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PubMed1996

Body posture photographs as a diagnostic aid for musculoskeletal disorders related to temporomandibular disorders (TMD).

The purpose of this study was to test the hypothesis that body posture could be an etiologic factor in patients with temporomandibular disorders. "Faculty" body posture has been considered to be an initiating and perpetuating etiologic factor in some temporomandibular disorders (TMD). Although in patients with temporomandibular disorders a significant craniocervical dysfunction has been established, a causal relationship between posture and TMD has not yet been proved. Two samples of 40 subjects each were selected, age and gender matched. The experimental group consisted of 40 patients, who were not previously treated for temporomandibular dysfunction. TMD of these patients was diagnosed on the basis of a questionnaire and a thorough intra- and extraoral examination. The clinical symptoms of TMD were confirmed with transcranial x-rays and the condylar tracings of the performed axiography. A clinical examination was done to confirm the good health of the control group. In addition, symptoms of craniocervical dysfunction within the experimental group were evaluated to make a proper referral to a physical therapist. Four photographs of the orthostatic posture were taken. In accordance with anthropometric guidelines, the following anatomical landmarks were palpated and applied on the skin with a dark lipstick on forehand: both acromiones of the scapula and the anterior (ASIS) and posterior superior iliac spine (PSIS). Statistical testing was performed to confirm the data fit a normal distribution. The differences between the experimental group and the control group were tested with Student's two sample T-test. Within the experimental group, a significant correlation existed between the shoulder line and the pelvis line, on the frontal as well as on the dorsal photograph. The results suggest a somatic basis for the observed postural imbalances in patients with temporomandibular disorders. The results, however, must be interpreted with reservation.

Adolescent↗
PubMed1999

The prevalence of some joint disorders in craniomandibular disorder (CMD) and bruxers as compared to CMD nonbruxer patients and controls.

The objective of this study was to assess and compare the frequency of some joint disorders in 130 CMD + bruxing behavior patients, 66 CMD/nonbruxing behaviors patients referred for diagnosis and treatment to the Center for the Study of Craniomandibular Disorders and 130 control subjects seeking routine dental care. Both patients and controls were consecutive referrals to the clinic occurring over a five year period. The mean age of the CMD + bruxing behavior group was about 35.48 years (range 14-54, SD = 8.45), and 36.84 years (range 17-60, SD = 9.30) in the 66 CMD nonbruxing behavior group, and 34.34 years (range 14-62, SD = 9.92) in the control group of 130 subjects. Information gathered included a questionnaire, history of signs and symptoms, and a clinical examination. Different types of joint disorders, muscle signs and symptoms and bruxing behavior were assessed in the CMD groups and in the corresponding control group. The study concluded that capsulitis/synovitis, retrodiskal pain and disk-attachment pain predominated in CMD + bruxing behavior patients. The data reinforces the need to assess CMD + bruxing behavior patients to evaluate signs and symptoms of such disorders in order to obtain additional information about the true source of pain and the need for proper management.

Adolescent↗
PubMed2003

Genome scan meta-analysis of schizophrenia and bipolar disorder, part III: Bipolar disorder.

Genome scans of bipolar disorder (BPD) have not produced consistent evidence for linkage. The rank-based genome scan meta-analysis (GSMA) method was applied to 18 BPD genome scan data sets in an effort to identify regions with significant support for linkage in the combined data. The two primary analyses considered available linkage data for "very narrow" (i.e., BP-I and schizoaffective disorder-BP) and "narrow" (i.e., adding BP-II disorder) disease models, with the ranks weighted for sample size. A "broad" model (i.e., adding recurrent major depression) and unweighted analyses were also performed. No region achieved genomewide statistical significance by several simulation-based criteria. The most significant P values (<.01) were observed on chromosomes 9p22.3-21.1 (very narrow), 10q11.21-22.1 (very narrow), and 14q24.1-32.12 (narrow). Nominally significant P values were observed in adjacent bins on chromosomes 9p and 18p-q, across all three disease models on chromosomes 14q and 18p-q, and across two models on chromosome 8q. Relatively few BPD pedigrees have been studied under narrow disease models relative to the schizophrenia GSMA data set, which produced more significant results. There was no overlap of the highest-ranked regions for the two disorders. The present results for the very narrow model are promising but suggest that more and larger data sets are needed. Alternatively, linkage might be detected in certain populations or subsets of pedigrees. The narrow and broad data sets had considerable power, according to simulation studies, but did not produce more highly significant evidence for linkage. We note that meta-analysis can sometimes provide support for linkage but cannot disprove linkage in any candidate region.

