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PubMed2000

Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders. A study of women with random sample population controls.

BACKGROUND: We compared ICD-10 psychiatric disorders in female patients with fibromyalgia (n=45) or functional dyspepsia (n=18) with age-matched random sample controls (n=49). METHOD: Version 2 of The Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used for present state examination and lifetime diagnoses. RESULTS: Current psychiatric disorders (somatoform pain disorder and specific phobia omitted) were diagnosed in 80% of fibromyalgia patients (OR=8.3), 83% of functional dyspepsia patients (OR=10.3) and 33% controls. Among fibromyalgia patients 27% had lifetime panic disorder. Lifetime mood disorders were found in 83% of functional dyspepsia patients. First-degree relatives with psychiatric disorder were found in 16% of the fibromyalgia patients, 50% of functional dyspepsia patients and 20% of controls. CONCLUSIONS: Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders in substantial subgroups. Psychiatric symptoms and somatic complaints are closely related in these disorders.

Adolescent↗
PubMed2001

Serotonin-induced platelet intracellular calcium mobilization in various psychiatric disorders: is it specific to bipolar disorder?

BACKGROUND: Serotonin (5-HT)-stimulated platelet intracellular calcium (Ca) mobilization has been reported to be enhanced in unmedicated depressive patients compared to those of normal healthy subjects, which suggests increased 5-HT2A receptor function in these patients. It has not been ascertained whether this enhanced response is specific to some type of affective disorders among various mental disorders. METHODS: We examined 5-HT-induced platelet intracellular Ca response in 152 unmedicated outpatients with various psychiatric disorders including bipolar disorder (BD), major depressive disorder with melancholia (DM), major depressive disorder without melancholia (DN), schizophrenia (SCH), panic disorder (PD), obsessive-compulsive disorder (OCD), social phobia (SP) and bulimia nervosa (BN), and 30 normal controls. RESULTS: We observed no significant differences in basal intracellular Ca concentration among all patient subgroups and normal controls. While the 5-HT-induced Ca response was significantly and specifically higher in patients with BD than in normal controls, no significant differences were found in the Ca response to 5-HT between patients with DM, DN, SCH, PD, OCD, SP and BN, and normal controls. LIMITATIONS: The sample sizes of each group are still small. Therefore, they have to be enlarged in the continuation of the study so as to increase the power of the statistical tests. CONCLUSION: These results indicate the possibility that enhanced signal transduction, mediated by the 5-HT2A receptor, may be specific to bipolar disorder.

Adult↗
PubMed1997

Psychosocial characteristics of adolescents with a past history of dysthymic disorder: comparison with adolescents with past histories of major depressive and non-affective disorders, and never mentally ill controls.

Little is known about the psychosocial functioning of persons who have recovered from dysthymic disorder. Such information might be useful in identifying trait markers for dysthymia, and for guiding continuation and maintenance treatment. We explored this issue using data from the Oregon Adolescent Depression Project, a large community-based study of the epidemiology of psychiatric disorders in a high school population. Four groups of adolescents were identified: 38 with a past history of dysthymic disorder; 217 with a past history of major depressive disorder; 142 with a past history of non-affective disorders; and 1079 with no lifetime history of psychopathology. The groups were compared on an extensive battery of psychosocial variables. The most consistent and diagnostically specific finding was that adolescents with a past history of dysthymic disorder reported having a significantly lower level of social support from friends than each of the other three groups of adolescents. Adolescents with a past history of dysthymic disorder also reported significantly higher levels of depressive, internalizing and externalizing symptoms and daily hassles than adolescents with no lifetime history of psychopathology. In addition, they reported higher levels of depressive symptoms and self-consciousness, but fewer externalizing symptoms than adolescents with a past history of non-affective disorders. These data suggest that adolescents with dysthymic disorder continue to experience significant difficulties in psychosocial functioning even after recovery.

Adolescent↗
PubMed2001

Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders.

