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PubMed1981

Suicide in children.

Suicide can be the tragic consequence of depression, even in childhood. Depression has been described in infants, is often overlooked in children and is a leading cause of death in adolescents. Childhood suicide is uncommon because of the child's lack of knowledge and limited physical resources. The high incidence of suicide in adolescents is, in part, due to impulsive activity. While drug therapy can be helpful, the management of frightened and depressed suicidal youngsters requires a network of helping professionals.

Adolescent↗
PubMed1994

Preliminary observations of DSM-III-R axis I comorbidity in men with paraphilias and paraphilia-related disorders.

BACKGROUND: We describe a comorbidity study of DSM-III-R-defined Axis I diagnoses comparing male outpatient paraphiliacs to men with nonparaphilic forms of sexual impulsivity designated as paraphilia-related disorders. METHOD: Data were prospectively collected from 60 consecutively evaluated outpatient males, aged 21-53 years, seeking treatment for the principal disorders of paraphilias (N = 34) and/or paraphilia-related disorders (N = 26). Subjects completed a semistructured psychiatric Intake Questionnaire and Sexual Inventory. The lifetime prevalence of DSM-III-R Axis I diagnoses, including disorders of sexual impulsivity, was assigned by follow-up psychiatric interviews. RESULTS: Both groups of men were diagnosed with an elevated lifetime prevalence of mood disorders (76.7%), especially early-onset dysthymia (53.3%); psychoactive substance abuse (46.7%), especially alcohol abuse (40.0%); and anxiety disorders (46.7%), especially social phobia (31.6%). The predominant forms of sexual impulsivity reported by both groups were "nonparaphilic" paraphilia-related disorders: compulsive masturbation (73.3%), protracted promiscuity (70.0%), and dependence on pornography (53.3%). CONCLUSION: There were no major differences in lifetime Axis I diagnoses to differentiate men with paraphilic disorders from those with paraphilia-related disorders. Both groups were likely to acknowledge multiple paraphilias and/or multiple paraphilia-related disorders suggesting that sexual impulsivity has diverse manifestations, which can include culturally "deviant" as well as "normative" behaviors. Several hypotheses regarding the possible etiologic relationship between depressive disorders and sexual impulsivity are suggested.

Adult↗
PubMed1994

[Arson--a disorder of impulse control?].

Reviewing the literature the current knowledge about the motivational basis of arson is discussed. Fire-setters form a heterogenous group; they seem to commit their crimes for different reasons. Some of them are imbecile, some suicidal, and other showed autoaggressive behaviour in the past; sometimes a connection with sexual excitement can be observed. The criteria for the diagnosis "pyromania" used in the classification manuals DSM-III-R and ICD-10 are strict, in order to facilitate an operationalised diagnosis. Most of the fire-settings cannot be classified under this subcategory of "disorders of impulse control". However, impairments of impulse control are typical characteristics in most cases of arson.

Antisocial Personality Disorder↗
PubMed1994

Compulsive buying: a report of 20 cases.

BACKGROUND: Compulsive buying is a probably common but little studied disorder. To further characterize this syndrome, the authors assessed 20 compulsive buyers. METHOD: Twenty consecutive psychiatric patients with problematic buying behavior characterized as (1) uncontrollable; (2) markedly distressing, time-consuming, and/or resulting in family, social, vocational, and/or financial difficulties; and (3) not occurring only in the context of hypomanic or manic symptoms were evaluated with structured diagnostic interviews. Family histories of psychiatric disorders and patients' responses to psychological and biological treatments were also assessed. RESULTS: Nineteen (95%) of the compulsive buyers studied had lifetime diagnoses of major mood disorders. Sixteen (80%) had lifetime diagnoses of anxiety disorders, 8 (40%) had impulse control disorders, and 7 (35%) had eating disorders. First-degree relatives displayed a high prevalence of mood disorders. Nine (69%) of 13 patients receiving thymoleptics at the time of compulsive buying episodes reported reduction or remission of their buying symptoms. CONCLUSION: Compulsive buying may cause significant psychological, interpersonal, and financial difficulties; may co-occur with other psychiatric disorders; may be treatable; and, thus, should be further studied as a mental disorder in its own right. To this end, preliminary operational criteria for its diagnosis are proposed.

Adult↗
PubMedDate not supplied

[Alternating addictions: apropos of 3 cases].