Bipolar Disorder↗
PubMed2002

Is parental report of upper respiratory infection at the onset of obsessive-compulsive disorder suggestive of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection?

The diagnosis of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) requires a prospectively determined association between group A beta-hemolytic streptococcal (GABHS) infection and obsessive-compulsive disorder (OCD) or tic disorder. Screening for GABHS infection imposes a significant burden on both patient and clinician. To heighten the index of suspicion for PANDAS, it would be useful to know if parent-reported upper respiratory infection (URI) is associated with PANDAS symptoms or associated characteristics. Eighty-three consecutive, clinically referred patients aged 6 to 17 years with a primary diagnosis of OCD and their primary caregivers were asked about URI signs and symptoms at the time of OCD onset, PANDAS symptoms, OCD and tic symptoms, comorbidity, and putative PANDAS risk factors. Specific inquiry regarding URI symptoms proved more informative than general inquiry. In the URI present versus URI absent group, more patients experienced a sudden rather than insidious onset of symptoms. Additionally, more patients with a URI plus sudden onset exhibited a comorbid tic disorder. Until validated biomarkers permit retrospective diagnosis, a history that OCD began around the time of a URI should clue the clinician to look prospectively for PANDAS. Additional research is required to define the boundaries of PANDAS and to develop psychometrically reliable and valid diagnostic strategies.

Adolescent↗
PubMed1993

Desipramine treatment of children with attention-deficit hyperactivity disorder and tic disorder or Tourette's syndrome.

OBJECTIVE: As many as 50% of patients with Tourette's syndrome (TS) also meet diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Since antipsychotics are of limited value in controlling the symptoms of ADHD and stimulants can exacerbate tics, alternative treatments are directly needed. The purpose of this study was the examination of the efficacy of desipramine (DMI) in the treatment of pediatric patients with chronic tic disorder (CTD; TS or chronic motor tics) + attention-deficit hyperactivity disorder (ADHD). METHOD: All pediatric patients with the diagnosis of CTD that were treated with DMI were ascertained from retrospective systematic chart reviews of a psychopharmacology clinic and a neurology service specialized in movement disorders. RESULTS: Of the 33 identified patients, 30 had comorbid CTD + ADHD and three had CTD alone. In all, 82% had significant improvement in CTD symptomatology and 80% significantly improved ADHD symptoms without major adverse effects over an average follow-up period of 16 months. CONCLUSIONS: Although the conclusions from this retrospective report can be seen as preliminary only until replicated in a controlled investigation, the magnitude and persistence of the response is encouraging and suggest a therapeutic role for DMI in the treatment of CTD + ADHD patients.

Adolescent↗
PubMed2002

Three-year course of learning disorders in special education students classified as behavioral disorder.

OBJECTIVE: To investigate the 3-year course of learning disorders (LDs) and academic achievement in a sample of students with psychiatric disorders who were newly classified by the special education category of behavioral disorder (BD). METHOD: The occurrence of four definitions for LD (both discrepancy and low achievement) based on the WISC-R and the Woodcock-Johnson Psychoeducational Battery was followed in 81 students with BD from the time of their enrollment in BD classes to their first reevaluation after 3 years. Odds ratios (ORs) were used to measure stability of LDs in these students. RESULTS: The prevalence of any LD was 64.2% at baseline and 61.7% at follow-up. Most of the 10 possible LD categories showed significant ORs, and the average OR was 21.9. At follow-up after 3 years, students both with and without LD at baseline had approximately the same achievement standard scores in reading and mathematics, but a significantly lower score for written language. Standard scores for the students without LD consistently were significantly higher than the scores for students with comorbid LD. CONCLUSION: LDs in this unique sample of students with psychiatric disorders remained common and generally stable over the first 3 years.

Adolescent↗
PubMed1995

Informed consent for the prosthodontic patient with temporomandibular disorders. Report of the Committee on Temporomandibular Disorders of the American College of Prosthodontists.

