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PubMedDate not supplied

Personality disorder in obsessive compulsive disorder: a controlled study.

In order to assess Axis II pathology in Obsessive Compulsive Disorder patients as compared to other anxiety disorder patients, the Personality Disorder Examination was administered to 258 anxiety disorder patients. In contrast to a number of recent reports, a low rate of personality disorder diagnoses were found in the OCD sample as well as the anxiety disorder control subjects. The findings of the current investigation are discussed in terms of state-trait confounding.

Agoraphobia↗

PubMed1999

Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease.

BACKGROUND & AIMS: The relationship between celiac disease and many autoimmune disorders has been explained by the sharing of a common genetic factor. In a multicenter national study, we examined the relationship between the prevalence of autoimmune disorders in celiac disease and the duration of exposure to gluten. METHODS: Over a 6-month period, 909 patients with celiac disease (group A; mean age, 16.1 +/- 3.8 years; grouped according to age at diagnosis into three subgroups [group A1, <2 years; group A2, 2-10 years; and group A3, >10 years]), 1268 healthy controls (group B; mean age, 20.8 +/- 4.5 years), and 163 patients with Crohn's disease (group C; mean age, 28.8 +/- 10 years) were evaluated for the presence of autoimmune disorders. RESULTS: Prevalence of autoimmune disorders in group A was significantly higher than in group B (14% vs. 2.8%; P < 0.000001) but not higher than in group C (12.9%). Prevalence of autoimmune disorders in celiac disease increased with increasing age at diagnosis: 5.1% in group A1, 17% in group A2, and 23.6% in group A3 (P = 0.000001). In group A3, the prevalence of autoimmune disorders was significantly higher than in group C. In a logistic regression model, age at diagnosis was the only significant predictor variable of the odds of developing an autoimmune disorder (r = 0.3; P < 0.000001). CONCLUSIONS: Our data show for the first time that the prevalence of autoimmune disorders in celiac disease is related to the duration of exposure to gluten.

Adolescent↗

PubMed1992

MCMI-II personality disorders in recent-onset bipolar disorders.

This study investigated the personality disorders of 21 recent-onset Bipolar Disorder patients using the revised Million Clinical Multiaxial Inventory (MCMI-II; Millon, 1987). Personality disorder assessments, conducted after patients' clinical symptoms had settled, indicated that 17 patients received at least one MCMI-II personality disorder diagnosis with a trend toward multiple diagnoses. Narcissistic, Antisocial, and Histrionic personality disorders were diagnosed most frequently and were the scales most elevated. Schizoid and Compulsive personality disorders were the scales least elevated. Diagnostic concordance between the MCMI-II and the Structured Interview for DSM-III Personality (SIDP; Pfohl, Stangl, & Zimmerman, 1983) was poor; the MCMI-II made more multiple diagnoses. Implications of the discrepancies between these instruments and suggestions for future research are discussed.

Adult↗

PubMed1982

A practical method for screening psychiatric disorder in children with speech and language disorders.

Children with speech and language disorders have been found to have a prevalence rate of psychiatric disorder of 50%. The authors sought to develop an efficient screening procedure to distinguish such children who have psychiatric disorder and those who do not. Cutoff scores for easily administered parent and teacher behavior rating questionnaires were investigated in a population of 256 children with speech and language disorders and known presence or absence of psychiatric disorder. It was learned that when the questionnaires are used together, a cutoff score of 31 or greater on either questionnaires are used together, a cutoff score of 31 or greater on either questionnaire has a positive predictive value of 74.1% and a negative predictive value of 76.1%. This screening method shows promise in assisting speech pathologists in comprehensive evaluation and treatment planning for children with speech and language disorders.

Adolescent↗

PubMed2007

Parent and child agreement for acute stress disorder, post-traumatic stress disorder and other psychopathology in a prospective study of children and adolescents exposed to single-event trauma.

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined by structured interview in a prospective study of assault and motor vehicle accident (MVA) child survivors, assessed at 2-4 weeks and 6 months post-trauma. Children were significantly more likely to meet criteria for ASD, as well as other ASD and PTSD symptom clusters, based on their own report than on their parent's report. Parent-child agreement for ASD was poor (Cohen's kappa = -.04), but fair for PTSD (Cohen's kappa = .21). Agreement ranged widely for other emotional disorders (Cohen's kappa = -.07-.64), with generalised anxiety disorder found to have superior parent-child agreement (when assessed by phi coefficients) relative to ASD and PTSD. The findings support the need to directly interview children and adolescents, particularly for the early screening of posttraumatic stress, and suggest that other anxiety disorders may have a clearer presentation post-trauma.

