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PubMedDate not supplied

History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: a controlled study.

To evaluate the association between history of childhood attention deficit/hyperactivity disorder (ADHD) symptoms and the diagnosis of borderline personality disorder (BPD) in adulthood, the Wender Utah Rating Scale (WURS) was administered to 42 consecutively admitted BPD subjects, 94 consecutively admitted controls with any cluster B personality disorder (PD) diagnosis other than BPD, 38 consecutively admitted controls with any cluster A or cluster C PD diagnosis but no cluster B PD diagnosis, and 69 consecutively admitted controls with no PD diagnosis. A fourth control group was composed by 201 nonclinical volunteers. According to Dunn-Bonferroni contrasts, BPD subjects showed a significantly higher mean WURS total score compared to all control groups (minimum t = 7.93, maximum t = 11.63, all Ps <.001). These contrasts remained significant even controlling for potential confounders such as antisocial personality disorder (ASPD) diagnosis, gender, inpatient status, and axis I diagnoses. The results of this study seem to support the hypothesis of an association between history of childhood ADHD symptoms and adult BPD diagnosis.

Adult↗
PubMed2004

Attention deficit hyperactivity disorder and concomitant communicative disorders.

The relationship between attention deficit hyperactivity disorder (ADHD) and communication disorders is complex and often misunderstood. Misunderstandings arise in part because of definitions and diagnostic categorizations that change over the years and because of overlapping symptoms between diagnostic categories. In addition, many of the symptoms that are necessary for the diagnosis of ADHD are prerequisite skills required to perform well on standardized language tests. Consequently, it is difficult to know the exact prevalence of ADHD and concomitant communicative disorders, especially language disorders. Several hypotheses are developed that indicate why the differential diagnosis is so difficult.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Mood disorder with psychotic features, schizoaffective disorder, and schizophrenia with mood features: trouble at the borders.

Psychiatry has long struggled with the problem of how to understand the relationship between psychotic symptoms and mood symptoms. In the past, these debates were over conceptualizations of categories based on syndromal definitions of mental illnesses. Ample data now exists that provide insight into the biologic basis for syndromal distinctions. We examine the syndromes of mood disorder with psychotic features, schizoaffective disorder, and schizophrenia with mood features, reviewing their classification, clinical features, course, and treatment. We provide evidence that, clinically, mood disorders and schizophrenia do not separate neatly. We will also review data arising from studies in brain imaging, molecular neurobiology, and genetics. Evidence is accumulating that overlap across diagnostic boundaries for both pathologic and etiologic factors exist, along with disorder-specific factors. The nosology that will carve the reality of psychotic illness at the joints awaits further advances in genetics and neurobiology. Or, alternatively, carving out categories may turn out to be less useful for some purposes than considering dimensions.

Diagnosis, Differential↗
PubMedDate not supplied

Obsessive-compulsive disorder in callers to the Anxiety Disorders Association of America.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic, impairing and often comorbid disorder. METHODS: 1000 subjects who called the Anxiety Disorders Association of America (ADAA) were surveyed and divided in three groups: (a) callers with OCD (OCD) and two overlapping control groups: (b) callers with no axis I disorder (NAC) and (c) with no-OCD (NOC) using a 97-item questionnaire. RESULTS: The rate of OCD was 14.5% (N = 145). Relative to the NOC group, OCD subjects were more likely to be female, White, younger and not married. Relative to the NAC group, subjects with OCD were more likely to be White, not married and younger. OCD was accompanied by significant comorbidity and was associated with an increased number of visits to health professionals than NAC subjects. There was no significant difference regarding unemployment rates among the three groups. However, OCD callers were more likely than both control groups to have missed work or have decreased productivity due to their mental condition. OCD subjects took an average of 1 psychotropic medication in the past year and were statistically more likely than the control groups to experience sleepiness and nervousness as side effects. CONCLUSIONS: OCD was fairly prevalent among ADAA callers and presented high levels of comorbidity, impairment, health care utilization and sensitivity to psychotropic side effects.

Absenteeism↗
PubMedDate not supplied

Validity of the distinction between primary and secondary substance use disorder in patients with bipolar disorder: data from the first 1000 STEP-BD participants.

