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PubMed2000

[Are eight-year olds already suffering from panic disorder? Investigation of prevalence with focus on panic disorder and agoraphobia].

A representative sample of 826 eight-year-old second-graders in Dresden was examined in a two-stage procedure to ascertain the 6-month prevalence of DSM-IV anxiety disorders. Particular care was taken to assess panic disorder. The eight-year-olds had already been interviewed personally in a screening session and in 230 children an individual diagnostic examination with a structured diagnostic interview was carried out. The total prevalence of anxiety disorder was 9.5%. No case of either panic disorder or agoraphobia was found. For the diagnosis of agoraphobia the DSM-IV diagnostic criterion was lacking in which situations typical to agoraphobia are feared or avoided because escape would be difficult or it would be difficult to reach help. Eight-year-olds do not forge this cognitive link. In agoraphobic situations 2.5% of the children (almost exclusively, girls) suffer from a specific phobia. The prevalence of anxiety disorders is markedly higher among girls than in boys.

Agoraphobia↗
PubMed2001

Manic depressive psychosis and schizophrenia are neurological disorders at the extremes of CNS maturation and nutritional disorders associated with a deficit in marine fat.

The maturational theory of brain development comprises manic depressive psychosis and schizophrenia. It holds that the disorders are part of human diversity in growth and maturation, which explains their ubiquity, shared susceptibility genes and multifactorial inheritance. Rate of maturation and age at puberty are the genotype; the disorders are localized at the extremes with normality in between. This is based on the association between onset of puberty and the final regressive event, with pruning of 40% of excitatory synapses leaving the inhibitory ones fairly unchanged. This makes excitability, a fundamental property of nervous tissue, a distinguishing factor: the earlier puberty, the greater excitability--the later puberty, the greater deficit. Biological treatment supports deviation from the norm: neuroleptics are convulsant; antidepressives are anti-epiletogenic. There is an association between onset of puberty and body-build: early maturers are pyknic broad-built, late ones linearly leptosomic. This discrepancy is similar to that in the two disorders, supporting the theory that body-build is the phenotype. Standard of living is the environmental factor, which affects pubertal age and shifts the panorama of mental illness accordingly. Unnatural death has increased with antipsychotics. Other treatment is needed. PUFA deficit has been observed in RBC in both disorders and striking improvements with addition of minor amounts of PUFA. This supports that dietary deficit might cause psychotic development and that prevention is possible. Other neurological disorders also profit from PUFA, underlining a general deficit in the diet.

Biological Evolution↗
PubMed2006

Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: a meta-regression of factors that may predict outcome.

OBJECTIVE: To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial. METHOD: We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to be 18 years or older and all have diagnosed depression, panic disorder (with or without agoraphobia) or generalized anxiety disorder (GAD). Outcomes of interest included symptom, functioning and health-related quality of life measures, reported as continuous variables at post-treatment. RESULTS: Cognitive behavioural therapy for depression, panic disorder and GAD had an effect size of 0.68 (95% CI=0.51-0.84, n=33 studies, 52 comparisons). The heterogeneity in the effect sizes was fully explained by treatment, duration of therapy, inclusion of severe patients in the trial, year of study, country of study, control group, language and number of dropouts from the control group. Disorder was not a significant predictor of the effect size. CONCLUSIONS: Cognitive behavioural therapy is significantly less effective for severe patients and trials that compared CBT to a wait-list control group found significantly larger effect sizes than those comparing CBT to an attention placebo, but not to a pill placebo. Further research is needed to determine whether CBT is effective when provided by others than psychologists and whether it is effective for non-English-speaking patient groups.

Anxiety Disorders↗
PubMed1992

Comorbidity of attention-deficit hyperactivity disorder and overanxious disorder.

One hundred seven preadolescent children who meet criteria for attention-deficit hyperactivity disorder (ADHD) were further diagnosed by structured interview with regard to oppositional defiant disorder, conduct disorder, and overanxious disorder (ANX). The ADHD population was subdivided into those with and without a comorbid ANX, and the two ADHD groups were compared with each other and a control group in terms of teacher ratings, behavioral observations during an academic task, and the Inhibition version of the Continuous Performance Test. The results suggested that ADHD/ANX children may be less impulsive and/or hyperactive than those children with ADHD alone though they remain more impaired than controls. There was also a trend for the comorbid group to show fewer conduct disorder symptoms. The implications of comorbidity for the study of both ADHD and ANX are discussed.

