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PubMedDate not supplied

Anorexia nervosa 6 years after onset: Part I. Personality disorders.

Fifty-one adolescent-onset anorexia nervosa (AN) cases recruited after community screening were compared with 51 age-, sex-, and school-matched cases with regard to personality disorders and autism-spectrum disorders (ASD)/empathy disorders at age 21 years. All 102 cases had originally been examined at a mean age of 16 years, slightly over a year after the reported onset of the eating disorder. Structured Clinical Interview for DSM-III-R (SCID) interviews were performed by a psychiatrist blind to the original eating disorder diagnosis. Most of the former AN cases were recovered with respect to weight, but the outcome in social areas was restricted. Personality disorders coded on axis II in the DSM-III-R and empathy disorders were much more common in the AN group than in the comparison (COMP) group. Obsessive-compulsive (OCD) and avoidant personality disorders were particularly common. Obsessive-compulsive behaviors showed a high degree of stability over time and were unrelated to weight problems. Together with empathy disorder, they tended to predict outcome better than the eating disorder as such. It is concluded that in some cases, AN may be seen to reflect but one axis I diagnosis occurring in the life of an individual with a chronic personality disorder.

Adolescent↗
PubMed1995

Role of genetic factors in depression based on studies of Tourette syndrome and ADHD probands and their relatives.

Tourette syndrome (TS) is a common, neuropsychiatric disorder which has many similarities to attention deficit hyperactivity disorder (ADHD). TS probands have a high frequency of a variety of behavioral disorders including depression. The depression may be due to a pleiotrophic effect of the Gts genes, proband ascertainment bias, or a result of coping with the chronic tics. To distinguish between these hypotheses we examined the responses to 17 Diagnostic Interview Schedule questions to evaluate the 9 DSM-III-R criteria for major depressive episode in 1,080 adults consisting of TS and ADHD probands, their relatives and controls. Using a Bonferonni corrected p there was a significant progressive increase in 16 of 17 depressive symptoms and for a life time history of a major depressive episode in groups with increased genetic loading for Gts genes. Similar trends were seen in the small number of ADHD probands and their relatives. There was also a significant increase for these variables in non-proband TS relatives versus non-TS relatives, indicating the association of depression with Gts genes was not due to ascertainment bias or the inappropriate choice of controls. Multiple linear regression analysis indicated that obsessive-compulsive behaviors, sex, ADHD, drug abuse, and age all showed a more significant effect on depressive symptoms than the number of tics. The presence or absence of TS in the relatives had a much greater effect on risk for depression than the presence or absence of an episode of major depression in the proband. These results are consistent with the hypothesis that Gts and ADHD genes play a major role in depression.

Adolescent↗
PubMed1995

Learning difficulties in children with Tourette syndrome.

Children with Tourette syndrome have been shown to have a variety of school difficulties. These difficulties, however, may be related to a single factor or to a combination of problems including tic severity, the use of tic-suppressing medication, executive dysfunction, a direct consequence of having a stigmatizing disorder, and coexisting attention deficit disorder, hyperactivity, obsessive-compulsive behaviors, or other psychopathologies. The goals for the treating health care team are to identify the presence of these factors, to clarify which are the major source of distress, and to develop an individualized multimodal treatment program. The prompt diagnosis of underlying problems and the prescription of appropriate therapy can play an important role in preventing school failure in children with Tourette syndrome.

Adrenergic alpha-Agonists↗
PubMed1997

Tics secondary to craniocerebral trauma.

We describe three adult patients who presented with multifocal motor and vocal tics secondary to craniocerebral trauma. In one case, the tics were accompanied by marked obsessive-compulsive behavior. All patients were involved in motor vehicle accidents resulting in closed craniocerebral trauma. The latency of onset between head trauma and the movement disorder varied between 1 day and a few months. Magnetic resonance imaging, which was performed in all three patients, did not detect any structural lesions of the basal ganglia or the brainstem. Extensive bifrontal leukoencephalopathy was found in one patient who suffered severe head trauma.