Accidents, Traffic↗

PubMed1986

Schedule for Affective Disorders and Schizophrenia--Lifetime Version modified for the study of anxiety disorders (SADS-LA): rationale and conceptual development.

The SADS-LA, a modification of the Lifetime Version of the Schedule for Affective Disorders and Schizophrenia, was designed specifically for studies requiring detailed lifetime information on anxiety disorders, symptoms and traits. This article focuses on current difficulties in assessing and conceptualizing anxiety disorders, as addressed in the SADS-LA. The following topics are discussed: conceptual differentiation of certain anxiety disorders; sub-threshold symptoms and syndromes; the relationship between affective and anxiety syndromes; the residual category, Generalized Anxiety Disorder. We emphasize a lifetime sequential approach to diagnostic assessment for a comprehensive understanding of the interrelationships between mental disorders.

Agoraphobia↗

PubMed2005

Examining the association between pediatric bipolar disorder and anxiety disorders in psychiatrically referred children and adolescents.

BACKGROUND: To examine the association between anxiety (ANX) and bipolar disorders (BPD) in a clinically referred pediatric sample. METHODS: Subjects were consecutively referred youth aged <18 years, with a DSM-III-R/DSM-IV diagnosis of BPD (n=297) or a disruptive behavior disorder (DBD) (n=1100) on structured interview. RESULTS: Bipolar disorder in youth was associated with a significantly increased risk for most of the DSM-IV anxiety disorders and was not specifically linked to any one disorder in particular. CONCLUSIONS: Bipolar disorder in youth is a significant risk factor for anxiety comorbidity. Considering the morbidity and dysfunction as well as the differing therapeutic needs associated with bipolar and anxiety symptomatology, appropriate therapeutic approaches will be needed for the management of youth with this comorbidity.

Adolescent↗

PubMedDate not supplied

Personality disorders in drug abusers: prevalence and their association with AXIS I disorders as predictors of treatment retention.

A sample of 226 drug-dependent individuals consecutively admitted to treatment in the major therapeutic programmes in Greece were assessed at intake with the EuropASI and SCL-90-R. At 4 to 6 weeks, 173 who were continuing treatment were reassessed with the SCL-90-R and interviewed with the SCID-R and the CIDI. Mean age of the subjects was 28 years, and 82.3% were male. Heroin was the main substance of abuse for the large majority (89.8%). Prevalence of AXIS II personality disorders (PD) was 59.5% and the majority (61.2%) had more than one PD. Cluster B was diagnosed in almost half of the subjects (48.6%), Antisocial Personality Disorder (APD) being the most prevalent (33.5%) type of PD. Subjects with APD had an earlier age of initiation of illicit drug use than those without. Subjects with a PD had twice the odds of having a comorbid AXIS I diagnosis and three times the odds of having a mood disorder than those without a PD. SCL-90-R assessments showed that psychiatric symptoms were significantly reduced in the period between intake and the fourth week in treatment. Somatization, Depression and Anxiety symptoms were however less reduced in subjects with a PD than in those without PD. Dropping out from treatment was more strongly predicted by AXIS I than AXIS II disorders, with an increased probability of dropping out in the presence of current mood disorders, whereas current anxiety disorder predicted treatment retention.

Adult↗

PubMed1995

Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder.

BACKGROUND: The findings from case reports and patient questionnaire surveys have been interpreted as indicating that administration of stimulants is ill-advised for the treatment of attention-deficit hyperactivity disorder in children with tic disorder. METHODS: Thirty-four prepubertal children with attention-deficit hyperactivity disorder and tic disorder received placebo and three dosages of methylphenidate hydrochloride (0.1, 0.3, and 0.5 mg/kg) twice daily for 2 weeks each, under double-blind conditions. Treatment effects were assessed using direct observations of child behavior in a simulated (clinic-based) classroom and using rating scales completed by the parents, teachers, and physician. RESULTS: Methylphenidate effectively suppressed hyperactive, disruptive, and aggressive behavior. There was no evidence that methylphenidate altered the severity of tic disorder, but it may have a weak effect on the frequency of motor (increase) and vocal (decrease) tics. CONCLUSION: Methylphenidate appears to be a safe and effective treatment for attention-deficit hyperactivity disorder in the majority of children with comorbid tic disorder.