The validity of a primary/secondary substance use disorder (SUD) distinction was evaluated in the first 1000 patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder. Patients with primary SUD (n = 116) were compared with those with secondary SUD (n = 275) on clinical course variables. Patients with secondary SUD had fewer days of euthymia, more episodes of mania and depression, and a greater history of suicide attempts. These findings were fully explained by variations in age of onset of bipolar disorder. The order of onset of SUDs was not linked to bipolar outcomes when age of onset of bipolar disorder was statistically controlled. The primary/secondary distinction for SUD is not valid when variations in the age of onset of the non-SUD are linked to course characteristics.

Adult↗
PubMedDate not supplied

Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders.

This article addresses the question whether borderline personality disorder (BPD) can be understood as a variant of bipolar disorder. In the past, borderline pathology has been seen as a variant of psychosis, depression, or posttraumatic stress disorder, but there are important differences between all of these conditions and BPD. The proposal that BPD falls within the bipolar spectrum depends on the assumption that affective instability develops through the same mechanism in both diagnostic categories. There are major differences in phenomenology, family history, longitudinal course, and treatment response between BPD and bipolar disorder, and the findings of comorbidity studies are equivocal. Thus, existing evidence is insufficient to support the concept that BPD falls in the bipolar spectrum.

Bipolar Disorder↗
PubMed2000

Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders.

OBJECTIVE: This paper reports on a study designed within the framework of the National Survey of Mental Health and Wellbeing to: estimate the prevalence of psychoses in urban areas of Australia; identify profiles of symptomatology, impairments and disabilities; collect information on services received and needed; and explore quality of life issues in a broadly representative sample of people with psychotic illnesses. METHOD: The study was conducted over four areas in the Australian Capital Territory, Queensland, Victoria and Western Australia, as a two-phase survey: (i) a census and screening for psychosis of all individuals who made contacts with mental health services during a period of 1 month in 1997; and (ii) interviews with a stratified random sample (n=980) of the screen-positive individuals (n=3800) using a standardised instrument. RESULTS: The point prevalence (1 month) of psychotic disorders in the urban population aged 18-64 is in the range of 4-7 per 1000 with a weighted mean of 4.7 per 1000. People with psychotic disorders experience high rates of functional impairments and disability, decreased quality of life, persistent symptoms, substance-use comorbidity and frequent side effects of medication. Although the utilisation of hospital-based and community mental health services, as well as of public and non-governmental helping agencies, is high, the majority live in extreme social isolation and adverse socioeconomic circumstances. Among the many unmet needs, the limited availability of community-based rehabilitation, supported accommodation and employment opportunities is particularly prominent. CONCLUSIONS: The so-called 'low-prevalence' psychotic disorders represent a major and complex public health problem, associated with heavy personal and social costs. There is a need for a broad programmatic approach, involving various sectors of the community, to tackle the multiple dimensions of clinical disorder, personal functioning and socioeconomic environment that influence the course and outcome of psychosis and ultimately determine the effectiveness of service-based intervention.

Activities of Daily Living↗
PubMed2005

Substance use disorders and Cluster B personality disorders: physiological, cognitive, and environmental correlates in a college sample.

Substance use disorders (SUDs) and Cluster B personality disorders (PDs) are both marked by impulsivity and poor behavioral control and may result in part from shared neurobiological or executive cognitive functioning deficits. To examine the potential utility of such models in explaining variance in SUDs and PDs at the lower end of symptom expression and impairment, 123 (73 female) volunteer college students were administered 2 measures of executive cognitive functioning; a task assessing autonomic reactivity to aversive noise blasts; a life events and a peer substance use measure; and structured clinical interviews to assess symptoms of substance abuse/dependence and antisocial, borderline, histrionic, and narcissistic PDs. As expected, symptoms of SUDs and PDs were significantly positively correlated. Antisocial PD, alcohol and cannabis use disorder symptoms were significantly positively related to proportion of friends who use alcohol and drugs regularly and drug use among romantic partners. Number of negative life events was positively related to PD symptoms and to alcohol use disorder symptoms. Executive cognitive functioning was not related to SUD and PD symptoms in the expected direction. Findings suggest that, among higher functioning young adults, environmental factors may be particularly relevant to our understanding of SUDs and certain PDs.