Anxiety Disorders↗
PubMed1993

Familial relationship between Gilles de la Tourette's syndrome, attention deficit disorder, learning disabilities, speech disorders, and stuttering.

OBJECTIVE: This study examined the familial relationship between Gilles de la Tourette's syndrome (GTS) and attention deficit disorder (ADD), learning problems, speech disorders, and stuttering. METHOD: This family study consisted of 338 first degree relatives of 85 GTS probands and 113 controls. All available relatives were personally assessed using structured interviews, and family history information was collected from all family members. Best-estimate diagnoses were assigned for GTS, ADD, learning problems, speech disorders, and stuttering. Analyses examined whether ADD, learning problems, speech disorders, and stuttering by themselves represent genetically variant expressions of GTS. RESULTS: There was no evidence that ADD, learning problems, speech disorders, or stuttering represent variant expressions of GTS. However, relatives with GTS were at increased risk for ADD regardless of the ADD diagnosis of the GTS proband. CONCLUSIONS: ADD, learning problems, stuttering, and speech problems by themselves are not variant forms of GTS. However, GTS and ADD may be etiologically related in some persons. There may be two types of individuals with GTS and ADD: ones in whom ADD is independent of GTS, and others in whom ADD is secondary to occurrence of GTS.

Adolescent↗
PubMed1995

Bipolar disorder and comorbid conduct disorder in childhood and adolescence.

OBJECTIVE: To report on the rate and associated features of comorbid conduct disorder (CD) in 26 bipolar (BP) youths and examine whether comorbidity affects clinical course. METHOD: The clinically referred subjects, 8 to 13 years old at study entry, were participating in a longitudinal investigation of childhood-onset psychiatric disorders. They were repeatedly examined during an interval of up to 12 years, and diagnosed by DSM-III criteria. RESULTS: There was a 69% rate of lifetime comorbidity and 54% rate of episode comorbidity with CD. CD predated the first BP episode for 11 youths and postdated it for 7. Only 12% of the 26 children had primary uncomplicated affective illness. Youngsters without CD comorbidity had a higher rate of primary affective illness, a somewhat greater number of BP episodes, but slightly better overall clinical course. They also had a greatly elevated rate of maternal mania, whereas BP youths with CD were notable for the rate of paternal substance abuse. CONCLUSIONS: Comorbid CD may exist in a large portion of young patients with BP disorder, confusing its clinical presentation and possibly accounting for some of the documented failure to detect BP disorder. Comorbid CD in bipolar youths appears to be associated with a somewhat worse clinical course. The overall indications are that comorbid CD may identify a subtype of very early onset BP disorder.

Adolescent↗
PubMed1986

A treatable language disorder: pharmacological treatment of pervasive developmental disorder.

Results of treatment of four patients are described. All of the patients had pervasive developmental disorder (PDD), a tic disorder, and a characteristic pattern of speech and language impairment. The patients were treated with haloperidol for their tic disorders, and concomitant with the reduction of the frequency and severity of tics was marked improvement in language. The patients averaged 3 months of language gain for each week of speech therapy directly after the initiation of haloperidol treatment for tics. Progress in speech and language therapy was extremely slow during the years prior to treatment with haloperidol. To the authors' knowledge, no language disorder has been described in the literature which shows such a predictable and marked response to pharmacological treatment. The authors hypothesize that tic disorders in individuals with PDD may be a marker for a more positive response to dopamine antagonists like haloperidol.

Child↗
PubMed1996

Intellectual functioning of inpatients with dissociative identity disorder and dissociative disorder not otherwise specified. Cognitive and neuropsychological aspects.

