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PubMed1991

Avoidant and dependent personality traits in relatives of patients with panic disorder, patients with dependent personality disorder, and normal controls.

Psychiatric researchers have long wondered whether personality traits might predispose toward or be integral to Axis I illnesses. The question is difficult to address because acute illness can either create personality traits or distort their measurement. The present study bypassed that problem by examining personality traits in relatives of patients. Panic disorder, dependent personality disorder, and control subjects were the proband groups. A cluster of traits that appeared to reflect low social self-confidence combined with a desire for social interaction occurred significantly more often in relatives of patients in both groups.

Adult↗
PubMed2001

Bridging theory and practice: conceptual understanding of treatments for children with attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), autism, and depression.

Serves as an introduction to a special edition of the journal on bridging theory and clinical practice for childhood disorders. Issues concerning the current trend of developing and evaluating new treatments devoid of a theoretical perspective are discussed. A conceptual model of child psychopathology is presented to illustrate the relevance and interplay between theory and the design and evaluation of treatments with particular emphasis on the selection and measurement of target behaviors. The means by which theory and empirical evidence interact and their relevance to understanding particular childhood disorders are discussed and emphasize the need for theoretical and conceptual models that describe the linkages among hypothesized brain substrates, cognitive function, behavior, and the environment to augment the development of potent biological and psychological interventions.

Attention Deficit Disorder with Hyperactivity↗
PubMed1985

Birth-cohort trends in rates of major depressive disorder among relatives of patients with affective disorder.

As part of the National Institute of Mental Health-Clinical Research Branch Collaborative Program on the Psychobiology of Depression Clinical Study, 2,289 relatives of 523 probands with affective disorder were interviewed with the Schedule for Affective Disorders and Schizophrenia and diagnosed for major depressive disorder by the Research Diagnostic Criteria. Data were analyzed using life-table and survival methods. The findings suggest a progressive increase in rates of depression in successive birth cohorts through the 20th century and an earlier age at onset of depression in each birth cohort. A predominance of female depressives was found in all birth cohorts but the magnitude of female-male differences fluctuated over the decades. The existence of these trends is reported to stimulate further research. These findings are discussed in terms of possible gene-environment interactions. However, no conclusive causal inferences can be drawn pending further investigation.

Actuarial Analysis↗
PubMed2001

Linkage of bipolar disorder to chromosome 18q and the validity of bipolar II disorder.

BACKGROUND: An analysis of the relationship between clinical features and allele sharing could clarify the issue of genetic linkage between bipolar affective disorder (BPAD) and chromosome 18q, contributing to the definition of genetically valid clinical subtypes. METHODS: Relatives ascertained through a proband who had bipolar I disorder (BPI) were interviewed by a psychiatrist, assigned an all-sources diagnosis, and genotyped with 32 markers on 18q21-23. Exploratory findings from the first 28 families (n = 247) were tested prospectively in an additional 30 families (n = 259), and the effect of confirmed findings on the linkage evidence was assessed. RESULTS: In exploratory analyses, paternal allele sharing on 18q21 was significantly (P =.03) associated with a diagnostic subtype, and was greatest in pairs where both siblings had bipolar II disorder (BPII). Prospective analysis confirmed the finding that BPII-BPII sibling pairs showed significantly (P =.016) greater paternal allele sharing. Paternal allele sharing across 18q21-23 was also significantly greater in families with at least one BPII-BPII sibling pair. In these families, multipoint affected sibling-pair linkage analysis produced a peak paternal lod score of 4.67 (1-lod confidence interval, 12 centimorgans [cM]) vs 1.53 (1-lod confidence interval, 44 cM) in all families. CONCLUSIONS: Affected sibling pairs with BPII discriminated between families who showed evidence of linkage to 18q, and families who did not. Families with a BPII sibling pair produced an increased lod score and improved linkage resolution. These findings, limited by the small number of BPII-BPII sibling pairs, strengthen the evidence of genetic linkage between BPAD and chromosome 18q, and provide preliminary support for BPII as a genetically valid subtype of BPAD.

Age of Onset↗
PubMed1998

Personality disorders in patients with eating disorders in Japan.