Adult↗
PubMed1999

Systematic chart review of the pharmacologic treatment of comorbid attention deficit hyperactivity disorder in youth with bipolar disorder.

The objective of this study was to evaluate pharmacological approaches for attention deficit hyperactivity disorder (ADHD) in children with bioplar disorder and comorbid ADHD. The medical charts of 38 patients with diagnoses of both Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised ADHD and bipolar disorder were reviewed over multiple visits to assess improvement and prescription patterns. Logistic regression was used to model the probability of improvement at each visit, and robust standard errors were estimated in order to account for correlation among individuals using Huber's correction for clustered data. The proportion of visits at which ADHD symptoms were rated as improved following initial improvement in manic symptoms was 7.5 times greater than before initial improvement of manic symptoms. The recurrence of manic symptoms following their initial stabilization significantly inhibited ADHD response to medication. Although tricyclic antidepressants (TCAs) significantly increased the probability of ADHD improvement following mood stabilization, there was also a significant association between treatment with TCAs and relapse of manic symptoms. Our results support the hypothesis that mood stabilization is a prerequisite for the successful pharmacologic treatment of ADHD in children with both ADHD and manic symptoms. Although TCAs can be helpful in the management of ADHD children with manic symptoms, these drugs should be used with caution since they can also have a destabilizing effect on manic symptoms.

Adolescent↗
PubMed2006

Clozapine use and relapses of substance use disorder among patients with co-occurring schizophrenia and substance use disorders.

BACKGROUND: Previous correlational research with schizophrenic patients has suggested that the second-generation antipsychotic medication clozapine helps to induce remissions of substance use disorder in patients with co-occurring psychosis and substance abuse. This research, however, could be biased by selection factors. Studying patients who are currently in substance abuse remission could control for level of motivation to stop using substances and other methodological confounds. METHODS: To test whether clozapine was associated with prevention of substance abuse relapses, we examined patients with schizophrenia or schizoaffective disorder who were in their first 6-month remission of substance use disorder during a prospective 10-year follow-up study. All patients received yearly multimodal assessments of substance use. Antipsychotic medications were prescribed by community doctors as part of usual clinical care. RESULTS: Patients using clozapine at the first 6-month period of substance abuse remission (n = 25) were much less likely to relapse over the next year compared with those on other antipsychotic medications (n = 70): 8.0% vs 40.0%, chi(2) = 8.73 (df = 1), P = .003. Although medication assignment was not randomized, several potential confounders were similar between the groups. CONCLUSION: Clozapine should be considered for the treatment of patients with schizophrenia and co-occurring substance use disorder to prevent relapses to substance abuse.

Adult↗
PubMed1995

Test of four hypotheses for the comorbidity of attention-deficit hyperactivity disorder and conduct disorder.

OBJECTIVE: To study the basis of the comorbidity of two common psychiatric disorders of childhood: attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD). METHOD: Subjects were 45 boys (aged 7 to 11 years) with either ADHD, CD, or ADHD + CD and 16 normal control children (NC) studied by means of a 2 (ADHD versus no ADHD) x 2 (CD versus no CD) design. We (1) tested whether similar or different patterns of cognitive, developmental risk, and psychosocial factors characterize the "pure" forms of the two disorders (i.e., ADHD and CD), and (2) compared the profile of the comorbid group (ADHD + CD) with those of the two pure groups. RESULTS: The ADHD group was significantly impaired on cognitive measures (inhibitory control and response alteration) and had greater delay in development and greater reading problems compared with CD and NC children; the CD group was exposed to significantly greater environmental adversity and had more severe problems in arithmetic than the ADHD and NC groups. The ADHD+CD group was similar to the ADHD group on cognitive, developmental, and reading measures and similar to the CD group on psychosocial and arithmetic measures. CONCLUSIONS: These results support the distinctiveness of ADHD and CD and the hypothesis that the comorbid condition of ADHD + CD is a hybrid of pure ADHD and pure CD.

Attention Deficit Disorder with Hyperactivity↗
PubMed1999

Risk for substance use disorders in youths with child- and adolescent-onset bipolar disorder.

