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PubMed2005

Familial aggregation of schizophrenia-spectrum disorders and obsessive-compulsive associated disorders in schizophrenia probands with and without OCD.

A substantial proportion of schizophrenia patients also has obsessive-compulsive disorder (OCD). To further validate the clinical validity of a schizo-obsessive diagnostic entity, we assessed morbid risks for schizophrenia-spectrum disorders and OC-associated disorders in first-degree relatives of schizophrenia probands with and without OCD. Two groups of schizophrenia probands [with OCD (n = 57) and without OCD (n = 60)] and community-based controls (n = 50) were recruited. One hundred eighty two first-degree relatives of probands with OCD-schizophrenia, 210 relatives of non-OCD schizophrenia probands, and 165 relatives of community subjects were interviewed directly [59.3% (108/182), 51.9% (109/210), and 54.5% (90/165), respectively], using the Structured Clinical Interview for Axis-I DSM-IV Disorders and Axis II DSM-III-R Personality Disorders and the remaining relatives were interviewed indirectly, using the Family History Research Diagnostic Criteria. Relatives of OCD-schizophrenia probands had significantly higher morbid risks for OCD-schizophrenia (2.2% vs. 0%; P = 0.033) and OCPD (7.14% vs. 1.90%; P = 0.014), and a trend towards higher morbid risk for OCD (4.41% vs. 1.43%; P = 0.08) compared to relatives of non-OCD schizophrenia probands. When morbid risks for OCD, OCPD, and OCD-schizophrenia were pooled together, the significant between-group difference became robust (13.74% vs. 3.33%; P = 0.0002). In contrast, relatives of the two schizophrenia groups did not differ significantly in morbid risks for schizophrenia-spectrum disorders, mood disorders, or substance abuse disorders. A differential aggregation of OC-associated disorders in relatives of OCD-schizophrenia versus non-OCD schizophrenia probands, provides further support for the validity of a putative OCD-schizophrenia ("schizo-obsessive") diagnostic entity.

Adult↗
PubMed2005

Eating disorders and emotional and physical well-being: associations between student self-reports of eating disorders and quality of life as measured by the SF-36.

OBJECTIVE: To assess health-related quality of life (HRQoL) in subjects with eating disorders in terms of eating disorder type and in relation to self-reports of longstanding illness, depression and self-harming behaviours. METHOD: Data on eating disorder history, SF-36 health status, longstanding illness, and self-reported frequencies of depression, self-harming behaviour, and suicidal thoughts or acts were collected during 1996 as part of a UK postal survey of students' health. Completed questionnaires were returned by 1439 of 3750 students (response rate 42%). RESULTS: Eighty-three respondents (5.8%; 8.9% of females) reported a probable eating disorder history: 54 (3.8%) bulimia nervosa, 22 (1.6%) binge eating disorder, and 7 (0.5%) anorexia nervosa. Eating disorder subjects reported more impairment in SF-36 emotional than physical well-being, with significantly lower mental (p < 0.001) but not physical (p = 0.21) component summary scores. This was most evident in bulimia nervosa and binge eating disorder subjects. Anorexia nervosa subjects reported fewer SF-36 emotional limitations although they were significantly more likely to report depression, self-harming behaviour, and suicidal ideation. DISCUSSION: An eating disorder history is accompanied by HRQoL impairment primarily in emotional well-being. Anorexia nervosa subjects perceive fewer limitations than subjects with other eating disorders. While this is consistent with previous reports of better SF-36 emotional well-being in those with restrictive eating behaviours, it may also suggest that the SF-36 is insensitive to emotional distress in anorexia nervosa.

Adult↗
PubMedDate not supplied

Eating disorders in female inpatients with versus without substance use disorders.

This study assessed the relationship between substance use disorders and eating disorders in female psychiatric inpatients. Structured diagnostic interviews were reliably administered to a series of inpatients with substance use disorders (n = 67) and a comparison sample without substance use disorders (n = 69). Eating disorder diagnoses as a whole, including eating disorder not otherwise specified, were distributed significantly more frequently among subjects with substance use disorders than among psychiatric controls. Frequencies of the specific diagnoses of bulimia nervosa and anorexia nervosa, however, did not differ significantly between groups. The results suggest that eating disorder features may be overrepresented among female inpatients with substance use disorders.

Adolescent↗
PubMedDate not supplied

Screening disordered eating attitudes and eating disorders in a sample of Turkish female college students.