Accidents, Traffic↗
PubMed1994

Do nonclinical checkers exhibit deficits in cognitive control? Tests of an inhibitory control hypothesis.

We tested the hypothesis that persons who engage in compulsive checking may do so to compensate for cognitive errors produced by deficient inhibitory control. In two experiments, undergraduates were classified by scores on the MOCI checking subscale as checkers or noncheckers. On self-report measures, checkers were significantly more depressed, more anxious, more prone to cognitive slips, and more likely to engage in obsessive-compulsive behaviors. However, checkers performed similarly to noncheckers on laboratory tests of inhibitory control of cognition. Checkers and noncheckers were equally able to (1) ignore distractors in a selective attention task, (2) suppress inappropriate word meanings in a sentence comprehension task, and (3) inhibit retrieval of to-be-forgotten items in a memory task. These results suggest that compulsive checking does not arise from failures of inhibitory control of cognition.

Adult↗
PubMed1998

Subtypes of stalking (obsessional following) in adolescents.

Stalking, which has been given the clinical term "obsessional following", is repetitive threatening or harassing behavior that creates a fear of harm in the victim. Empirical and theoretical literature on this form of behavior is beginning to develop and focuses primarily on adults. Three major subtypes of obsessional following have been identified: erotomania, love obsessional, and simple obsessional/borderline erotomania. Using this typology and available empirical research, a context is set in which three cases of adolescent obsessional following are discussed and analysed. These cases document that stalking/obsessional following occurs in adolescents and that important similarities and differences appear to exist between adult and adolescent offenders. Hypotheses are generated to encourage further study of this significant problem.

Adolescent↗
PubMed1995

The utilization of nonpatient samples in the study of obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is increasingly studied in nonpatients, primarily through the selection of individuals who score high on a self-report measure of OCD. The usefulness of this methodology for understanding OCD presupposes that some of the individuals in the high-scoring group meet diagnostic criteria for OCD, that the obsessive-compulsive behaviors in the high-scoring individuals are stable across time to a certain degree, and that the features associated with OCD in patients also are found in the high-scoring nonpatients. Two studies are reported which provide support for these three assumptions. Together the studies suggest that OCD can be productively examined by the selection of individuals who score high on a self-report measure of OCD. Cautions in the use of this methodology for the study of OCD are also noted.

Adult↗
PubMed2000

Comparing stalking victimization from legal and victim perspectives.

Because stalking has only recently been recognized as a serious social problem and criminal justice concern, it is not surprising that there is little consensus among lawmakers about what constitutes stalking. To further understanding of how legal definitions and victim definitions of stalking intersect and diverge, this study compares stalking prevalence using a definition of stalking that is based on the model antistalking code for states developed by the Federal government versus a definition of stalking that is victim delineated. Data for the study come from a national telephone survey that queried 8,000 men and 8,000 women about their experiences with stalking victimization using both direct questions that contained the word "stalking" and behaviorally specific questions. Results show that prevalence estimates increase when respondents are allowed to self-define stalking victimization. However, victim definitions of stalking tend to converge with the model antistalking code's definition of stalking in the vast majority of cases. Only 4% of survey respondents defined themselves as stalking victims but failed to meet the legal definition of a stalking victim. A negligible proportion denied being stalked despite the fact they met the legal definition of a stalking victim.

Adolescent↗
PubMed1977

Frightened men: a wish for intimacy and a fear of closeness.

Men who failed to achieve an adequate separation from their mothers are particularly prone to experience serious distress with their marriages during their middle years, when the wish for intimacy, coupled with a fear of closeness never resolved during infancy, is retriggered. An onslaught of biological, social, and psychological stresses force acknowledgement of previously denied needs for succor, plunging them into battle with their wife-surrogate mother. The resulting counterphobic, hypersexual, ofter self-destructive behaviors are usually falsely interpreted as oedipal. Clinical material in this report strongly suggests this distress is not primarily related to genital sexual issues or fears of castration, but more often concerns issues of autonomy and independence which typically involve the mother and which arose in the toddler or anal phase. Supportive evidence for this thesis from cross-cultural observations, child developmental studies, and primatology is presented, and the usefulness of this view in facilitating clinical work with such men is described.

