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PubMedDate not supplied

Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior?

OBJECTIVE: This study examines factors affecting the frequency of physician consultations by individuals with functional gastrointestinal disorders (FGD) in a group of subjects with functional dyspepsia or irritable bowel syndrome. Systematic selection of persons who were already seeing a physician for one of these problems was avoided by conducting an epidemiological field study rather than a clinical study. METHODS: A representative sample of the German population (N=2201) completed a questionnaire that included, in addition to the criterion (number of physician visits in the past 12 months), items aimed at identifying the target group and questions about physical symptoms, illness behavior, living situation, personality features, and sociodemographic status (a total of 31 predictors). RESULTS: Individuals with functional gastrointestinal disorders who consulted a physician for their gastrointestinal disorders and those who did not differed significantly, especially on psychological measures. The differences between these individuals and the general population were greater for the consulters than for the nonconsulters. Multiple regression analyses yielded nine predictors that explained 40.2% of the variance of the criterion. The best predictors of frequency of physician consultations were the duration of periods with symptoms and psychological factors, such as the severity of depression and the patients' views on the cause of their illness. CONCLUSIONS: The psychopathology seen in people with functional gastrointestinal disorders is of two types: one is a characteristic of the illness itself and the other leads the individual to consult a physician. When gastroenterologists see patients with such disorders, they can assume that they may be dealing with a self-selected group of individuals with psychological stress. Psychological assessment would, therefore, be useful to determine whether a given individual with FGD might benefit from psychotherapy.

Adult↗
PubMed2006

Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: prevalence and impact on health.

BACKGROUND: Symptoms of functional gastrointestinal disorders (FGID) associated with mood disorders (MD), such as depression and anxiety, occur in some patients with quiescent inflammatory bowel disease (IBD) and could be caused by changes in gut motility, visceral hypersensitivity, or psychological dysfunction. We assessed the prevalence of FGID symptoms and mood disorders in ambulatory patients with quiescent IBD and examined their impact on health-related quality of life (HRQOL) and use of health resources. METHODS: Consecutive ambulatory patients with IBD completed a survey of Rome II criteria for FGID, the Hospital Anxiety and Depression Survey, HRQOL indices, and health resource utilization. Logistic and linear regression analyses tested for predictors of FGID and HRQOL. RESULTS: Of 361 patients surveyed, 149 (44 ulcerative colitis [UC] and 105 Crohn's disease [CD]) had inactive IBD during the previous 12 months. Symptoms of at least 1 FGID occurred in 81.9%. Functional anorectal disorders were the most prevalent (53.7%) followed by functional bowel disorders (51.7%), and both were of greater prevalence than in the Canadian population (41.6% and 22.6%, respectively). Irritable bowel syndrome symptoms were more common in inactive CD than in UC (26% versus 9.1%, P = .01) and functional constipation was more common in inactive UC than in CD (26.2% versus 5.8%, P < .01). MD occurred in 27.3% of UC and 31.3% of CD patients. Age > or =40 years and anxiety independently predicted an FGID. Both FGID symptoms and MD were associated with impaired HRQOL and increased use of health services. CONCLUSIONS: Many patients with inactive IBD have symptoms compatible with FGID. Both FGID-like symptoms and MD are associated with impaired HRQOL and increased health resource utilization. Recognition and treatment of FGID and MD could potentially improve daily functioning of IBD patients.

Adult↗
PubMed2005

The epidemiology of bipolar disorder: sociodemographic, disability and service utilization data from the Australian National Study of Low Prevalence (Psychotic) Disorders.

