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PubMed2004

Psychiatric comorbidity and Eating Disorder Inventory (EDI) profiles in eating disorder patients.

OBJECTIVE: This study examines potential overlaps between psychiatric comorbidity (Axis I and II) and scores on the subscales of the Eating Disorder Inventory (EDI) in women with eating disorders (EDs). METHOD: In a sample of 248 women (72 with anorexia nervosa, 140 with bulimia nervosa, and 36 with eating disorders not otherwise specified), we determined psychiatric comorbidity using the Structured Clinical Interview for DSM-IV. Behavioural and psychological characteristics of EDs were quantified with the EDI. RESULTS: Psychiatric comorbidity was high in both axes (74% for Axis I and 68% for Axis II). While most EDI subscales pertaining to psychological traits showed significant associations with Axis I and II disorders, the subscales concerning eating and perception of weight and shape were much less associated with psychiatric comorbidity. Affective and anxiety disorders, as well as personality disorders of clusters A and C, showed a similar pattern with links to most psychological subscales. The profile for substance-related disorders was different, showing associations with the Ineffectiveness and Interoceptive Awareness scales. Personality disorders of cluster B were related only to the Bulimia subscale and not to any of the psychological subscales. CONCLUSIONS: The EDI appears to primarily reflect Axis I and II disorders related to affective and anxiety problems. Clinicians and researchers employing the EDI should be aware that it is not sensitive for all forms of comorbidity prevalent in ED patients.

Adolescent↗
PubMed2002

Concurrent validity of the anxiety disorders section of the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions.

Evaluated the concurrent validity of the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994): Child and Parents Versions (ADIS for DSM-IV-C/P; Silverman & Albano, 1996) social phobia, separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and panic disorder diagnoses. Children referred to an outpatient anxiety disorder clinic (N = 186; ages 8 to 17), and their parents completed the Multidimensional Anxiety Scale for Children (MASC; March, 1998) and the ADIS-C/P interview. There was no convergence between MASC scores and ADIS-C/P GAD diagnoses. However, there was strong correspondence between ADIS-C/P social phobia, SAD, and panic disorder diagnoses and the empirically derived MASC factor scores corresponding to these disorders. These results provide support for the concurrent validity of the anxiety disorders section of the ADIS-C/P.

Adolescent↗
PubMed1997

Perceptions of parental bonding in patients with various personality disorders, lifetime depressive disorders, and healthy controls.

The aims of the present study was (a) to examine the relationship between parental bonding and various personality disorders, when the effect of a lifetime depressive disorder was statistically controlled for, and (b) to examine the relationship between parental bonding and a lifetime depressive disorder when the effects of various personality disorders were accounted for. The study included 135 psychiatric outpatients and 41 healthy controls. The patients were diagnosed according to DSM-III-R axis I and axis II. Results indicated that obsessive-compulsive personality disorder was associated with reports of lower levels of paternal care and higher levels of paternal overprotection, while cluster B personality disorder was associated with reports of high parental overprotection. Avoidant, dependent, and cluster A personality disorders were not associated with abnormal parental bonding. Lifetime depressive disorders were associated with reports of low maternal care and high maternal overprotection when the effect of a personality disorder was accounted for.

Adult↗
PubMed2006

Clarifying the convergence between obsessive compulsive personality disorder criteria and obsessive compulsive disorder.

In this study we examined the convergence between obsessive-compulsive personality disorder (OCPD) criteria and obsessive-compulsive disorder (OCD). Baseline assessments of 629 participants of the Collaborative Longitudinal Personality Disorders Study were used to examine the associations between OCPD criteria and diagnoses of OCD. Three of the eight OCPD criteria--hoarding, perfectionism, and preoccupation with details--were significantly more frequent in subjects with OCD (n = 89) than in subjects without OCD (n = 540). Logistic regressions were used to predict the probability of each OCPD criterion as a function of Axis I diagnoses (OCD, additional anxiety disorders, and major depressive disorder). Associations between OCD and these three OCPD criteria remained significant in the logistic regressions, showing unique associations with OCD and odds ratios ranging from 2.71 to 2.99. In addition, other anxiety disorders and major depressive disorder showed few associations with specific OCPD criteria. This study suggests variability in the strength of the relationships between specific OCPD criteria and OCD. The findings also support a unique relationship between OCPD symptoms and OCD, compared to other anxiety disorders or major depression. Future efforts to explore the link between Axis I and Axis II disorders may be enriched by conducting analyses at the symptom level.

