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PubMed2004

Time perception, impulsivity, emotionality, and personality in self-harming borderline personality disorder patients.

To investigate how time perception may contribute to the symptoms of self-harming Borderline Personality Disorder (BPD) patients, 19 self-harming BPD inpatients and 39 normal controls were given measures of time perception, impulsivity, personality, emotion, and BPD characteristics. A test sensitive to orbitofrontal cortex (OFC) function ("Frontal" Behavior Questionnaire) was also administered, as the OFC has been associated with impulsivity and time perception. BPD patients produced less time than controls, and this correlated with impulsiveness and other characteristics commonly associated with BPD. BPD patients were also less conscientious, extraverted, and open to experience, as well as more impulsive (self-report and behaviorally), emotional, neurotic, and reported more BPD characteristics, compared to controls. The results suggest that some of these core characteristics of BPD may be on a continuum with the normal population and, impulsivity in particular, may be related to time perception deficits (i.e., a faster subjective sense of time). Finally, BPD patients scored higher on the Frontal Behavior Questionnaire, suggesting that some symptoms of the BPD syndrome may be related to problems associated with the OFC. A control spatial working memory task (SWM) revealed that SWM deficits could not explain any of the BPD patients' poor performance. While impulsivity was correlated with time perception across all participants, emotionality, introversion, and lack of openness to experience were not. This suggests that different symptoms of the borderline personality syndrome may be separable, and therefore, related to different cognitive deficits, and potentially to different brain systems. This may have important implications for treatment strategies for BPD.

Adolescent↗
PubMed2004

Dimensions of impulsivity and aggression associated with suicide attempts among bipolar patients: a preliminary study.

Impulsivity and hostility are often thought to be interrelated among depressed patients with suicidal behavior, but few studies have examined this relationship empirically. In this study, we assessed trait impulsivity and hostility among 52 DSM-IV bipolar subjects with and without histories of suicide attempts. Impulsivity and hostility were correlated among attempters (r = .41, p = .03) but not non-attempters (r = .22, p = .28). As compared to non-attempters, attempters had significantly higher levels of overall hostility, more extensive subcomponents of hostility, and a trend toward higher overall impulsivity. Associations between lifetime suicide attempts and overall hostility were significant while controlling for current depression severity and lifetime illness duration. Aggression and impulsivity appear linked among bipolar patients with lifetime suicide attempts but may be independent constructs among non-attempters. The presence of both factors may elevate risk for suicidal behavior.

Adult↗
PubMed2004

Laboratory measured behavioral impulsivity relates to suicide attempt history.

The purpose of this study was to examine the relationship between laboratory behavioral measured impulsivity (using the Immediate and Delayed Memory Tasks) and suicidal attempt histories. Three groups of adults were recruited, those with either: no previous suicide attempts (Control, n = 20), only a single suicide attempt (Single, n = 20), or multiple suicidal attempts (Multiple, n = 10). As hypothesized, impulsive responses increased with the number of suicide attempts (Control < Single < Multiple). This study helps to demonstrate how laboratory behavioral measures of impulsivity can be used to discriminate groups based on suicidal histories among samples not currently exhibiting significant suicidal behaviors.

Adult↗
PubMed2003

DSM-IV alcohol and substance abuse and dependence in homeless youth.

OBJECTIVE: The purpose of this study is to describe endorsement rates of substance use criteria among homeless adolescents and to evaluate the reliability of diagnostic formulations among a group of adolescents who use more frequently and more heavily than other samples of adolescents. METHOD: Substance use rates and DSM-IV abuse and dependence criteria were assessed among 198 (109 male) homeless youths between the ages of 13 and 19, as part of a larger study. Endorsement rates and reliability analyses were completed for diagnostic criteria assessed for alcohol, marijuana, amphetamines and heroin. RESULTS: Consistent with other studies of homeless youth, data revealed high rates of substance use and high rates of substance dependence. Both dependence and abuse diagnoses were associated with greater rates of use. DSM-IV criteria showed acceptable internal reliability, although variability was observed when applied to different substances. Of the drugs assessed, problems with heroin use appeared to be best, and marijuana use least, represented by dependence criteria. Criteria pertaining to continued use despite interference with role obligations and the experience of craving were consistently related to other dependence criteria. CONCLUSIONS: DSM-IV substance dependence criteria appear to have good internal reliability within a sample of adolescents who use at extremely high rates. Continued development of diagnostic systems for adolescent substance use should consider the social context of use, differential patterns of symptoms across different substances and the inclusion of additional criteria found reliable among adolescent samples.