OBJECTIVES: Data from the Australian National Study of Low Prevalence (Psychotic) Disorders were used to describe the clinical and sociodemographic profile of individuals with bipolar disorder, their levels of impairment and disability, and use of medication and treatment services. METHODS: A 1-month census of contacts with mental health services, private psychiatric and general practices, as well as contact points in marginalized settings, was conducted in a national catchment of 1.1 million adults. The census yielded 3,800 individuals who screened positive for psychosis, of whom a random sample of 980 were administered a comprehensive semi-structured interview schedule. Results are presented on 112 persons with an ICD-10 diagnosis of bipolar disorder. RESULTS: Overall, 69.6% of the 112 persons who met the ICD-10 criteria for bipolar disorder reported a recurrent episodic illness, 25.0% had a chronic course without clear remissions, and 5.4% had a single episode of mania. Assessed on a lifetime basis, suicidal ideation was common (78.6%) and levels of drug and alcohol abuse/dependence were high (32.1%). The majority (84.8%) had had at least one contact with inpatient, outpatient or emergency services in the previous year. Those with serious impairment had levels of service utilization similar to the rest of the sample, but were more likely to report a poorer quality of life and unmet service needs. While the percentage experiencing social and occupational dysfunction was substantial and similar for both sexes, women appeared to be better integrated socially than men. Comparisons with schizophrenia patients within the same survey sample highlighted less chronic impairment but equal or greater utilization of services by bipolar patients. CONCLUSIONS: Despite low levels of chronicity, the burden of social disablement associated with bipolar disorder is high. The data suggest a number of important gaps in the provision of services for this predominantly treated population.

Adult↗
PubMed2005

Metabolic syndrome in bipolar disorder: findings from the Bipolar Disorder Center for Pennsylvanians.

OBJECTIVE: This study sought to evaluate the presence of the metabolic syndrome in a group of 171 patients with bipolar disorder who were consecutively recruited in the Bipolar Disorder Center for Pennsylvanians. METHODS: Data were collected from participants entering the Bipolar Disorder Center for Pennsylvanians protocol between 2003 and 2004. The study focused on the presence of the metabolic syndrome, as defined by the National Cholesterol Education Program Expert Panel on Detection, Evaluation And Treatment of High Blood Cholesterol in Adults (NCEP ATP III). RESULTS: Thirty percent of the sample met the NCEP ATP III criterion for the metabolic syndrome, 49% met the criterion for abdominal obesity, 41% met the criterion for hypertriglyceridemia, 48% met the criterion for hypertriglyceridemia or were on a cholesterol-lowering medication, 23% met the criterion for low high-density lipoprotein cholesterol, 39% met the criterion for hypertension and 8% met the criterion for high fasting glucose or antidiabetic medication use. Patients with the metabolic syndrome and patients endorsing the obesity criterion were more likely (p = 0.05 and p = 0.004, respectively) to report a lifetime history of suicide attempt/s. CONCLUSIONS: The prevalence of the metabolic syndrome in patients with bipolar disorder is alarmingly high, as it is for the general population. The prevalence of obesity is even higher than the already very high prevalence that has been estimated for the US general population. Our findings are a reason for concern, considering the difficulty in implementing prevention and treatment programs in the bipolar population. We strongly support the development and testing of interventions specifically designed for preventing and treating the metabolic syndrome and its components in patients with bipolar disorder.

Academic Medical Centers↗
PubMed1983

Age-related sleep-wake disorders at a sleep disorder center.

The specific sleep disorders of 97 patients 61-81 years old were compared with those of 264 middle-aged (41-60 years old) and 202 young (20-40 years old) patients. Sleep disorder diagnoses were made according to the Diagnostic Classification of the Association of Sleep Disorders Centers based on evaluations consisting of mental and physical examinations and all-night sleep recordings. Most young and middle-aged patients complained of excessive daytime sleepiness; the elderly complained of insomnia as often as excessive daytime sleepiness. The evaluations revealed objective findings in 93 per cent of the elderly, but only 77 per cent of younger patients. Nocturnal myoclonus or restless leg syndrome was the diagnosed cause of 23 per cent of elderly patients' sleep-wake problems, but only 11 per cent of middle-aged and 4 per cent of young patients had this problem. Respiratory disorders of sleep were found in 27 per cent of elderly, 35 per cent of middle-aged, and 20 per cent of young patients. Elderly patients (6 per cent) had psychiatric disorders diagnosed as the causes for their problems less frequently than did younger patients (22 per cent).

Adult↗
PubMed1992

Noradrenergic neuronal dysregulation in panic disorder: the effects of intravenous yohimbine and clonidine in panic disorder patients.