The concept of addiction is now of interest in psychiatry, but is a great subject of controversies. It is now recognized that as different disorders as alcoholism, drug addiction, bulimia, kleptomania, trichotillomania, pathological gambling are to be considered as addictive states. Other pathological behaviours could be included in the addictive spectrum (i.e. suicidal behaviours, compulsive spending). The comorbidity rates of these disorder are elevated in these populations. For example, high comorbidity rates are found between kleptomania and bulimia or drug addiction and pathological gambling. Polyaddictive states are well established. For some subjects, more than one addiction is present in life-time, but not occurring in the same period. We present three patients in whom different addictive states occurred alternately. All the patients had a history of compulsive spending and kleptomania, two of them had a history of bulimia and sexual compulsion. Some clinical characteristics were common: recurrent mood disorder, depression preceeding the addictive state, no psychoactive substance disorder. In all patients, severity of depressive state decreased when addiction appeared. Depressive symptoms varied inversely to addiction severity. The hypothesis about psychopathological links between kleptomania and bulimia on one hand and mood disorders on the other hand has been known for a long time. Kleptomania as other impulsive disorders is, for some authors, understood in the meaning of a "spectrum affective disorder". For these three patients, an antidepressant effect of the behavioural addictions is suggested. In fact, the addictions appeared alternately. The possibility of common psychopathological and/or biological mechanisms for behavioural addiction is supported by these clinical observations, that could contribute to the addiction concept validity.

Adult↗
PubMed1997

Kansas v. Hendricks.

The U.S. Supreme Court considered an appeal by the State of Kansas that arose from the Kansas Supreme Court's invalidation of the Kansas Sexually Violent Predator Act. The Act establishes procedures for the civil commitment of persons who, due to a "mental abnormality" or "personality disorder," are likely to engage in "predatory acts of sexual violence." The Supreme Court held that the Act's definition of "mental abnormality" satisfies substantive due process requirements. The Court further held that since the Act does not establish criminal proceedings, it does not violate the Constitution's double jeopardy prohibitions or its ban on ex post facto lawmaking. The Court's holding and its implications are discussed.

Adult↗
PubMed1998

Aggressive and impulsive behavior in military psychiatric inpatients.

OBJECTIVE: To determine if a history of aggressive/impulsive behavior adversely affected the return to full duty of a military psychiatric inpatient population. METHOD: Charts were reviewed for aggressive/impulsive behavior as indicated by self-report on a standardized admission form and by history in 211 consecutive admissions pooled from two separate 2-month intervals during a 9-month period. RESULTS: Seventy-three percent of the population was between the ages of 17 and 24 years. Sixty-eight percent of the population reported a history of at least one school suspension/expulsion, arrest, or military nonjudicial punishment (males, 74%; females, 45%). Seven percent of patients reporting aggressive/impulsive behavior were returned to full duty unconditionally, compared with 28% of patients not reporting said behavior. Eighteen percent of patients met the criteria for adult antisocial behavior. Only one patient with adult antisocial behavior was returned to full duty. CONCLUSIONS: This study found that a history of aggressive/impulsive behavior was positively correlated with substance abuse and negatively correlated with return to full military duty.

Adolescent↗
PubMed2005

[Pathological buying -- a literature review].

This review summarizes the literature on pathological buying published during the past 15 years. Pathological or compulsive buying is defined as frequent preoccupation with buying or impulses to buy that are experienced as irresistible, intrusive, and/or senseless. The buying behavior causes marked distress, interferes with social functioning, and often results in financial problems. Studies on the phenomenology, diagnosis, classification, comorbidity, epidemiology, and treatment are presented. Pathological buying should be diagnosed as impulse control disorder not otherwise specified (ICD-10 F63.9). Psychiatric comorbidity is frequent, particulary mood, anxiety, substance use, eating, impulse control and obsessive-compulsive disorders. The positive results of pharmacological treatment with antidepressants (usually SSRI) and opioid antagonists could not be confirmed in controlled trials. A disorder specific cognitive-behavioral group treatment manual was published in USA. A controlled study is currently conducted in USA and since 2003 at the Department of Psychosomatics and Psychotherapy at the University Hospital Erlangen.

Behavior, Addictive↗
PubMed2005

Association between smoking and attention-deficit/hyperactivity disorder symptoms in a population-based sample of young adults.