Adult↗
PubMed1997

Comorbidity of personality disorders and major depression in patients with somatoform pain disorders or medical illnesses with long-standing work disability.

The comorbidity between major depression and personality disorders in patients with long-standing work disability at a rehabilitation clinic was investigated. Sixty patients with a somatoform pain disorder and 66 patients with different medical illnesses were assessed by means of a self rating scale for major depression, and the SCID screen personality disorder questionnaire. In the total series, 27% of the patients had a diagnosis of major depression and 34.9% had at least one personality disorder. Personality disorders were significantly more common in patients with medical illness than in patients with a somatoform pain disorder. There was a high frequency of comorbidity between major depression and personality disorders, especially borderline and avoidant personality disorders. If this is due to a common pathogenetic mechanism, it could explain why SSRIs are effective in both depression and some personality disorders.

Adult↗
PubMedDate not supplied

Morbid risks for major disorders and frequencies of personality disorders among spouses of psychiatric inpatients and controls.

Three hundred fifty-three psychiatric inpatients and their 192 living spouses and 98 control subjects and their 54 living spouses were examined and interviewed for affective, schizoaffective, schizophrenic (Research Diagnostic Criteria [RDC]), and personality disorders (DSM-III-R) using the Lifetime Version of the Schedule for Affective Disorders and Schizophrenia (SADS-L) and the Structured Clinical Interview for DSM-III-Personality Disorders (SCID). The morbid risks of spouses for unipolar depression were between .15 and .25, and those for other major disorders were below .03. The morbid risks of spouses of bipolar patients for unipolar depression exceeded those of other spouses by 50% without reaching statistical significance. Personality disorders were found in 44.6% of patients, in 8.4% of patients' spouses, and in 9.8% of healthy controls. There was only one couple in which the husband and wife had each had a major disorder before marriage. Only four husband-wife pairs suffered the same personality disorder. Spouses of patients do not have significantly more psychiatric disorders than healthy controls; therefore, assortative mating can only be of minor relevance in family studies.

Adult↗
PubMed1987

Psychiatric diagnosis of patients with substance abuse problems: a comparison of two procedures, the DIS and the SADS-L. Alcoholism, drug abuse/dependence, anxiety disorders and antisocial personality disorder.

We compared DSM-III and RDC diagnoses from the DIS to RDC diagnoses from the SADS-L for alcohol and drug use disorders, anxiety disorders and Antisocial Personality Disorder in a group of patients with substance abuse problems. Kappa values for substance use disorders were fairly good. The instruments did not agree well on anxiety disorders, or on Antisocial Personality Disorder. Criterion differences gave rise to some of the disagreement between the instruments on Antisocial Personality Disorder, but the causes of disagreement for the anxiety disorders were not so clear. The implications of these findings are discussed.

Adult↗
PubMed2005

Dysthymic disorder contributes to oppositional defiant behaviour in children with Attention Deficit Hyperactivity Disorder, combined type (ADHD-CT).

BACKGROUND: The specific relationships between oppositional defiant disorder (ODD), ADHD-CT, dysthymic disorder (DD) and anxiety disorders symptoms have not been studied in children with ADHD-CT. The relationship to DD is important because DD is common, has an earlier age of onset, is associated with significant morbidity and with increased rates of treatment non-responsiveness when comorbid with major depressive disorder and/or ADHD-CT. METHODS: 200 clinically referred children with ADHD-CT, without comorbid major depressive disorder, were identified. "ODD", "ADHD-CT", "DD" and "anxiety disorders" symptoms were defined by composite measures of (1) semi-structured clinical interview and (2) parent and/or child standardized questionnaires. Standard multiple regression was used to examine how well "ADHD-CT", "DD" and "anxiety disorders" symptoms predict "ODD" symptoms. RESULTS: Only "ADHD-CT" (15% of the variance) and "DD" (8% of the variance) symptoms made independent significant contributions to the prediction of "ODD" symptoms. LIMITATIONS: The study's sample size did not allow "ODD" and "conduct disorder" symptoms to be analysed separately. CONCLUSIONS: The association of DD with ODD may reflect a unique contribution of DD to ODD in children, whether ADHD-CT is present or not, or only when ADHD-CT is present.

Age of Onset↗
PubMed2006

Preferential aggregation of obsessive-compulsive spectrum disorders in schizophrenia patients with obsessive-compulsive disorder.

