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PubMed1997

Antisocial traits in psychiatrically ill veterans without antisocial personality disorder: relationship to Axis I disorders and effects on functioning.

The prevalence of antisocial traits was investigated in a group of veterans who were in treatment at an out-patient psychiatric clinic and who did not meet diagnostic criteria for an antisocial personality disorder. Standardized DSM-III-R interviews were used to diagnose Axis I disorders and antisocial personality disorders and traits. Frequencies of antisocial traits were compared between patients and controls as well as between diagnostic subgroups in the clinical population. Odds ratios were used to assess the effect of antisocial traits on several standardized measures of functioning. There was no overall difference in the dimensional measure of antisocial traits between the clinical and normal groups. There were trends for the frequency of individual traits to vary by Axis I diagnosis. The amount of antisocial traits (measured dimensionally) negatively affected measures of functioning for the overall clinical population. Different specific antisocial traits were associated with trends towards poorer functioning in the alcohol, major depression and post-traumatic stress syndrome subgroups. It is recommended that future research in the area of antisocial traits pay careful attention to the possible negative effects on functioning of subthreshold antisocial traits and also to Axis I comorbidity.

Alcoholism↗
PubMed1997

Influences on adolescent substance dependence: conduct disorder, depression, attention deficit hyperactivity disorder, and gender.

OBJECTIVE: In adolescents, conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), and depression are frequently comorbid with substance dependence (SD). We hypothesized that the prevalence and severity of CD, major depressive disorder (MDD), and ADHD would differ by gender, and that these conditions would associate differentially with severity of SD in males and females. METHODS: We examined these issues, using standardized diagnostic interviews, in 285 male and 82 female adolescents referred for comorbid CD and SD. RESULTS: Males and females did not differ significantly in severity of substance involvement, MDD, or ADHD, but males had more severe CD. MDD severity was the only variable significantly associated with SD severity for females, while for males, severity of CD combined with MDD and ADHD was significantly associated with SD severity. CONCLUSIONS: Among referred adolescents, CD, MDD, and ADHD may all be important concomitants of SD in males, while in females, depression may be the primary variable related to SD.

Adolescent↗
PubMed2003

A systematic review of the behavioral effects of levetiracetam in adults with epilepsy, cognitive disorders, or an anxiety disorder during clinical trials.

This report reviews behavioral adverse events occurring among adults receiving levetiracetam (LEV) or placebo who participated in short-term, placebo-controlled studies in epilepsy (1023), cognitive disorders (719), or anxiety disorders (1510) and epilepsy patients (1393) observed in long-term trials. Behavioral events (affective, psychotic, and suicidal symptoms) were significantly more common among epilepsy patients than cognition or anxiety patients treated with LEV for similar durations (P=0.022). Affective symptoms occurring at 1% or more often in epilepsy placebo-controlled trials included depression (3.8% LEV-2.1% placebo), nervousness (3.8%-1.8%), hostility (2.3%-0.9%), anxiety (1.8%-1.1%), and emotional lability (1.7%-0.2%). Patients with cognitive and anxiety disorders had lower incidences of these symptoms. The incidence of behavioral events in LEV-treated epilepsy patients was lower than rates reported for some other antiepileptic drugs. These data support the hypothesis that some feature related to epilepsy is the cause of many behavioral events rather than the addition of a specific antiepileptic drug.

Humans↗
PubMed2004

The effects of emotional salience on thought disorder in patients with bipolar affective disorder.

BACKGROUND: This study aimed to explore the effects of emotionally salient material on thought disorder in patients with bipolar affective disorder. METHOD: Seventy-one participants (20 manic, 15 depressed, 16 currently well patients and 20 non-psychiatric-controls) were interviewed in two conditions: an emotionally salient interview and a non-salient interview. Speech samples were rated using the Scale for the Assessment of Thought, Language and Communication. RESULTS: Manic patients presented with significantly more thought disorder than any other group in both conditions and exhibited the greatest reaction to emotionally salient material. CONCLUSION: The effects of emotional salience on thought, language and communication are not unique to schizophrenic patients. The speech of manic patients is more affectively responsive than the speech of remitted, bipolar depressed and normal participants. The implications of these findings are discussed.

