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PubMed1997

Age and remission of psychiatric disorders.

OBJECTIVE: To examine the relationship between remission of psychiatric disorders and age. METHODS: We interviewed 3258 randomly selected adult residents of Edmonton using the Diagnostic Interview Schedule (DIS), which yielded DIS/DSM-III diagnoses. Remission was defined as being free of symptoms of the index lifetime disorder in the year preceding the interview, this being the difference between the lifetime and one-year prevalence. For each age group, the proportion of cases with and without symptoms in the preceding year was calculated. Numbers and proportions of cases were estimated after adjusting to the census population and weighting for household size. Only the more common disorders were examined; any comorbidities were ignored. RESULTS: Drug abuse or dependence, antisocial personality disorder (in both sexes), and alcohol abuse or dependence (in men) all showed remission rates that increased with age. Panic disorder and obsessive-compulsive disorder (OCD) showed a decreased likelihood of remission with increasing age. Major depression and phobias showed little tendency to remission with age. Considering all disorders together, the one-year remission rate for all ages combined was only 33.2%, with a tendency for lower remission rates to be found in those aged 55 to 64. CONCLUSIONS: As may be expected, antisocial personality, drug abuse or dependence, and alcohol abuse or dependence tend to show increased remission rates with increasing age. In OCD and panic disorder, the low rates of remission found in all age groups indicate that these disorders produce significant long-term morbidity. For depression, which had an overall remission rate of less than 50%, the stable low rate of remission probably indicates not only the difficulties of treatment but also the low rates at which cases get treated.

Adolescent↗
PubMed2003

Do eating disorders co-occur with personality disorders? Comparison groups matter.

OBJECTIVE: To assess and compare lifetime rates of occurrence of eating disorders (ED) with four Axis II personality disorders (PD) and with major depressive disorder (MDD) without PD. The eating disorders met criteria outlined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). METHOD: Six hundred sixty-eight patients recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were reliably assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders. The distribution of ED diagnoses was compared among four PD study groups (schizotypal, borderline, avoidant, obsessive-compulsive) and a fifth study group with MDD without any PD. RESULTS: The distribution of lifetime diagnoses of anorexia nervosa (N = 40), bulimia nervosa (N = 56), and eating disorder not otherwise specified (N = 118) did not differ significantly across the five study groups, between the MDD group versus all PD groups, and among the four PD study groups. CONCLUSIONS: ED diagnoses did not differentially co-occur significantly across common Axis I and II disorders. The pattern of ED lifetime co-occurrence rates demonstrates the powerful influence of base rates and highlights that declarations of comorbidity demand significant variations from base-rate patterns.

Adolescent↗
PubMed1996

Compulsive washing in the absence of phobic and illness anxiety.

A new typology of washing compulsions has been proposed: those that arise from a sense of dirtiness, those that arise from a sense of mental pollution, and finally, those that arise from a fear of illness. A case series is reported suggesting that a further class of washing behaviour can be described attributable to the personality trait of perfectionism.

Adult↗
PubMed2002

Personality traits and socio-epidemiological status of hospitalised elderly benzodiazepine users.

OBJECTIVE: to define personality traits and socio-epidemiological status of hospitalised elderly chronic benzodiazepine (BZD) users. METHODS: this case controlled study assessed psychological characteristics (using the Millon Clinical Multiaxial Inventory-MCMI-I) and socio-epidemiological status (sex, age, education, marital status and housing) in 40 hospitalised geriatric patients taking BZDs for at least 3 months and 40 non-users, excluding dementia. RESULTS: comparisons between groups: Compulsive personality pattern was more pronounced in the control group (p = 0.008). Severe personality pathology: a predisposition to borderline disorder was stronger among the BZD-users (p = 0.001). Clinical syndromes: anxiety, dysthymic disorder (p < 0.001) and tendency to alcohol dependence (p = 0.020) prevailed in the BZD-users. No severe syndromes were found. Widowed persons were more prevalent between the BZD-users (p = 0.03). All significant differences resulted from disparities between females. Predictors of BZD-use and clustering of traits: Dysthymic disorder was predictive of BZD-use (odds ratio (OR) 6.3 [95% confidence intervals (CI) 2.2-18.2]). It was strongly correlated with anxiety (r(s) = 0.93) and somatoform disorder (r(s) = 0.71). Dysthymic disorder and alcohol dependence predicted BZD-use in women (OR 15.3 [CI: 2.4-95.7] and OR 9.1 [CI: 1.2-64.9], respectively). There were no specific predictors in men. CONCLUSIONS: chronic elderly BZD-users are typically widowed females with dysthymic disorder, anxiety, predisposition to alcohol dependence and borderline disorder. Before prescribing BZDs, it is important to recognize the nature of the elderly population at risk for BZD-use and to consider a broader-ranging therapeutic management of the predisposing personality traits.