It has been hypothesized that college women are particularly susceptible to the development and maintenance of disturbed eating behaviors. The purpose of this study was to determine the frequency of disordered eating attitudes and eating disorders in a sample of Turkish female college students. The Eating Attitudes Test was administered to a sample of 414 female college students. The subjects who had a score of 30 or higher were accepted as having disordered eating attitudes, and all of them have been examined using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition for eating disorders. Of the overall sample, 17.1% of subjects were classified as having disordered eating attitudes. This subgroup of subjects was then compared with the remainder on all the other measures. The differences between students with disordered eating attitudes and those without on sociodemographic variables (except for age) were not statistically significant. The rate was 1% for eating disorders including anorexia nervosa (0.5%) and bulimia nervosa (0.5%). This study suggested that the prevalences of disordered eating attitudes and anorexia nervosa among female college students in Turkey were similar to those found in Western societies, but the rate for bulimia nervosa was lower compared with Western societies.

Adolescent↗
PubMedDate not supplied

Disordered verbalizations in schizophrenia: a speech disturbance or thought disorder?

This research provides empirical data relevant to the long-standing theoretical issue of whether disordered speech in schizophrenia should be viewed as a speech disturbance or a thought disorder. The study analyzed whether schizophrenia patients with disordered speech on one test also show strange nonverbal behavior and unrealistic ideas on other assessments. One hundred eighty-four patients, including 55 schizophrenia patients, were assessed at the acute phase and followed up twice, over 4.5 years. Patients were assessed (1) with a standardized measure that can elicit disordered speech, (2) with a different measure that can elicit an atypical sorting of objects and an intermingling of personal ideas, and (3) for delusions (unrealistic thinking). Schizophrenia patients with disordered speech on the Proverbs Test also (1) sorted objects strangely on the Object Sorting Test (P <.05), (2) showed an intermingling of personal ideas into their thinking (P <.01), and (3) had delusional ideas when assessed at two successive follow-ups over a multiyear period (P <.001). The data suggest that most schizophrenia patients and other psychotic patients with disordered speech also show strange nonverbal behavior and unrealistic ideas/beliefs. These data support a theoretical framework in which disordered speech in schizophrenia and other types of psychotic patients is viewed as not just due to a speech disorder, but is often part of a broader constellation that includes gross reality distortions, strange behavior and ideas, and disordered thinking.

Adult↗
PubMed1998

Functional gastrointestinal disorders and eating disorders. Relevance of the association in clinical management.

BACKGROUND: As functional gastrointestinal disorders (FGID) are common in eating disorder patients, we aimed to assess past eating disorders in patients referred for current FGID. METHODS: One hundred and twenty-seven consecutive FGID outpatients and 163 patients with gallstone disease (GD) were enrolled. All patients were interviewed to detect GI symptoms (by means of the GI Symptom Rating Scale), lifetime eating disorders (on the basis of DSM-IV criteria), and current psychologic distress (on the Hospital Anxiety and Depression Scale). RESULTS: Past eating disorders were significantly more prevalent in FGID (15.7%) than in GD patients (3.1%) (chi-square = 14.6, P < 0.001). FGID patients with past eating disorders were significantly younger, more educated, more psychologically distressed, more dyspeptic, and more were women than FGID patients without past eating disorders. CONCLUSIONS: This study confirms the previously found association between functional GI symptoms and eating disorders and shows that functional GI symptoms may still persist even after the recovery from eating disorders, particularly in psychologically distressed patients.

Abdominal Pain↗
PubMed2006

Association of catecholamine-O-methyltransferase and 5-HTTLPR genotype with eating disorder-related behavior and attitudes in females with eating disorders.

OBJECTIVE: There is growing evidence, that genetic variants contribute to the pathogenesis of anorexia nervosa and bulimia nervosa. Genetic studies have revealed candidate genes, but no satisfactory associations with the disorders have been found so far. The aim of the present study was to evaluate, whether behavioral and attitudinal traits of the disorders can serve as phenotypes with a possible association with two common functional polymorphisms of the monoaminergic pathways. METHOD: Forty-five female in-patients of a specialized hospital for eating disorders were included into the study. Eating disorder symptomatology was assessed using the Eating Disorder Inventory-2. The functional catecholamine-O-methyltransferase (COMT) 158 Val-->Met polymorphism and the deletion/insertion polymorphism of the serotonin transporter promoter 5-HTTLPR were determined. RESULTS: Carriers of at least one Met-allele of the COMT gene had significantly higher total scores of the Eating Disorder Inventory-2, as well as significantly higher scores on the subscales bulimia, ineffectiveness, interoceptive awareness, maturity fears and impulse regulation. Carriers of the deletion of the 5-HTTLPR had significantly higher scores on the subscales drive for thinness and body dissatisfaction. CONCLUSION: We found associations between the COMT and the 5-HTTLPR polymorphisms and specific clinical, behavioral and attitudinal traits of eating disorders. These polymorphisms may predispose their carriers to exhibit certain symptoms of eating disorders or confer a general risk for more severe forms of these disorders.