Attention Deficit Disorder with Hyperactivity↗

PubMed1998

Posttraumatic stress disorder and drug disorders: testing causal pathways.

BACKGROUND: Although there is a high degree of comorbidity between posttraumatic stress disorder (PTSD) and drug use disorders, little is known about causal relationships between PTSD, exposure to traumatic events, and drug use disorders. METHODS: In a longitudinal study in southeast Michigan, 1007 adults aged 21 to 30 years were initially assessed in 1989 and were followed up 3 and 5 years later, in 1992 and 1994. Psychiatric disorders according to DSM-III-R criteria were measured by the National Institute of Mental Health Diagnostic Interview Schedule. To take into account temporal sequencing, the associations between PTSD, traumatic events, and drug use disorders were analyzed by using Cox proportional hazards models with time-dependent covariates. RESULTS: Posttraumatic stress disorder signaled an increased risk of drug abuse or dependence (hazards ratio, 4.5; 95% confidence interval, 2.6-7.6, adjusted for sex), whereas exposure to traumatic events in the absence of PTSD did not increase the risk of drug abuse or dependence. The risk for abuse or dependence was the highest for prescribed psychoactive drugs (hazards ratio, 13.0; 95% confidence interval, 5.3-32.0). There was no evidence that preexisting drug abuse or dependence increased the risk of subsequent exposure to traumatic events or the risk of PTSD after traumatic exposure. CONCLUSION: The results suggest that drug abuse or dependence in persons with PTSD might be the inadvertent result of efforts to medicate symptoms, although the possibility of shared vulnerability to PTSD and drug use disorders cannot be ruled out.

Adult↗

PubMed2014

Expression of ZNF804A in human brain and alterations in schizophrenia, bipolar disorder, and major depressive disorder: a novel transcript fetally regulated by the psychosis risk variant rs1344706.

IMPORTANCE: The single-nucleotide polymorphism rs1344706 in the zinc finger protein 804A gene (ZNF804A) shows genome-wide association with schizophrenia and bipolar disorder. Little is known regarding the expression of ZNF804A and the functionality of rs1344706. OBJECTIVES: To characterize ZNF804A expression in human brain and to investigate how it changes across the life span and how it is affected by rs1344706, schizophrenia, bipolar disorder, and major depressive disorder. DESIGN, SETTING, AND PARTICIPANTS: Molecular and immunochemical methods were used to study ZNF804A messenger RNA (mRNA) and ZNF804A protein, respectively. ZNF804A transcripts were investigated using next-generation sequencing and polymerase chain reaction-based methods, and ZNF804A protein was investigated using Western blots and immunohistochemistry. Samples of dorsolateral prefrontal cortex and inferior parietal lobe tissue were interrogated from 697 participants between 14 weeks' gestational age and age 85 years, including patients with schizophrenia, bipolar disorder, or major depressive disorder. MAIN OUTCOMES AND MEASURES: Quantitative measurements of ZNF804A mRNA and immunoreactivity, and the effect of diagnosis and rs1344706 genotype. RESULTS: ZNF804A was expressed across the life span, with highest expression prenatally. An abundant and developmentally regulated truncated ZNF804A transcript was identified, missing exons 1 and 2 (ZNF804AE3E4) and predicted to encode a protein lacking the zinc finger domain. rs1344706 influenced expression of ZNF804AE3E4 mRNA in fetal brain (P = .02). In contrast, full-length ZNF804A showed no association with genotype (P > .05). ZNF804AE3E4 mRNA expression was decreased in patients with schizophrenia (P = .006) and increased in those with major depressive disorder (P < .001), and there was a genotype-by-diagnosis interaction in bipolar disorder (P = .002). ZNF804A immunoreactivity was detected in fetal and adult human cerebral cortex. It was localized primarily to pyramidal neurons, with cytoplasmic as well as dendritic and nuclear staining. No differences in ZNF804A-immunoreactive neurons were seen in schizophrenia or related to rs1344706 (P > .05). CONCLUSIONS AND RELEVANCE: rs1344706 influences the expression of ZNF804AE3E4, a novel splice variant. The effect is limited to fetal brain and to this isoform. It may be part of the mechanism by which allelic variation in ZNF804A affects risk of psychosis. ZNF804A is translated in human brain, where its functions may extend beyond its predicted role as a transcription factor.