The reliability of current and lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) anxiety and mood disorders was examined in 362 outpatients who underwent 2 independent administrations of the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). Good to excellent reliability was obtained for the majority of DSM-IV categories. For many disorders, a common source of unreliability was disagreements on whether constituent symptoms were sufficient in number, severity, or duration to meet. DSM-IV diagnostic criteria. These analyses also highlighted potential boundary problems for some disorders (e.g., generalized anxiety disorder and major depressive disorder). Analyses of ADIS-IV-L clinical ratings (0-8 scales) indicated favorable interrater agreement for the dimensional features of DSM-IV anxiety and mood disorders. The findings are discussed in regard to their implications for the classification of emotional disorders.

Adult↗
PubMed2004

Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder.

OBJECTIVE: To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). METHOD: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filter criteria ("equity", "strength of evidence", "feasibility" and "acceptability to stakeholders") is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs). RESULTS: Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater. CONCLUSIONS: Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.

Antidepressive Agents, Tricyclic↗
PubMed2004

Disrupted in schizophrenia 1 (DISC1): association with schizophrenia, schizoaffective disorder, and bipolar disorder.

Schizophrenia, schizoaffective disorder, and bipolar disorder are common psychiatric disorders with high heritabilities and variable phenotypes. The Disrupted in Schizophrenia 1 (DISC1) gene, on chromosome 1q42, was originally discovered and linked to schizophrenia in a Scottish kindred carrying a balanced translocation that disrupts DISC1 and DISC2. More recently, DISC1 was linked to schizophrenia, broadly defined, in the general Finnish population, through the undertransmission to affected women of a common haplotype from the region of intron 1/exon 2. We present data from a case-control study of a North American white population, confirming the underrepresentation of a common haplotype of the intron 1/exon 2 region in individuals with schizoaffective disorder. Multiple haplotypes contained within four haplotype blocks extending between exon 1 and exon 9 are associated with schizophrenia, schizoaffective disorder, and bipolar disorder. We also find overrepresentation of the exon 9 missense allele Phe607 in schizoaffective disorder. These data support the idea that these apparently distinct disorders have at least a partially convergent etiology and that variation at the DISC1 locus predisposes individuals to a variety of psychiatric disorders.

Adult↗
PubMed2006

The development of a research agenda for substance use disorders diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V).

AIMS: This paper describes the background to the establishment of the Substance Use Disorders Workgroup, which was charged with developing the research agenda for the development of the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It summarizes 18 articles that were commissioned to inform that process. METHODS: A preliminary list of research topics, developed at the DSM-V Launch Conference in 2004, led to the identification of subjects that were subject to formal presentations and detailed discussion at the Substance Use Disorders Conference in February 2005. RESULTS: The 18 articles presented in this supplement examine: (1) categorical versus dimensional diagnoses; (2) the neurobiological basis of substance use disorders; (3) social and cultural perspectives; (4) the crosswalk between DSM-IV and the International Classification of Diseases Tenth Revision (ICD-10); (5) comorbidity of substance use disorders and mental health disorders; (6) subtypes of disorders; (7) issues in adolescence; (8) substance-specific criteria; (9) the place of non-substance addictive disorders; and (10) the available research resources. CONCLUSIONS: In the final paper a broadly based research agenda for the development of diagnostic concepts and criteria for substance use disorders is presented.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2004

Does the risk of developing dementia increase with the number of episodes in patients with depressive disorder and in patients with bipolar disorder?

OBJECTIVE: Several findings suggest that some patients with depressive or bipolar disorder may be at increased risk of developing dementia. The present study aimed to investigate whether the risk of developing dementia increases with the number of affective episodes in patients with depressive disorder and in patients with bipolar disorder. METHODS: This was a case register study including all hospital admissions with primary affective disorder in Denmark during 1970-99. The effect of the number of prior episodes leading to admission on the rate of readmission with a diagnosis of dementia following the first discharge after 1985 was estimated. A total of 18,726 patients with depressive disorder and 4248 patients with bipolar disorder were included in the study. RESULTS: The rate of a diagnosis of dementia on readmission was significantly related to the number of prior affective episodes leading to admission. On average, the rate of dementia tended to increase 13% with every episode leading to admission for patients with depressive disorder and 6% with every episode leading to admission for patients with bipolar disorder, when adjusted for differences in age and sex. CONCLUSION: On average, the risk of dementia seems to increase with the number of episodes in depressive and bipolar affective disorders.