OBJECTIVE: To validate a complex association between schizophrenia and obsessive-compulsive disorder (OCD). METHOD: We used the Structured Clinical Interview for DSM-IV Axis I disorders to compare the rate of OCD spectrum and additional Axis I disorders in 100 patients who met criteria for both schizophrenia and OCD, non-OCD schizophrenia (n = 100), and OCD (n = 35). RESULTS: There was a robust between-group difference in the number of patients with one or more OCD spectrum disorders (schizo-obsessive n = 30, compared with schizophrenia n = 8; P = 0.001), that is, higher rates of body dysmorphic (8% compared with 0%) and tic (16% compared with 4%) disorders. No difference was revealed in affective, anxiety, and substance use disorders. We found comparable rates of OCD spectrum disorders in the schizo-obsessive and OCD groups (30% and 42.8%, respectively; P = 0.32). CONCLUSION: Preferential aggregation of OCD spectrum disorders in the schizo-obsessive group supports this unique clinical association. Whether a schizo-obsessive interface represents comorbidity or a specific subtype of schizophrenia warrants further investigation.

Adult↗
PubMed2025

Post-traumatic stress disorder and REM-sleep behavior disorder: exploring genetic associations and causal links.

OBJECTIVE: To explore potential genetic and/or causal associations between Post-Traumatic Stress Disorder and neurodegeneration-related isolated/idiopathic rapid-eye-movement sleep behavior disorder. METHODS: We conducted polygenic risk score, genetic correlation, and Mendelian randomization analyses using the latest genome-wide association studies summary statistics and individual genotyping data. Next, a blinded observer examined dopamine transporter imaging binding status-a marker of neurodegeneration-in patients with isolated/idiopathic rapid-eye movement sleep behavior disorder, with (N = 6) and without Post-Traumatic Stress Disorder (N = 32). RESULTS: Polygenic risk scores for Post-Traumatic Stress Disorder were associated with isolated/idiopathic rapid-eye-movement sleep behavior disorder, with each standard deviation increase linked to 14.7% higher odds (odds ratio = 1.15, 95% confidence interval: 1.04 to 1.26, p = 0.005). However, genetic correlation was weak, and Mendelian randomization did not support a potential causal relationship. The proportion of individuals with abnormal dopamine transporter imaging binding status was significantly higher in the Post-Traumatic Stress Disorder group compared to those without the disorder (p=0.01, X2 = 6.62). INTERPRETATION: Polygenic risk scores analysis identified an association between Post-Traumatic Stress Disorder and neurodegeneration-related isolated/idiopathic rapid-eye-movement sleep behavior disorder, consistent with the result from the small exploratory substudy. The lack of strong genetic correlation or causation may reflect limited sample size. Further research with larger and more diverse cohorts is crucial to clarify the genetic, biological and physiological mechanisms underlying this association.

Journal Article↗
PubMed2005

Validation of the Italian version of the "Mood Disorder Questionnaire" for the screening of bipolar disorders.

UNLABELLED: The study measured the accuracy of the Italian version of the Mood Disorder Questionnaire (MDQ) as a screening instrument for bipolar disorders in a psychiatric setting. METHODS: 154 consecutive subjects attending the Division of Psychiatry of the University of Cagliari (Italy), were screened for bipolar disorders using the Italian translation of the MDQ, and diagnostically interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) by physicians. RESULTS: On the basis of the SCID: 51 (33.1%) received a diagnosis of bipolar or schizoaffective bipolar type disorders, 63 (40.9%) were diagnosed as having at least one psychiatric disorder in Axis I (other than bipolar or schizoaffective bipolar type disorders), whilst 40 (25.9%) were unaffected by any type of psychiatric disorder. MDQ showed a good accuracy for bipolar or schizoaffective bipolar type disorders: the cut-off 4 had sensitivity 0.90 and specificity 0.58; the cut-off 5 had sensitivity 0.84 and specificity 0.70; and the cut-off 6 had sensitivity 0.76 and specificity 0.86. The accuracy for bipolar II disorders was sufficient but not excellent: the cut-off 4 had sensitivity 0.80 and specificity 0.45; the cut-off 5 had sensitivity 0.70 and specificity 0.55; and the cut-off 6 had sensitivity 0.55 and specificity 0.65. CONCLUSION: Our results seem to indicate a good accuracy of MDQ, and confirm the results of recent surveys conducted in the USA. Moreover the instrument needs to be validated in other settings (e.g. in general practice).

Journal Article↗
PubMed2002

Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood.