Adolescent↗

PubMed1997

Discriminating between generalized anxiety disorder and anxiety disorder not otherwise specified in a Hispanic population: is it only a matter of worry?

One hundred and two Hispanic persons who presented for treatment at a specialized anxiety disorders clinic were evaluated at intake using the Anxiety Disorders Interview Schedule-Revised (ADIS-R; DiNardo and Barlow [1988] Albany: Center for Stress and Anxiety Disorders, State University of New York at Albany). Results indicated that 14% of these patients suffered from anxiety and/or affective disorders that were not adequately captured by our current diagnostic system. Given that the majority of these cases were characterized by predominantly anxious features, further investigation was undertaken to determine the degree of overlap between these patients (anxiety disorder, not otherwise specified; NOS) and those with generalized anxiety disorder (GAD). The two groups differed only with regard to the number of excessive worries they reported and not in terms of somatic symptomatology, psychosocial stressors, or demographic variables. These data suggest that excessive worry may be a discriminating factor between the GAD and NOS groups, providing support for the notion of GAD as a disorder of chromic worry. Future research is needed to tease apart the relative influences of culture and socioeconomic status on our findings.

Adult↗

PubMed1995

Obsessive compulsive disorder and mood disorders: a family study.

Obsessive compulsive disorder (OCD) often coexists with major depression (MD), with rates varying from 35 to 75%. The nature of the depressive symptomatology can be investigated by familial aggregation analysis, assuming that the disorder which occurs first is the one showing greater genetic liability and should have higher familial concentration. Therefore, the aim of our study was to assess the familial loading for OCD and mood disorders in the families of OCD patients with different chronology of onset for the mood disorder, to evaluate how the familial pattern of the diseases differs with different temporal sequences in which the two syndromes occur. A total of 172 OCD patients entered the study; 112 were pure OCD probands, 12 were unable to separate the onset of the two syndromes, 11 had prior mood disorder, and 37 of them had experienced their first depressive episodes after the onset of OCD. Information about the family history was collected by means of the Family History-Research Diagnostic Criteria (FH-RDC) and by directly interviewing at least 2 relatives per family. Morbidity risks for OCD indicate a familial concentration of the disorder in all groups, except the MD/OCD group. We found the highest rate of relatives affected by mood disorders in the families of patients with first onset of MD (28.8%), whereas in the other 3 groups MRs were much lower. These results suggest the affective nature of OCD patients who experienced first onset of MD. Thus, the chronology of onset seems to identify 2 different typologies of familial distribution.

Adult↗

PubMed2003

The natural course of bulimia nervosa and eating disorder not otherwise specified is not influenced by personality disorders.

OBJECTIVE: To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) and to test the effects of personality disorder (PD) comorbidity on the outcomes. METHOD: Ninety-two female patients with current BN (N=23) or EDNOS (N=69) were evaluated at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS). Eating disorders (EDs) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders. Personality disorders (PDs) were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV). The course of BN and EDNOS was assessed with the Longitudinal Interval Follow-up Evaluation and the course of PDs was evaluated with the Follow-Along version of the DIPD-IV at 6, 12, and 24 months. RESULTS: Probability of remission at 24 months was 40% for BN and 59% for EDNOS. To test the effects of PD comorbidity on course, ED patients were divided into groups with no, one, and two or more PDs. Cox proportional regression analyses revealed that BN had a longer time to remission than EDNOS (p<.05). The number of PDs was not a significant predictor of time to remission, nor was the presence of Axis I psychiatric comorbidity or Global Assessment of Functioning scores. Analyses using proportional hazards regression with time-varying covariates revealed that PD instability was unrelated to changes in ED. CONCLUSIONS: BN has a worse 24-month course (longer time to remission) than EDNOS. The natural course of BN and EDNOS is not influenced significantly by the presence, severity, or time-varying changes of co-occurring PDs, co-occurring Axis I disorders, or by global functioning.