Adolescent↗
PubMed2005

An experience sampling study of associations between affect and alcohol use and problems among college students.

OBJECTIVE: This study used experienced sampling methodology to examine the relationship between affective functioning and alcohol consumption and problems. METHOD: Fifty-six college students provided baseline data on measures of impulsivity and distress tolerance and provided experience sampling data for 2 weeks on measures of negative affect, positive affect, and alcohol consumption and problems. Women made up 54% of the sample. The sample ranged in age from 21 to 23 (mean [SD] = 21.50 [0.57]); 98% were white and 2% were Asian. RESULTS: As predicted, higher levels of both positive and negative affect during the day were associated with higher rates of consumption that night. In contrast, negative, but not positive, affect was associated with alcohol-related problems after controlling for alcohol consumption. Impulsivity was associated with higher consumption and problems and moderated the relationships between negative affect and problems and also between alcohol consumption and problems. Low distress tolerance was associated with a decreased association between positive affectivity and alcohol consumption. CONCLUSIONS: This study replicated and extended previous research on affective models of alcohol use and problems through the use of experience sampling methodology. The results demonstrated associations between affective variables and alcohol consumption and problems measured through near real-time assessment. The results suggest a functional association between alcohol consumption and problems and both within-person changes in affect and between-person differences in impulsivity and distress tolerance.

Adult↗
PubMed1992

Kleptomania, mood disorder and lithium.

Kleptomania has been found in association with major depression in a fairly large number of reports in recent years. We describe a patient with concurrent DSM-III-R Bipolar Mood Disorder and Kleptomania, whose symptoms remitted completely, apparently in response to lithium therapy, which raised the possibility that pharmacological treatment may benefit kleptomania. Further studies are needed to establish the possible relationship between kleptomania, mood disorders and lithium therapy.

Bipolar Disorder↗
PubMed1997

Confirmatory research on the assessment of murderers.

Prior research, from the psychodynamically oriented literature, characterizes homicidal offenders as impulsive, vulnerable to stress, with difficulties in emotional control, particularly anger. In 1995 Coram reported Rorschach data from a sample of murderers which tentatively support earlier findings. This paper argues that confirmatory data from measures which objectively assess emotional states and behaviors could elucidate this issue.

Antisocial Personality Disorder↗
PubMed2003

Differences in cognitive distortions between problem and social gamblers.

The cognitive model of gambling argues that irrational beliefs and erroneous perceptions including illusions of control, superstitious beliefs, expectancies of winning, attributional biases, selective memory, and entrapment play a pivotal role in the development and maintenance of impaired control over patterns of gambling behaviours. Assessment strategies using self-report, behavioural inferences, and verbalizations produced by 'thinking aloud' techniques, and the effectiveness of treatment interventions designed to correct cognitive distortions have provided substantive empirical evidence supporting this model. However, research has yet to measure such differences between the quality, intensity, or conviction of specific dysfunctional beliefs held by problem in contrast to social gamblers. At the theoretical level, the absence of such demonstrable differences would undermine the validity of the cognitive explanatory model. Based on a review of the available literature, a preliminary measure to assess differences in irrational gambling beliefs was constructed and administered to a convenience sample of 56 problem gamblers and 52 social gamblers. In support of the cognitive model, analysis indicated that, compared to social gamblers, problem gamblers endorsed more irrational beliefs across all domains except for the variable of 'denial'. Implications for research issues relevant to the identification of irrational beliefs that may be subjected to challenge within a cognitive therapy paradigm are mentioned.

Adult↗
PubMed2003

Assessment of pathological gamblers who use slot machines.