We assessed the prevalence of personality disorders (PD) using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) in 36 patients with restricting anorexia nervosa, 30 patients with anorexia nervosa and bulimia nervosa, and 42 patients with bulimia nervosa. Of the 108 patients, 51% met the criteria for at least one PD. The patients with PD had more severe clinical features in terms of bulimic behaviors, concurrent depressive, anxious, and obsessive-compulsive symptoms, and psychopathology related to eating disorders compared to the patients without any PD. The patients with PD, especially borderline PD, also had more severe global functioning and greater numbers of suicidal attempts and hospital admissions. We compare these results with those reported in the Western world and discuss them cross-culturally.

Adolescent↗
PubMed2005

Family therapy for attention-deficit disorder or attention-deficit/hyperactivity disorder in children and adolescents.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is diagnosed in between 3% and 7% of school-age children and consists of the core symptoms of inattention, impulsivity and hyperactivity. Children are often treated with medication, usually stimulant medication such as methylphenidate. Stimulant medication has been found to be effective for alleviating ADHD symptoms, at least in the short term. ADHD is also treated with a variety of psychosocial and psychoeducational interventions for parents, children, and with multicomponent interventions combined with medication management. However, many patients (10 to 13% of patients) cannot or prefer not to take medication. Family therapy without medication may help to develop structure in the family, help to manage children's behaviour, and may help families cope with distress from the presence of the disorder. OBJECTIVES: This review seeks to address the question of whether family therapy without medication can reduce the core symptoms of ADHD as compared to no treatment or standard treatment. SEARCH STRATEGY: The following electronic databases were searched using a specific search strategy: The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to April 2004), PsycINFO (1872 to April 2004), CINAHL (1982 to April 2004), Biosis (Biological Abstracts) (1985 to March 2004), Dissertation Abstracts (1980 to April 2004), and Sociological Abstracts (Sociofile) (1963 to April 2004). Hand searches of relevant journals and bibliographies were also conducted and experts in the field were contacted for further information. SELECTION CRITERIA: Included studies were randomised controlled trials investigating the efficacy of behavioural family therapy, cognitive behavioural family therapy, or functional family therapy for children with ADHD or ADD (Attention Deficit Disorder). DATA COLLECTION AND ANALYSIS: Studies were evaluated for methodological quality and to determine whether they met the inclusion criteria. MAIN RESULTS: This assessment yielded two studies. Data were extracted for both studies. The findings from Jensen 1999 (N=579) indicate that no difference can be detected between the efficacy of behavioural family therapy and treatment as usual in the community. The finding from the available data from Horn 1991 slightly favours treatment over medication placebo. AUTHORS' CONCLUSIONS: Further research examining the effectiveness of family therapy versus a no-treatment control condition is needed to determine whether family therapy is an effective intervention for children with ADHD. There were no results available from studies investigating forms of family therapy other than behavioural family therapy.

Adolescent↗
PubMed2002

Comorbidity of obsessive-compulsive disorders and duration of eating disorders.

OBJECTIVE: This study explored the comorbidity of obsessive-compulsive disorder (OCD) and eating disorders (ED) and examined the relationship between OCD comorbidity and the duration of ED. Subjects with OCD were expected to show a longer history of ED. METHOD: ED females (N = 237; 84 with anorexia nervosa and 153 with bulimia nervosa) were assessed using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-1). Data were analyzed by logistic regression to determine whether OCD comorbidity is associated with duration of ED. RESULTS: The total sample showed a prevalence rate for OCD of 29.5%. OCD prevalence did not differ between anorexic and bulimic subjects. OCD comorbidity was significantly associated with a longer history of ED. CONCLUSION: The findings of the study support previous research indicating a high comorbidity of ED with OCD. The results also suggest that OCD may play a role in the course of ED. Prospective studies are necessary to examine this hypothesis further.

Adolescent↗
PubMed2005

Interpretation and use of weight information in the evaluation of eating disorders: counselor response to weight information in a National Eating Disorders Educational and Screening Program.