BACKGROUND: Data from a community-based longitudinal investigation were used to investigate whether adolescents with eating disorders are at an elevated risk for physical and mental disorders during early adulthood. METHODS: Psychosocial and psychiatric interviews were administered to a representative community sample of 717 adolescents and their mothers from 2 counties in the state of New York in 1983, 1985 to 1986, and 1991 to 1993. In 1983, the mean age of the youths was 13.8 years. RESULTS: Adolescents with eating disorders were at a substantially elevated risk for anxiety disorders, cardiovascular symptoms, chronic fatigue, chronic pain, depressive disorders, limitations in activities due to poor health, infectious diseases, insomnia, neurological symptoms, and suicide attempts during early adulthood after age, sex, socioeconomic status, co-occurring psychiatric disorders, adolescent health problems, body mass index, and worries about health during adulthood were controlled statistically. Problems with eating or weight during adolescence predicted poor health outcomes during adulthood, regardless of whether an eating disorder had been present. Only 22% of the adolescents with current eating disorders had received psychiatric treatment within the past year. CONCLUSION: Eating disorders during adolescence may be associated with an elevated risk for a broad range of physical and mental health problems during early adulthood.

Adolescent↗
PubMed1992

Differences in reported symptom profile between panic disorder and other DSM-III-R anxiety disorders.

Previous research has indicated that reports of panic attacks are associated with a different set of symptoms to reports of generalized anxiety. The present two studies attempted to extend these findings to specific (situational) fears. In Study 1, 55 subjects with panic disorder were compared on their symptom profile during their panic attacks to 65 subjects with other anxiety disorders [simple phobia, social phobia and obsessive-compulsive disorder (OCD)] during response to their feared cue. The results indicated that, compared to subjects with other anxiety disorders, subjects with panic disorder were more likely to report parasthesias, dizziness, faintness, unreality, dyspnea, fear of dying and fear of going crazy/losing control. In Study 2, 90 subjects meeting diagnostic criteria for both panic disorder and another anxiety disorder (simple phobia, social phobia or OCD) were compared on the symptoms experienced during their unexpected panic attacks and their situationally-triggered fears respectively. Combining the symptoms found in Study 1 to differ between the groups into a linear combination, there was a significant interaction found between the type of fear reaction (panic attack vs cued fear response) and symptom group. Taken together, these findings suggest that reports of unexpected panic attacks associated with panic disorder are characterized by a different symptom profile to reports of specific fear reactions that are part of a phobic disorder or OCD.

Adult↗
PubMed1996

Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders.

The lifetime rate of suicide attempts among subjects in the Epidemiologic Catchment Area database with bipolar disorder, unipolar disorder, and any other DSM-III-defined Axis I disorder were determined. The latter constituted a control or reference group. The lifetime rates of suicide attempts of persons in these diagnostic groups were 29.2%, 15.9%, and 4.2%, respectively. Multivariate logistic regression analysis was used to calculate the odds ratio of subjects within a diagnostic group having a history of a suicide attempt relative to subjects in a second group. The odds ratio of subjects with bipolar disorder having a history of a suicide attempt relative to subjects in the control group was 6.2 (df 1, x(2) = 5347.2, p < .0001). The odds ratio of subjects with unipolar disorder having a history of a suicide attempt relative to subjects in the control group was 3.1 (df = 1, x(2) = 4785.2, p < .0001). The odds ratio of subjects with bipolar disorder having a history of a suicide attempt relative to unipolar subjects was 2.0 (df = 1, x(2) = 697.9, p < .0001). Bipolar disorder has a strong relationship to a history of suicide attempts relative to unipolar disorder and other Axis I disorders.

Adolescent↗
PubMed2005

Panic disorder and bipolar disorder: anxiety sensitivity as a potential mediator of panic during manic states.

BACKGROUND: Panic disorder (PD) occurs at high rates in bipolar disorder and more commonly than in unipolar depression. Reports of PD onset during hypomania and depressive mania (i.e., mixed states) raise questions about whether the affective disturbances of bipolar disorder play a specific role in the exacerbation or onset of PD. Anxiety sensitivity (AS), a risk factor for PD appears greater in bipolar disorder compared to unipolar depression, although the association of specific mood states with AS remains unknown. METHODS: We examined the association of current mood state (i.e., mixed state, mania or hypomania, bipolar depression, unipolar depression, and euthymia) with Anxiety Sensitivity Index (ASI) scores in 202 individuals with bipolar disorder (n=110) or major depressive disorder (n=92). RESULTS: Current mood state was significantly associated with ASI score (Chi-square=21.2, df=4, p=0.0003). In multiple regression analyses, including covariates for comorbid anxiety disorders, current mania or hypomania was a significant predictor of ASI scores (p<0.04). Current mixed state tended toward a similar association (p<0.10). LIMITATIONS: Conclusions are limited by the study's cross-sectional nature and relatively small sample size. CONCLUSIONS: These findings of elevated AS during manic states, independent of comorbid anxiety disorders, provide preliminary support for the hypothesis that manic states contribute to risk for the development or exacerbation of PD, and that AS may contribute to the high prevalence and severity of PD comorbid with bipolar disorder.