In order to evaluate possible abnormal noradrenergic neuronal functional regulation in patients with panic disorder, the behavioral, biochemical and cardiovascular effects of intravenous yohimbine (0.4 mg/kg) and clonidine (2 micrograms/kg) were determined in 15 healthy subjects and 38 patients with panic disorder. A subgroup of 24 panic disorder patients were observed to experience yohimbine-induced panic attacks and had larger yohimbine-induced increases in plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) than healthy subjects and other panic disorder patients. A blunted growth hormone response to clonidine and a significant clonidine-induced decrease in plasma MHPG was also observed in this subgroup of panic disorder patients. These data replicate and extend previous investigations, which are consistent with a large body of preclinical and human data relating increased noradrenergic neuronal function to human anxiety and fear states.

Adult↗
PubMed1999

Major mental disorders in Addis Ababa, Ethiopia. I. Schizophrenia, schizoaffective and cognitive disorders.

We report here on a survey conducted in Addis Ababa between September and December of 1994 to estimate the prevalence and socio-demographic correlates of schizophrenia, schizoaffective, and severe cognitive disorders. An Amharic version of the CIDI was used to collect data from a random community sample of 1420 individuals aged 15 and above. Weighted lifetime and one-month prevalence were 0.4% and 0.3%, for schizophrenia, and 0.5% and 0.4% for schizoaffective disorders, respectively. The prevalence of severe cognitive disorders was found to be 2.6%. Multivariate logistic analysis showed that the risk of lifetime psychosis (schizophrenia, schizoaffective, bipolar disorders, and depressive episodes with psychotic symptoms) was significantly higher in the age group 25-44 years compared to the reference age group of 15-24 years: adjusted Odds Ratio and 95% confidence interval, OR (95% CI) = 2.41 (1.01, 5.74); it was also significantly higher in the never married group compared to those married: OR (95% CI) = 3.01 (1.08, 8.42). The risk was significantly lower in the employed compared to the unemployed: OR (95% CI) = 0.42 (0.18, 1.00). There was a statistically significant trend of increasing risk of severe cognitive disorders with increasing age. The trend was in the reverse direction for educational status, the risk decreasing significantly with increasing educational attainment.

Adolescent↗
PubMed1993

Delusional disorder and mood disorder: can they coexist?

DSM III-R acknowledges that delusional disorder and mood disturbance can coexist. The aim of the study is to analyze mood disturbances occurring within a delusional disorder. An external validator, as the increased familial risk of psychiatric disorder, is also added to clarify the relationship between the two diagnostic areas. We found a high frequency of mood disturbances in our patients (50.7%). We were able to identify a proportion of delusional patients affected by a recurrent form of mood disturbance (35.2%); in about 42% of these patients the onset of the mood disturbance preceded the onset of the delusional disorder by a considerable interval of time. Our hypothesis is that, in these cases, the observed mood disturbance could represent a codiagnosis of true mood disorder. This hypothesis is partly supported by familial data.

Adult↗
PubMed1984

A comparison of panic disorder and generalized anxiety disorder.

Subjects from a family study who had panic disorder and generalized anxiety disorder were compared on the pattern of their symptoms, age and type of onset, personality characteristics, course of illness, and outcome. Subjects with generalized anxiety disorder were shown to have fewer autonomic symptoms and an earlier, more gradual onset. Their illness was also observed to have a more chronic course and a more favorable outcome, although these differences were not statistically significant. The validity of generalized anxiety disorder and panic disorder as discrete diagnostic entities is supported.

Adult↗
PubMed1999

Comparison of ketamine-induced thought disorder in healthy volunteers and thought disorder in schizophrenia.

OBJECTIVE: This study sought to determine whether thought disorder induced in healthy volunteers by the N-methyl-D-aspartic acid (NMDA) receptor antagonist ketamine resembles the thought disorder found in patients with schizophrenia. METHOD: The Scale for the Assessment of Thought, Language, and Communication was used to assess thought disorder in healthy volunteers (N = 10) who received subanesthetic doses of ketamine and in a group of clinically stable inpatients with schizophrenia (N = 15) who did not receive ketamine. RESULTS: Mean scores on the Scale for the Assessment of Thought, Language, and Communication for patients with schizophrenia and healthy volunteers receiving ketamine did not differ significantly. Moreover, three of the four highest rated test items in both groups were the same. CONCLUSIONS: These data suggest that ketamine-induced thought disorder in healthy volunteers is not dissimilar to the thought disorder in patients with schizophrenia and provide support for the involvement of the NMDA receptor in a cardinal symptom of schizophrenia.

