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PubMed2003

The mood disorder questionnaire improves recognition of bipolar disorder in psychiatric care.

BACKGROUND: We investigated our translation of The Mood Disorder Questionnaire (MDQ) as a screening instrument for bipolar disorder in a psychiatric setting in Finland. METHODS: In a pilot study for the Jorvi Bipolar Study (JoBS), 109 consecutive non-schizophrenic psychiatric out- and inpatients in Espoo, Finland, were screened for bipolar disorder using the Finnish translation of the MDQ, and 38 of them diagnostically interviewed with the SCID. RESULTS: Forty subjects (37%) were positive in the MDQ screen. In the SCID interview, twenty patients were found to suffer from bipolar disorder, of whom seven (70%) of ten patients with bipolar I but only two (20%) of ten with bipolar II disorder had been previously clinically correctly diagnosed. The translated MDQ was found internally consistent (alpha 0.79) and a feasible screening tool. CONCLUSIONS: Bipolar disorder, particularly type II, remains commonly unrecognized in psychiatric settings. The Mood Disorder Questionnaire is a feasible screen for bipolar disorder, which could well be integrated into psychiatric routine practice.

Adult↗
PubMed2000

Ten-year outcome: patients with schizoaffective disorders, schizophrenia, affective disorders and mood-incongruent psychotic symptoms.

BACKGROUND: It is unclear whether outcome in schizoaffective disorders is more similar to schizophrenia or affective disorders. AIMS: To provide longitudinal data on clinical course and outcome in schizoaffective disorders versus schizophrenia and affective disorders, and determine whether mood-incongruent psychotic symptoms have negative prognostic implications. METHOD: A total of 210 patients with schizoaffective disorders, schizophrenia, bipolar manic disorders and depression were assessed at hospitalisation and then followed up four times over 10 years. RESULTS: At all four follow-ups, fewer patients with schizoaffective disorders than with schizophrenia showed uniformly poor outcome. Patients with mood-incongruent psychotic symptoms during index hospitalisation showed significantly poorer subsequent outcome (P < 0.05). CONCLUSIONS: Schizoaffective outcome was better than schizophrenic outcome and poorer than outcome for psychotic affective disorders. Mood-incongruent psychotic symptoms have negative prognostic implications. The results could fit a symptom dimension view of schizoaffective course.

Acute Disease↗
PubMed2000

Assessing ADHD and comorbid disorders in children: the Child Behavior Checklist and the Devereux Scales of Mental Disorders.

Evaluated discriminant validity and clinical utility of selected subscales of the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) and the Child Behavior Checklist (CBCL; Achenbach, 1991a) in 228 children referred to a clinic for the evaluation and treatment of attention deficit hyperactivity disorder (ADHD). The DSMD is a multiaxial behavior rating scale that measures symptomatology for a broad range of child psychopathology as described in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-R-III] and 4th ed. [DSM-IV]; American Psychiatric Association, 1987, 1994). Discriminant function analyses as well as sensitivity, specificity, and predictive power analyses were computed to evaluate the discriminant validity and clinical utility of selected DSMD and CBCL subscales for assessing ADHD, oppositional defiant disorder (ODD), and anxiety disorders. Results indicated that the DSMD compared very favorably with the CBCL in the ability to discriminate between children with ADHD and those without ADHD and between children with comorbid ODD and anxiety disorders and children who did not meet criteria for these disorders. The DSMD Attention subscale may be somewhat better at ruling in ADHD combined subtype (ADHD-C) and ADHD inattentive subtype (ADHD-I) than the CBCL Attention Problems subscale, but the CBCL Attention Problems subscale may have slightly better utility than the DSMD Attention subscale in ruling out these subtypes. Both the CBCL and DSMD were more useful for ruling out than for ruling in ODD and anxiety disorders.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Convergent and discriminative validity of interview and questionnaire measures of personality disorder in mentally disordered offenders: a multitrait-multimethod analysis using confirmatory factor analysis.

