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PubMed2000

Bipolar disorder and attention-deficit/hyperactivity disorder in children and adolescents.

The relationship between bipolar disorder and attention-deficit/hyperactivity disorder (ADHD) in children and adolescents has been one of the most hotly debated topics in recent child psychiatry literature. At the heart of the matter is whether large numbers of children with bipolar disorder are being unrecognized or misdiagnosed. The differential diagnoses of juvenile-onset bipolar disorder can be complicated by many factors, but the most common clinical dilemmas seem to arise from overlapping symptomatology with ADHD and the differing treatment strategies these diagnoses imply. This article discusses the similarities and differences between these disorders with respect to phenomenology, epidemiology, family history, brain imaging, and treatment response.

Adolescent↗
PubMed2000

The differential diagnosis of epilepsy, pseudoseizures, dissociative identity disorder, and dissociative disorder not otherwise specified.

The authors review the co-occurrences of dissociative symptoms and disorders with epilepsy and pseudo-seizures and examine newer diagnostic instruments that assist in accurate diagnosis of persons with concomitant seizure behaviors and dissociative symptoms. They also review seizure behaviors and electroencephalographic findings in persons with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) and dissociative symptoms in persons with epilepsy and with pseudoseizures. Dissociative symptoms in 15 patients with epilepsy and 15 with pseudo-seizures were examined using the Dissociative Experiences Scale (DES) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). On the SCID-D, pseudo-seizure patients had significantly higher dissociative symptom scores than epileptic patients, but DES scores did not reliably distinguish epileptic and pseudo-seizure patients. Misdiagnosis of persons with seizures and dissociative symptoms can be avoided by careful adherence to DSM dissociative disorder criteria, the use of video-EEG monitoring, and systematic assessment of dissociative symptoms with the SCID-D.

Adult↗
PubMed2001

Attention deficit hyperactivity disorder, reading disability, and personality disorders in a prison population.

Attention Deficit Hyperactivity Disorder (ADHD) has long been recognized in children, and for many the disorder persists into adulthood. There is a growing concern that the adults with ADHD who have the least favorable outcome, are among those who end up in prison. The aim of this study was to assess childhood ADHD and its persistence into adulthood among a representative sample of Norwegian prison inmates, as well as personality disorders and reading difficulties, which in previous studies have been linked to ADHD. The results indicate that persistent ADHD is very common among prison inmates. Personality disorders and reading difficulties are also common. Psychiatric comorbidity complicates the diagnosis of ADHD in adults. A greater awareness about ADHD in adults certainly is warranted, especially within the prison system because of the risk of misdiagnosing psychiatric disorders and also the risk of missing a condition possibly amenable to treatment.

Adult↗
PubMed2002

Reduced salivary cortisol in children with comorbid Attention deficit hyperactivity disorder and oppositional defiant disorder.

OBJECTIVES: There is growing interest in the role of the hypothalamic-pituitary-adrenal (HPA) axis in neuropsychiatric disorders and there is some evidence that the HPA axis may be underfunctional in behaviorally disturbed children. However, co-morbidity is common in childhood neuropsychiatric disorders. Stimulant medication is widely used in the treatment of Attention-deficit hyperactivity disorder (ADHD) and can increase cortisol secretion when given acutely. We therefore set out to determine the whether salivary cortisol would be reduced in a group of children with ADHD/ODD (Oppositional-defiant disorder) and to examine the effect of stimulant medication on any such relationship. DESIGN: Salivary cortisol was determined in thirty-two children with co-morbid ADHD and Oppositional-defiant disorder (ODD) according to DSM-IV criteria, compared to twenty-five healthy controls of similar age and ethnic background. Data were analysed according to prescription of stimulant medication in the patient group. RESULTS: Salivary cortisol was significantly lower in the ADHD/ODD group than in the controls. Further analysis revealed that this reduction was restricted to the subgroup of patients not prescribed stimulant medication. CONCLUSIONS: The results support the possibility of a dysfunction of control of the HPA axis in these behaviorally disturbed children. A reduction in salivary cortisol could reflect underarousal, an elevated threshold for detection of stressors or a subsensitivity of the HPA axis itself. It remains to be determined whether the ability of stimulant medications to negate the apparent deficit in cortisol secretion in these ADHD/ODD patients is an unrelated consequence of increased dopamine release or a reflection of their therapeutic benefit. The use of stimulant medication for co-existing ADHD should be taken into account in future studies of cortisol in behaviorally disturbed children.

