presence of orbitopathy) at the time of diagnosis of hyperthyroidism. Methods. We describe a cohort of 208 patients with newly diagnosed Graves' hyperthyroidism. Patients were enrolled in a multiphase study of antithyroid drug therapy of Graves' hyperthyroidism, entitled “Remission Induction and Sustenance in Graves' Disease (RISG).” Patients were systematically tested for degree of biochemical hyperthyroidism, enlarged thyroid volume by ultrasonography, and the presence of orbitopathy. Results. Positive correlations were found between the levels of TSH-receptor autoantibodies in serum and the three manifestations of Graves' disease: severeness of hyperthyroidism, presence of enlarged thyroid, and presence of orbitopathy, as well as between the different types of manifestations. Only around half of patients had enlarged thyroid gland at the time of diagnosis of hyperthyroidism, whereas 25–30% had orbitopathy. Conclusions. A positive but rather weak correlation was found between TSH-receptor antibodies in serum and the major clinical manifestation of Graves' disease. Only half of the patients had an enlarged thyroid gland at the time of diagnosis.
PMCID: PMC3945164  PMID: 24696787
25.  Hostility, Anger and Depression Predict Increases in C3 over a 10-Year Period 
Brain, behavior, and immunity  2007;21(6):816-823.
We examined the relation of hostility, anger and depression to 10-year changes in the third (C3) and fourth (C4) complement in 313, apparently healthy male participants enrolled in the Air Force Health Study (AFHS), a 20-year study designed to evaluate the health consequences of dioxin exposure. Hostility, depression and anger were assessed using subscales from the Minnesota Multiphasic Personality Inventory (MMPI), which was administered in 1985. Given the high intercorrelations among these psychological scales, we used a principal component analysis to generate a composite score representing the linear combination of the hostility, anger and depression scales. The dependent variables, C3 and C4 levels, were determined from samples collected in 1992, 1997 and 2002. Regression analyses controlling for age, race, alcohol use, body mass index and cigarette use as well as onset of disease and use of lipid lowering and blood pressure medications during follow-up revealed a significant time X composite score interaction for C3 complement (p < .0003), but not C4. Post-hoc analyses revealed that high composite scores were associated with larger 10-year increases in C3. These observations suggest that men who are hostile and are prone to experience frequent and intense feelings of anger and depression show activation of the complement system, and specifically increases in C3, that may contribute to the development of coronary heart disease.
PMCID: PMC1995457  PMID: 17321106
Complement; hostility; anger; depression; men

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