Measures of personality disorder from the International Personality Disorder Examination, Personality Diagnostic Questionnaire, and Millon Clinical Multiaxial Inventory (MCMI-II) were obtained from detained male mentally disordered offenders (N = 156), and convergent and discriminant validity were examined by confirmatory factor analysis of the multitrait-multimethod matrix. Hierarchical comparisons of models varying in their specification of trait and method variance established the appropriateness of a model supporting both convergence and discrimination across methods, but these were variable across constructs and measures. Convergence was good for avoidant, schizoid, and antisocial disorders, but poor for histrionic, narcissistic, and obsessive-compulsive disorders. Avoidant, schizoid, and schizotypal disorders were not clearly distinguishable from each other. Measurement error attributable to method variance was substantial for all instruments and for most disorders. The commonly alleged superiority of interview over questionnaire methods was not supported, and the MCMI-II demonstrated proportionately more "true" variance. However, assessment methods may be differentially sensitive to different kinds of personality disorder problems.

Adult↗
PubMed2000

Clozapine for treatment-refractory schizophrenia, schizoaffective disorder, and psychotic bipolar disorder: a 24-month naturalistic study.

BACKGROUND: The aim of this study was to evaluate the 24-month response to clozapine in patients with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder. METHOD: Ninety-one psychotic patients with a principal DSM-III-R diagnosis of schizophrenia (N = 31), schizoaffective disorder (N = 26), or bipolar disorder with psychotic features (N = 34) were treated naturalistically with clozapine at flexible dosages over a 24-month period. Improvement was assessed by the 18-item Brief Psychiatric Rating Scale and the Clinical Global Impressions-Severity of Illness scale. RESULTS: All patients showed significant improvement 24 months from intake (p < .001). Such an improvement was significantly greater among patients with schizoaffective disorder or bipolar disorder than in patients with schizophrenia (p < .05). The presence of suicidal ideation at intake predicted greater improvement at endpoint. CONCLUSION: Clozapine appears to be effective and relatively well tolerated in acute and long-term treatment of patients with psychotic bipolar disorder or schizoaffective disorder who have not responded to conventional pharmacotherapies.

Adult↗
PubMed2003

Sertraline versus imipramine treatment of comorbid panic disorder and major depressive disorder.

OBJECTIVE: To evaluate the efficacy and tolerability of sertraline and imipramine in patients with comorbid panic disorder and major depressive disorder. METHOD: Outpatients meeting a DSM-IV diagnosis of panic disorder and concurrent major depressive disorder were randomized in a 2:1 ratio to 26 weeks of double-blind treatment with either sertraline, in daily doses of 50 to 100 mg, or imipramine, in daily doses of 100 to 200 mg. Primary outcome measures were panic attack frequency (derived from patient diaries) and the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: 138 patients were treated with sertraline (76% female; mean age = 40 years) and 69 with imipramine (70% female; mean age = 40 years). The symptoms of both major depressive disorder and panic disorder responded significantly and equivalently to both drugs. Endpoint improvement with sertraline versus imipramine, respectively, on the MADRS was 11.1 +/- 10.8 versus 11.2 +/- 10.4, and on the Clinical Global Impressions-Improvement scale (CGI-I) was 2.1 +/- 1.3 versus 2.4 +/- 1.6. Among study completers, CGI-I responder rates were 88% with sertraline and 91% with imipramine. Treatment outcome was concordant for both diagnoses in approximately 70% of patients and discordant in approximately 30%. Overall, sertraline was significantly better tolerated with significantly fewer discontinuations due to adverse events (11% vs. 22%; chi(2) = 4.39, df = 1, p =.04). CONCLUSION: Both sertraline and imipramine were found to be highly effective treatments for both major depressive disorder and panic disorder, with sertraline showing significantly greater tolerability and compliance during long-term treatment than imipramine.

Adult↗
PubMed1999

[Usefulness of melatonin for developmental sleep and emotional/behavior disorders--studies of melatonin trial on 50 patients with developmental disorders].