Adult↗
PubMed1993

Sexual abuse and eating disorders. Borderline personality disorder as a mediating factor?

Sexual abuse appears to be causally linked to eating disorders, particularly those involving bulimic features. However, the psychological factors that mediate between these two phenomena are not understood. Recent findings suggest that borderline personality disorder may explain some of the association. The present research investigates the potential links between reported sexual abuse, borderline personality disorder, and eating psychopathology in a case series of 100 women with eating disorders. The results suggest that borderline personality disorder is a psychological factor that explains a small part of the causal link between sexual abuse and bulimic behaviour--especially frequency of bingeing. However, other factors are likely to be involved, and further research is suggested to investigate these.

Adult↗
PubMed2001

The revised version of the Screen for Child Anxiety Related Emotional Disorders (SCARED-R): treatment sensitivity in an early intervention trial for childhood anxiety disorders.

OBJECTIVES: The revised version of the Screen for Childhood Anxiety Related Emotional Disorders (SCARED-R) is a recently developed self-report questionnaire for measuring DSM-IV defined anxiety disorder symptoms in children. The current study examined the treatment sensitivity of the SCARED-R. METHODS: Thirty-six children (aged 8-13 years) who fulfilled the criteria for generalized anxiety disorder, separation anxiety disorder, and/or social phobia received either group or individual cognitive-behavioural treatment. Children completed the SCARED-R and a traditional measure of childhood anxiety, the State-Trait Anxiety Inventory for Children (STAIC), at three points in time: (1) 6 months before treatment (i.e. baseline), (2) pre-treatment, and (3) post-treatment. RESULTS: Results showed that children's SCARED-R and STAIC scores did not change from baseline to pre-treatment, but significantly declined from pre-treatment to post-treatment. An additional finding of the present study was that group and individual CBT were equally effective in reducing children's anxiety symptoms. CONCLUSIONS: It can be concluded that the SCARED-R reliably taps treatment effects and thus should be regarded as a useful self-report index of childhood anxiety in clinical and research settings. Furthermore, the data support the notion that CBT should be generally regarded as an efficacious intervention for anxiety disordered children.

Adolescent↗
PubMed2004

[Bipolar disorder with late onset: an organic variety of mood disorder?].

Bipolar disorder (BD) is commonly associated with late adolescence or early adulthood, although a substantial proportion of patients develops the condition in later life. The results of early clinical investigations suggested that cases of bipolar disorder with onset in later life were more often associated with 'organic causes', and could potentially justify the distinction between early and late onset bipolar disorder. This paper reviews currently available evidence in support of the organic hypothesis for late onset bipolar disorder. It concludes that the split of bipolar disorder according to age at onset is artificial, and lacks clinical significance and epidemiological support.

Adult↗
PubMedDate not supplied

[Verbal communication disorders and language disorders in cortical dementias (I). The current state of the art in research].

INTRODUCTION: This is the first part of a research work into primary and secondary language disorders (LD) in the stages of minimum to mild pathological deterioration in the degenerative process of cortical dementias. AIMS. In this first part, in the light of recent models of symbolic computation of language processing, we review the most significant publications on the subject matter. DEVELOPMENT: We begin with an introduction to the historical development of the approaches used to deal with the subject. Following that, we briefly describe the components of the language processing system (LPS) in the light of symbolic computation models. We then analyse the publications dealing with those models. Our aim was to determine whether the LD reported in those publications are the result of a primary involvement of any of the LPS components, or whether they are only the result of disorders affecting other components of the cognitive system. In this case, the supposed LD would be secondary and thus a communication, but not language, disorder. CONCLUSIONS: Despite the important variations from one individual to another that have been systematically observed by different authors, it seems that only LD belonging to so called primary progressive aphasia are actually cases of this disorder. In all the other dementias in the above mentioned stages of the development process these disorders are secondary to the involvement of other subsystems of the LPS.

Aged↗
PubMedDate not supplied

[Familial impact of children with the combined subtype of attention deficit hyperactivity disorder: the effects of associated behavioural disorders].