Adaptation, Psychological↗
PubMed2004

The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive-compulsive symptoms: hypothesis or entity? Practical considerations for the clinician.

Clinicians have been faced with much publicity and contradictory scientific evidence regarding a recently described condition termed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). It has been proposed that children with PANDAS experience tics, obsessive-compulsive behavior, and perhaps other neuropsychiatric symptoms as an autoimmune response to streptococcal infection. We review current scientific information and conclude that PANDAS remains a yet-unproven hypothesis. Until more definitive scientific proof is forthcoming, there seems to be insufficient evidence to support 1) routine microbiologic or serologic testing for group A streptococcus in children who present with neuropsychiatric symptoms or 2) the clinical use of antibiotic or immune-modifying therapies in such patients. The optimum diagnostic and therapeutic approach awaits the results of additional research studies.

Adjuvants, Immunologic↗
PubMed2003

Stalking: knowns and unknowns.

The current work reviews literature on the nature of stalking. Despite its nebulous nature and differing legal and clinical definitions of stalking, researchers and practitioners are referring to the same phenomenon. Stalking is chronic, consisting of a number of nuisance behaviors that appear consistent over countries and samples. Different categorizations of stalkers and their victims exist, but ex-partner stalkers are a distinctive category with respect to their prevalence, violence risk, and attrition rate. Different samples and definitions and false victimization reports obscure reliable lifetime prevalence estimates, but these appear to be around 12%-16% among women and 4%-7% among men. Stalking has deleterious effects on victims but some of the effects may be the result of stalking's exacerbating of existing vulnerabilities. Future research should focus on subgroups of stalkers and their victims, on cross-cultural investigations, and on the co-occurrence of stalking with other crimes.

Adaptation, Psychological↗
PubMed2000

Research on stalking: what do we know and where do we go?

Findings of the article in this two-volume series on stalking are reviewed. Building on the findings of the National Violence Against Women Survey (Tjaden & Thoennes, 1998), this series of studies adds to the literature in defining and measuring stalking behaviors. Repeated stalking victimization is reported by up to 62% of young adults, although frequencies depend on the sample and the precise definition used. Self-definitions of stalking victimization may be quite different from legal definitions. Although the majority of legally defined stalkers (where victim fear is a key component) are men stalking women, studies utilizing other definitions find many more women as stalkers, with no significant gender differences in many studies. In many cases, it does appear that stalking is one part of a larger pattern of relationship physical and psychological abuse. Data on emotional reactions and coping strategies of victims are also reviewed, along with findings on characteristics of stalkers.

Adaptation, Psychological↗
PubMed2000

The relationship between types and severity of repetitive behaviors in Gilles de la Tourette's disorder and obsessive-compulsive disorder.

BACKGROUND: This study investigated which categories of obsessive-compulsive and Tourette-related behaviors in Gilles de la Tourette's disorder and obsessive-compulsive disorder (OCD) without tics are experienced as most severe across the study groups and what the differences are in symptom distribution between the study groups. METHOD: Fourteen subjects with both Tourette's disorder and OCD, 18 subjects with Tourette's only, 21 subjects with OCD (no tics), and 29 control subjects were studied using a semistructured interview designed to equally assess Tourette- and OCD-related behaviors according to DSM-III-R criteria. Each reported repetitive behavior was evaluated on the presence of anxiety and on goal-directedness. Anxiety-related items were categorized as obsessions or compulsions and non-anxiety-related items as impulsions. Severity of each reported item was assessed with respect to time per day consumed and amount of distress and interference induced by the item. Following these criteria, each reported item was classified as a symptom, a subthreshold symptom, or just as being present. RESULTS: Across the study groups, obsessions were experienced as more severe than (Tourette-related) impulsions and compulsions. Within the study groups, patients with both Tourette's disorder and OCD reported more symptomatic Tourette-related impulsions, such as mental play, echophenomena, and impulsive or self-injurious behaviors; less overall symptomatic obsessions; and less symptomatic washing than patients with OCD (no tics). The differences among individuals with Tourette's with or without OCD reflected differences in symptom severity rather than differences in symptom distribution. CONCLUSION: Obsessions are more time consuming, distressing, and interfering than compulsions and impulsions. Furthermore, the symptomatic repetitive behaviors were distributed differently among patients with both Tourette's disorder and OCD and patients with OCD (no tics). Patients with Tourette's and OCD are phenomenologically more similar to Tourette's than to OCD. These differences possibly represent differences in underlying pathophysiology between Tourette's and tic-free OCD.

