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At least 1,045 records · Page 58Linked to original sources
PubMed2004

Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder: an ambulatory monitor study.

BACKGROUND: Physiologic responses of patients with anxiety disorders to everyday events are poorly understood. OBJECTIVE: To compare self-reports and physiologic recordings in patients with panic disorder (PD), patients with generalized anxiety disorder (GAD), and nonanxious controls during daily activities. DESIGN: Participants underwent four 6-hour recording sessions during daily activities while wearing an ambulatory monitor. Physiologic and subjective data were recorded every 30 minutes and during subject-signaled periods of increased anxiety or tension or panic attack. SETTING: Participants' everyday environment. PARTICIPANTS: Twenty-six patients with PD and 40 with GAD, both without substantial comorbidity, and 24 controls. INTERVENTIONS: Recordings obtained during everyday activities. MAIN OUTCOME MEASURES: Recordings of heart interbeat intervals, skin conductance levels, respirations, motion, and ratings of subjective somatic symptoms and tension or anxiety. RESULTS: Patients with anxiety disorders rated higher on psychic and somatic anxiety symptoms than did controls. Common to both anxiety disorders was diminished autonomic flexibility that manifested itself throughout the day, accompanied by less precise perception of bodily states. The main differences between patients with PD and GAD were a heightened sensitivity to body sensations and more frequent button presses. There also was a trend toward heightened basal arousal in patients with PD, manifesting itself in a faster heart rate throughout the day. CONCLUSIONS: Patients with PD or GAD are more sensitive to bodily changes than nonanxious individuals, and patients with PD are more sensitive than those with GAD. Patients with PD experience more frequent distress than those with GAD and controls, but their physiologic responses are comparable in intensity. The findings suggest that the perception of panic attacks reflects central rather than peripheral responses. The diminished autonomic flexibility observed in both anxiety conditions may result from dysfunctional information processing during heightened anxiety that fails to discriminate between anxiety-related and neutral inputs.

Adult↗
PubMed2000

Peek-a-boo fragile site at 16d associated with Tourette syndrome, bipolar disorder, autistic disorder, and mental retardation.

Five patients with a fragile site at 16q22-23 and neuropsychiatric disorders are reported. Three of five had Tourette disorder, three had mental retardation, two had bipolar disorder, and one had autistic disorder. During our attempts to study the fragile sites in more detail we were unable to reproduce the fragile sites found several years earlier. The potential relationship between the fragile sites and the neuropsychiatric disorders in these patients is discussed. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:69-73, 2000.

Adolescent↗
PubMedDate not supplied

The emerging role of valproate in bipolar disorder and other psychiatric disorders.

Although valproate, a simple branched-chain fatty acid, is generally considered to be an antiepileptic agent, a large literature dating back to 1966 describes its use in primary psychiatric disorders. The significant role that gamma-aminobutyric acid plays in mood provided the rationale to examine valproate in this regard. Numerous uncontrolled as well as placebo- and lithium-controlled studies verified the drug's efficacy in the short-term management of bipolar and schizoaffective disorders. The response appears to be independent of response to traditional therapies such as lithium, neuroleptics, and carbamazepine, and may be maintained for extended periods of time. Valproate should be considered not only in patients with mood disorders who are intolerant of or nonresponsive to traditional therapies, but also in those with rapid cycling, electroencephalographic abnormalities, head trauma antedating the onset of psychiatric illness, or any other factor suggesting an organic component. Preliminary uncontrolled studies suggest that the drug may also eventually play a role in the management of panic disorder and behavioral dyscontrol (agitation, aggression, temper outbursts). Its adverse event profile is well known from years of experience in the management of epilepsy and does not appear to be altered in the presence of psychiatric disorders. Similarly, the drug-drug interaction potential of valproate is reasonably well known, although further research into interactions with psychotropic agents is warranted.

Anticonvulsants↗
PubMed2005

Re-evaluating the distinction between Axis I and Axis II disorders: the case of borderline personality disorder.

The division between Axis I clinical syndromes and Axis II personality disorders is a long-standing distinction based primarily on three guiding principles: phenomenology, cause, and course. Clinical syndromes were generally thought to be characterized by transient symptoms with biological causes and an unstable course; personality disorders were supposed by many to be characterized by long-standing personality traits, whose roots were primarily psychological, and a stable and unremitting course. Borderline personality disorder (BPD), however, is a condition characterized by distinct clinical symptoms, varied causes, and a relatively unstable course. Past theorizing about the distinction between Axis I and Axis II disorders is presented in light of recent empirical evidence refuting the rationalization for the separation of personality disorders and clinical syndromes using BPD as a means for comparison.