Adolescent↗
PubMed1992

Formal thought disorder in pediatric complex partial seizure disorder.

We compared the formal thought disorder ratings of 27 children with complex partial seizure disorder, 31 schizophrenic children and 58 normal children. The epileptic children with fullscale IQ scores below 100 had significantly more formal thought disorder than normal children with a similar IQ. The severity of their formal thought disorder was related to the age of seizure onset, seizure control and a diagnosis of schizophrenia spectrum disorder. The schizophrenic children had thought disorder irrespective of IQ scores. The cognitive correlates of their formal thought disorder scores differed from those of the epileptic children. Possible anatomical substrates of thought disorder in childhood complex partial seizure disorder and schizophrenia are discussed.

Attention↗
PubMed1997

Panic disorder versus panic disorder with major depression; defining and understanding differences in psychiatric morbidity.

The present study examined the impact of comorbid major depressive disorder (MDD) on psychiatric morbidity, panic symptomatology and frequency of other comorbid psychiatric conditions in subjects with panic disorder (PD). Four hundred thirty-seven patients with PD were evaluated at intake as part of a multicenter longitudinal study of anxiety disorders; 113 of these patients were also in an episode of MDD. Patients were diagnosed by DSM-III-R criteria utilizing structured clinical interviews. The 113 PD/MDD patients were compared with the 324 remaining PD subjects regarding panic symptoms at intake, sociodemographic, quality of life and psychiatric morbidity variables. Differences in frequency of other comorbid Axis I psychiatric disorders were assessed at intake; personality disorders were evaluated twelve months after intake. The results revealed the PD/MDD patients exhibit increased morbidity and decreased psychosocial functioning as compared to PD patients. Personality disorders were more prevalent in the PD/MDD group at six month follow-up assessment; the PD/MDD group also had an increased frequency of posttraumatic stress disorder (PTSD) and more comorbid Axis I anxiety disorders as compared to the PD group. The total number and frequency of panic symptoms was highly consistent between the two patient groups.

Adolescent↗
PubMedDate not supplied

DSM-III-R personality disorders in panic and obsessive-compulsive disorder: a comparison study.

Forty-eight patients with panic disorder/agoraphobia (PAD) and 30 with obsessive-compulsive disorder (OCD) were assessed for DSM-III-R axis II personality disorders (PD) and the presence of the same anxiety disorder in the relatives of probands (homotypic disorders). No specific personality disorder was present significantly more often in either of the two groups. Agoraphobia was not associated with higher rates of axis II disorders in PAD patients. Duration of illness did not influence the presence of a PD in patients of both groups. Secondary cases of the same anxiety disorder were significantly more common among first-degree relatives of PAD patients. A discriminant analysis performed on the most frequent personality traits of both groups provided a correct classification of cases of 97.4%. Our results do not support the hypothesis of PD as secondary to anxiety disorders and confirm previous findings of a lack of specificity between DSM-III-R axis II categories and OCD and PAD.

Adult↗
PubMedDate not supplied

Life events and the 1-year prevalence of major depressive episode, generalized anxiety disorder, and panic disorder in a community sample.

A community survey was conducted in Edmonton, Alberta, Canada, in which 3,070 respondents completed the Diagnostic Interview Schedule (DIS) and the Life Events Scale (LES) of Paykel. During the year before the interview, there were 222, 234, and 38 cases of major depressive episode (MDE), generalized anxiety disorder (GAD), and panic disorder (PD), respectively, where individuals may have had more than one disorder. It was not possible to time the onset of the disorder relative to the occurrence of life events, and so correlations, no casual relationships, were examined. The LES score showed an increasing trend across disorder categories defined as follows: MDE and GAD both absent; MDE absent and GAD present; MDE present and GAD absent; and MDE and GAD both present. A similar trend was observed for most of the LES subscales studied, but only in the case of events classified as "entrance," "undesirable," and "marital" was there statistical significance. The results suggest that stressful life events are correlated with both MDE and GAD, that individuals with MDE only tend to have a greater burden of stressful events and comorbid disorders than persons with GAD only, and that the presence of both disorders is associated with an even greater level of stress and number of comorbid disorders. The similar patterns across LES subscales suggest that MDE and GAD are not related to specific types of live events, at least not those covered by the LES questionnaire.