The prosthodontic treatment of patients with a history of temporomandibular disorders presents unique risk-management problems because of the varied nature, uncertain prognosis, and frequent recurrence of these disorders. Patients with temporomandibular disorders frequently require managed treatment over extended periods of time and may complicate the delivery and outcome of prosthodontic treatment. Informed consent is needed to protect both the patient and the prosthodontist because it facilitates proper communication, goal setting, and cooperation. The purpose of this article is to discuss the essential elements of informed consent and to present an informed consent program useful in the prosthodontic treatment of patients with temporomandibular disorders.

Dental Care for Chronically Ill↗
PubMed1997

Organic delusional disorder in psychiatric in-patients: comparison with delusional disorder.

Organic delusional disorder (ODD) is rarely diagnosed in psychiatric in-patients, and may be misdiagnosed as delusional disorder (DD) from a similar clinical presentation. The aim of the present study was to investigate the characteristics of ODD and to make a comparison with those of DD patients. Patients who conformed to DSM-III-R criteria for ODD were recruited from an 8-year psychiatric in-patient database. Matching controls were DD patients admitted over the same time period. The prevalence of ODD according to DSM-III-R criteria was 0.4% of total admissions and 2.9% of organic mental disorders. Compared to DD patients, ODD patients less often had a family psychiatric history, and had an older age of onset of psychiatric disorder, longer hospital stays and lower treatment dosage of antipsychotic drugs. It is suggested that a detailed medical history and examination are needed in patients with delusion, especially in patients with a late onset of psychiatric symptoms and no family psychiatric history.

Adult↗
PubMed1968

Sleep disorders: disorders of arousal? Enuresis, somnambulism, and nightmares occur in confusional states of arousal, not in "dreaming sleep".

In summary, the classical sleep disorders of nocturnal enuresis, somnambulism, the nightmare, and the sleep terror occur preferentially during arousal from slow-wave sleep and are virtually never associated with the rapid-eye-movement dreaming state. Original data are reported here which indicate that physiological differences from normal subjects, of a type predisposing the individual to a particular attack pattern, are present throughout the night. The episode, at least in the case of enuresis, appears to be simply a reinforcement of these differences to a clinically overt level. A number of features are common to all four sleep disorders. These had been shown previously to be attributable to the arousal itself. New data obtained by means of evoked potential techniques suggest that these common symptoms of the confusional period that follows non-REM sleep are related to alterations of cerebral reactivity, at least of the visual system. The symptoms which distinguish the individual attack types (that is, micturition, prolonged confusional fugues, overt terror) appear to be based upon physiological changes present throughout sleep which are markedly accentuated during arousal from slow-wave sleep. These changes may in some way be related to diurnal psychic conflicts. But, to date, it has proved impossible to demonstrate potentially causal psychological activity, dreaming or other forms of mental activity, or even a psychological void in sleep just preceding the attacks. The presence of all-night or even daytime predisposing physiological changes and the difficulty in obtaining any solid evidence of a preceding psychological cause explain, no doubt, why the results of efforts to cure the disorders at the moment of their occurrence (for example, by conditioning procedures in nocturnal enuresis) have been far from satisfactory. I stress the points that the attacks are best considered disorders of arousal and that the slow-wave sleep arousal episode which sets the stage for these attacks is a normal cyclic event. Indeed it is the most intense recurrent arousal that an individual regularly experiences. The most fruitful possibilities for future research would appear to be more detailed studies of those physiological changes that predispose individuals to certain types of attacks when they undergo intense arousal or stress; the reversal of these changes by psychological or pharmacological means; and more refined investigations of the physiological and psychological characteristics of the process of cyclic arousal from non-REM sleep.

Adolescent↗
PubMed1997

Differential diagnosis between attention-deficit/hyperactivity disorder and pervasive developmental disorder--not otherwise specified.

The lack of clarity in diagnostic classification and the lack of specificity of assessment devices deter accurate identification of children with Pervasive Developmental Disorder-Not Otherwise Specified (PDD--NOS). The current study was designed to assess the utility of the Personality Inventory for Children (PIC) and the Conners Parent Rating Scale (CPRS-48) in differentiating PDD--NOS from Attention Deficit Hyperactivity Disorder (ADHD), disorders with overlapping symptom constellations. Subjects were 44 children recruited from a tertiary-care center with the diagnosis of ADHD or PDD--NOS. Results showed significant differences between groups on PIC scales assessing internalizing behaviors, social skills, and unusual affect and behavior. There were no group differences on the externalizing or learning scales of the CPRS-48. Discriminant function analysis using preselected PIC variables yielded a correct group classification of 92.7%. The PIC appears to be a useful tool in the differential diagnosis between PDD--NOS and ADD, while the CPRS-48, a commonly used screening measure for attentional and behavioral disorders, does not.