Borderline Personality Disorder↗
PubMed1993

Allergic disorders and attention deficit disorder in children.

It has been suggested that children with attention deficit disorder-hyperactivity (ADDH) are likely to show allergic disorders, and that both ADDH and allergic disorders may share a common biological background. In a large sample of children from the general population we found no association between parent, teacher, and self-reports of ADDH behaviors and a history of allergic disorders (asthma, eczema, rhinitis, and urticaria) at ages 9 or 13 years. Similarly, reports of ADDH behaviors at age 13 years were not related to level of atopic responsiveness by skin test or serum IgE levels. Our findings call into question the hypothesis that there is a relationship between ADDH and allergic disorder.

Adolescent↗
PubMed1993

Differentiating pervasive developmental disorder not otherwise specified from autism and language disorders.

Features useful in distinguishing children with pervasive developmental disorder (PDD) from those with autism or language disorder were developed from a retrospective chart review using groups of children with PDD-NOS and MA- and sex-matched autistic and language-disordered groups. Charts were reviewed using a list of 80 items compiled from various sources. Items that had adequate interrater reliability and significantly discriminated the PDD-NOS cases from the language-disordered or autistic cases were then evaluated using a second set of cases and signal detection methods. Fewer items significantly discriminated cases with autism from those with PDD-NOS as compared to cases with language disorder. Clinical implications are discussed.

Autistic Disorder↗
PubMed2007

Fluoxetine monotherapy in attention-deficit/hyperactivity disorder and comorbid non-bipolar mood disorders in children and adolescents.

Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for developing comorbid non-bipolar mood disorders. Fluoxetine monotherapy is an established treatment for pediatric mood disorders; however its efficacy in ADHD and comorbid mood disorder is unknown. Therefore, we evaluated 30 children who met DSM-IV criteria for ADHD and comorbid non-bipolar mood disorders in a prospective, 6-12-week open-label, study of fluoxetine monotherapy. Fluoxetine was associated with significant decreases in the severity of depressive symptoms, and also, associated with significant decreases on subscales of inattention/overactivity and aggression/defiant symptoms-47% of participants were much or very much improved without observed adverse effects.

Adolescent↗
PubMedDate not supplied

Psychiatric disorder in adolescent offspring of parents with affective disorder in a non-referred sample.

The relationship between parental psychopathology and psychiatric disturbance in 153 offspring aged 6-19 was assessed in 81 families randomly selected from a prepaid health plan. Offspring of parents with a history of affective disorders and of parents with non-affective psychiatric disorders had higher rates of psychiatric diagnoses and poorer adaptive functioning than children of parents who had never experienced a psychiatric illness. Offspring whose parents had affective disorder had a rate of affective disorder of 30% compared to a rate of 2% in the rest of the sample. This relationship between parental affective disorder and poor child outcome was observed when the separated and divorced families were removed from the analyses.

Adolescent↗
PubMed2005

Review of aetiological concepts of temporomandibular pain disorders: towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors.

Several studies have reported that musculoskeletal disorders of the stomatognathic system, commonly known as temporomandibular disorders (TMD) resemble musculoskeletal disorders and chronic pain disorders in general. There is also general consensus that combined biomedical and biopsychosocial methods best support the assessment and management of the cardinal features of TMD, i.e., pain and dysfunction or physical (peripheral) and psychosocial (central) factors. This overview of the aetiology of TMD will outline conceptualizations of past models and present the current view that patients with TMD should be assessed according to both the physical disorder and the psychosocial illness impact factors. The conceptual theories outlined in this review include biomedical models related to temporomandibular joints, muscles of mastication and occlusal factors, psychological models and the biopsychosocial models. An integrated and multidimensional approach concerning physical and psychosocial factors in temporomandibular pain and dysfunction is presented as an example of how the biopsychosocial model and information processing theory may apply in the conceptualization and management of TMD for various health care professionals.

Humans↗
PubMed2005

Do personality disorders predict negative treatment outcome in obsessive-compulsive disorders? A prospective 6-month follow-up study.