Adaptation, Psychological↗
PubMed2001

Parsing pediatric bipolar disorder from its associated comorbidity with the disruptive behavior disorders.

The unique pattern of comorbidity found in pediatric mania greatly complicates accurate diagnosis, the course of the disorder, and its treatment. The pattern of comorbidity is unique by adult standards, especially its overlap with attention-deficit/hyperactivity disorder (ADHD), aggression, and conduct disorder. Clinically, symptoms of mania have been discounted as severe ADHD or ignored in the context of aggressive conduct disorder. This atypicality may lead to neglect of the mood component. The addition of high rates of additional disorders contributes to the severe morbidity, dysfunction, and incapacitation frequently observed in these children. A comprehensive approach to diagnostic evaluation is the keystone to establishing an effective treatment program because response to treatment differs with individual disorders. Recognition of the multiplicity of disorders guides therapeutic options in these often refractory conditions. What was previously considered refractory ADHD, oppositionality, aggression, and conduct disorder may respond after mood stabilization. We review these issues in this article.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Late onset dysthymic disorder and major depression differ from early onset dysthymic disorder and major depression in elderly outpatients.

BACKGROUND: Age of onset may affect clinical features and prognosis in elderly patients with major depression (MDD), but there is a lack of such data in elderly patients with dysthymic disorder (DD) and systematic comparisons of late onset MDD and DD have not been conducted. METHODS: In a Late Life Depression Clinic, patients > or = 60 years old who met DSM-III-R or DSM-IV criteria for MDD or DD were studied. The 24-item Hamilton Rating Scale for Depression (HRSD) and SCID-P were completed, family history was obtained, and medical illnesses were assessed. RESULTS: In the total sample (n=370; 211 MDD and 159 DD), compared to early onset patients, late onset (onset > or =60 years) patients had a higher rate of cardiovascular disease (chi(2)=4.12, df=1, P<0.05), lower rate of anxiety disorder (chi(2)=4.19, df=1, P<0.05), and a lower rate of family history of affective disorder (chi(2)=9.37, df=1, P<0.002). Late onset DD patients were more likely to have cardiovascular disease than early onset DD patients (chi(2)=5.63, df=1, P<0.02), but the rate of cardiovascular disease did not differ between late and early onset MDD patients (chi(2)=0.35, df=1, P<0.6). Late onset MDD patients were less likely to have a family history of affective disorder than early onset MDD patients (chi(2)=10.71, df=1, P<0.001). Prevalence of anxiety disorders did not differ between the early and late onset MDD patients (chi(2)=0.07, df=1, P<0.79), but was more common in the early onset DD compared to the late onset DD patients (17.98% versus 4.29%, chi(2)=6.98, df=1, P<0.01). Late onset DD did not differ from late onset MDD in the rates of cardiovascular disease, anxiety disorders, and family history of affective disorder. Excluding patients with double depression (n=32) did not alter the cardiovascular or family history findings, but the difference in anxiety disorders between early and late onset DD patients was no longer significant. LIMITATIONS: Academic clinic sample results may not generalize to community populations. CONCLUSIONS: In the elderly, late-onset DD is typically different from early onset DD. Cerebrovascular disease appears to play a role in the etiology of late onset DD. The similarities between late onset DD and late onset MDD suggest a single condition along a continuum.

Aged↗
PubMed2000

The impact of comorbid mood and personality disorders in the cognitive-behavioral treatment of panic disorder.

The present review examined the effect of comorbid major depressive disorder and personality disorder on the outcome of cognitive-behavioral interventions for panic disorder. Panic disorder patients often present with these comorbid conditions, but for the most part, treatment studies have paid little attention to them. Most studies on the effects of comorbidity on treatment outcome address pharmacological treatment. However, there is a growing literature on the effect of additional disorders on the outcome of cognitive-behavioral interventions for panic disorder. Findings from the studies of comorbidity with depression are equivocal, possibly reflecting inconsistencies in measurement methodology across studies. However, personality psychopathology was found to exert a detrimental effect on the outcome of cognitive-behavioral treatment for panic disorder. Further research is necessary to elucidate the impact of these concurrent conditions on cognitive-behavioral treatment for panic disorder. It is suggested that studies utilizing cognitive-behavioral treatment routinely examine the influence of comorbid conditions on treatment outcome.