OBJECTIVE: Eating disorders are frequently undetected and inadequately treated in clinical settings. The current study investigated whether weight data were used appropriately in making recommendations for further care in the first National Eating Disorders Screening Program (NEDSP). METHOD: Accuracy of counselors' assessment of appropriateness of weight for height and adherence to an algorithm using weight to determine need for further evaluation were assessed for the 5,684 adult participants in a two-stage screening program held on college campuses. RESULTS: In 95% of cases, the counselors correctly used the algorithm developed for the NEDSP to assign participants to weight categories ranging from normal to extremely underweight. However, counselors were poorly adherent to an algorithm directing them to recommend urgent evaluation to all extremely underweight participants--that is, those with a weight at or below 75% of expected weight. Of the extremely underweight participants (n = 32), only 25.0% (n = 8) received an appropriate recommendation for urgent evaluation, whereas 59.4% (n = 19) received a recommendation for further (but nonurgent) evaluation, and 15.6% (n = 5) did not receive a recommendation to seek any evaluation. DISCUSSION: Clinicians appeared not to use weight data appropriately to make clinical recommendations for extremely underweight individuals. These results suggest that further specific emphasis on the health risks of extreme underweight may be helpful in training clinicians to manage patients with eating disorders.

Adolescent↗
PubMed2006

Lithium augmentation of topiramate for bipolar disorder with comorbid binge eating disorder and obesity.

OBJECTIVE: To evaluate the effectiveness of lithium augmentation of topiramate on mood symptoms, binge eating behavior, and body weight in obese bipolar patients with binge eating disorder (BED) seeking weight management. METHOD: We conducted a naturalistic study of 12 consecutive outpatients with bipolar disorders, BED, and obesity who received lithium augmentation for mood instability during the course of topiramate-based pharmacotherapy for obesity and BED. Lithium was added to topiramate (mean dose 514 mg i.d.) and titrated to a mean dose of 1009 mg i.d. (mean plasma concentration 0.7 mmol/L). Treatment response was assessed by comparing changes in clinical severity scales for mood and eating disorders, weekly binge eating frequency, and weight for the 2 months before and the first 2 months during lithium treatment. RESULTS: A statistically significant improvement in global severity of mood symptoms was observed after as compared to before lithium augmentation. Statistically insignificant reductions in weight and in binge frequency and severity were also observed after lithium addition. CONCLUSION: Optimal weight loss treatment in obese patients with comorbid bipolar and BEDs may require stabilization of mood. The combination of lithium and topiramate may have a role in the management of this difficult-to-treat population.

Adult↗
PubMed1997

Guidelines for the therapeutic use of botulinum toxin in movement disorders. Italian Study Group for Movement Disorders, Italian Society of Neurology.

Since its introduction in the early '80s the use of botulinum toxin has improved the quality of life of the patients affected by movement disorders. Toxin's neuromuscular blocking action allows a symptomatic treatment of those clinical conditions characterised by excessive muscular activity. Although the dosages used are safe and the side-effects are reversible, a correct use of botulinum toxin depends on the knowledge of its clinical pharmacology and of the anatomy of the body segments to be injected. In addition, the treatment of more complex conditions, i.e. laringeal dystonia, imposes an inter-disciplinary approach and specialised injection techniques. In this review, the Italian Study Group on Movement Disorders presents the consensus guidelines for the therapeutic use of botulinum toxin in movement disorders. The main toxin types, their use and administration modalities, and the training guidelines will be presented.

Botulinum Toxins↗
PubMed2001

[Factitious disorders. Hematologic, neurologic and dermatologic symptoms in a physician with factitious disorder].

HISTORY AND FINDINGS: A 38-year-old female physician was admitted with the suspected diagnosis of a myelodysplastic syndrome. The self-reported history was inconsistent and incoherent. On physical examination neurological and dermatological disorders could be found. EXAMINATIONS: A bone marrow puncture revealed a toxicity-induced bone marrow damage. Extensive examinations to evaluate the neurological symptoms did not show any pathological findings. A toxicological screening identified opioids, benzodiazepines and promethazine. TREATMENT AND COURSE: Because of the inconsistent history and the contradictory results of our clinical tests, we asked in other hospitals for past admissions and were thus able to have insight into a hospital career that grasped numerous different admission diagnoses. All presented symptoms, especially the bone marrow damage, were self-induced by the patient. CONCLUSIONS: For the first time in this patient's history, a factitious disorder was diagnosed after a hospital career of almost 10 years. In this publication, the case is thoroughly presented. Additionally, the current literature is reviewed with latest recommendations for therapeutic strategies about this poorly understood disorder.

Adult↗
PubMed2004

[Eating disorders in childhood and adolescence. Anorexia nervosa, bulimia nervosa, binge eating disorder].