We studied the usefulness of melatonin for sleep disorders and emotional/behavior disturbances of patients with developmental disorders. The efficacy and side effects of melatonin at bedtime were evaluated in 50 children and young adults with sleep disorders (3-28 years old, 41 males and 9 females, autism [AU] in 27 patients, mentally retardation [MR] in 20 patients, and severe motor and intellectual disability [SMID] in 3 patients). The sleep disorders consisted of various types of insomnia in 44 patients and of circadian rhythm sleep disorders in 6 patients. Thirty nine of the insomnia patients and 3 of the circadian rhythm sleep disorder patients experienced improvement in response to melatonin. In some cases, the efficacies were diminished after the daily medication of melatonin. With the emotional/behavior disturbances, excitabilities were often improved in cases whose sleep disorders were also improved. There was almost no change in contrariness, stereotyped behavior and in school/workshop refusal. Melatonin at bedtime was efficacious in 42 of the 50 patients with sleep disorders. In 17 patients, there were side effects (residual drowsiness on the next morning, awakening in the middle of sleep, excitement after awakening and before going to sleep, etc.). But these side effects were not serious. The effects of melatonin were influenced by the type of sleep disturbances, the factors of the environment and the mental conditions. Taking side effects into account, we judged melatonin to be useful in 34 patients.

Adolescent↗
PubMed2005

Treatment of comorbidity in conduct disorder with attention-deficit hyperactivity disorder (ADHD).

Conduct disorder (CD) is one of the most common psychiatric disorders in childhood and adolescence. It is characterized by a variety of chronic antisocial behaviors, a repetitive and persistent pattern of behavior that violates the basic rights of others, major age-appropriate societal norms, or both. Aggressive behavior, lying, stealing, fire-setting, and running away from home and school are the most frequent manifestations of CD and are often accompanied by hyperactivity, impulsive behavior, explosiveness, cognitive and learning problems, and poor social skills. The rate of comorbidity is high, with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) being the most common; comorbid anxiety and depressive disorders are also seen, especially in adolescents. The diagnostic process should include the use of structured interviews, and scores from reliable and valid rating scales that cover all psychiatric disorders must be considered in the differential diagnosis, because CD alone is an extreme rarity and multiple disorders are almost always the rule rather than exception. Treatment should include parenting skills training combined with training of the child to improve his or her relationships with peers, academic performance, and compliance with legitimate demands of authority figures. The appropriate use of medications and integration of patient/parent education and support, as well as individual, group, family, residential, and inpatient treatment may be beneficial for patients with CD and ADHD. The article describes a number of psychopharmacological agents that are used in patients with CD with ADHD and other comorbid disorders. Drugs that may be useful include psychostimulants; atomoxetine (Strattera); antidepressants (imipramine [Tofranil], desipramine [Norpramin]); Selective Serotonin Reuptake Inhibitors (SSRIs); atypical antipsychotics such as risperidone (Risperdal); or mood regulators including lithium (Eskalith).

Adolescent↗
PubMed2005

Epidemiology of autistic disorder and other pervasive developmental disorders.

Is the incidence of autistic disorder and other pervasive developmental disorders (PDDs) increasing? Recent epidemiological surveys of autistic disorder and other PDDs have heightened awareness of and concern about the prevalence of these disorders; however, differences in survey methodology, particularly changes in case definition and case identification over time, have made comparisons between surveys difficult to perform and interpret. Recent surveys suggest that the rate of all PDDs is about 60 per 10,000. The prevalence of autism today is estimated at 13 per 10,000, Asperger's disorder is approximately 3 per 10,000, and childhood disintegrative disorder is very rare at about 0.2 per 10,000. The assessment process, sample size, publication year, and geographic location of studies all have an effect on prevalence estimates. In addition, data from many of these surveys indicate correlates of autistic disorder and other PDDs with IQ, gender, and other medical disorders.

Adolescent↗
PubMed1998

Neuropsychological deficits in obsessive-compulsive disorder: a comparison with unipolar depression, panic disorder, and normal controls.

BACKGROUND: The neuropsychological dysfunction associated with obsessive-compulsive disorder (OCD) has similarities to the deficits reported in other affective or anxiety disorders. We directly compared cognitive function in patients with OCD with that in matched patients with unipolar depression and panic disorder and healthy control subjects to establish the specific nature of neuropsychological deficits in OCD. METHODS: Thirty patients with OCD, 30 patients with panic disorder, 20 patients with unipolar depression, and 30 controls completed a computerized neuropsychological battery that assessed the accuracy and latency of executive, visual memory, and attentional functions. RESULTS: The groups did not differ according to age, years of education, or estimated IQ. However, we found group differences in cognitive performance. The patients with OCD were impaired on measures of spatial working memory, spatial recognition, and motor initiation and execution. In contrast, performance of these tasks by patients with panic disorder or depression did not differ from that of controls. There were no group differences for performance on the measures of planning, cognitive speed, pattern recognition, and delayed matching to sample, although patients with depression were impaired for attentional set shifting. CONCLUSIONS: Neuropsychological deficits were observed in patients with OCD that were not observed in matched patients with panic disorder or unipolar depression. As such, the cognitive dysfunction in OCD appears to be related to the specific illness processes associated with the disorder.