OBJECTIVE: Previous work in adults has suggested that early-onset bipolar disorder (BPD) is associated with an elevated risk for substance use disorders (SUD). To this end, the authors assessed the risk for SUD in child- versus adolescent-onset BPD with attention to comorbid psychopathology. METHOD: All youths (aged 13-18 years) with available structured psychiatric interviews were studied systematically. From clinic subjects (N = 333), 86 subjects with DSM-III-R BPD were identified. To evaluate the risk for SUD and BPD while attending to developmental issues, the authors stratified the BPD sample into those with child-onset BPD (< or = 12 years of age, n = 50) and those with adolescent-onset BPD (13-18 years of age, n = 36). RESULTS: In mid-adolescence, youths with adolescent-onset BPD were at significantly increased risk for SUD relative to those with child-onset BPD (39% versus 8%; p = .001). Compared with those with child-onset BPD, those with adolescent-onset BPD had 8.8 times the risk for SUD (95% confidence interval = 2.2-34.7; chi 7(2) = 9.7, p = .002). The presence of conduct disorder or other comorbid psychopathology within BPD did not account for the risk for SUD. CONCLUSIONS: Adolescent-onset BPD is associated with a much higher risk for SUD than child-onset BPD, which was not accounted for by conduct disorder or other comorbid psychopathology. Youths with adolescent-onset BPD should be monitored and educated about SUD risk. The identification and treatment of manic symptomatology may offer therapeutic opportunities to decrease the risk for SUD in these high-risk youths.

Adolescent↗
PubMed2000

The Texas Children's Medication Algorithm Project: Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Attention-Deficit/Hyperactivity Disorder. Part I. Attention-Deficit/Hyperactivity Disorder.

OBJECTIVES: Expert consensus methodology was used to develop evidence-based, consensually agreed-upon medication treatment algorithms for attention-deficit/hyperactivity disorder (ADHD) in the public mental health sector. Although treatment algorithms for adult mental disorders have been developed, this represents one of the first attempts to develop similar algorithms for childhood mental disorders. Although these algorithms were developed initially for the public sector, the goals of this approach are to increase the uniformity of treatment and improve the clinical outcomes of children and adolescents with ADHD in a variety of treatment settings. METHOD: A consensus conference of academic clinicians and researchers, practicing clinicians, administrators, consumers, and families was convened to develop evidence-based consensus algorithms for the pharmacotherapy of childhood ADHD. After a series of presentations of current research evidence and panel discussion, the consensus panel met and drafted the algorithms along with guidelines for implementation. RESULTS: The panel developed consensually agreed-upon algorithms for ADHD with and without specific comorbid disorders. The algorithms consist of systematic strategies for psychopharmacological interventions and tactics to ensure successful implementation of the strategies. While the algorithms focused on the medication management of ADHD, the conference emphasized that psychosocial treatments are often a critical component of the overall management of ADHD. CONCLUSIONS: Medication algorithms for ADHD can be developed with consensus. A companion article will discuss the implementation of these algorithms.

Adrenergic alpha-Agonists↗
PubMed2002

Anxiety and depression symptoms and response to methylphenidate in children with attention-deficit hyperactivity disorder and tic disorder.

This study examined response to methylphenidate in children with attention-deficit/hyperactivity disorder (ADHD) and chronic multiple tic disorder. The primary goal was to determine if children with anxiety or depression symptoms showed a less favorable response to treatment. Subjects were 38 prepubertal children who participated in an 8-week, double-blind, placebo-controlled, methylphenidate crossover evaluation. Treatment effects were assessed with direct observations of child behavior in public school and clinic settings; rating scales completed by parents, teachers, and clinicians; and laboratory analogue tasks. There was little evidence (group data) that children with anxiety or depression symptoms responded in a clinically different manner to methylphenidate than youngsters who did not exhibit these symptoms, particularly in school observations of the core features of ADHD. Seeming differences between children with and without comorbid anxiety or depression symptoms and drug response are likely explained by differences in pretreatment levels of negativistic behaviors (i.e., symptoms of oppositional defiant disorder or conduct disorder). Methylphenidate appears to be effective for the management of ADHD behaviors in children with mild to moderate anxiety or depression symptoms; nevertheless, much research remains to be performed in this area.