The intellectual functioning of 105 inpatients with multiple personality disorder and dissociative disorder not otherwise specified was assessed using the Wechsler Adult Intelligence Scale-Revised as part of a comprehensive research protocol. There were no significant intellectual differences between the groups on any major intelligence quotient summary score or any of the age-adjusted empirical factor scores. The anecdotal but widely accepted hypotheses that dissociative patients either have above average premorbid intelligence or that their current intellectual functioning is deleteriously affected by their fluctuant psychiatric disorder were not supported in this sample. A significant subsample of the multiple personality disorder group manifested abnormal interest scatter on the Wechsler Adult Intelligence Scale-Revised verbal subtests, and this variability was attributed to subtle neuropsychological deficits on the Memory/Distractibility factor. We speculate that dissociative patients might need to be evaluated for attention deficit disorder in addition to the range of dissociative symptoms in a comprehensive evaluation.

Adult↗
PubMed1998

Comorbid mood disorders as modifiers of treatment response among inpatients with borderline personality disorder.

Structured clinical interviews of 63 female inpatients diagnosed with borderline personality disorder were used to study the relations of comorbid mood disorders to treatment response. Diagnostic information was gathered using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Information about psychotic symptoms was also based upon responses to the SCID-P. Treatment response was assessed through weekly ratings on the Symptom Checklist-90-Revised over 25 weeks of hospitalization. Initial depression but not initial or previous bipolar disorder was found to predict treatment course. Initial psychotic symptoms were also found to predict treatment course among patients with initial bipolar disorder and tended to modify the trajectory of symptoms over time among patients with initial depression. Possible explanations for these findings are explored and discussed.

Adult↗
PubMed2005

Prefrontal cortex, thalamus, and cerebellar volumes in adolescents and young adults with adolescent-onset alcohol use disorders and comorbid mental disorders.

BACKGROUND: In adults, prefrontal, thalamic, and cerebellar brain injury is associated with excessive ethanol intake. As these brain structures are actively maturing during adolescence, we hypothesized that subjects with adolescent-onset alcohol use disorders, compared with control subjects, would have smaller brain volumes in these areas. Thus, we compared prefrontal-thalamic-cerebellar measures of adolescents and young adults with adolescent-onset alcohol use disorders (AUD, defined as DSM-IV alcohol dependence or abuse) with those of sociodemographically similar control subjects. METHODS: Magnetic resonance imaging was used to measure prefrontal cortex, thalamic, and cerebellar volumes in 14 subjects (eight males, six females) with an AUD (mean age, 17.0+/-2.1 years) and 28 control subjects (16 males, 12 females; 16.9+/-2.3 years). All AUD subjects were recruited from substance abuse treatment programs and had comorbid mental disorders. RESULTS: Subjects with alcohol use disorders had smaller prefrontal cortex and prefrontal cortex white matter volumes compared with control subjects. Right, left, and total thalamic, pons/brainstem, right and left cerebellar hemispheric, total cerebellar, and cerebellar vermis volumes did not differ between groups. There was a significant sex-by-group effect, indicating that males with an adolescent-onset AUD compared with control males had smaller cerebellar volumes, whereas the two female groups did not differ in cerebellar volumes. Prefrontal cortex volume variables significantly correlated with measures of alcohol consumption. CONCLUSIONS: These findings suggest that a smaller prefrontal cortex is associated with early-onset drinking in individuals with comorbid mental disorders. Further studies are warranted to examine if a smaller prefrontal cortex represents a vulnerability to, or a consequence of, early-onset drinking.

Adolescent↗
PubMed2006

Comorbidity of substance use with depression and other mental disorders: from Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) to DSM-V.

AIMS: To arrive at recommendations for addressing co-occurring psychiatric and substance use disorders in the development of the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-V) criteria. METHODS: Synthesis of findings of other papers from a consensus conference and from the literature on diagnosis and treatment of co-occurring psychiatric and substance use disorders. Most of the relevant studies examine co-occurring depression. RESULTS: The diagnosis and treatment of psychiatric syndromes that co-occur with substance use disorders has been a source of controversy, fueled in part by limitations of pre-DSM-IV nosologies. The DSM-IV scheme of classifying co-occurring disorders as primary (also referred to as independent) or substance-induced has promise in terms of good predictive validity, although pertinent longitudinal and treatment studies are limited. The substance-induced category answers the need of clinicians for a way to categorize patients with clinically significant psychiatric symptoms that occur in the setting of ongoing substance use. CONCLUSIONS: DSM-V should retain the primary (independent) and substance-induced categories. In DSM-IV these categories are broadly defined and leave much to clinical judgement. Existing data sets should be brought to bear to refine the criteria, making them more detailed with clearer anchor points and more specificity around particular substances and psychiatric syndromes. More longitudinal studies and clinical trials are also needed. Looking beyond DSM-V, co-occurring psychiatric syndromes are likely to be important in the quest for a nosology founded on pathophysiology.