Adult↗
PubMed1993

A follow-up study of early onset psychosis: comparison between outcome diagnoses of schizophrenia, mood disorders, and personality disorders.

This study examined the outcome of youth previously diagnosed with psychotic disorders at a public-sector tertiary care hospital. Of 95 children and adolescents retrospectively identified, follow-up information (mean interval 3.9 years) was obtained on 24 subjects with an outcome diagnosis of schizophrenia, 9 with psychotic mood disorders, 5 with personality disorders (antisocial or borderline), and 1 with schizo-affective disorder. The schizophrenic group was more often odd premorbidly and functioned worse at outcome, while the mood-disordered group had a shorter follow-up period and was more often anxious or dysthymic premorbidly. The personality-disordered group resembled the schizophrenics in their degree of impairment and chronicity. All three groups had high rates of family disruption, low SES, substance abuse, and chronicity, and were similar in their degree of premorbid impairment, length of prodrome, age of onset, initial diagnosis, and family psychiatric history. Misdiagnosis at onset was quite common and highlights the need for systematic longitudinal assessment of early onset psychotic disorders.

Adolescent↗
PubMedDate not supplied

Correlates of DSM-III personality disorder in panic disorder and agoraphobia.

One hundred eighty-seven patients meeting DSM-III criteria for panic disorder (n = 26) or agoraphobia with panic (n = 161) were assessed with the Personality Diagnostic Questionnaire (PDQ), a self-rating scale designed to assess Axis II personality disorders and traits. Results replicated our earlier findings of a preponderance of dependent, avoidant, and histrionic features and the finding that patients exhibiting a greater number of personality traits were also significantly more symptomatic. Patients with the diagnosis of panic disorder did not differ on any personality disorder variables from patients with the diagnosis of agoraphobia with panic. Furthermore, none of the specific symptom dimensions, i.e., panic, anxiety, or agoraphobia, was selected as a unique predictor of any personality variables in the regression analyses. Rather, the most important correlates of personality disorder in these patients consisted of general factors such as dysphoric mood, social phobia, or interpersonal sensitivity, and Eysenck's neuroticism dimension. The results are discussed in light of recent findings suggesting a nonspecific link between panic disorder or agoraphobia and personality disorder.

Adult↗
PubMed1995

Personality disorders and personality variations in relatives of patients with bipolar affective disorders.

Family studies may elucidate etiological relationships between two psychopathological conditions. This study explored the prevalences of personality disorders (DSM-III-R) and the variation of personality traits measured by the Munich Personality Test (MPT) in first-degree relatives of patients with bipolar disorder in comparison to control families recruited in the general population. Although the overall prevalence of having any personality disorder did not distinguish both groups of relatives we found significantly more compulsive personality disorders among relatives of probands with bipolar disorder. Relatives of patients with bipolar disorder also revealed significantly higher mean scores of "rigidity' (MPT); other personality traits, including neuroticism and extraversion, did not distinguish both groups. The observed differences in personality features between both groups of relatives are not mediated by current or previous axis I disorders. Therefore, they may reflect overlap of etiological factors of familial origin.

Adult↗
PubMed1983

Phenomenologic relationship of eating disorders to major affective disorder.

We administered the National Institute of Mental Health Diagnostic Interview Schedule to 41 patients with a lifetime history of anorexia nervosa (25 with and 16 without bulimia) and to 49 patients with bulimia alone. Results showed that 77% of the patients with eating disorders had a lifetime diagnosis of DSM-III major affective disorder, a rate significantly higher than that found in comparison groups composed of the first-degree relatives of probands with schizophrenia and bipolar disorder. High lifetime rates of anxiety disorders, substance use disorders, and kleptomania were also observed. By contrast, few cases of personality disorders and no cases of schizophrenia were found. These findings combine with the results of studies of family history, long-term outcome, response to biological tests, and treatment response to suggest that anorexia nervosa and bulimia may be closely related to major affective disorder.