The aim of the present study was to classify pathological gamblers based on their psychopathology as related to the variable sensation-seeking, and to check possible differences between the groups on the sociodemographic variables. The sample was composed of 110 male pathological gamblers using slot machines who requested treatment at the Pathological Gambling Unit at the Ciutat Sanitària i Universitària de Bellvitge. It was observed that pathological gamblers comprise three clusters, differentiated with differing severity depression, psychoticism, somatization, impulsiveness, interpersonal sensitivity, and phobic anxiety. Cluster 1, representing 46.7% of the sample, showed mean scores higher than or equal to T=63. On the subscales of Depression, Psychoticism, Interpersonal Sensitivity, Phobic Anxiety, and Obsessiveness-Compulsiveness the score was close to T=63 (the clinical cut-off score). Cluster 2, representing 23.8% of the sample, scored higher than Cluster 1 on the following subscales: Depression, Phobic Anxiety, Interpersonal Sensitivity, Psychoticism, Obsessive-Compulsive, and Somatization. On Cluster 3 highest mean scores were observed on all SCL-90-R dimensions relative to the other two groups. What distinguished these subgroups is not symptomatology but the severity of the psychopathology. On the other hand, sensation seeking was similar for the three clusters, and the slight differences depended on the subjects' psychopathology.

Adult↗
PubMed2004

Validation of the lie/bet screen for pathological gambling on two normal population data sets.

The validity of the Lie/Bet Screen was tested on two community population samples, one adult (n=2,014) and one adolescent sample (n=3,237), in Norway. With positive responses on at least one of the questions on Lie/Bet Screen used as the cutoff point the screen showed high both sensitivity and specificity. The negative predictive value was also high, but the positive predictive value was comparatively lower. A prediction of probable pathological gambling or "At-risk gambling" based on both Lie/Bet questions identified a valid screening in the two samples (0.54% in adults, 5.6% in adolescents). Compared to the use of the full DSM-IV this is pretty close, with the figures 0.45% and 5.22%. It is concluded that the Lie/Bet Screen may function as a good screening device for pathological gambling plus At-risk gambling in normal community samples.

Adolescent↗
PubMed2005

Confirmatory factor analysis of parents' and teachers' ratings of DSM-IV symptoms of attention deficit hyperactivity disorder in a Spanish sample.

Confirmatory factor analysis examined the factor structure of DSM IV Attention Deficit Hyperactivity Disorder symptoms and analyzed the differences in informants' ratings of ADHD symptoms by children's age and sex. A sample of 1,018 Spanish school children, 574 girls and 444 boys, ages 4 to 12 years, was rated by teachers and parents. Confirmatory factor analysis showed a similar fit for the three-factor model of Inattention, Hyperactivity, and Impulsivity (teachers: CFI = .976, RMR = .041, % of total variance = 83.2; parents: CFI = .969, RMR = .037, % of total variance = 82.7) and for the two-factor model of Inattention and Hyperactivity Impulsivity (teachers: CFI = .958, RMR = .044, % of total variance = 79.3; parents: CFI = .961, RMR = .038, % of total variance, 79.9). The two-factor model was selected as a parsi monious representation of the teachers' and parents' ratings of ADHD symptoms. Analyses of variance indicated significant differences in teachers' and parents' mean ratings across sex and school grades of children.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

Study of compulsive buying in depressed patients.