Comorbidity↗
PubMed2006

Adolescents and substance-related disorders: research agenda to guide decisions on Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V).

AIMS: Since the publication of the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), many studies have addressed substance use disorders (SUD) in adolescents. Based on that adolescent literature, this paper suggests further research to help guide decisions about revising for DSM-V the SUD criteria in DSM-IV. METHODS: The author has reviewed the 'Substance Related Disorders' section of DSM-IV-TR, recalled his experience in helping to draft that section, accessed relevant articles in PubMed and reviewed his own extensive file of literature citations. RESULTS: This paper suggests six questions for adolescent research to help guide the framers of DSM-V's 'Substance Related Disorders' section: (a) DSM-IV did not provide a diagnosis of cannabis withdrawal; should DSM-V continue that position? (b) Should SUD be included or referenced among 'Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence'? (c) Can inter-rater reliability of the substance abuse (SA) criteria be improved with altered example situations, text descriptions or phrasing of the current criteria? (d) Between ages 14 and 18 years is earlier onset of SUD a severity marker that could be incorporated into DSM-V as a predictor of worse course? (e) In DSM-V could a phenotypic descriptor of pathological multi-substance involvement document severity and predict course of SUD? (f) Could clinicians and patients benefit from DSM-V-related postpublication procedures for classifying emerging new drugs into DSM-V's categories? CONCLUSIONS: Without substantive changes in SA or substance dependence diagnostic criteria, research may improve the usefulness of those criteria for adolescents.

Adolescent↗
PubMed2005

Neuropsychological deficits in adolescents with conduct disorder and comorbid bipolar disorder: a pilot study.

OBJECTIVE: We report pilot data on neuropsychological deficits in aggressive juvenile offenders with and without bipolar disorder compared with each other and healthy controls. METHOD: We assessed 52 adolescents and their parent or guardians: 36 incarcerated juvenile offenders and 16 community controls using the Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Life-Time Version and a neuropsychological testing battery. All incarcerated subjects (n=34) met criteria for Conduct Disorder (CD); 26 are classified as Non-BD-CD, and eight with CD and Bipolar disorder (CD-BD). These subjects were compared to community controls (n=16) matched for age, gender, SES and ethnicity. RESULTS: Relative to controls, the Non-BD-CD subjects' impairments (p<0.05) were in cognitive ability, set shifting/inhibition, planning and verbal memory-language functioning. The CD-BD group displayed impairments (p<0.05) relative to controls in cognitive ability, set shifting, verbal memory-language functioning, and visuospatial tasks. The Non-BD-CD and CD-BD groups however did not display significant differences on most neuropsychological measures compared with each other. When we controlled for Attention Deficit Hyperactivity Disorder, the Non-CD-BP subjects continued to show deficits on Verbal measures where the CD-BD subjects maintained deficits in measures of cognitive ability, verbal measures and visual spatial tests. CONCLUSIONS: Juvenile offender with CD displayed a wide range of deficits on neuropsychological testing compared with controls. Although juvenile offenders with and without BD differed on their clinical presentation, differences on neuropsychological measures are not specific and may be related to comorbid diagnoses.

Adolescent↗
PubMed2005

Comparison of childhood disintegrative disorder and disintegrative psychosis not diagnosed as childhood disintegrative disorder.