Adult↗
PubMed1994

Tourette's syndrome in a special education population: a pilot study involving a single school district.

To determine whether children requiring special education represent a high-risk group for identifying Tourette's syndrome (TS), we performed direct examinations for the presence of tics in 35 special education and 35 regular classroom students from a single school district. Of the special education students, nine (26%) had definite or probable tics as compared with only two (6%) of the regular classroom students. About one-third of the students with tics currently meet diagnostic criteria for TS and probably more will do so in the future. About one-half of the subjects with tics have evidence of obsessive-compulsive behavior (OCB) or an attention-deficit hyperactivity disorder (ADHD). For three randomly selected students with definite tics, direct examinations of first-degree relatives revealed the presence of tics in all families. Subjects to the limitations of this pilot study, we conclude that TS and related tic disorders are commonly associated with the need for special education in this single school district. TS might also be an important contributor to school problems in the childhood population at large and may be a highly prevalent condition. In addition, we conclude that childhood tics are associated with OCB and ADHD, are genetically determined, and are part of the TS clinical spectrum.

Adolescent↗
PubMed2001

Risperidone versus pimozide in Tourette's disorder: a comparative double-blind parallel-group study.

BACKGROUND: The treatment of Tourette's disorder with classical neuroleptics is limited by their side effects. Risperidone is a new efficacious antipsychotic with a low propensity for extrapyramidal side effects. To establish risperidone's therapeutic potential in Tourette's disorder, we studied the safety and efficacy of risperidone in comparison with pimozide in patients with Tourette's disorder diagnosed according to DSM-III-R. METHOD: In a 12-week, multicenter, double-blind, parallel-group study, 26 patients were treated with risperidone (mean daily dose = 3.8 mg), and 24 patients were treated with pimozide (mean daily dose = 2.9 mg). RESULTS: There was significant improvement of tics with respect to the Tourette's Symptom Severity Scale (TSSS) for both groups. Forty-one patients completed the study. At endpoint, 54% (14/26) of the risperidone patients and 38% (9/24) of the pimozide patients had only very mild or no symptoms on the global severity rating of the TSSS. Both treatment groups had improved significantly at endpoint in regard to Global Assessment of Functioning and Clinical Global Impressions scale outcomes. Symptoms of anxiety and depressive mood improved significantly from baseline in both groups. Obsessive-compulsive behavior improvement reached significance only in the risperidone group. Although the severity of extrapyramidal side effects was low in both groups, fewer patients in the risperidone group reported extrapyramidal side effects (N = 4) compared with the pimozide group (N = 8). Depression, fatigue, and somnolence were reported as the most prominent side effects in both treatment groups. CONCLUSION: Both drugs were efficacious and well tolerated in patients with Tourette's disorder. Risperidone may become the first-line drug in the treatment of Tourette's disorder owing to a more favorable efficacy and tolerability profile.

Adolescent↗
PubMed2004

Endocrinologic and psychologic evaluation of 21-hydroxylase deficiency carriers and matched normal subjects: evidence for physical and/or psychologic vulnerability to stress.