Adolescent↗
PubMed1994

Confirmation of childhood abuse in child and adolescent cases of multiple personality disorder and dissociative disorder not otherwise specified.

The diagnostic validity of multiple personality disorder (MPD) and its association to trauma have been questioned because corroboration of child abuse in studies of patients with MPD is scant. The purpose of this study was to determine on a retrospective basis whether external corroboration of child abuse could be found in a group of patients with MPD and dissociative disorder not otherwise specified. A group of child and adolescent psychiatric inpatients and outpatients was chosen because of the extensive number of collateral records collected on them in a tertiary care setting. This group was also chosen because of the intense interest paid by child protective services and courts to child abuse during the past 15 years. This retrospective chart review confirmed child abuse in eight of nine patients with MPD and in all 12 cases of dissociative disorder not otherwise specified. This study provides further evidence of the association of severe dissociative disorders with trauma, particularly child abuse. Future studies should be prospective and blinded to avoid the possibility of investigator bias, and should include a control group for comparison of base rate of child abuse.

Adolescent↗
PubMed1993

Development of screeners for depressive disorders and substance disorder history.

If screeners are going to be widely incorporated in clinical care to increase the detection of common psychiatric disorders, they need to be brief, easy to score, and sensitive across diverse patient populations. Few screeners exist that meet these criteria. This problem is addressed in this study by identifying a subset of questions from the Diagnostic Interview Schedule (DIS), which predicted simultaneously obtained DIS diagnoses. A two-item screener to detect depression or dysthymia within the last year and three-item screeners for lifetime drug disorders and alcohol disorders were tested in community residents, medical, and mental health patients. The sensitivity of the depression screener ranged between 83% and 94%. The sensitivity of the drug screener ranged between 91% and 94%, excluding one site with an extremely low prevalence of drug problems. The sensitivity of the alcohol screener ranged between 87% and 92%. Specificity for all three screeners exceeded 90% in community and medical samples, while being somewhat lower among mental health patients. These findings indicate that these brief screeners may be useful in a variety of epidemiologic studies to provide estimates of common psychiatric disorders when complete diagnostic interviews are not feasible. If further validation studies support these sensitivity and specificity estimates, these new instruments may also be valuable as initial brief screeners in a two-stage screening process to improve clinicians' recognition of common mental health problems that complicate case management and impair patient functioning.

Adult↗
PubMed1994

Clonidine therapy for comorbid attention deficit hyperactivity disorder and conduct disorder: preliminary findings in a children's inpatient unit.

This retrospective study examined the clinical course of 18 prepubertal boys (aged 6 to 12) who had dual diagnoses of attention deficit hyperactivity disorder and conduct disorder and who received clonidine on an inpatient basis after failed trials of conventional drug therapy, consisting predominantly of psychostimulants. The effects of clonidine were assessed during inpatient treatment and after discharge at intervals of 1 to 2 months. Eleven (61%) of the children had marked improvement as measured by clinical impression. Transient sedation lasting 2 to 3 days occurred after initial administration or dosage increase; otherwise, clonidine was well tolerated. Our findings suggest that clonidine may prove to be an alternative treatment of comorbid attention deficit hyperactivity disorder and conduct disorder.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

Association study of a null mutation in the dopamine D4 receptor gene in Italian patients with obsessive-compulsive disorder, bipolar mood disorder and schizophrenia.

Although serotonergic dysregulation is a leading pathogenetic hypothesis for obsessive-compulsive disorder (OCD), some evidence also suggests a possible dysregulation of the dopaminergic system in this disorder. Therefore, individual differences in deoxyribonucleic acid (DNA) coding for dopamine receptor proteins might contribute to the genetic background of this disorder. Previously we reported a null mutation in exon 1 of the dopamine D4 receptor gene. The variant type is characterized by a 13 bp deletion and is predicted to code for a truncated, non-functional receptor. We assessed the frequency of this polymorphism in 157 OCD patients, 196 schizophrenics, 111 bipolars and 162 healthy controls of Italian descent. Our findings do not implicate a role for this mutation in conferring a susceptibility to OCD and confirm previous negative results regarding its involvement in schizophrenia and bipolar disorder.

Bipolar Disorder↗