BACKGROUND: Comorbid personality disorders (PDs) are discussed as risk factors for a negative treatment outcome in obsessive-compulsive disorder (OCD). However, studies published so far have produced conflicting results. The present study examined whether PDs affect treatment outcome in patients with OCD. METHOD: The treatment sample consisted of 55 patients with OCD who were consecutively referred to a Behaviour Therapy Unit for an in-patient or day-clinic treatment. Treatment consisted of an individualised and multimodal cognitive behaviour therapy (CBT, with or without antidepressive medication). Measurements were taken prior and after treatment and 6-month after admission. RESULTS: A large percentage of patients benefited from treatment irrespective of the presence of a PD and were able to maintain their improvement at follow-up. Duration of treatment was not prolonged in OCD patients with concomitant Axis II disorders. However, some specific personality traits (schizotypal, passive-aggressive) were baseline determinants for later treatment failure at trend level. CONCLUSIONS: Results are encouraging for therapists working with patients co-diagnosed with Axis II disorders since these patients are not necessarily non-responders. The results stress the importance of a specifically tailored treatment approach based on an individual case formulation in OCD patients with complex symptomatology and comorbid Axis II disorders.

Adolescent↗
PubMed2004

Verbal memory and aspects of attentional control in children and adolescents with anxiety disorders or depressive disorders.

BACKGROUND: The aim was to examine basic performance on attention and memory tasks in treatment-naive children and adolescents with anxiety disorder or depressive disorder and in healthy subjects under drug-free conditions. METHODS: Basic neurocognitive performance on attention and verbal memory tasks was examined in children and adolescents with emotional disorders, between 6 and 17 years of age. A total of 34 children with an anxiety disorder, 31 children with a depressive disorder, and 33 healthy controls were assessed with a comprehensive neuropsychological test battery. All children were treatment-naive at the time of testing. Five different computerised attention tasks and the Rey Auditory-Verbal Learning Test were administered. RESULTS: A significant effect of diagnosis was found for verbal memory but not for attention. LIMITATIONS: The large age range and inclusion of different diagnoses resulted in rather inhomogeneous groups. CONCLUSION: The present study provided evidence for an undisturbed attentional performance in both patient groups and a dissociation in memory functioning between anxious and depressed children. Memory impairment was found to be specifically associated with childhood depression.

Adolescent↗
PubMed2004

Internal cue exposure and the treatment of substance use disorders: lessons from the treatment of panic disorder.

Despite early recognition of the importance of internal cues (craving sensations and emotional states) for relapse in substance use disorders, relatively little attention has been devoted to exposure-based treatments targeting these cues. Drawing upon research on the conceptualization and treatment of panic disorder, we discuss the application of internal (largely emotional) cue exposure for substance use disorders. Our model for this discussion was based on the role of exposure to feared sensations of anxiety in the treatment of panic disorder and benzodiazepine (BZ) discontinuation. Shared research strategies between panic disorder and substance use--studies of biological provocation and anxiety sensitivity--were discussed, as were gender differences in drug-use motives. In accordance with research on anxiety sensitivity, provocation effects, and the treatment of benzodiazepine withdrawal, we discussed the potential value of internal cue-exposure strategies for individuals who use substances as a way to cope with negative affect.

Anti-Anxiety Agents↗
PubMed2005

In vivo flooding for anxiety disorders: proposing its utility in the treatment posttraumatic stress disorder.

Exposure techniques have now been used in the treatment of anxiety disorders for several decades. Although such techniques are a dominant feature of current therapies for disorders such as posttraumatic stress disorder and acute stress disorder, examination of their relative merits has been less studied. The purpose of this review is to suggest the usefulness of in vivo flooding in the treatment of posttraumatic stress. We discuss the relevant exposure literature by briefly examining the efficacy of these techniques in the treatment of anxiety. The theoretical and methodological limitations of investigations to date of exposure methods that have been used in posttraumatic stress treatment studies are then reviewed. We highlight the fact that in vivo flooding, an exposure technique that has been used to treat some anxiety-based disorders, has received scant clinical and research attention as a treatment for posttraumatic stress. A case is made for further study of in vivo flooding in the treatment of posttraumatic stress.

Anxiety Disorders↗
PubMed2005

Child maltreatment and HPA axis dysregulation: relationship to major depressive disorder and post traumatic stress disorder in females.