Adult↗
PubMed1996

Reduced benzodiazepine sensitivity in patients with panic disorder: comparison with patients with obsessive-compulsive disorder and normal subjects.

OBJECTIVE: The authors sought to replicate their previous finding of reduced response to diazepam in patients with panic disorder, to test whether this effect was specific for panic disorder, and to determine whether this reduced response was merely an artifact of resistance to sedation from anxiety-related overarousal. METHOD: The effects of four increasing intravenous doses of diazepam on saccadic eye movement velocity and accuracy (the latter being a saccadic variable that is unaffected by sedation), short-term memory, and self- and observer-rated sedation were assessed in 18 patients with panic disorder, 15 patients with obsessive-compulsive disorder, and 14 normal comparison subjects. The ratios of effect to blood level areas under the curve for both ascending and descending limbs of the effect/blood level curves were compared for each variable. RESULTS: Patients with panic disorder showed significantly less diazepam effect on saccadic velocity and accuracy for the ascending limb of the blood level curve than comparison subjects. Patients with obsessive-compulsive disorder showed similar differences from comparison subjects but only for saccadic velocity. There were no group differences in diazepam effects on memory and sedation. CONCLUSIONS: Patients with panic disorder are less sensitive than comparison subjects to diazepam. Although this difference is not an artifact of resistance to sedation, it may not be specific for panic disorder but rather may reflect a more nonspecific aspect of anxiety disorders.

Adult↗
PubMed1997

One-year follow-up of secondary versus primary mental disorder in persons with comorbid substance use disorders.

OBJECTIVE: Service utilization and outcomes of dually diagnosed patients with independent mental disorders and those with substance-induced mental disorders were compared. METHOD: Diagnosis, service use, and severity of substance use problems at baseline and 1 year later were assessed in consecutively admitted inpatients with independent mental disorders plus substance use disorders (N = 71), substance-induced mental disorders plus substance use disorders (N = 38), and independent mental disorders only (N = 59). RESULTS: At follow-up, patients with substance-induced mental disorders at baseline were more likely to have been rehospitalized than the other groups, were more likely to have used outpatient substance abuse services, were less likely to have an independent mental disorder, and had the most severe alcohol- and drug-related impairment. CONCLUSIONS: Treatment programs for both types of dual diagnosis patients must address mental health concerns.

Adolescent↗
PubMed2002

Quality of life in social anxiety disorder compared with panic disorder and the general population.

OBJECTIVE: Quality of life in a treatment-seeking cohort of patients with social anxiety disorder was compared with that of patients with panic disorder who were matched for age, comorbid illnesses, and gender and with population-based norms. METHODS: The study participants were 33 patients with social anxiety disorder and 33 patients with panic disorder who had participated in clinical trials and who had completed the Medical Outcomes Study Short-Form-36 (SF-36) as part of a baseline evaluation. The patients did not have significant comorbid psychiatric disorders. Paired t tests were used to compare baseline scores on subscales of the SF-36 between the two cohorts. One-sample t tests were used to compare scores on subscales of the SF-36 with expectation scores based on 2,474 persons from the general population. RESULTS: Compared with the general population, the patients with social anxiety disorder had significantly greater impairment as measured by the SF-36 social functioning and mental health subscales. Subscale scores also indicated poorer emotional role functioning, but the difference was not significant. However, they were significantly less impaired than the patients with panic disorder in terms of physical functioning, physical role, and mental health. CONCLUSIONS: Patients with social anxiety disorder who do not have significant comorbid depression or anxiety are substantially impaired in quality of life, but to a lesser extent than patients with panic disorder, who suffer from both mental and physical impairments in quality of life.

Adult↗
PubMed1995

Comorbidity of dissociative disorders among patients with substance use disorders.