Attention Deficit Disorder with Hyperactivity↗
PubMed1992

Maximum likelihood estimates of the ability of the MMPI and MCMI personality disorder scales and the SIDP to identify personality disorders.

The ability of the Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI) personality disorder scales and the Structured Interview for DSM-III Personality Disorders (SIDP) to identify personality disorders was estimated statistically using 122 subjects. Each technique was reasonably accurate when various diagnoses were excluded, but they were quite variable in identifying members of specific diagnostic categories. The same general pattern was seen when the disorders were combined into three general diagnostic clusters. The techniques excluded cluster membership fairly well, although there was little agreement across techniques for identifying cluster membership. The MCMI, however, was moderately adept at identifying membership in all three clusters. It was suggested that these instruments should be used cautiously in clinical settings and that additional data on their performance be obtained.

Adult↗
PubMed1999

Personality and affectivity characteristics associated with eating disorders: a comparison of eating disordered, weight-preoccupied, and normal samples.

The purpose of this study was to assess the relative contribution of personality and emotional experience to self-reported eating attitudes in a group of patients with clinically diagnosed eating disorders, a weight-reduction training group (Weight Watchers), and a control group without body weight problems. Participants in this study (N = 114) completed Estonian versions of the Eating Disorder Inventory-2 (EDI-2; Garner, 1991), NEO Personality Inventory (Costa & McCrae, 1989), and Positive Affect and Negative Affect Schedule, Expanded Form (Watson & Clark, 1994). Data demonstrated validity of the Estonian version of EDI-2 in its ability to identify problems on a continuum of disordered eating behavior. Among the Big Five personality dimensions, Neuroticism made the largest contribution to EDI-2 subscales. Two other dimensions, Openness to Experience and Conscientiousness, also predispose individuals to eating problems. Personality traits made a larger contribution to the self-reported eating pathology than the self-rated effects experienced during the last few weeks. It was argued that personality dispositions have a larger relevancy in the etiology of eating disorders than emotional state.

Adolescent↗
PubMedDate not supplied

Impulsivity, suicidality and alcohol use disorders in adolescents and young adults with borderline personality disorder.

Borderline Personality Disorder (BPD) is a severe and disabling psychiatric condition that typically emerges in late adolescence or early adulthood. Nearly 50% of individuals with BPD have a co-occurring Alcohol Use Disorder (AUD) at some point in the course of their illness. This study explores clinical characteristics of adolescents and young adults (age 30 years and younger) with BPD and AUD (N=21) compared to BPD without any history of substance use disorders (N=17). Based on theoretical considerations and previous findings, we hypothesized that adolescents and young adults with BPD and AUDs would be more impulsive and exhibit higher rates of suicidal behavior than individuals with BPD and no substance use disorders. Consistent with our first hypothesis, the BPD/AUD group was more impulsive than the BPD only group. However, the two groups did not differ on measures of suicidal behavior. Overall, impulsivity was correlated with total number of suicide attempts in the adolescent/young adult group. When older BPD participants were included in the comparison (up to age 55), the BPD/AUD group exhibited more lifetime suicide attempts that were higher in medical lethality than the BPD only group, suggesting an overall increased lifetime suicide risk in the BPD/AUD group. The relationship between impulsivity, AUD, and suicidal behavior and lifetime suicide risk in adolescent and young adults with BPD is discussed.

Adult↗
PubMedDate not supplied

Is attention-deficit hyperactivity disorder in adults a valid disorder?