The most important eating disorders are anorexia and bulimia, which most frequently occur for the first time during adolescence and continue into adulthood. Medical complications and accompanying psychological disturbances cause a significant mortality rate of up to 6% in anorexia and up to 3% in bulimia. The pathogenesis of eating disorders is still unclear. Current etiological concepts are multidimensional including biological, individual, familial, and sociocultural factors. In spite of a great variety of therapeutic possibilities, the prognosis for eating disorders is quite poor. In the long term, only about 50% of the persons affected overcome their illness. Preventive measures are therefore indispensable.

Adolescent↗
PubMed2005

The associations between substance use disorders, schizophrenia-spectrum disorders, and Axis IV psychosocial problems.

BACKGROUND: Substance abuse among individuals with schizophrenia-spectrum disorders (SSDs) is associated with a range of adverse psychosocial outcomes in the areas of occupational functioning, housing stability, economic independence, access to health care, and involvement with the legal system. The aim of this study was to estimate the effects of substance use disorders (SUDs), SSDS, and dual diagnosis with both disorders on the risk for six important Axis IV psychosocial problems. This was accomplished using a large dataset of patients who are representative of individuals in routine US psychiatric practice. METHOD: Weighted data from the 1999 Study of Psychiatric Patients and Treatments from a practice-based research network of the American Psychiatric Institute for Research and Education were analyzed. Some 615 US psychiatrists provided detailed clinical, psychosocial, and health services information on 1,843 patients, including 285 patients with one or more SUDs without an SSD, 180 patients with a diagnosis of an SSD without substance abuse comorbidity, and 68 dually diagnosed patients. Logistic regression models were used to determine effect estimates (adjusted odds ratios), and corresponding 95% confidence intervals were calculated. RESULTS: After adjusting for sociodemographic variables and for SSD diagnosis, SUD diagnosis was independently associated with increased risk for five of the Axis IV psychosocial problems of interest (occupational problems, housing problems, economic problems, problems with access to health care services, and problems related to interaction with the legal system/crime) when compared to all other psychiatric patients (n=1,310). After adjusting for the sociodemographic variables and for SUD diagnosis, SSD diagnosis (compared to all other psychiatric diagnoses) was associated with Axis IV economic problems, but not with the other five psychosocial problems of interest. The presence of both an SUD and an SSD diagnosis (dual diagnosis) was associated with a greater risk for four of the six Axis IV psychosocial problems studied, compared to the risks associated with either diagnosis alone. Limiting the substance of abuse to alcohol resulted in similar findings. CONCLUSIONS: Although SUDs are associated with increased risk for poor social adjustment, the comorbidity of SUDs and SSDs is associated with greatly compounded psychosocial burdens. These findings, from a large sample of representative US psychiatric patients, demonstrate the ongoing need for improved services and policies for those specially burdened patients with the dual diagnosis of both an SSD and substance abuse or dependence.

Adult↗
PubMed2005

What distinguishes autism spectrum disorders from other developmental disorders before the age of four years?

The increasing recognition of the benefits of early intervention for children with autism spectrum disorder (ASD) stresses the importance of early identification of children who might benefit from those programs. However, in the early years of life it may be difficult to distinguish children with ASD from children with other developmental disorders. The aim of the present study was to identify behavioural patterns that could facilitate this differentiation. Prior to diagnostic assessment, 2- and 3-year-old children (n=30), all referred to a clinic for "possible autism", were observed in a semi-structured play interaction, and their parents were interviewed about the children's early development from 0 to 24 months. Following diagnostic assessment, the 17 children fulfilling the ICD-10 criteria for ASD were compared to the 13 children diagnosed with other developmental disorders (outside the autism spectrum). On the basis of parent reports only a few distinguishing signs of ASD were found before 24 months of age. On the basis of professional observations in a semi-structured play interaction several distinguishing signs were found for the 2- and 3-year-olds; smiles in response, responds to name, follows pointing, looks to "read" faces, initiates requesting verbal and nonverbal behaviours, and functional play.

Age Factors↗
PubMed2025

Co-morbid monogenic disorders at chromosome region 1q2: LMNA- and FLG-related disorders in a patient referred for assessment of joint hypermobility.

