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Complex segregation analysis of obsessive-compulsive disorder in 141 families of eating disorder probands, with and without obsessive-compulsive disorder.

Probands affected with eating disorders (ED) present a higher number of relatives affected with obsessive-compulsive disorders/tic disorders than a comparison population. Therefore, we hypothesized that ED and obsessive-compulsive disorder (OCD) might share the same biological liability, and that a single major gene might account for that liability. We tested this hypothesis by applying a complex segregation analysis to 141 families of probands affected with ED (89 with anorexia nervosa, restricting and binge-eating types, 52 with bulimia nervosa). Given the hypothesized relationship between OCD and genetic spectrum disorders, we considered these diagnoses as affected phenotype in relatives. In Italian ED families, ED and OCD followed a Mendelian dominant model of transmission. When probands were divided according to co-diagnosis of OCD, best fit in the subgroup of families of 114 probands without OCD co-diagnosis was for a Mendelian dominant model of transmission whereas a Mendelian additive model of transmission represented best fit in the subgroup of families of 27 probands with an OCD co-diagnosis. Genetic transmission was not shown in those families where the only affected phenotype was ED. The existence of a Mendelian mode of genetic transmission within ED families supports the hypothesis that a common genetic liability could account for both ED and OCD.

Adult↗

Oppositional disorder in children: a validation study comparing conduct disorder, oppositional disorder and normal control children.

Subjects with oppositional disorder (OD, N = 21) and conduct disorder (CD, N = 22) were compared with normal controls (NC, N = 20) to determine whether OD is a distinct disorder. OD subjects exhibited high rates of associated attention deficit, emotional and learning disorders. Compared with NC, OD subjects had high rates of problems in social relationships and came from families characterized by marital fights, dysfunction, and paternal psychopathology. Compared with CD, OD was less often characterized by undersocialization and separations from fathers and more often characterized by dissatisfaction in the marital relationship. These results suggest that OD is a variant of CD rather than of normality.

Achievement↗

[Family functioning and psychosocial characteristics in children with attention deficit hyperactivity disorder with comorbid oppositional defiant disorder or conduct disorder].

OBJECTIVE: To compare the parental sociodemographic characteristics, prenatal and postnatal developmental variables, IQ and behavioral disturbances as well as family functioning and current psychiatric disorders in the parents of children with attention deficit hyperactivity disorder (ADHD) and the parents of children with ADHD and comorbid oppositional defiant disorder (ODD) or conduct disorder (CD). METHOD: The sample consists of 92 children in the 6-11 age range, diagnosed with ADHD and ADHD with comorbid ODD/CD using DSM-IV diagnostic criteria. Parents completed the Child Behavior Checklist (CBCL) 4-18 and the Family Assessment Device (FAD) and were interviewed for current psychiatric treatment and alcohol consumption. RESULTS: 69.6% of the sample was diagnosed with ADHD and 30.4% with ADHD + ODD/CD. There were no differences between the two groups with respect to age, intelligence, characteristics of the neonatal period, age of walking and age of speech. Children with ADHD and comorbid ODD/CD had high CBCL subscale scores except for the social withdrawal and sexual problems subscales. Maternal depression and paternal drinking problems were high in the ADHD+ODD/CD group. The families of children with ADHD+ODD/CD also scored high at the level of 'unhealthy functioning' in the Roles and Behaviour Control subscales of the FAD. CONCLUSION: The treatment of children diagnosed with ADHD with comorbid ODD / CD should include parental treatment and intervention addressing parental skills.

Adult↗

No association of the tryptophan hydroxylase gene with bipolar affective disorder, unipolar affective disorder, or suicidal behaviour in major affective disorder.

Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in the synthesis of 5-hydroxytryptamine (5-HT). An association study in bipolar affective disorder I or unipolar major affective disorder was performed by using a Bfa I restriction site polymorphism within intron 7 of the tryptophan hydroxylase gene. A total of 118 bipolar, 125 unipolar, and 437 control subjects were used in the study (1:3.7 bipolar:control, 1:3.5 unipolar:control). There were no significant differences in TPH allele or genotype frequencies between the affective disorder and control groups. In addition, bipolar and/or unipolar subjects with or without a history of suicide attempts were compared for the TPH polymorphism. No significant differences were found between suicidal and non-suicidal groups in major affective disorder, in contrast to a previous study suggesting an association of this polymorphism with a history of suicide attempts among alcoholic violent offenders.

Bipolar Disorder↗

Predicting hospital discharge status for patients with schizophrenia, schizoaffective disorder, borderline personality disorder, and unipolar affective disorder.