Attention Deficit Disorder with Hyperactivity↗
PubMed2002

Social anxiety disorder and generalized anxiety disorder: serotonergic and dopaminergic neurocircuitry.

Awareness that an amygdala-based fear circuit plays a crucial role in mediating fear conditioning as well as anxiety symptoms is growing. The efficacy of selective serotonin reuptake inhibitors in certain anxiety disorders has been argued to reflect their ability to modulate this circuit. Whether additional neurocircuits play a differentiating role in specific anxiety disorders, such as social anxiety disorder and generalized anxiety disorder (GAD), is an ongoing subject of investigation. A review of the literature suggests that in social anxiety disorder, dopaminergically mediated striatal circuits may also be important, while in GAD, there may be abnormalities of prefrontal areas. Future work will undoubtedly clarify how genetic and environmental factors interact to fashion the neurocircuitry that mediates anxiety symptoms.

Amygdala↗
PubMed2003

Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder.

OBJECTIVE: To assess the experience of selected individuals living with bipolar disorder and compare this experience with that of a similar group of individuals sampled in 1992. METHOD: In June 2000, 4192 self-administered questionnaires were sent to National Depressive and Manic-Depressive Association chapters for distribution to support group participants diagnosed with bipolar disorder. By July 31, 2000, the first 600 completed surveys were analyzed. RESULTS: Over one third of respondents sought professional help within 1 year of the onset of symptoms. Unfortunately, 69% were misdiagnosed, with the most frequent misdiagnosis being unipolar depression. Those who were misdiagnosed consulted a mean of 4 physicians prior to receiving the correct diagnosis. Over one third waited 10 years or more before receiving an accurate diagnosis. Despite having underreported manic symptoms, more than half believe their physicians' lack of understanding of bipolar disorder prevented a correct diagnosis from being made earlier. In 2000, the respondents reported a greater negative impact of bipolar disorder on families, social relationships, and employment than did the respondents in 1992. Overall, respondents were satisfied with their current treatment, which often included medication, talk therapy, and support groups. Respondents who were highly satisfied with their treatment provider had a more positive outlook on their illness and their ability to cope with it. CONCLUSION: Individuals with bipolar disorder reported that the illness manifests itself early in life but that accurate diagnosis lags by many years. The illness exacts great hardships on the individual and the family and has a profoundly negative effect on careers. These findings are very similar to those reported nearly a decade ago.

Adaptation, Psychological↗
PubMedDate not supplied

[Correlations between personality changes and symptom changes in somatization disorders and anxiety disorders--a comparative study].

AIM: The comparison of the relations between personality changes and main symptom changes observed during complex integrative psychotherapy in 100 somatization patients and 100 anxiety disorder patients. METHOD: Two self-descriptive measures--the 16PF of R.B. Cattell and the Symptom Checklist "O" were used in the study. The second measure chosen for the study was a 14-scale screen for the presence of functional disorder symptoms and 5 scales referring to phobias, general anxiety, somatization and conversions. Questionnaires were fulfilled twice--before and after psychotherapy. RESULTS: It was observed that the main symptoms in the group of anxiety disordered patients decreased with the increase of sociability (r = 0.36 p < 0.001), activity and withstanding difficult situations (r = 0.35, p < 0.001) self-confidence (r = 0.21, p < 0.05) and the reduction of submission (r = -0.36 p < 0.001), however the main symptoms in the somatization disorder group lowered with the growth of the ego strength (r = 0.44, p < 0.001; r = 0.41 p < 0.001) and the reduction of imaginative sensitivity (r = -0.31, p < 0.01). CONCLUSIONS: The results point out to the differences in the connections of the symptoms of functional disorders with the personality and confirm clinical reports on differences between somatization patients and neurotic patients.