Concerns have been raised regarding the validity of the diagnosis of attention-deficit hyperactivity disorder in adults. The purpose of this report is to evaluate critically whether this diagnosis in adults meets acceptable standards for diagnostic validity. A systematic search was conducted of the psychiatric and psychological literature for empirical studies dealing with adult attention-deficit hyperactivity disorder with childhood onset. These studies were examined for evidence of descriptive, predictive, and concurrent validity. The literature shows that this disorder can be reliably diagnosed in adults and that the diagnosis confers considerable power to forecast complications and treatment response. In addition, evidence is mounting for genetic transmission, specific treatment responses, and abnormalities in brain structure and function in affected individuals. Evidence from the literature is increasingly pointing to the validity of adult attention-deficit hyperactivity disorder.

Adult↗
PubMed2000

Acute Stress Disorder Scale: a self-report measure of acute stress disorder.

The Acute Stress Disorder Scale (ASDS) is a self-report inventory that (a) indexes acute stress disorder (ASD) and (b) predicts posttraumatic stress disorder (PTSD). The ASDS is a 19-item inventory that is based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) criteria. The ASDS possessed good sensitivity (95%) and specificity (83%) for identifying ASD against the ASD Interview on 99 civilian trauma survivors. Test-retest reliability of the ASDS scores between 2 and 7 days was strong (r = .94). The ASDS predicted 91% of bushfire survivors who developed PTSD and 93% of those who did not; one third of those identified by the ASDS as being at risk did not develop PTSD, however. The ASDS shows promise as a screening instrument to identify acutely traumatized individuals who warrant more thorough assessment for risk of PTSD.

Acute Disease↗
PubMedDate not supplied

[Early prevention of externalizing disorders--basic principles and parent-centered approaches to prevention of expansive childhood behavior disorders].

Conduct disorder is an area of mental disorder, in which prevention seems to be advisable for different reasons. First, relevant factors that help identifying a population at risk are well-known. Second, a number of research efforts showed negative developmental trajectories for children with early conduct disorder, and third, we have effective treatment programs that facilitate deriving prevention strategies. This paper first describes results which clarify the need for prevention. Then basic principles and contents of effective prevention programs for conduct disorder are described. Finally, four behaviorally oriented examples from the numerous existing universal, selected and indicated prevention programs are illustrated and discussed.

Adolescent↗
PubMed2002

[Attention deficit disorder, hyperkinetic disorder and DAMP in children. Diagnosis and differential diagnosis].

INTRODUCTION: The aim was to evaluate the diagnostic methods and differential diagnostic spectrum in children admitted for ADHD (attention-deficit hyperactivity disorder), hyperkinetic disorder, or DAMP (deficit in attention, motor control and perception), including evaluation of the factors that are of greatest value in making a diagnosis. MATERIAL AND METHODS: Data were recorded on admission and again after 12-15 months for all children admitted for suspected attention deficit to the children's department, Gentofte County Hospital in 1999. RESULTS: Of the 68 children admitted with the same behaviour, 27 had attention deficit (14 children with DAMP and 12 with ADHD) and 41 children had other disorders, including seven with pervasive developmental disorders, ten children who were mentally retarded, and 12 with psychosocial problems. DISCUSSION: The most important diagnostic method was a psychological investigation, if necessary in combination with a neuropsychological and/or motor examination. The Danish reference programme for children with DAMP seems the most reliable of the various diagnostic systems that exist today.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

[Patterns of service use for mental health disorders in Belgium. Results of the European Study on Epidemiology of Mental Disorders (ESEMeD)].

OBJECTIVE: To describe patterns of service use for emotional reasons or mental health in adult, non-institutionalised Belgians. METHOD: A representative random sample of non-institutionalised inhabitants from Belgium aged 18 or older (N = 2419) were interviewed between April 2001 and June 2002. The interview was performed by lay interviewers using the most recent version of the Composite International Diagnostic Interview (CIDI-2000). Apart from assessing mental disorders, the participants were asked to report their formal health services utilization due to their emotions or mental health in the past 12 months. RESULTS: About 11% reported the presence of a mental disorder in the past 12 months, of which one in three consulted a formal health service. Persons with a mood disorder were most likely to seek help (43%), followed by those with anxiety (38%) or an alcohol disorder (17%). General practitioners were consulted most often, sometimes combined with a psychiatrist. Among those who sought help, the majority received pharmacological treatment (sometimes combined with psychological treatment), and up to 25% did not receive any treatment. CONCLUSION: The utilization of formal health services for emotional raisons or mental health is very limited in Belgium. Moreover, a considerable proportion of those who sought help, did not get an appropriate treatment.

Adolescent↗