The empiric literature reports few distinctive features among patients discharged against medical advice (AMA) or absent without leave and regularly discharged inpatients. Interactive relationships between predictors of discharge status and diagnosis have not been studied, however. This study used discriminant function analyses to test for predictors of discharge with medical advice, AMA, and by transfer for inpatients with schizophrenia (N = 132), schizoaffective disorder (N = 61), borderline personality disorder (N = 69), and unipolar affective disorder (N = 42) from a follow-up study. Results showed that indexes of chronic psychosis predicted transfer for all diagnoses. Angry, impulsive behavior and unstable relationships predicted AMA discharge in all but the unipolar patients. For the latter, being married was most powerfully associated with AMA status.

Adolescent↗

Hospital discharge status and long-term outcome for patients with schizophrenia, schizoaffective disorder, borderline personality disorder, and unipolar affective disorder.

The prognosis of self-discharged inpatients has seldom been studied, especially by diagnosis, and is frequently assumed to be poor. This study evaluated the long-term (15-year average) outcome of inpatients discharged with medical advice (WMA), against medical advice (AMA), or by transfer for patients with schizophrenia (N = 113), schizoaffective disorder (N = 46), borderline personality disorder (N = 63), and unipolar affective disorder (N = 33) from a follow-up study. Results showed that outcome among discharge cohorts varied considerably depending on diagnostic category. Within each diagnostic cohort, outcome of transferred patients was poorest. The outcome of AMA-discharged patients was poorer than the outcome of patients discharged with medical advice only in the unipolar cohort, except that AMA discharge in schizoaffective patients correlated significantly with suicide.

Adolescent↗

Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study.

The association between trauma and personality disorders (PDs), while receiving much attention and debate, has not been comprehensively examined for multiple types of trauma and PDs. The authors examined data from a multisite study of four PD groups: schizotypal, borderline (BPD), avoidant, and obsessive-compulsive, and a major depression comparison group. Rates of traumatic exposure to specific types of trauma, age of first trauma onset, and rates of posttraumatic stress disorder are compared. Results indicate that BPD participants reported the highest rate of traumatic exposure (particularly to sexual traumas, including childhood sexual abuse), the highest rate of posttraumatic stress disorder, and youngest age of first traumatic event. Those with the more severe PDs (schizotypal, BPD) reported more types of traumatic exposure and higher rates of being physically attacked (childhood and adult) when compared to other groups. These results suggest a specific relationship between BPD and sexual trauma (childhood and adult) that does not exist among other PDs. In addition, they support an association between severity of PD and severity of traumatic exposure, as indicated by earlier trauma onset, trauma of an assaultive and personal nature, and more types of traumatic events.

Adolescent↗

Gender appropriateness of symptom criteria for attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and conduct disorder.

We examined the gender appropriateness of the DSM-IV symptoms of attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). In Study 1, 100 mothers (35 of children with and 65 of children without ADHD) rated how gender-typical and problematic they saw DSM-IV symptoms of ADHD, ODD, and CD; feminine descriptions of ADHD, ODD, and CD behaviors that we created; and relationally and overtly aggressive behaviors. Mothers rated the DSM-IV symptoms and overt aggression as boy-descriptive, and the feminine items that we created and relational aggression as girl-descriptive. Mothers saw the feminine items as less problematic than the masculine items. In Study 2, for 80 girls (40 with and 40 without ADHD), mothers' ratings on the feminine items were related to the corresponding DSM-IV symptoms, and to general psychopathology and impairment. Most correlations were significant and support the construct validity of the feminine items.

Adolescent↗

Problem of item overlap between the psychopathy screening device and attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder rating scales.

Content validity requires a clear definition of the construct of interest and the delineation of the construct from similar constructs. Content validity also requires that the items be representative of the construct as well as specific to the construct. An examination of the items on the Psychopathy Screening Device (PSD), a parent- and teacher-rating scale of childhood psychopathy, indicates significant overlap with the symptoms and associated features of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). The failure of the PSD to have unique items results in poor discriminant validity with ADHD, ODD, and CD rating scales. More careful attention to content validation guidelines is required to develop a more useful measure of childhood psychopathy.

Antisocial Personality Disorder↗

Personality disorders in the community: results from the Australian National Survey of Mental Health and Wellbeing Part II. Relationships between personality disorder, Axis I mental disorders and physical conditions with disability and health consultations.