OBJECTIVES: The study replicated methods used in an earlier study to determine the prevalence of dissociative disorders among patients with substance use disorders and to examine demographic characteristics and history of childhood abuse among patients with and without dissociative comorbidity. METHODS: A total of 100 inpatients who were completing a substance abuse treatment program at a VA medical center were interviewed using the Dissociative Disorders Interview Schedule, which diagnoses dissociative disorders. Two additional screening measures of dissociative symptoms were used, as well as an instrument to measure IQ. RESULTS: Fifteen percent of the sample were diagnosed as having a dissociative disorder. Compared with patients without a dissociative disorder, the patients with a dissociative disorder had significantly higher median scores on the two screening measures, indicating more dissociative experiences and the presence of five distinct symptom clusters. The two groups did not differ in history of childhood abuse or IQ. CONCLUSIONS: The results support earlier findings suggesting that patients with substance abuse disorder should be routinely screened for dissociative symptoms and disorders.

Adult↗
PubMed2006

The lay concept of conduct disorder: do nonprofessionals use syndromal symptoms or internal dysfunction to distinguish disorder from delinquency?

BACKGROUND: Conduct disorder (CD) must be distinguished from nondisordered delinquent behaviour to avoid false positives, especially when diagnosing youth from difficult environments. However, the nature of this distinction remains controversial. The DSM-IV observes that its own syndromal CD diagnostic criteria conflict with its definition of mental disorder, which requires that symptoms be considered a manifestation of internal dysfunction to warrant disorder diagnosis. Previous research indicates that professional judgments tend to be guided by the dysfunction requirement, not syndromal symptoms alone. However, there are almost no data on lay conceptualizations. Thus it remains unknown whether judgments about CD are anchored in a broadly shared understanding of mental disorder that provides a basis for professional-lay consensus. OBJECTIVE: The present study tests which conception of CD, syndromal-symptoms or dysfunction-requirement, corresponds most closely to lay judgments of disorder or nondisorder and compares lay and professional judgments. We hypothesized that lay disorder judgments, like professional judgments, tend to presuppose the dysfunction requirement. METHOD: Three lay samples (nonclinical social workers, nonpsychiatric nurses, and undergraduates) rated their agreement that youths described in clinical vignettes have a mental disorder. All vignettes satisfied DSM-IV CD diagnostic criteria. Vignettes were varied to present syndromal symptoms only, symptoms suggesting internal dysfunction, and symptoms resulting from reactions to negative circumstances, without dysfunction. RESULTS: All lay samples attributed disorder more often to youths whose symptoms suggested internal dysfunction than to youths with similar symptoms but without a likely dysfunction. CONCLUSIONS: The dysfunction requirement appears to reflect a widely shared lay and professional concept of disorder.

Attitude to Health↗
PubMed1995

Conduct disorder and substance use disorder: comorbidity in a clinical sample of preadolescents and adolescents.

OBJECTIVE: To examine the rate of comorbidity between conduct disorder and substance use disorder in a clinical sample using the Diagnostic Interview for Children and Adolescents--Revised. METHOD: Examined the pattern of conduct disorder symptoms, including type, number, and severity, in conduct-disordered youth diagnosed with, and without a comorbid substance use disorder. RESULTS: The examination revealed no significant differences in the incidence of comorbidity between younger (aged 10 to 13) and older (above age 13) youth. Among youth who met criteria for conduct disorder, 52% also met criteria for a substance use disorder. Odds ratios indicated that the probability of comorbidity of conduct and substance use disorders was higher in the younger group. CONCLUSION: Substance abuse and dependence tend to develop rapidly following first use, suggesting that a slim window of opportunity exists to prevent substance disorders once drug use has begun.

Adolescent↗
PubMed2004

Impact of stressful life events, familial loading and their interaction on the onset of mood disorders: study in a high-risk cohort of adolescent offspring of parents with bipolar disorder.

BACKGROUND: Stressful life events are established as risk factors for the onset of mood disorders, but few studies have investigated their impact on the development of mood disorders in adolescents. AIMS: To study the effect of life events on the development of mood disorders in the offspring of parents with bipolar disorder, with respect to the possibility of a decay effect and modification by familial loading. METHOD: In a high-risk cohort of 140 Dutch adolescent offspring of parents with bipolar disorder, we assessed life events, current and past DSM-IV diagnoses and familial loading. To explore their interaction and impact on mood disorder onset, we constructed four different models and used a multivariate survival analysis with time-dependent covariates. RESULTS: The relationship between life events and mood disorder was described optimally with a model in which the effects of life events gradually decayed by 25% per year. The effect of life event load was not significantly stronger in the case of high familial loading. CONCLUSIONS: Independent of familial loading, life events increase the liability to mood disorders in children of patients with bipolar disorder but the effects slowly diminish with time.