The phenotypic similarities and genetic heterogeneity occurring in diverse forms of Ehlers Danlos Syndrome (EDS) subtypes and many heritable connective tissue disorders can pose a diagnostic challenge. In the wake of the growing applications of next-generation sequencing technologies including exome and genome sequencing, opportunities for achieving definitive genetic diagnosis are increasingly arising. We present a 46-year-old man with joint laxity, recurrent joint subluxations, pelvic floor dysfunction, and postural orthostatic tachycardia syndrome (POTS), who was referred for EDS assessment. His medical history included morbid obesity requiring gastric bypass surgery, hearing loss, asthma, retinopathy, myopia, atrial septal defect, narcolepsy with cataplexy, polyneuropathy, folliculitis, lichen simplex chronicus, atopic dermatitis, and hypogonadism. His family history was significant for multiple first- and second-degree relatives who died from cardiac diseases including cases of childhood deaths. Physical examination showed joint laxity with Beighton score of 3/9, bilateral pes planus, hearing loss and macrocephaly. Exome sequencing revealed heterozygous variants LMNA c.1262 T > C p.L421P [classified as likely pathogenic], FLG c.2282_2285del p. S761Cfs*36 [classified as pathogenic], and FLG c.1501 C > T p. R501* [classified as pathogenic]. Mitochondria sequencing revealed a variant of uncertain significance (VUS), MT-ND2 m.5047 T > C p.V193A that is present at 9% heteroplasmy in blood. These findings show co-occurrence of pathogenic sequence variants in neighboring genes located in chromosome 1q2 region [LMNA and FLG] in a patient with features of hereditary connective tissue disorders. Our study highlights the capability of exome sequencing in achieving some actionable diagnosis in cases of co-morbid genetic disorders with overlapping and non-specific symptoms.

Humans↗
PubMed2006

Labor force activity among Australians with musculoskeletal disorders comorbid with depression and anxiety disorders.

AIM: Musculoskeletal disorders (MSD) are a leading cause of work-related disability. This investigation explored the impact of MSD comorbid with depression and anxiety disorders, on labor force activity. METHODS: The Australian Bureau of Statistics provided confidentialized data files collected from a household sample of 37,580 people. MSD, affective, and anxiety disorders were identified and employment restrictions were assessed at four levels of severity. RESULTS: Anxiety and depression of six months duration was present in 12.1% of people with MSD. Comorbidity magnified the negative impacts of single conditions on labor force activity. Most at risk were people with back problems and comorbid depression, people with arthritis or other MSD and comorbid anxiety, males with MSD and comorbid depression, and females with MSD and comorbid anxiety. CONCLUSIONS: The results suggest that the occupational rehabilitation needs of people with MSD comorbid with depression or anxiety may currently be underestimated.

Adolescent↗
PubMed1990

Adrenergic status in anxiety disorders: platelet alpha 2-adrenergic receptor binding, blood pressure, pulse, and plasma catecholamines in panic and generalized anxiety disorder patients and in normal subjects.

In order to evaluate adrenergic function in anxiety disorders, platelet alpha 2-adrenergic binding parameters and supine and standing blood pressure, pulse, and venous plasma epinephrine and norepinephrine were determined in patients with panic attacks or generalized anxiety disorder and in normal subjects. The maximum number of binding sites (Bmax) for the partial agonist tritiated clonidine was significantly lower for both patient groups than for normal subjects, and the Bmax for the antagonist tritiated yohimbine was significantly lower for panic patients. There were no other substantive differences across groups. Prior exposure to psychotropic drugs might account for the results for clonidine binding, but not for yohimbine. The Bmax for clonidine was correlated with norepinephrine increases upon standing and, for panic patients, with the severity of full unexpected panic attacks. These data provide further evidence of adrenergic receptor abnormalities in people with anxiety disorders.

Adult↗
PubMed1989

Noradrenergic function in generalized anxiety disorder: effects of yohimbine in healthy subjects and patients with generalized anxiety disorder.

There is extensive preclinical and clinical support for the hypothesis that hyperactivity of noradrenergic neuronal systems is related to the pathophysiology of some forms of human anxiety. In the present investigation, the behavioral, biochemical, and cardiovascular responses to the alpha 2-adrenergic receptor antagonist, yohimbine, was determined in 20 patients with generalized anxiety disorder (GAD) and 20 healthy subjects. The responses to yohimbine were generally similar in the two groups except there was a trend for the yohimbine-induced increase in plasma 3-methoxy-4-hydroxyphenylglycol to be less in the GAD patients. These findings contrast with previous studies of the effects of yohimbine in panic disorder patients and, thereby, support a neurobiological distinction between these two disorders.

Adult↗