Aged↗
PubMed2001

The paraphilic and hypersexual disorders: an overview.

In this article, the first of a two-part series, the authors present reasons for considering the paraphilic and hypersexual disorders together and provide an overview of these disorders. The DSM-IV diagnostic criteria for paraphilias are reviewed, and proposed criteria for hypersexual disorders are presented. The question of whether the paraphilic and hypersexual disorders should be considered within the spectrum of obsessive-compulsive disorders is considered. The authors then review the epidemiology of these disorders, and discuss some implications of recent sexual predator legislation. The authors discuss the etiology of the paraphilias and hypersexual disorders, and consider the role of endocrinological function, findings from brain imaging and neuropsychological testing, findings from primate research, the monoamine hypothesis, the imprinting hypothesis, social learning theory, the concept of courtship disorder, the role of obsessive-compulsive elements, psychodynamic theories, and genetic factors. The phenomenology of the paraphilias and hypersexual disorders is discussed, including the tendency for multiple paraphilias to co-occur, the lack of a specific offender profile, the predominance of males among those with paraphilias, the incidence of a history of victimization in individuals with paraphilias and compulsive sexual disorders, the onset and course of both types of disorders, and the lack of internal motivation for change in individuals with paraphilias and hypersexual disorders. The authors then discuss disorders that commonly co-occur with paraphilias and compulsive sexual disorders, including mood disorders, substance abuse and dependence disorders, attention-deficit/hyperactivity disorder, anxiety and impulse control disorders, and personality disorders. The second article in the series will discuss the clinical assessment and the behavioral and psychopharmacological treatment of these disorders. A guide for clinicians and patients on where and how to find specialized clinicians and treatment resources in the United States will also be provided.

Journal Article↗
PubMed1984

Use of clomipramine in treatment of obsessive-compulsive symptomatology.

An open clinical trial was conducted on the use of oral clomipramine in the treatment of obsessive-compulsive symptomatology in patients with various primary psychiatric diagnoses. The overall success rate of the 50 patients was 60%; those with a primary diagnosis of obsessive-compulsive disorder had an 80% success rate. No significant differences in outcome were observed by current age, age of illness onset, duration of illness, or severity of illness. Minnesota Multiphasic Personality Inventories of a subsample of the population revealed a significantly higher T score for depression in the successful patients. Since 83% of the successful patients had adequate prior treatments on other antidepressants without improvement in their obsessive-compulsive symptoms, it would appear that clomipramine is effective in treating obsessive-compulsive symptoms as well as depressive symptoms.

Adolescent↗
PubMed2000

Low novelty-seeking differentiates obsessive-compulsive disorder from major depression.

OBJECTIVE: To make a direct comparison of patients with obsessive-compulsive disorder (OCD) and major depression (MD) and a normal control group in terms of the Temperament and Character Inventory (TCI) personality dimensions. METHOD: Additionally to 43 patients with primary OCD, 43 MD patients and 43 normal subjects who were matched against the OCD patients for sex and age filled out the TCI. RESULTS: Compared to the controls, the OCD and MD patients scored significantly higher on harm avoidance and significantly lower on self-directedness and co-operativeness. The OCD patients scored significantly lower on novelty-seeking than the MD patients and the controls. CONCLUSION: Whereas OCD and MD share similar personality deviations on harm avoidance, self-directedness and co-operativeness, OCD is distinguishable from MD in terms of low novelty-seeking. Low novelty-seeking may have a profound relationship to the specific aetiology of OCD.

Adolescent↗
PubMed1996

Personality traits in LLPDD and normal controls during follicular and luteal menstrual-cycle phases.

In 15 women with Late Luteal Phase Dysphoric Disorder (LLPDD) and in 15 normal control subjects, personality traits were assessed using the Millon Clinical Multiaxial Inventory (MCMI) during follicular and luteal menstrual-cycle phases. Compared with controls, LLPDD subjects had less compulsive but more passive/aggressive and borderline/cycloid traits, and more depression and hypomania. Menstrual-cycle phase did not significantly affect personality variables in either group. In particular, depression and hypomania in LLPDD subjects suggests a relationship with affective disorders.

Adult↗
PubMed1998

Phenotypic and genetic structure of traits delineating personality disorder.