Carriers of congenital adrenal hyperplasia due to 21-hydroxylase (21-OH) deficiency demonstrate increased secretion of cortisol precursors after ACTH stimulation, suggestive of impaired cortisol production and compensatory increases in hypothalamic CRH secretion. Because both cortisol and CRH have behavioral effects, and hypothalamic CRH hypersecretion has been associated with chronic states of anxiety and depression, we performed endocrine and psychologic studies in consecutively admitted parents of patients with classic congenital adrenal hyperplasia due to 21-OH deficiency and parents of children with other chronic endocrine disorders. The number of excluded carriers because of pathologic reasons was higher than that of controls (P = 0.05). Carriers of 21-OH deficiency had a lower mean 24-h urinary free cortisol excretion (26.4 +/- 3.4 vs. 42.7 +/- 6.4 microg/d, P = 0.03) and higher peak ACTH (75.7 +/- 8.1 vs. 54.2 +/- 5.9 pg/ml, P = 0.04) and 17-hydroxyprogesterone (224.2 +/- 28.1 vs. 107.1 +/- 12.5 ng/dl, P < 0.001) concentrations post CRH stimulation than control subjects. Cortisol and androstenedione responses were similar in the two groups. Psychometric assessment performed by administering the State-Anxiety Inventory, Beck Depression Inventory, Profile of Mood States, Symptom Checklist-90R, and Temperament and Character Inventory revealed no differences between the two subject groups. Interestingly, a stepwise multiple linear regression model analysis in each population sample revealed that in carriers of 21-OH deficiency but not in the control subjects, a lower mean 24-h urinary free cortisol excretion and a higher ACTH response to ovine CRH stimulation predicted predisposition to obsessive-compulsive behavior, novelty seeking, reward dependence, and harm avoidance. We conclude that carriers of 21-OH deficiency appear to have mild hypocortisolism and compensatory changes of CRH secretion secondary to lower cortisol concentrations. These changes might predict mild predisposition of these subjects to physical and psychologic pathology, suggesting that larger studies are necessary.

Adrenal Hyperplasia, Congenital↗
PubMed1983

The mechanisms of permanence time: support for a psychodynamic hypothesis of psychological aging.

We often observe in advanced age a degree of obsessionalization in behavior, attitudes, and interests. This phenomenon, seemingly the expression of unconscious defense mechanisms, may be explained in various ways: as a consequence of losses related to aging; as regression in the service of the self; as an expression of the "death instinct." Another level of reflection is concerned with the influence of the perception of time. Confronted by the curtailing of one's expectation of life, the aged person may unconsciously yearn for some kind of permanence, designed to conjure away the effect of passing time. We find such a process underlying rigidity, collecting, or hypochondria, which may be regarded as "mechanisms of permanence." These strategies, although constituting for the aged person a defense intended, in fantasy, to preserve life, in reality constitute a trap that excludes life.

Adaptation, Psychological↗
PubMed2000

Intimate partner violence and stalking behavior: exploration of patterns and correlates in a sample of acutely battered women.

The aims of this study were to provide descriptive data on stalking in a sample of acutely battered women and to assess the interrelationship between constructs of emotional abuse, physical violence, and stalking in battered women. We recruited a sample of 114 battered women from shelters, agencies, and from the community at large. Results support the growing consensus that violent and harassing stalking behaviors occur with alarming frequency among physically battered women, both while they are in the relationship and after they leave their abusive partners. Emotional and psychological abuse emerged as strong predictors of within- and postrelationship stalking, and contributed a unique variance to women's fears of future serious harm or death, even after the effects of physical violence were controlled. The length of time a woman was out of the violent relationship was the strongest predictor of postseparation stalking, with increased stalking found with greater time out of the relationship. Results suggest the need to further study the heterogeneity of stalking and to clarify its relationship to constructs of emotional and physical abuse in diverse samples that include stalked but nonbattered women, as women exposed to emotional abuse, and dating violence.

Adolescent↗