Adult↗
PubMed2005

A comparison of gains after treatment at a psychiatric outpatient clinic in patients with cluster A + B, or cluster C personality disorders, and non-psychotic axis I disorders.

Few studies exist on the outcome of patients with personality disorders (PDs) treated at ordinary outpatient clinics. This study examines the gains of such patients 2 years after treatment start at an outpatient clinic. Three patient groups were sampled: cluster A + B PDs, cluster C PDs and axis I disorders. Fifty-eight patients (53%) were amenable to follow-up, and they did not show less psychopathology than the non-compliers. All patients had structured interviews and filled in questionnaires. Patients in the PDs cluster A + B group showed considerable gains, while that was not found for the PDs cluster C and Axis I disorder groups. Since almost all patients received long-term psychotherapy sometimes combined with antidepressant drugs, the finding that such a treatment mainly shows gains in more severely disturbed PDs patients should be replicated in larger samples at ordinary psychiatric outpatient clinics.

Adolescent↗
PubMed1998

Illness intrusiveness in individuals with panic disorder, obsessive-compulsive disorder, or social phobia.

To measure the extent to which anxiety disorders interfere with various domains of functioning, the Illness Intrusiveness Ratings Scale (IIRS) was completed by individuals with a DSM-IV principal diagnosis of panic disorder (PD; N = 35), obsessive-compulsive disorder (OCD; N = 51), or social phobia (SP; N = 49). Although the three groups did not differ on total IIRS scores, group differences did emerge for particular domains of functioning. Patients with OCD reported significantly more interference with respect to passive recreation (e.g., reading) than did SP patients and with respect to religious expression compared with both PD and SP patients. Patients with SP reported more impairment with respect to social relationships and self-expression/self-improvement compared with the other two groups. When compared with populations with a variety of other chronic illnesses, patients in the present study reported much higher levels of illness intrusiveness. The implications of these findings and future directions for research are discussed.

Adult↗
PubMed1994

Children with autistic spectrum disorder and a family history of affective disorder.

This paper compiles the clinical behavioral phenomenology of individuals with autistic spectrum disorder (ASD) with a family history of bipolar affective disorder (BPAD) or major depression and no identified neurological disorder, based on repeated clinical interviews during extended follow-up (ranging from six months to 21 (mean 3.9) years. Their pattern of affective and cognitive symptoms showed notable similarities across the entire group, despite wide variations in severity; was congruent with standard definitions of ASD; showed many features of childhood BPAD, including affective extremes, cyclicity, obsessive traits, special abilities, and regression after initial normal development; and differed from that of autistic children with neurological etiologies. These observations support the concept that ASD in some cases may be etiologically related to BPAD.

Adolescent↗
PubMedDate not supplied

A second visually impaired, mentally retarded male with pervasive developmental disorder, Tourette disorder and Ganser's syndrome: diagnostic classification and treatment.

The authors report a second visually impaired, mentally retarded male who presents with symptoms consistent with atypical pervasive developmental disorder, Tourette disorder, and a syndrome of approximate answers (Ganser's syndrome). Both this case and an earlier reported case are significant in that they identify two children with strikingly similar long-standing symptoms and developmental histories. Since these findings may have broader relevance to children with multiple coexisting disorders, diagnostic and intervention strategies in this population are reviewed.

Adolescent↗
PubMed2001

A retrospective review of clinical characteristics and treatment response in body dysmorphic disorder versus obsessive-compulsive disorder.