Adult↗
PubMed2005

Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder?

BACKGROUND: Anxiety symptoms are associated with elevated coronary heart disease (CHD) risk, but it is not known whether such associations extend to anxiety disorders or if they are independent of depression. We sought to determine if generalized anxiety disorder is associated with elevated CHD risk, and whether this association is independent of or interacts with major depressive disorder. METHODS: Generalized anxiety and major depressive disorders were assessed in a cross-sectional survey of a representative sample of U.S. adults aged 25-74 (N=3032). Coronary heart disease risk was determined by self-reported smoking status, body mass index, and recent medication use for hypertension, hypercholesterolemia, and diabetes. RESULTS: Generalized anxiety disorder independently predicted increased CHD risk (F(1,3018)=5.14; b=0.39; 95% confidence interval (0.05-0.72)) and tended to denote the greatest risk in the absence of major depressive disorder. LIMITATIONS: The cross-sectional design cannot determine the causal direction of the association. CONCLUSIONS: Generalized anxiety disorder appears to be associated with elevated CHD risk in the general population. It may denote excess CHD risk relative to major depressive disorder, and clinicians should consider CHD risk when treating generalized anxiety disorder.

Adult↗
PubMedDate not supplied

Association between anxiety disorders and substance use disorders among young persons: results of a 21-year longitudinal study.

OBJECTIVE: To examine the linkages between anxiety disorders and the development of substance use disorders in a birth cohort of young people studied to young adulthood. METHOD: Data were gathered over the course of a longitudinal study of a birth cohort of over 1000 New Zealand born young people. Over the course of the study, data were gathered on: (a) anxiety disorders and substance use disorders at ages 16-18 and 18-21; (b) a range of potential confounding factors including measures of childhood, social, and family factors. RESULTS: Young people with anxiety disorders had odds of substance dependence that were between 1.3 and 3.9 times higher than young people without anxiety disorders. These associations were largely explained by a series of covariate factors relating to: (a) childhood and family factors; (b) prior substance dependence; (c) comorbid depression; (d) peer affiliations. After adjustment for these factors, anxiety disorder was unrelated to all measures of substance use. CONCLUSIONS: Young people with anxiety disorders are at increased risk of substance dependence. However, this association appears to be largely or wholly non causal and reflects the associations between childhood factors, prior substance dependence, comorbid depression, peer affiliations and the development of anxiety disorders.

Adolescent↗
PubMed2001

Physiologic instability in panic disorder and generalized anxiety disorder.

BACKGROUND: Because panic attacks can be accompanied by surges in physiologic activation, we tested the hypothesis that panic disorder is characterized by fluctuations of physiologic variables in the absence of external triggers. METHODS: Sixteen patients with panic disorder, 15 with generalized anxiety disorder, and 19 normal control subjects were asked to sit quietly for 30 min. Electrodermal, cardiovascular, and respiratory measures were analyzed using complex demodulation to quantify variability in physiologic indices. RESULTS: Both patient groups reported equally more anxiety and cardiac symptoms than control subjects, but certain other somatic symptoms, including breathlessness, were elevated only in panic disorder patients. Mean end-tidal pCO(2) and respiratory rates were lower, and tidal volume and the number of sighs were higher in panic disorder patients than control subjects. Neither cardiovascular (heart rate, arterial pressure, cardiac output), nor electrodermal instability including sighs distinguished the groups; however, tidal volume instability was greater in panic disorder than generalized anxiety disorder patients or control subjects. Several other respiratory measures (pCO(2), respiratory rate, minute volume, duty cycle) showed greater instability in both patient groups than in control subjects. CONCLUSIONS: Respiration is particularly unstable in panic disorder, underlining the importance of respiratory physiology in understanding this disorder. Whether our findings represent state or trait characteristics is discussed.

Adult↗