AIMS: To determine the impact that children with ADHD-C (attention deficit hyperactivity disorder, combined subtype) have on their family by analysing their parents' perceptions, and to examine whether the presence of associated behavioural disorders affect that impact. SUBJECTS AND METHODS: Participants in the study included one group made up of the parents of 27 children with ADHD-C and another group consisting of the parents of 27 children without ADHD. The parents in the ADHD-C group were divided into two subgroups according to whether or not their children had an oppositional defiant disorder and/or a co-morbid conduct disorder (10 and 17 families, respectively). RESULTS AND CONCLUSIONS: The results of the analyses performed showed significant differences between the perceptions of the parents of the control children and those of the parents of children with ADHD-C in the following categories: feelings and attitudes, social life, matrimonial relationship, day-to-day relationships with peers and siblings, stress and difficulty in living with their child. Comparisons between the two subgroups of children with ADHD-C did not reveal any significant differences in any of the categories that were analysed, and showed ADHD-C to be the fundamental factor underlying the problems in the family context. Some items, however, suggested that the problem is more serious in the subtype with associated behavioural disorders.

Attention Deficit Disorder with Hyperactivity↗
PubMed1990

A controlled family history study of Tourette's syndrome, I: Attention-deficit hyperactivity disorder and learning disorders.

Gilles de la Tourette's syndrome (TS) is a common, hereditary neuropsychiatric disorder. While its diagnostic feature is the presence of suppressible motor and vocal tics, a wide range of impulsive, compulsive, attentional, learning, mood, and anxiety disorders are also present in many patients. To determine if attentional and learning problems are part of the expression of the Gts gene (or genes), the authors analyzed family histories of 130 TS probands with 1851 relatives and 25 control probands with 541 relatives--a total of 2392 relatives. The frequency of attention-deficit hyperactivity disorder (ADHD) or learning disorders was significantly increased in the relatives of the TS probands. The data on first-degree relatives suggest that when the Gts gene is expressed in this form, in two thirds of the cases tics are also present and in one third they are not. These observations are consistent with the proposal that ADHD and learning disorders form an integral part of the expression of the Gts gene or genes.

Adolescent↗
PubMed1996

Eating disorder and obsessive-compulsive disorder: neurochemical and phenomenological commonalities.

This paper explores a possible connection between neurochemistry and cognitions in eating disorders (ED). Cognitions play an important role in ED. However, a possible neurochemical origin of these cognitions has not been explored. Obsessive-compulsive disorder (OCD) is known as a disorder of thinking. Extensive neurochemical research conducted on this disorder indicates a connection between serotonin (5-HT) dysregulation and cognitions in OCD. This study used research done on OCD as a template to interpret the available research findings in ED and their possible meaning in terms of neurochemical origin of cognitions in ED. This paper suggests that the neurochemical and behavioral expression of both ED and OCD occur on a continuum. At one end of the continuum, ED and OCD are expressed through constrained behaviors of an avoidant quality. This pole is also characterized by high levels of serotonin markers. At the other end, both disorders are characterized by disinhibited approach behavior. This end of the continuum is characterized by low levels of 5-HT markers. It is suggested that these levels of 5-HT generate cognitions that may in turn promote specific behaviors.

Anorexia Nervosa↗
PubMedDate not supplied

[Results of long-term observation (3-11 years) of patients with dual diagnosis: body dysmorphic disorder and delusional disorder, somatic type].

This work presents results of a retrospective and prospective research of 15 persons with a double diagnosis: body dysmorphic disorder, and delusional disorder, somatic type. It was established that these disorders starting in adolescence, occurred in persons who earlier had traits of avoidant and obsessive-compulsive personality or social phobia. In most subjects with dysmorphophobia there was comorbidity of dysthymia or major depression. An improvement in the state of these patients, most often after implementation of complex therapeutic measures: psychotherapy as well as pharmacotherapy with neuroleptic and SSRI's or clomipramine has to do with withdrawal of delusions, whereas the symptoms of body dysmorphic disorder usually last for years. In some patients delusional disorders had a tendency to reoccur or to be chronic, and lead to a considerable impairment of social functioning.

Adolescent↗