CONTEXT: Attention-deficit/hyperactivity disorder (ADHD) has been associated with increased risk of smoking, and some studies have suggested that inattentive symptoms specifically may underlie this risk. Few studies, however, have examined ADHD symptoms in nonclinical samples to determine the extent to which the number of symptoms-independent of the full diagnosis-confer risk for smoking-related outcomes. OBJECTIVE: To evaluate the relation between smoking-related variables and the number of retrospectively reported ADHD inattentive and hyperactive/impulsive symptoms in a population-based sample of young adults. DESIGN, SETTING, AND PARTICIPANTS: The study population consists of 15 197 eligible participants from wave III of the National Longitudinal Study of Adolescent Health, a nationally representative sample of adolescents followed from 1995 to 2002. MAIN OUTCOME MEASURES: Logistic regression was used to examine the relation between self-reported ADHD symptoms and the lifetime likelihood of being a regular smoker, defined by having smoked at least 1 cigarette a day for 30 days. For individuals reporting regular smoking, we also examined the extent to which ADHD symptoms predicted age at onset of regular smoking and number of cigarettes smoked. RESULTS: A linear relation was identified between the number of self-reported inattentive and hyperactive/impulsive symptoms and smoking outcome measures (P<.001 for each symptom domain). Controlling for demographic and conduct disorder symptoms, each reported inattention and hyperactivity/impulsivity symptom significantly increased the likelihood of ever regular smoking (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.08-1.14 and OR, 1.16; 95% CI, 1.13-1.19, respectively). For those reporting lifetime regular smoking, reported symptoms decreased the estimated age at onset and increased the number of cigarettes smoked. CONCLUSIONS: Self-reported ADHD symptoms were found to be associated with adult smoking outcome variables in this nationally representative sample, providing further evidence of a likely link between ADHD symptoms and risk for tobacco use.

Adolescent↗
PubMed2003

Anxiety and impulsivity levels identify relevant subtypes in adolescents with at-risk behavior.

BACKGROUND: Impulsivity (I) and anxiety (A) were hypothesized to be crucial clinical features in adolescents with at-risk behavior. We therefore classified them into sub-groups according to these two major dimensions. The study examined the relevance of these groups by describing their major diagnoses and behavioral characteristics. METHODS: During a 1-year period, all in-patients consecutively admitted for at-risk behavior, except those with a previous psychotropic treatment and/or schizophrenic disorders, were rated for anxiety and impulsivity, and categorized into four groups: impulsive and anxious (IA), impulsive and non-anxious (Ia), non-impulsive and anxious (iA), non-impulsive and non-anxious (ia). We assessed the main behavioral disturbances (suicide attempt, carving, violence, delinquency, substance abuse, and eating disorder) and the main current axis I disorder in each sub-group. RESULTS: A total of 69 patients were included. In the IA group 62% exhibited hypomanic episodes and 87% recurrent suicide attempts. In the Ia group all exhibited conduct disorders, 93% were males, 80% delinquents, and 100% violent with others. Both groups reported a high percentage of cannabis use (67%). The iA group exhibited anorexia nervosa (73%) with a major depressive episode. The ia patients were mainly non-violent, first suicide attempts with low risk. LIMITATIONS: Long-term data are needed to assess the stability of these groups. CONCLUSIONS: We found that sub-typing adolescents with at-risk behavior into four groups according to their level of anxiety and impulsivity was highly predictive of being suicidal with mood disorders (AI), delinquent with conduct disorder (Ia), anorectic or depressed (Ai), and with substance abuse associated only to impulsivity. It is likely that this sub-typing of patients may be useful for prevention and therapeutics. The impulsive-anxious group (IA) appears closely related to the soft bipolar spectrum. A replication and follow-up data are now needed.

Adolescent↗
PubMed2006

Pharmacological treatment of psychiatric comorbidity in bipolar disorder: a review of controlled trials.

OBJECTIVE: Little is known about the treatment of psychiatric comorbidities in bipolar disorder. The aim of this review was to summarize the literature on controlled pharmacological trials that have been conducted in psychiatric conditions that commonly co-occur in bipolar disorder. METHODS: A Medline search (1980-October 2005) using the terms bipolar disorder and randomized controlled trials, comorbidity, anxiety disorders, alcohol abuse or dependence, substance abuse or dependence, eating disorder, impulse control disorders, attention-deficit disorder, lithium, anticonvulsants, atypical antipsychotic drugs, antidepressants, stimulants was used. RESULTS: The literature establishes a strong association between bipolar disorder and substance abuse/dependence, anxiety disorders, impulse control disorders, eating disorders and attention-deficit hyperactivity disorder. Comorbidity often complicates the diagnosis and the treatment of bipolar disorder and worsens its course of illness and prognosis. Few controlled pharmacological studies have examined the treatment of comorbid conditions in patients with bipolar disorder. CONCLUSIONS: Treatment of psychiatric comorbidities in bipolar disorder is not based on controlled data but is largely empirically based. Controlled trials in patients with bipolar disorder and comorbidity are urgently needed.

Antidepressive Agents↗