BACKGROUND: Although body dysmorphic disorder (BDD) has many features in common with obsessive-compulsive disorder (OCD) and is frequently comorbid with OCD, few studies have directly compared the 2 disorders. Although BDD and OCD respond to similar medications and cognitive-behavioral therapy (CBT), their response to treatment has never been directly compared. METHOD: We studied 107 consecutive patients with DSM-III-R OCD (N = 96) or BDD (N = 11) treated openly for 6 weeks with intensive CBT, medication, and psychosocial rehabilitation, in a specialized partial hospitalization program for severely ill OCD patients. All patients were assessed, before and after treatment, with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Global Assessment Scale (GAS). Retrospectively, we compared the clinical characteristics, symptom severity, and response to treatment of BDD patients with those of OCD patients. RESULTS: BDD patients and OCD patients had similar sex ratio, age, treatment duration, prevalence of comorbid major depression, and pretreatment Y-BOCS and GAS scores. BDD patients had significantly higher pretreatment HAM-D and HAM-A scores. The proportions of patients treated with serotonin reuptake inhibitors and antipsychotics did not differ between groups. Both groups improved with treatment, with significant (p < .001) changes in Y-BOCS, HAM-D, HAM-A, and GAS scores. Change in Y-BOCS did not differ between groups, but changes in HAM-D and HAM-A were significantly greater in BDD patients than in OCD patients. CONCLUSION: While BDD may be associated with greater severity of depressive and anxiety symptoms than OCD, this study suggests that BDD may respond to intensive, multimodal treatment.

Adult↗
PubMed1989

[Borderline schizophrenia and cyclothymic disorder associated with disorders of the menstrual cycle].

Clinico-pathological investigation of borderline schizophrenia (42 women) and cyclothymia (22 women) with concomitant disorders in menstrual function was performed in a regional out-patient gynecological department. Major types of the course of mild psychopathology were identified which involve the endocrine gynecological dysfunction. Functional disorders of the menstrual cycle are seen as a class of numerous somatic signs masking the psychopathology in its proper sense in mental diseases and emerging at the edge of "soft" endogenous mental disorder. The authors postulate that the central nervous system regions responsible for child birth are involved into these forms of mental pathology. The issues of differentiating these ailments involving gynecological dysfunction from the true endocrine-gynecological pathology are discussed.

Adult↗
PubMedDate not supplied

[Sleep disorders in patients with personality disorders].

63 patients with personality disorders have been hospitalized in a Sleep Disorder Clinic. Sleep disorders usually started during childhood, disappeared ant the reappeared around the age of 25. The polysomnographic data do not show a specific profile. Most of the patients were of the schizotypal or the borderline type. Therapeutic guidelines are presented.

Adult↗
PubMed1995

Phenomenology of intentional repetitive behaviors in obsessive-compulsive disorder and Tourette's disorder.

BACKGROUND: Recent evidence suggests that obsessive-compulsive disorder (OCD) and Tourette's disorder are related and have overlapping clinical features. The purpose of this study was to test the following hypotheses regarding intentional repetitive behaviors in these two disorders: (1) In OCD without comorbid Tourette's, they are preceded by cognitive phenomena and autonomic anxiety, but not sensory phenomena, and (2) in Tourette's without comorbid OCD, they are preceded by sensory phenomena, but not cognitive phenomena nor autonomic anxiety. METHOD: Fifteen adult OCD outpatients without tics and 17 adult Tourette's outpatients without OCD were evaluated with a structured interview. Questions assessed cognitive, sensory, and affective experiences related to intentional repetitive behaviors. RESULTS: Five of 17 Tourette's subjects were excluded because they had only unintentional or occasionally intentional tics. All OCD patients reported some cognitions preceding their intentional repetitive behaviors, whereas only 2 of 12 Tourette's patients reported cognitions. In comparison, all Tourette's patients reported sensory phenomena preceding repetitive behaviors, and none of the OCD patients reported such sensations. In addition, 13 OCD patients reported at least mild autonomic anxiety associated with their repetitive behaviors, whereas no Tourette's patients reported such symptoms. CONCLUSION: Intentional repetitive behaviors in OCD differ from those in Tourette's and are associated with cognitive and autonomic phenomena. Sensory phenomena preceded intentional repetitive behaviors in Tourette's but not in OCD patients. The dimensions examined in this study (cognition, sensory phenomena, and autonomic anxiety) may represent valid clinical factors for characterization of repetitive behaviors in OCD and Tourette's.