Adult↗
PubMed2003

[Posttraumatic stress disorder and bipolar mood disorder].

Bipolar disorder (BD) is not only an endogenous condition. Severe negative life events have been shown to influence the development of the first episode and lifetime course of BD. Posttraumatic stress disorder (PTSD) is a severe and incapacitating mental condition that affect a significant proportion of the general population at some time in their lives. The concomitant presence of BD and PTSD has been shown to be more frequent than previously suggested and psychotic patients with trauma histories have a tendency to present more severe symptoms and are more proned to present substance use disorders. Trauma-related intrusive memories and nightmares of PTSD have been associated with mood changes. Also, kindling and behavioral sensitization have been proposed to explain the etiology and course of both disorders. Pharmacological approaches for this comorbidity are still based on empirical or not controlled approaches. In this article, we critically review the current literature regarding this co morbid condition, and highlight some aspects related to epidemiology, etiology, course and pharmacological treatment of both disorders. Overall, our review emphasizes the importance of systematically evaluate trauma histories in patients with BD.

Bipolar Disorder↗
PubMedDate not supplied

[Post-traumatic stress disorder and substance use disorder: treatment intervention].

There is an increasing interest to find efficacious treatments for patients with post-traumatic stress disorder (PTSD) and comorbid substance use disorder (SUD). Therefore, in this paper the studies published on the psychological and pharmacological treatment for the management of comorbid PTSD and SUD will be discussed, as these are highly prevalent and shown in part I. The few studies published to date suggest that patients benefit most form an integrated treatment approach for the comorbid disorders. Psychological treatments based on cognitive behavioural strategies appear to be useful for patients with PTSD and comorbid SUD disorder. Medications such as SSRIs and particularly sertraline that efficacious for PTSD, seem to be as well for this dual disorder. In addition, pharmacological options, among them quetiapine or bupropion have shown promising results in preliminary studies.

Humans↗
PubMed1991

Lessons to be learned from long-term treatment of affective disorders: potential utility in panic disorder.

Although the research on long-term treatment for panic disorder is in an early stage, there is a considerable body of data on affective disorders. The author discusses three long-term projects pertinent to affective disorders, with the idea that they may suggest possible avenues of research in the field of panic disorder: (1) the MacArthur Foundation task force arrives at consensus definitions and proposes tentative operational criteria; (2) the National Institute of Mental Health Collaborative Study compares the effects of lithium carbonate, imipramine, the lithium/imipramine combination, and placebo in preventing the recurrence of affective disorders; and (3) the Pittsburgh Study explores the efficacy of the combination of imipramine and interpersonal psychotherapy as a preventive strategy against recurrence of depression.

Antidepressive Agents↗
PubMed1995

[Reliability of brain stem audiometry in specific learning disorders (disorders of sensory integration)].

Diagnostic audiological tests performed in ten children from 1985 to 1991 showed remarkable differences between the results of behavioral audiometry (free field or pure tone audiometry) and those of auditory evoked response audiometry. Auditory brainstem response (ABR) was absent in seven children with sensory neural hearing loss. Neuropsychological evaluation was performed on four children, neuropsychological observation was performed on two children, pediatric examination was performed on three children and one child showed signs of neuropediatric disorder. The results of neuropsychological evaluation showed moderate to severe learning disabilities (sensory integration disorders, learning disorders) in all four children tested. Available neuropsychological observation also indicated the presence of sensory integration disorders in two children. Two children had multiple handicaps with cerebral abnormalities, two further children were diagnosed as suffering from "minimal cerebral dysfunction," one of which was mentally retarded. The fact that ABRs were absent in seven children indicates that a response desynchronisation in the auditory pathway may exist in these disorders. Thus, ABR might not be a reliable method for audiological testing in children with learning disabilities or other cerebral dysfunctions, but serves as an adjunct to conventional testing methods.