A history of child maltreatment increases the vulnerability to the development of Major Depressive Disorder (MDD) and/or Posttraumatic Stress Disorder (PTSD), especially in females. Both MDD and PTSD are associated with a dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. Dysregulation of the HPA axis may be an important etiological link between child maltreatment and subsequent psychiatric disorder, yet little is known about the relationship between exposure and outcome. The aim of this review is to explore the role of HPA axis dysregulation in the link between child maltreatment and MDD/PTSD among women. Studies of females with MDD frequently indicate a hyperactivity of the HPA axis, and contribute to our understanding of the underlying mechanisms involved in mood dysregulation. Evidence for HPA axis dysregulation in PTSD is less convincing and suggests that timing of the stressful experience as well as the type of the trauma may influence the outcome. The strongest evidence to date suggesting that the development of the HPA axis may be affected by early life stressful experiences comes from pre-clinical animal studies. Together these studies add to our understanding of the role of the HPA axis in psychiatric disorders in relation to stress. The literature on HPA axis function in both children and adults following child maltreatment further highlights the potential relevance of early stress to later onset of major psychiatric disorders. Such knowledge may also contribute to the development of early interventions targeted at primary prevention.

Adolescent↗
PubMed2002

Anticipation of age at onset of obsessive-compulsive spectrum disorders in patients with obsessive-compulsive disorder.

Anticipation of age at onset has been observed in several neuropsychiatric disorders. Recent studies have associated anticipation with the presence of unstable DNA and have suggested that trinucleotide repeats may be the main cause in some of these diseases. However, several selection biases may mimic the presence of such an effect. In this study we evaluated the presence of this effect in 40 families of probands with obsessive-compulsive disorder (OCD) compared with affected subjects in the parental generation. We controlled for ascertainment biases by taking into account the age at interview of probands. Using a different recruitment strategy, we controlled for anticipation in a sub-sample of offspring of 13 OCD patients, affected with OC spectrum disorders. While the younger generation showed a significantly earlier age at onset than the parental generation, no effect of age at interview was observed. Drawing on the results, we hypothesised that the presence of anticipation in OCD and OC spectrum disorders could be due to a specific genetic effect (unstable DNA), as it has been hypothesised for other disorders showing this effect.

Adult↗
PubMed1998

Evolution of personality disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.

This article reviews the history and evolution of the diagnosis of personality disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) from its first edition in 1952 through its fourth edition in 1994. The article also traces the earliest origins of personality disorders (e.g., Hippocrates) through the modern foundational works of Pritchard, Schneider, and Horney. Analysis of the changes across the editions of the DSM suggest slow but steady progress in the clarification and classification of personality disorders, although formidable challenges remain. A call for future research as to reliability and validity of personality disorders is made, and suggestions for research are offered.

History, 20th Century↗
PubMed2000

Attention-deficit hyperactivity disorder and posttraumatic stress disorder: differential diagnosis in childhood sexual abuse.

Attention-deficit hyperactivity disorders (ADHD) and posttraumatic stress disorder (PTSD) are the most commonly diagnosed disorders in sexually abused children (SAC). There is a high degree of symptom overlap and comorbidity between these disorders, and differential diagnosis can be confusing. Current diagnostic criteria do not include PTSD as a differential diagnosis for ADHD, nor do existing assessment guidelines address these diagnostic similarities. This may have serious implications for SAC. This literature review describes the psychological impact of child sexual abuse and possible consequences for misdiagnosing ADHD in SAC. A comparison of criteria from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994) criteria for ADHD and PTSD is presented, and commonalities are discussed. On the basis of this comparison, recommendations are made for improving clinical decision-making and for facilitating differential diagnosis. Routine inquiry about traumatic experiences in children presenting with ADHD symptoms is suggested to increase accuracy in differential diagnosis.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Affective disorders, personality and personality disorders.

OBJECTIVE: The article deals with the complex conceptual history and current concepts on the relationship between personality, personality disorders and affective disorders. It is discussed whether these concepts represent distinct clinical entities or whether they lie on a continuum. METHOD: We reviewed the classical literature from the 19th and the first half of the 20th centuries as well as analysed recent empirical data in order to summarize the current knowledge on this topic with respect to its historical origin. As a particular example, the position of the depressive personality disorder is evaluated. RESULTS: Considerable heterogeneity can be seen, both theoretically and empirically. The two major concepts are based either on a continuum model or favour distinct clinical entities, corresponding to a more dimensional or category-orientated recording method. CONCLUSION: The relationship between personality disorders and affective disorders is still unclear and is a highly debated issue. There is as yet no consensus, but a certain shift to dimensional models can be recognized.

History, 19th Century↗