BACKGROUND: Compulsive buying is defined by the presence of repetitive impulsive and excessive buying leading to personal and familial distress. Patients with this disorder also suffer from mood disorder in 50% to 100% of the cases studied, and antidepressants help to decrease the frequency and the severity of uncontrolled buying. To define the correlation between compulsive buying and depression, we assessed this behavior among 119 inpatients answering to DSM-III-R criteria for major depressive episode. Additionally, we evaluated for comorbidity in the patients suffering from compulsive buying and in those free from this disorder. Impulsivity and sensation seeking were also compared in the two groups. METHOD: Diagnosis of compulsive buying was made using standardized criteria and a specific rating scale. Diagnosis of depression and assessment of comorbidity were investigated using the Mini International Neuropsychiatric Interview and a modified version of the Minnesota Impulsive Disorders Interview. All patients answered the Zuckerman Sensation-Seeking Scale and the Barrat Impulsivity Rating Scale. RESULTS: The prevalence of the disorder was 31.9%; 38 of the 119 depressed patients were diagnosed as compulsive buyers. Patients from the compulsive buying group were younger in age, more often women than men, and more frequently unmarried. They presented more often than others with recurrent depression (relative risk = 1.4), disorders associated with deficits in impulse control such as kleptomania (relative risk = 8.5) or bulimia (relative risk = 2.8), benzodiazepine abuse or dependence disorder (relative risk = 4.7), and two or more dependence disorders (relative risk = 1.99). Subscores for experience seeking using the Zuckerman Sensation-Seeking Scale were significantly higher (p = .04) and scores of impulsivity were much higher (p < .0001) than corresponding scores in the group without compulsive buying behavior. CONCLUSION: Compulsive buying is frequent among depressed patients. In most cases, the behavior is associated with other impulse control disorders or dependence disorders and a high level of impulsivity.

Adult↗
PubMed1999

Hoarding in obsessive-compulsive disorder: a report of 20 cases.

BACKGROUND: We describe the demographic characteristics, hoarding phenomenology, comorbid disorders, family histories, and treatment response of 20 adult obsessive-compulsive disorder (OCD) patients exhibiting hoarding behavior. METHOD: We utilized the Structured Clinical Interview for DSM-III-R, the Yale-Brown Obsessive Compulsive Scale, and a semistructured interview to gather data. RESULTS: We studied 9 women and 11 men. Their hoarding began from age 5 years to age 46 years (mean +/- SD age at onset = 20 +/- 11 years); hoarding was evident before the onset of other OCD symptoms in 9 patients. The most commonly hoarded items were newspapers and magazines, junk mail, old clothes, notes or lists, and old receipts. Hoarded material occupied from one room plus most or all closets to more than one room plus all closets, the garage, and yard. Seven patients rented additional storage space for hoarded items. Eighty-four percent of patients reported a family history of hoarding, and 80% grew up in a household where someone else hoarded. The most frequent primary motives for hoarding were fears of discarding something useful and discarding something that would be needed in the future. Lifetime prevalence of major depression and of impulse-control disorders, especially compulsive shopping, were high; only 3 patients met DSM-IV criteria for obsessive-compulsive personality disorder. Response of hoarding to selective serotonin reuptake inhibitors was less robust than is expected for obsessive-compulsive disorder. CONCLUSION: Whether hoarding behaviors mark a subset of obsessive-compulsive disorder patients with a different pathophysiology or functional anatomy deserves investigation.

Adolescent↗
PubMed2002

An open-label study of citalopram in the treatment of pathological gambling.

BACKGROUND: This study evaluated the effectiveness of citalopram in the treatment of pathological gambling. METHOD: Fifteen adult pathological gamblers (DSM-IV criteria) were administered citalopram in an open-label fashion for up to 12 weeks. Subjects were rated at baseline and at 2-week intervals on measures of gambling severity and depression, and monthly on quality of life. RESULTS: Patients reported significant (p < .05) improvements on all gambling measures including the number of days gambled, the amount of money lost gambling, preoccupation with gambling, and urges to gamble. Thirteen (86.7%) of the patients were rated as "much improved" or "very much improved" on a clinician-rated Clinical Global Impressions scale for gambling. Patients reported improvement in depression and overall quality of life. Patients with major depressive disorder (MDD) (N = 8) improved to approximately the same degree as patients without MDD (N = 7). For most patients, clinical improvement occurred during the first 2 weeks of treatment; for the 9 patients who completed the entire 12-week trial, these gains were maintained. CONCLUSION: Citalopram appears to be an effective treatment for pathological gambling, and this benefit was independent of its antidepressant properties. Future studies employing a control group will be important to examine the extent of the response to nonspecific factors of treatment.

Adolescent↗
PubMed2002

Major depressive disorder and axis I diagnostic comorbidity.