BACKGROUND: The aims of this study were threefold. First, to ascertain whether personality disorder (PD) was a significant predictor of disability (as measured in a variety of ways) over and above that contributed by Axis I mental disorders and physical conditions. Second, whether the number of PD diagnoses given to an individual resulted in increasing severity of disability, and third, whether PD was a significant predictor of health and mental health consultations with GPs, psychiatrists, and psychologists, respectively, over the last 12 months. METHOD: Data were obtained from the National Survey of Mental Health and Wellbeing, conducted between May and August 1997. A stratified random sample of households was generated, from which all those aged 18 and over were considered potential interviewees. There were 10,641 respondents to the survey, and this represented a response rate of 78 %. Each interviewee was asked questions indexing specific ICD-10 PD criteria. RESULTS: Five measures of disability were examined. It was found that PD was a significant predictor of disability once Axis I and physical conditions were taken into account for four of the five disability measures. For three of the dichotomously-scored disability measures, odds ratios ranged from 1.88 to 6.32 for PD, whilst for the dimensionally-scored Mental Summary Subscale of the SF-12, a beta weight of -0.17 was recorded for PD. As regards number of PDs having a quasi-linear relationship to disability, there was some indication of this on the SF-12 Mental Summary Subscale and the two role functioning measures, and less so on the other two measures. As regards mental consultations, PD was a predictor of visits to GPs, psychiatrists and psychologists, over and above Axis I disorders and physical conditions. CONCLUSION: The study reports findings from a nationwide survey conducted within Australia and as such the data are less influenced by the selection and setting bias inherent in other germane studies. However, it does support previous findings that PD is a significant predictor of disability and mental health consultations independent of Axis I disorders and physical conditions.

Australia↗

Comorbidity of dependent personality disorder and separation anxiety disorder in addictive disorders and in healthy subjects.

The aim of the study was to determine the comorbidity of dependent personality disorder (DPD) and separation anxiety disorder (SAD) in large nonclinical and clinical samples. Using a cross-sectional method, the relationship between these disorders was studied in 784 healthy subjects and in 708 subjects presenting with various addictive behaviors. DPD was significantly associated with SAD in healthy subjects, alcoholics, drug abusers and anorectic and bulimic patients. The comorbidities of SAD and DPD suggest that specific therapeutic strategies could be discussed. Moreover, longitudinal studies are required to determine if SAD constitutes a risk factor for DPD.

Adolescent↗

The relation among perfectionism, obsessive-compulsive personality disorder and obsessive-compulsive disorder in individuals with eating disorders.

OBJECTIVE: Perfectionism and obsessionality are core features of eating disorders (ED), yet the nature of their relation remains unknown. Understanding the relation between these traits may enhance our ability to identify relevant behavioral endophenotypes for ED. METHOD: Six-hundred seven individuals with anorexia and bulimia nervosa from the International Price Foundation Genetic Study were assessed for perfectionism, obsessive-compulsive personality disorder (OCPD), and obsessive-compulsive disorder (OCD). RESULTS: No differences were found across ED subtypes in the prevalence of OCPD and OCD, nor with the association between OCD and OCPD. Perfectionism scores were highest in individuals with OCPD whether alone or in combination with OCD. CONCLUSION: Perfectionism appears to be more closely associated with obsessive-compulsive personality symptoms rather than OCD. The pairing of perfectionism with OCPD may be a relevant core behavioral feature underlying vulnerability to ED.

Adolescent↗

Dual disorders: clients suffering from psychiatric disorders and alcohol or drug abuse disorders.

If home care providers are to be diligent in assessing the total well-being of their clients, they need to assess for dual disorders (DDs), a co-occurrence (comorbidity) of psychiatric disorders and alcohol or other drug disorders (AODDs). Table 1 lists acronyms for different types of DDs. Home care clients who suffer from depression and other mental health problems are not uncommon, nor are clients who suffer from AODDs. What health professionals often do not realize, however, is that clients may be suffering from both. Failure to effectively treat clients' DDs will negatively affect their recovery. Their DD may be causing or contributing to their physical problems and affecting their judgment, motivation, and insight into their problems.

Community Health Nursing↗

Internal validity of attention deficit hyperactivity disorder, oppositional defiant disorder, and overt conduct disorder symptoms in young children: implications from teacher ratings for a dimensional approach to symptom validity.