Adult↗
PubMed1998

Cross-cultural validity of the Eating Disorder Inventory: a study of Chinese patients with eating disorders in Hong Kong.

OBJECTIVE: To evaluate the cross-cultural validity of the Chinese version of the Eating Disorder Inventory (EDI) in a clinical sample of patients with eating disorders in Hong Kong. METHOD: After comprehensive clinical assessment, a consecutive series (1990-1996) of Chinese patients with bulimia nervosa (N = 17) and broadly diagnosed anorexia nervosa (N = 26) completed the Chinese EDI. Results were compared with those of Chinese female undergraduates (N = 606) and Canadian patients with eating disorders. RESULTS: The EDI profiles of bulimic and fat phobic anorectic patients were remarkably and modestly similar to those of their Canadian counterparts. The EDI meaningfully distinguished bulimic patients and fat phobic anorectic patients from local undergraduates, but exhibited deficient criterion-related validity in nonfat phobic anorectic patients. DISCUSSION: The questionable validity of certain EDI subscales in nonfat phobic patients reflects the ethnospecific constructs upon which they are based, and weakens the efficacy of the EDI in screening for anorexia nervosa in Chinese populations. Apart from illustrating some of the conceptual and methodological issues that need to be tackled in the cross-cultural study of the eating disorders, this study furnishes empirical support for the syndromal homogeneity of bulimia nervosa, and the clinical grouping of anorexia nervosa into fat phobic and nonfat phobic subtypes.

Adult↗
PubMed1995

Onset of binge eating, dieting, obesity, and mood disorders among subjects seeking treatment for binge eating disorder.

Binge eating disorder (BED) identified in adulthood is often clinically associated with obesity and a lifetime history of affective disorders. Several authors have suggested that dieting may predispose individuals to binge eating which then may lead to obesity. However, few BED studies have examined the chronology of the onset of binge eating, dieting, obesity, and mood disorders. This study evaluated retrospective reports from 30 women participating in a BED treatment study. Although the majority of subjects in this adult sample were obese, initiation of binge eating behavior usually occurred during adolescence at a time when most subjects reported being of normal weight. Obesity developed several years after the age of onset of meeting BED criteria. Onset of binge eating usually predated that of dieting or major depressive disorder in the majority of subjects. The results support the importance of early intervention for binge eating.

Adolescent↗
PubMed2003

Panic disorder in public sector primary care: clinical characteristics and illness severity compared with "mainstream" primary care panic disorder.

The prevalence of anxiety disorders is increased among low-income individuals, who are more likely to seek mental health care in medical as opposed to specialty settings because of limited insurance access and restricted availability of public sector mental health resources. However, little is known about the clinical characteristics and illness severity of anxiety disorders in this setting. We studied the clinical characteristics of low-income compared with middle-income primary care panic patients. Clinical, functional, and service use measures obtained at baseline interview in 39 panic disorder patients seen in one public sector medical clinic were compared with 76 patients seen in two middle-income clinics. All patients were participants in a randomized effectiveness pharmacotherapy trial [Roy Byrne et al., Arch Gen Psychiatry 2001;58:869-876]. Public sector patients were more often older, male, single, unemployed, of lower income, and non-Caucasian ethnicity. They had more severe clinical symptoms, more medical comorbidity, worse physical and role health status, and more emergency room visits. Low income and unemployment accounted for most of the differences in non-anxiety-related measures. However, type of clinic still contributed independently to the greater severity of specific measures of panic/anxiety (Panic Disorder Severity Scale and Marks Fear Scale scores), suggesting that the increased stress and limited social resources associated with low-income and disadvantaged status may have more specific effects on anxiety than other aspects of psychopathology.