Adolescent↗

PubMed1987

Platelet [3H]imipramine binding in generalized anxiety disorder, panic disorder, and agoraphobia with panic attacks.

The density of platelet [3H]imipramine binding sites is reported to be decreased in unipolar depression and, hence, is a putative biological marker. There is considerable evidence for a phenomenological and biological relationship of panic disorder with affective disorder. We studied platelet [3H]imipramine binding site density in unmedicated subjects with generalized anxiety disorder (GAD; n = 55), panic disorder (PD) with and without agoraphobia (n = 52), and normal controls (n = 26) in order to determine whether or not patients with panic disorder differed from controls in this biological assay. We found no differences in binding site density (Bmax) or affinity (Kd) among the PD, PD with agoraphobia, GAD, and control groups. Nor did we find a relationship between Bmax or Kd and the severity of depressive symptoms or the presence of a family history of affective disorder. In view of two conflicting prior studies, the use of [3H]imipramine binding in panic disorder remains problematic.

Adult↗

PubMed1993

Does formal thought disorder differ among patients with schizophrenic, schizophreniform and manic schizoaffective disorders?

The aim of this study was to examine whether specific forms of formal thought disorder distinguish schizophrenia from schizophreniform and schizoaffective psychoses. The sample was composed of 82 consecutively admitted patients with schizophrenic symptoms. Of these, 28 had a diagnosis of schizophrenia by RDC and DSM-IIIR criteria, 28 a diagnosis of schizophrenia by RDC but not DSM-IIIR (consequently they were labeled schizophreniform), and 26 a diagnosis of manic schizoaffective disorder by RDC criteria. They were assessed by a semi-structured interview for schizophrenia, by scales for positive and negative symptoms (SAPS and SANS) and by prognostic indicators. The assessment of thought disorder was carried out by using the Thought, Language and Communication scale (TLC). The schizophrenic patients showed higher global scores on formal thought disorder, and some of its subtypes were 'most specific' to schizophrenia (poverty of speech, poverty of content of speech, illogicality, tangentiality and perseveration). Schizophrenics had more loose associations than schizophreniforms. Manic schizoaffectives had higher scores on positive versus negative formal thought disorder than schizophreniforms. We suggested that the assessment of disordered thinking by the TLC may facilitate the differential diagnosis of psychotic disorders during the acute phase of the illness.

Adolescent↗

PubMed2005

Autism and Asperger's disorder: are they movement disorders involving the cerebellum and/or basal ganglia?

Autism and Asperger's disorder (AD) are childhood developmental disorders of unknown aetiology. Autism and AD share several behavioural features, and it is not clear whether they are distinct disorders or variants of the same disorder. Recent studies indicate that disordered movement may be another feature of autism and AD, and that this may reflect dysfunction within the frontostriatal and/or cerebellar motor circuits. While disordered movement in autism and AD has been examined in a variety of ways, it is relatively under-researched compared to the cognitive, affective, and behavioural disturbances seen in these disorders. This review examines the role of the frontostriatal and cerebellar motor systems in the behavioural features of autism and AD, with gait as a proxy, and discusses difficulties with their diagnosis and their possible pathogenesis.

Animals↗

PubMed2007

Personality disorders in early adolescence and the development of later substance use disorders in the general population.

Assessments of personality disorder (PD) and conduct disorder (CD) in a random community sample at mean age 13 were employed to predict subsequent substance abuse disorder (SUD), trajectories of symptoms of abuse or dependence on alcohol, marijuana, or other illicit substances, and hazard of initiating marijuana use over the subsequent decade. Personality disorders and conduct disorder were associated with diagnoses and symptoms of SUDs in every model and their effects were independent of correlated family risks, participant sex, and other Axis I disorders. Specific elevated PD symptoms in early adolescence were also associated with differential trajectories of already initiated SUD symptoms as well as elevated risk for future onset of SUD symptoms. For several models the greatest of these effects were shown for borderline PD and for conduct disorder, the predecessor of adult antisocial PD. Passive-aggressive PD also showed independent elevation effects on substance use symptoms for alcohol and marijuana. Analyses over 30 years suggest that Cluster B PD (borderline, histrionic, narcissistic) are independent risks for development of SUD and warrant clinical attention.

Adolescent↗