Adolescent↗
PubMed1999

Sadistic personality disorder in sex offenders: relationship to antisocial personality disorder and sexual sadism.

To investigate the relationship of sadistic personality disorder (SPD), as defined in the appendix of DSM-III-R, to other personality disorders and to sexual sadism, 70 sex offenders (27 child molesters, 33 rapists, and 10 murderers) were assessed by the International Personality Disorder Examination. In 19 subjects (27.2%) from the total sample, SPD was diagnosed. The highest overlap appeared with borderline personality disorder (31.6%) and antisocial personality disorder (42.1%). However, in four cases SPD was the only personality disorder diagnosed. Factor analysis of the antisocial and sadistic criteria resulted in four major factors--one factor with high loadings on the sadistic criteria and the violent criteria of antisocial personality disorder, two factors with different forms of adult and juvenile aggression, and a fourth factor with high loadings on the antisocial criteria covering exploitative behavior. The results do not support SPD as a discrete disorder. Nevertheless, SPD may be seen as an important subdimension of antisocial personality disorder, distinct from more exploitative forms of antisocial behavior with less violence. Of those patients with SPD, 42.1% also had a DSM-III-R diagnosis of sexual sadism, which may be the most dangerous configuration.

Adult↗
PubMed2003

Evaluation of bizarre-idiosyncratic thinking scale as a measure of thought disorder in children and adolescents with severe psychiatric disorders.

To investigate the prevalence of thought disorder and the possible appropriateness of the Bizarre-Idiosyncratic Thinking Scale for children and adolescents with severe psychiatric disorders, 96 child and adolescent inpatients and day hospital patients, ages 6 to 18 years, at a state psychiatric hospital were rated by review of retrospective records using Marengo and Harrow's 1986 Evaluation of Bizarre-Idiosyncratic Thinking Scale for the presence of thought disorder in the Thematic Apperception Test and Rorschach Inkblot Test responses. Although the Evaluation of Bizarre-Idiosyncratic Thinking Scale had not been previously used with children and adolescents, the analysis suggested possible indications of thought disorder in several diagnostic groups. No significant differences were found on the Rorschach between patients with Schizophrenia and Psychosis, Not Otherwise Specified and those with Attention Deficit Hyperactivity Disorder, Major Depression, and Conduct Disorder. On the basis of the Thinking Scale ratings, the Thematic Apperception Test responses showed significantly higher ratings of thought disorder for patients with Schizophrenia and Psychosis, Not Otherwise Specified. There was no general relation between thought disorder and age or IQ, but schizophrenic patients, aged 13 and older, had more thought disorder than schizophrenic patients who were younger than 13.

Adolescent↗
PubMed2006

[Prevention of psychiatric disorders and suicide in the Belgium population older than 60 years. Results of the European Study on Epidemiology of Mental Disorders (ESEMeD)].

PURPOSE: This study aimed to examine the 12-month and lifetime prevalence rates of pure and comorbid mental disorders (mood, anxiety and alcohol disorders) in Belgian home-dwelling elderly. METHODS: A representative random sample of 665 non-instutionalized older adults (60+) from Belgium was interviewed in 2000 and 2001. DSM-IV disorders were assessed by interviewers trained to use a revised version of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) of the World Health Organization. RESULTS: Twenty percent of the respondents reported a lifetime history of at least one mental disorder; 5% met criteria for a a mental disorder in the past twelve months. Mood and anxiety disorders were the most common mental disorders. Almost 5% of the respondents reported suicidal ideation in their lifetime, while 0.22% had suicidal ideation in the past twelve months preceding the interview. CONCLUSIONS: Mental disorders are not uncommon in the Belgian home-dwelling elderly. The results of this study imply that in 2000-2001 at least five percent of the older adults living in the community had at least one mental disorder. Two in thousand older adults reported suicidal ideations in the 12 months preceding the interview.

Aged↗