Cognitive Behavioral Therapy↗
PubMed2002

Comorbid anxiety disorders in civilians seeking treatment for posttraumatic stress disorder.

Research indicates that posttraumatic stress disorder (PTSD) is associated with high rates of comorbid psychiatric diagnoses. Yet, it remains unknown whether PTSD is associated with greater comorbidity relative to patients with other anxiety disorders. This study examined prevalence of comorbid anxiety disorders with PTSD relative to other disorders among a treatment-seeking population. Patients with PTSD (n = 83) evidenced greater overall comorbidity as compared to patients with other anxiety (n = 151) or Axis I (n = 73) disorders. Compared to patients with panic disorder, patients with PTSD were more likely to be diagnosed with depression and social phobia, but not other anxiety disorders. Extent of anxiety disorder comorbidity was not related to PTSD severity. These findings are discussed in terms of their relevance for treatment of PTSD.

Adult↗
PubMed2002

Somatoform disorders in children and adolescents: a comparison with other internalizing disorders.

A chart review of children and adolescents attending a university-based psychiatric outpatient clinic over a 1-year period was done. Nineteen consecutive patients with somatoform disorders were compared with 26 consecutive patients with other internalizing disorders, i.e., depressive disorders and/or anxiety disorders without disruptive behavior problems. Mean age, sex distribution, cognitive level, and duration of symptoms were not different between groups. Self- and parent-reported levels of psychopathology, including depression, anxiety, suicidal ideation, and deliberate self-harm, differentiated between somatoform disorders and other internalizing disorders at the group level. Levels of adaptive functioning and functional somatic symptoms did not. High levels of medically unexplained symptoms should prompt the clinician for assessing depressive symptoms and anxiety. Findings also support the use of DSM-IV criteria in pediatric patients to differentiate somatoform disorders from other internalizing disorders.

Adolescent↗
PubMed2004

Alcohol, tobacco, and drug use disorders and personality disorder symptoms.

In a nonclinical sample of 395 young adults, the authors evaluated the relations between major personality traits, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) personality disorder symptoms, and DSM-IV alcohol use disorders (AUDs). Consistent with previous findings, traits related to disinhibition and negative affectivity were consistently associated with AUDs, as were Cluster B personality disorder symptoms (especially antisocial and borderline disorder symptoms). Multivariate analyses revealed that Cluster B symptoms were significantly associated with AUDs above and beyond what was accounted for by personality traits. Further, the authors found differential patterns of relations between other substance use disorders (SUDs; i.e., tobacco dependence and drug use diagnoses) and personality disorder symptoms. Overall, these results suggest that personality disorder symptoms predict unique variance in SUDs that reflect maladaptive aspects of personality traits.

Adolescent↗
PubMed1999

Comparison of internalizing and externalizing symptoms in children with attention-deficit hyperactivity disorder with and without comorbid tic disorder.

This study examined the relation between internalizing and externalizing symptoms in two groups of prepubertal boys (with and without multiple chronic tic disorder) with diagnosed attention-deficit hyperactivity disorder (ADHD). Parents and teachers completed the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF), respectively. Children were carefully evaluated for the absence of a chronic tic disorder. Boys with ADHD and chronic multiple tic disorder (ADHD/+tics) received significantly higher (p = .0032, Bonferroni correction) scores for the Anxious/Depressed, Thought Problems, and Attention Problem scales of the CBCL and the Delinquent Behavior, Thought Problems, and Somatic Complaints scales of the TRF than did boys without chronic tic disorder (ADHD/-tics). Although many of the individual items that differentiated (p < .05) the two groups of boys pertained to behaviors that characterize motor tics, obsessions, or compulsions, the ADHD/+tics group exhibited higher rates of anxious behavior (CBCL) and obscene language (TRF) than did the ADHD/-tics group. Anxiety/depressive symptoms were associated with aggressive/oppositional behavior in both samples. Children with mild tic disorder were more similar (CBCL) to ADHD/-tics boys than they were to children with more severe tic disorder. The relatively higher rate of comorbidity in the ADHD/+tics group suggests that tics may be a marker for more severe symptomatology in clinic-referred samples of children with ADHD. Furthermore, these data suggest that it is not the presence, per se, but rather the severity of tic disorder that is associated with higher rates of emotional and behavioral disturbances.

Anxiety Disorders↗