Adolescent↗
PubMed2006

Affective disorders, anxiety disorders and psychological distress in non-drinkers.

BACKGROUND: Non-drinkers have elevated levels of psychological distress but a recent study reported no elevation in prevalence of diagnosed disorders. We aimed to determine the prevalence of affective and anxiety disorders (from the CIDI-A) in current abstainers and contrast results with findings for psychological distress (K10) in the same sample. METHODS: Cross-sectional, representative household survey of adult Australians. RESULTS: Non-/occasional drinkers had higher levels of psychological distress than light drinkers, and distress in heavy drinkers was even higher. Heavy drinkers also had the highest rates of most disorders. Non-/occasional drinkers showed significantly elevated prevalence only of dysthymia, agoraphobia and posttraumatic stress disorder compared with light drinkers. LIMITATIONS: Statistical power was limited for investigating low prevalence disorders. History of alcohol consumption was not collected. The CIDI-A and K10 have finite validity. CONCLUSIONS: This study confirmed J-shaped relationships between psychological distress and alcohol consumption. Although affective and anxiety disorders also showed non-linear relationships with alcohol consumption, non-/occasional drinkers are not at increased risk for all disorders compared to light drinkers. The pattern of symptomatology in non-/occasional drinkers may be of a different character to that in heavy drinkers, as well as being less severe.

Adolescent↗
PubMed2003

Can a subtype of conduct disorder linked to bipolar disorder be identified? Integration of findings from the Massachusetts General Hospital Pediatric Psychopharmacology Research Program.

Our intent was to investigate systematically the overlap between conduct disorder (CD) and bipolar disorder (BPD). We hypothesized that neither CD nor manic symptoms were secondary to the other disorder and that children with the two disorders would have correlates of both. Results from a series of programmatic studies examining phenotypic features of bipolar and conduct disorder alone or combined in probands and relatives were evaluated within and without the context of ADHD. Examination of the clinical features, patterns of psychiatric comorbidity, functioning in multiple domains, and familiality showed that children with CD and BPD had similar features of each disorder irrespective of the comorbidity with the other disorder. Our data suggest that when BPD and CD co-occur in children, both are correctly diagnosed. In these comorbid cases, CD symptoms should not be viewed as secondary to BPD, and manic symptoms should not be viewed as secondary to CD.

Adolescent↗
PubMedDate not supplied

Effect of comorbid anxiety, depressive, and personality disorders on treatment outcome of somatoform disorders.

Comorbid mental disorders of DSM-IV axis I and axis II have repeatedly been found to be a negative predictor for the treatment of axis I disorders, although recent contrary findings exist. Little is known about the effect of comorbidity on the therapy outcome of somatoform disorders. We compared three types of comorbidity, (1) personality disorders (PDs), (2) major depression (MDD) and anxiety (ANX) disorders, and (3) PDS and MDD and ANX, with regard to their relevance for the treatment outcome of somatoform disorders. One hundred twenty-six inpatients were assessed at least 4 weeks before admission to treatment, upon admission, and again at discharge. Somatoform, hypochondriacal, and depressive symptomatology, dysfunctional cognitions about body and health, dysfunctional social relationships, and other clinical characteristics were measured. Diagnostic assessments were based on the DSM-IV. Our findings suggest that none of the three types of comorbidity influence the therapy outcome of somatoform disorders or have a modifying effect on the level of psychopathology.

Analysis of Variance↗
PubMed1998

Depressive personality: associations with DSM-III-R mood and personality disorders and negative and positive affectivity, 30-month stability, and prediction of course of Axis I depressive disorders.

The authors addressed 5 issues bearing on the validity of the construct of depressive personality disorder (DPD): its relationship with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) mood and personality disorders and normal personality dimensions of negative and positive affectivity, its stability over 30-months, and its impact on the course of Axis I depressive disorders. Two samples were used: 156 outpatients with mood disorders, personality disorders, or both, and 267 of their 1st-degree relatives. The association between DPD and dysthymia was fairly modest, whereas the associations with major depression and the personality disorders were quite low. DPD was moderately correlated with both negative and positive affectivity; however, it contributed unique information beyond that available from the 2 emotional superfactors. Finally, DPD was moderately stable over a 30-month period and was associated with a poorer course of depression.

Adult↗