Audiometry, Evoked Response↗
PubMed1995

Respiratory and other symptoms in panic disorder versus other anxiety disorders.

Respiratory abnormalities have been proposed as a central feature of panic disorder, but the literature is not unanimous. Symptoms of anxiety were quantitatively recorded with the Hamilton Rating Scale for Anxiety (HAM-A) in 72 psychiatric out-patients in two anxiety disorders clinics in Israel; 44 patients had panic disorder with or without agoraphobia and 28 patients had other anxiety disorders. Panic patients had more cardiovascular symptoms, but not more respiratory symptoms, than other patients. The relative importance of respiratory symptoms in panic disorder is not yet settled.

Adult↗
PubMed1994

Rethinking the comparison of borderline personality disorder and multiple personality disorder.

This article has made a number of points that assert what is today a minority position within the fields of MPD/DID and BPD. We hope our views will stimulate attempts by others to rethink their positions and test our assertions, so that issues surrounding these two disorders can be sharpened. For the sake of the clarity of future work, we summarize in outline form the essence of our viewpoint. 1. BPD and MPD/DID have similar appearing symptoms, such as identity problems, unstable affect modulation, self-destructive behaviors, chaotic impulse control, and troubled interpersonal relationships, but they have decisive differences in underlying dynamics, process, and structure. 2. DSM tends to blur these two disorders by its emphasis on phenomenology over inner structure, thus fostering misleading conclusions when DSM criteria are used to test for comorbidity or overlap between BPD and MPD/DID. 3. BPD and MPD/DID are both described dynamically as using the defense of splitting, but we contend that the splitting in each disorder is fundamentally different from the splitting in the other. BPD uses a polarization form of splitting, whereas MPD/DID uses ego splitting or identity division. 4. Both disorders partake in the process of dissociation, but the quality of dissociation in BPD is a "low-tech" spaced out type, whereas that of MPD/DID is a "high-tech" waking dream. 5. BPD structure is also "low tech," with polarization of self, object, and relationship. MPD/DID structure is "high tech," with heavily symbolic, highly nuanced variations of self, object, and relationship. 6. Although both conditions have etiologic elements of trauma, BPD has a larger degree of developmental deficiency, with a failure to complete the task of entering a repression hierarchy of defenses. MPD/DID, by use of primary process-linked symbolic dissociation, is able to continue development to the repression hierarchy, although at a profound cost of simultaneous suspension of reality testing. BPD patients suffer from the rigid use of too few defenses; MPD/DID patients suffer from the obsolete use of too many defenses. 7. BPD patients grow up in homes in which overtly expressed aggression is more tolerated, or at least more openly experienced. MPD/DID patients grow up in homes in which the fact of aggression is kept a secret. This has consequences for the formation of psychic structure in each disorder.(ABSTRACT TRUNCATED AT 400 WORDS)

Aggression↗
PubMed1996

[A specific disorder in Kanji writing in a learning disabled child with a visual cognition disorder--a cognitive-neuropsychological and electrophysiological analysis].

We reported a learning disabled child with a specific disorder involving Kanji writing. The patient was a 13-year-old boy. Although he manifested generally normal intellectual ability and his performance on WISC-R indicated that VIQ was 101 and PIQ 84, he could only write approximately 20% of Kanji, which he learned at age 6 to 7. On cognitive-psychological tests, he showed a visual cognition disorder that was different from that in a previously reported case during information processing. Electrophysiologically, he showed a disorder in visual task-relevant potentials. The mechanism underlying this patient appears to be a retrieval disorder for complex graphic forms in addition to a visual cognition disorder because of two reasons. One is that he could distinguish Kanji from similar graphic forms. The other is that he could read Kanji aloud.

Adolescent↗
PubMedDate not supplied

[Body dysmorphic disorder as an obsessive-compulsive spectrum disorder].