Adolescent↗
PubMed2004

Social anxiety disorder in callers to the Anxiety Disorders Association of America.

Social anxiety disorder (SAD) is among the most common anxiety disorders with a lifetime prevalence of up to 16%. Among callers to the Anxiety Disorders Association of America (ADAA), we surveyed 1,000 participants using a 97-item questionnaire to understand the characteristics of participants with SAD and subthreshold SAD (SSAD). Current prevalence rates of SAD (n=295) and SSAD (n=41) were 29.5% and 4.1%, respectively. SAD and SSAD participants were more likely to be younger, single, with less education and lower income than their no axis-I-psychiatric-disorder controls (NAC). In addition, they presented with more psychiatric comorbidity, lifetime numbers of trauma, recent psychotropic use and side effects. Increased medical comorbidity, health service utilization, as well as reduced work productivity were also found, particularly among SAD participants. SSAD participants were comparable to SAD participants for most of the measures with a few exceptions, mainly less psychiatric comorbidity, less medication use for panic attack and social fear, and fewer visits to the health professionals. In conclusion, SAD was highly prevalent among callers to the ADAA. SAD participants were particularly impaired and tended to use the health care system extensively. Although SSAD participants were less impaired than those with SAD, they were disadvantaged in many ways. Early diagnosis and better treatment are urged for reducing costs and improving life. An organization such as ADAA can play a vital role in bringing this about.

Adult↗
PubMed2004

Reliability of the Eating Disorder Examination in patients with binge eating disorder.

OBJECTIVE: This study examined the interrater and test-retest reliabilities of the Eating Disorder Examination (EDE) in patients with binge eating disorder (BED). METHOD: Interrater reliability and short-term (6-14 days) test-retest reliability of the EDE were examined in two study groups of 18 patients with BED. RESULTS: Interrater reliability was excellent for objective bulimic episodes and days (correlations above .98) and very good for the EDE scales, albeit somewhat variable (correlations range from .65 to .96). Test-retest reliabilities were very good for objective bulimic episodes (.70) and days (.71) and were good (significant) for the EDE scales, albeit somewhat variable (correlations range from .50 to .88). Interrater reliability was excellent for subjective bulimic episodes and days but test-retest reliabilities were unacceptable. CONCLUSIONS: These findings support the reliability of the EDE for patients with BED. The EDE has utility for assessing the number of large binge episodes (objective bulimic episodes), as well as the number of days during which large binge episodes occurred. The EDE also demonstrates very good interrater and test-retest reliabilities for assessing the associated features of eating disorders in patients with BED. The results for subjective bulimic episodes are consistent with previous studies, suggesting that these eating behaviors may not be reliable indicators of eating disorders.

Adult↗
PubMed2007

A retrospective comparison of purging type disorders: eating disorder not otherwise specified and bulimia nervosa.

OBJECTIVE: In light of recent research indicating the clinical significance of eating disorder not otherwise specified-purging only (EDNOS-P), differences between women with lifetime bulimia nervosa purging subtype (BN-P) and EDNOS-P were examined. METHOD: Three groups of women were examined, a control group (n = 684) and two groups with lifetime eating disorders: BN-P (n = 22), and EDNOS-P (n = 53). RESULTS: Women with lifetime BN-P were significantly more likely to use vomiting than women with EDNOS-P but the latter group relied more on laxative abuse. Compared with controls, women with both eating disorders had higher weight and shape concern, dietary restraint, lifetime major depression, and suicidality. The BN-P group had significantly higher eating concern, dietary restraint, and suicidality than the EDNOS-P group. CONCLUSION: In accordance with previous research examining women with current eating disorders, EDNOS-P is indicated to be clinically significant. On the whole, the pattern of results indicated that EDNOS-P lies somewhere between BN-P and healthy controls in its clinical significance.

Adult↗