BACKGROUND: The evidence suggests that personality traits are hierarchically organized with more specific or lower-order traits combining to form more generalized higher-order traits. Agreement exists across studies regarding the lower-order traits that delineate personality disorder but not the higher-order traits. This study seeks to identify the higher-order structure of personality disorder by examining the phenotypic and genetic structures underlying lower-order traits. METHODS: Eighteen lower-order traits were assessed using the Dimensional Assessment of Personality Disorder-Basic Questionnaire in samples of 656 personality disordered patients, 939 general population subjects, and a volunteer sample of 686 twin pairs. RESULTS: Principal components analysis yielded 4 components, labeled Emotional Dysregulation, Dissocial Behavior, Inhibitedness, and Compulsivity, that were similar across the 3 samples. Multivariate genetic analyses also yielded 4 genetic and environmental factors that were remarkably similar to the phenotypic factors. Analysis of the residual heritability of the lower-order traits when the effects of the higher-order factors were removed revealed a substantial residual heritable component for 12 of the 18 traits. CONCLUSIONS: The results support the following conclusions. First, the stable structure of traits across clinical and nonclinical samples is consistent with dimensional representations of personality disorders. Second, the higher-order traits of personality disorder strongly resemble dimensions of normal personality. This implies that a dimensional classification should be compatible with normative personality. Third, the residual heritability of the lower-order traits suggests that the personality phenotypes are based on a large number of specific genetic components.

Adolescent↗
PubMedDate not supplied

"Dude, you don't have Tourette's:" Tourette's syndrome, beyond the tics.

While coprolalia is the most well-known symptom of Tourette's syndrome (TS), it affects only a minority of persons with the condition. TS is a chronic neurobiological condition consisting of vocal and motor tics. Many children with TS have associated obsessive-compulsive disorder (OCD) and/or attention deficit hyperactivity disorder (ADHD), both of which can interfere with school, peer, and family functioning more than the tics themselves. The article distinguishes TS from other tic disorders and reviews literature on epidemiology, etiology, clinical course, and diagnostic and treatment issues. The article discusses the role of primary care pediatric and advanced practice nurses in the diagnosis and management of TS and details helpful interventions in the arenas of personal, family, and educational support, as well as symptom management and indications for medications. The author also suggests areas for future nursing research.

Adaptation, Psychological↗
PubMed1975

Relationship of certain childhood 'traits' to adult psychiatric disorders.

An investigation of 174 adult psychiatric outpatients reporting on nine different difficulties they may have experienced as children suggests certain links between childhood difficulties and lifelong personality traits, as well as adult psychiatric symptomatology. Findings suggest that the childhood traits related to schizophrenia might be manifestations of minimal organic brain dysfunctioning.

Adult↗
PubMed1993

Perceived parental characteristics of patients with obsessive compulsive disorder, depression, and panic disorder.

It has been hypothesized that parents of patients with obsessive compulsive disorder exhibit specific traits. 320 consecutive inpatient admissions who met criteria for OCD, depression, and panic disorder checked a list of adjectives to describe their parents. Patients with OCD were 1) less likely to perceive their mothers as disorganized than depressives, 2) more likely to perceive their mothers as overprotective than depressives and 3) less likely to perceive their fathers as demanding than patients with panic.

Adolescent↗
PubMedDate not supplied

Evidence of a schizotypy subtype in OCD.

OCD patients represent a heterogeneous mix of clinical phenotypes, likely reflecting a wide range of genetic vulnerabilities. In other medical illnesses, neurobiologically-based traits with a genetic component that are associated with the target disorder have been successfully used to detect patients with a specific genetic liability to disease. The overlap between symptoms of OCD and Schizophrenia suggested that schizotypal traits could have the potential to distinguish a relatively homogeneous subtype of OCD. We obtained schizotypy scores for 119 affected adult probands who met lifetime criteria for DSM-IV OCD. Five subscales from the Structured Interview of Schizotypy were used to assess ideas of reference, suspiciousness, magical thinking, illusions and psychotic-like thought. Selected for their obvious face validity with the cardinal signs of schizophrenia, Cronbach's alpha suggested that these subscales also provided a reliable measure of positive sign schizotypy (0.83). Fifty percent of our OCD sample had mild to severe positive schizotypy signs. t- and chi2 tests of significance suggested seven variables that distinguished OCD patients with schizotypy, including earlier age of onset, greater number of comorbid diagnoses and increased rates of learning disability, aggressive and somatic obsessions and counting and arranging compulsions. Three of these seven variables, including learning disabilities, counting compulsions and history of specific phobia, significantly increased the odds of schizotypy among patients with lifetime OCD. These findings enhanced the validity of the schizotypy construct in OCD. Whether this schizotypy subtype can distinguish a subgroup of patients with relatively homogeneous genetic characteristics waits further investigation.

Adolescent↗

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