Considerable evidence supports consideration of body dysmorphic disorder (BDD) and obsessive-compulsive disorder as related disorders. BDD may share common phenomenological and neurobiological features with OGD and other disorders characterized by repetitive thoughts and behaviors and mediated by serotonin dysfunction. Within this substrate, specific psychological and sociological factors may shape the specific BDD syndrome. Further research incorporating dimensional models of these disorders, may delineate specific similarities and differences.

Body Image↗
PubMed1997

[Eating disorders and borderline personality disorder: what are the connections?].

Various forms of evidence suggest that eating disorders display a special co-aggregation with borderline personality disorder (BPD). In this article, the authors review findings suggesting an apparent affinity between BPD and bulimia. The authors then discuss the implication of BPD on the symptomatic expression and response to treatment of eating disorders. Finally, they explore heuristic dimensions that may explain the specific association of BPD with eating disorders. A discussion follows proposing researchable hypotheses that may permit a better differentiation of processes contributing to the evolution of eating disorders and BPD.

Borderline Personality Disorder↗
PubMed2007

Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: a prospective study.

This study aimed at the identification of acute and post-traumatic stress responses, and comorbid mental disorders in breast cancer patients. Structured clinical interviews for DSM-IV (SCID) were conducted post-surgery with 127 patients (t1). Screening measures were used to assess post-traumatic stress responses, anxiety, and depression at t1 and at 6 months follow-up (t2). Based on the SCID, prevalence rates were 2.4% for both, cancer-related ASD and PTSD. Experiences most frequently described as traumatic were the cancer diagnosis itself and subsequent feelings of uncertainty. Patients with lifetime PTSD (8.7%) were more likely to meet the criteria for cancer-related ASD or PTSD (OR=14.1). Prevalence estimates were 7.1% for Adjustment Disorder, 4.7% for Major Depression, 3.1% for Dysthymic Disorder and 6.3% for Generalized Anxiety Disorder. Using the screening instruments, IES-R, PCL-C and HADS, we found PTSD in 18.5% at t1 and 11.2-16.3% at t2. The estimates of anxiety and depression reveal rates of 39.6% (t1) and 32.7% (t2) for anxiety, as well as 16.0% (t1) and 13.3% (t2) for depression (t1) (cut-off> or =8). The diagnosis of a life-threatening illness has been included as a potential trauma in the DSM-IV. However, it has to be critically evaluated whether subjective feelings of uncertainty like fears of treatment count among traumatic stressors, and thus, whether the diagnosis of PTSD is appropriate in this group of cancer patients. However, a large number of women with emotional distress illustrate the need for psychosocial counseling and support in this early treatment phase.

Acute Disease↗
PubMed2006

Disentangling depressive personality disorder from avoidant, borderline, and obsessive-compulsive personality disorders.

Several studies have found that 3 personality disorders (PDs) tend to share moderate rates of comorbidity with depressive PD: avoidant, borderline, and obsessive-compulsive. This study sought to evaluate the diagnostic criteria of each disorder in an effort to understand where areas of overlap may occur and to modify criteria sets where reasonable to reduce any degree of overlap. One thousand two hundred psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality Disorders. The highest degree of comorbidity was observed between avoidant PD and depressive PD. Logistic regression analyses indicated that 2 criteria-avoidant criterion 5 and depressive criterion 2-could be removed from the diagnostic criteria sets and reduce the rates of overlap by as much as 15%. A factor analysis of the criteria of all 4 PDs indicated that there is a common clustering of many of the symptoms of avoidant, borderline, depressive, and obsessive-compulsive PDs and that borderline symptoms tend to cluster together most consistently. Avoidant and obsessive-compulsive personality symptoms clustered in ways that may reflect a problem of how to engage with others, suggestive of an approach-avoidance conflict. Depressive PD symptoms clustered in a way suggestive of problems with anger that is directed toward oneself and others. The factor analysis results suggest that an organization of symptoms around themes of conflict may provide useful ways of understanding the personality patterns of these 4 disorders.

Adult↗