Uses a dimensional approach to evaluate the internal validity of the attention deficit hyperactivity disorder (ADHD) inattention (I) and hyperactivity/impulsivity (H/I), oppositional defiant disorder (ODD), and overt conduct disorder (CD) symptoms (i.e., whether a symptom has a stronger correlation with its own dimension than the other three dimensions). In Study 1, teachers rated 1,445 children on the DSM-III-R I, H/I, ODD, and overt CD symptoms. In Study 2, teachers rated 1,711 children on the DSM-IV I, H/I, ODD, and overt CD symptoms. All the I symptoms showed internal validity in both studies. In contrast, the H/I symptoms and the ODD symptoms, especially the H/I symptoms, showed weaker internal validity. All the overt CD symptoms showed internal validity except the DSM-IV bullies others symptom, with this symptom being more strongly related to the ODD dimension. Confirmatory factor analysis provided support for a 4-factor model consisting of I, H/I, ODD, and overt CD factors. Finally, the importance of internal validity for the construct validation of the disruptive behavior symptoms is discussed.

Adolescent↗

Longitudinal outcome of temporomandibular disorders: a 5-year epidemiologic study of muscle disorders defined by research diagnostic criteria for temporomandibular disorders.

AIMS: To investigate the course of myofascial pain defined by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) over a period of 5 years, and to identify prognostic factors from baseline data. METHODS: Subjects were 155 consecutive patients and 80 community cases identified from an age-stratified representative population sample; all met the primary selection criterion of reporting pain in the temporomandibular joint (TMJ) or masticatory muscles. The 2 groups were combined to yield a total sample of 235 subjects (50 male, 185 female; mean age = 39 years). Subjects were evaluated at baseline, 1 year, 3 years, and 5 years by trained examiners using standardized, reliable methods. Psychological and behavioral factors were assessed by self report. RESULTS: According to RDC/TMD criteria, 50 (31%) of the 165 subjects presenting with myofascial pain (MFP) at baseline continued to have their disorder over a period of 5 years; 55 (33%) remitted, and 60 (36%) were recurrent cases. Bivariate statistics and multivariate logistic regression analyses indicated that baseline pain frequency, number of painful palpation sites, and total number of body sites with pain were significant predictors of persistent vs remitted and recurrent cases. No predictors that distinguished remission vs recurrence could be identified. Thirty subjects from the 70 without a diagnosis of MFP at baseline developed a new MFP. A high baseline somatization score (without pain items) was a significant risk factor for onset of MFP. CONCLUSION: Muscle disorders classified by RDC/TMD are predominantly chronic or fluctuating pain conditions, with a modest probability (31%) of remission.

Adolescent↗

[Obsessive disorders and syndromes and affective disorders. Apropos of a French epidemiologic obsessive compulsive disorders and obsessive compulsive syndromes DRT survey].

What was known in the past as "obsessive psychoneurosis" was considered to be rare, chronic and difficult to treat. New definitions proposed by APA diagnostic systems (DSM III, DSM III-R, DSM IV) and the WHO (ICD-10) have opened up the possibility of epidemiologic studies in the population as a whole and among patients consulting psychiatrists and general practitioners. All these studies reveal a much higher prevalence, the incidence increasing from 0.05% (former estimate) to about 2.5% of the general population (American ECA survey). This implies new clinical and etiopathogenic concepts of this pathology. Experience of so-called antidepressant drugs, with an essentially serotoninergic action, bringing about a notable improvement in obsessive disorders, has greatly contributed to these changes. COD and COS are very often interlinked with other psychiatric symptomatology, this frequent co-morbidity raising the question of the autonomy of certain syndromes, as well as that of the borders between the normal and pathological. The TOC of clinicians are not the same as the TOC of epidemiologists. Another problem is that of the role played by these obsessive disorders in what has been referred to as "general neurotic syndrome". What is the relationship between mood disorders and anxious pathology as a whole, insofar as the same drugs are indicated in these various disease patterns. We report here the results of the DRT survey involving patients presenting for the first time to psychiatrists in office practice and concerning 731 COD and COS, i.e. 17 % of 4 364 adult out-patients (6.5 % definite COD, 2.7 % probable COD and 7.5 % COS).

Adult↗

Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: individuals with symptoms of attention-deficit/hyperactivity disorder and conduct disorder are uniquely at risk.

Most prior literature examining the relations among attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use and abuse suggests that CD fully account for the ADHD-substance abuse relation. This study sought to test an alternate theory that individuals with symptoms of both ADHD and CD are at a special risk for substance abuse. Relations between childhood ADHD and CD symptoms, and young adult tobacco, alcohol, marijuana, and hard drug use and dependence symptoms, were examined in a sample of 481 young adults. ADHD and CD symptoms interacted to predict marijuana dependence symptoms and hard drug use and dependence symptoms, such that individuals with high levels of both ADHD and CD had the highest levels of these outcomes.

Adult↗