To clarify the difference of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) childhood disintegrative disorder (CDD) from International Classification of Diseases (9th revision; ICD-9) disintegrative psychosis (DP), 10 CDD children (mean age, 7.7 years) and 18 DP children (mean, 6.5 years) not diagnosed as CDD divided into DSM-IV autistic disorder (DP-AD; n = 11) and pervasive developmental disorders not otherwise specified (DP-PDDNOS; n = 7) were compared on 31 variables not directly related to the normalcy before regression. The CDD, DP-AD, and DP-PDDNOS groups did not differ significantly in 28 variables. The DP-PDDNOS group met significantly a smaller number of items in criterion A of DSM-IV autistic disorder criteria than the CDD and DP-AD groups, both of which did not differ significantly in this respect. The CDD group tended to be more abnormal in auditory responsiveness and verbal communication than the DP-PDDNOS group. While CDD is distinct from DP-PDDNOS, its validity apart from AD with regression remains to be studied.

Age of Onset↗
PubMed1998

Cognitive deficits in schizophrenia and affective disorders: evidence for a final common pathway disorder.

This study was designed to determine whether patients with schizophrenia and those with affective disorders display a common pattern of cognitive deficits. Cognitive performance was assessed with a neuropsychological test battery in consecutively admitted in-patients with schizophrenia (n=100) and affective disorders (n=100). The two groups of patients showed a similar pattern of cognitive deficits, especially in tests focusing on attentional capacities. The groups only differed significantly in their performance on the Wisconsin Card Sorting Test (WCST), with the schizophrenic patients performing less well. These results suggest that, with the exception of the deficit as measured by the WCST, similar cognitive impairments exist in schizophrenia and affective disorders, even at very early stages of the illness. Therefore, patients with schizophrenia and those with affective disorders cannot be qualitatively distinguished with sufficient reliability. We postulate that the cognitive deficit pattern represents a final common pathway disorder in the two groups of patients.

Adolescent↗
PubMedDate not supplied

Melatonin in psychiatric disorders - subtyping affective disorder.

Altered diurnal secretory patterns, i.e. altered phase and/or amplitude of melatonin have been reported in sleep and affective disorders. The alteration may depend on environmental factors which in vulnerable individuals may cause sleep and/or affective disorders. Early stress in conjunction with development of resistance to corticotropin-releasing hormone may be linked to the low melatonin syndrome in subgroups of depressed patients. Also the seasonal variation in melatonin as well as serotonin may be linked to the seasonal pattern seen in subgroups of affective disorders. Melatonin may be used as a combined marker for proneness to develop affective disorders especially in latent carriers of bipolar disorders.

Biomarkers↗
PubMed2004

Distribution of symptoms of conduct disorder and antisocial personality disorder in Turkey.

BACKGROUND: A variety of conduct disorder (CD) symptoms are seen together as a symptom cluster. Among CD symptoms there are serious and stubborn antisocial behaviors: lying, swindling, running away from home/school, destructiveness, arson, kidnapping women, sexual abuse, and armed robbery. The objective of this study was to discover the relationship between CD and antisocial personality disorder (APD) and the distribution of the symptoms of these disorders. SAMPLING AND METHODS: The research sample consisted of 994 individuals between the ages of 18 and 65 years in Sivas province. Subjects were given the Diagnostic Interview Schedule-III-R (DIS-III-R) APD subscale. RESULTS: The lifetime prevalence for CD and APD was found to be 21.03 and 3.02%, respectively. In both disorders the percentage of men was higher than for women. The comorbidity of both disorders was found to be 14.35%. The most frequently seen CD symptom in normal society is 'lying', but in those with CD 'initiates a fight several times' is the most frequently seen symptom. In those with APD the most frequently seen symptom is 'truant from school several times'. CONCLUSIONS: Identifying risk factors in children could be an important step in preventing the progression of CD and APD.

Adolescent↗
PubMed1986

The relationship between affective disorder and eating disorders: a review of the literature.

The authors review the relationship between affective disorder and anorexia nervosa and bulimia across five lines of inquiry: clinical reports, psychometrics, family history, drug studies, and follow-up investigations. They conclude that affective disorder and eating disorders are related but that the nature of the relationship is unclear. After discussing possible mediating patterns, the authors propose an interactive, multidetermined understanding as the most appropriate model. They recommend that future research in this area attempt to identify subpopulations of patients with affective disorder and eating disorders by means of a longitudinal, multilevel strategy with serial determinations.

Adolescent↗