BACKGROUND: Recognition of comorbid conditions in patients presenting for the treatment of depression is clinically important because the presence of other disorders can influence treatment planning. In the present study, we examined the frequency of diagnostic comorbidity in psychiatric outpatients presenting for treatment of nonbipolar major depressive disorder (MDD) and patients' desire for treatment for the comorbid disorders. METHOD: Four hundred seventy-nine psychiatric outpatients with DSM-IV nonbipolar MDD were evaluated with a modified version of the Structured Clinical Interview for DSM-IV. RESULTS: Excluding nicotine dependence, at the time of the evaluation 64.1% (N = 307) of the patients met criteria for at least 1 of the 23 specific Axis I disorders, and more than one third (36.7%, N = 176) had 2 or more disorders. Anxiety disorders, as a group, were the most frequent current comorbid disorders (56.8%), and social phobia was the most frequent individual disorder. Including subthreshold conditions, the percentage of patients with at least 1 disorder increased to 73.5%. When the scope of assessment was expanded to include nicotine dependence, nicotine dependence was the most frequent lifetime individual disorder (38.2%) and the second most frequent current disorder (27.3%). There was considerable variability among the disorders regarding desire for treatment of the comorbid condition. CONCLUSION: The majority of nonbipolar depressed patients have a current comorbid disorder, especially an anxiety disorder, although the actual rate of comorbidity depends on the breadth of the assessment.

Adult↗
PubMed2002

Anger and aggression in psychiatric outpatients.

BACKGROUND: This study sought to evaluate the degree of anger and aggression experienced by psychiatric outpatients and to determine whether anger is as prominent an emotional state in these patients as are depression and anxiety. We also sought to determine which Axis I and Axis II disorders were associated with increased rates of subjective anger and aggressive behavior. METHOD: 1300 individuals presenting to a psychiatric outpatient practice underwent semistructured interviews to evaluate current DSM-IV Axis I (N = 1300) and Axis II disorders (N = 687). Levels of subjective anger and aggression during the preceding week were assessed in each patient, and the odds ratios were calculated for each disorder. A multiple regression analysis was performed to determine which psychiatric disorders independently contributed to the presence of subjective anger and aggressive behavior. RESULTS: Approximately one half of our sample reported currently experiencing moderate-to-severe levels of subjective anger, and about one quarter had demonstrated aggressive behavior in the preceding week. This level of anger was found to be comparable to the levels of depressed mood and psychic anxiety reported by our sample. Major depressive disorder, bipolar I disorder, intermittent explosive disorder, and cluster B personality disorders independently contributed to the presence of both anger and aggression. CONCLUSION: Anger and aggression are prominent in psychiatric outpatients to a degree that may rival that of depression and anxiety; it is therefore important that clinicians routinely screen for these symptoms.

Adult↗
PubMed2003

The effects of clozapine versus haloperidol on measures of impulsive aggression and suicidality in chronic schizophrenia patients: an open, nonrandomized, 6-month study.

BACKGROUND: The risk of suicide for schizophrenia patients is 20 to 50 times higher than that for the general population. Long-term treatment with clozapine, an atypical antipsychotic, has been shown to reduce the rate of suicide by 80% to 85%. The goal of the present study was to examine whether clozapine's effect on the reduction of suicidal behavior in chronic schizophrenic patients could be due to a reduction in impulsive-aggressive behavior. METHOD: 44 patients with chronic DSM-IV schizophrenia were treated with clozapine or haloperidol decanoate in an open prospective 6-month trial. Changes in measures of suicidality, impulsiveness, aggression, depressed mood, and positive and negative symptoms were assessed at baseline and at 6 months. RESULTS: The clozapine-treated group (N = 18) had a significantly greater reduction on all outcome measures compared with the haloperidol decanoate-treated group (N = 26). Only in the clozapine-treated group did the reduction in measures of suicidality correlate significantly with a reduction in impulsiveness and aggression. The reductions in suicidality and impulsive aggression were not significantly correlated with reductions in depressed mood or positive and negative symptom scores in either group. CONCLUSION: These data suggest that the reduction in suicidality following long-term clozapine treatment may be related to a reduction in impulsiveness and aggression.

Adolescent↗