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PubMed1997

Psychiatric disorders in women with bulimia nervosa and their first-degree relatives: effects of comorbid substance dependence.

OBJECTIVE: Women with bulimia nervosa (BN) and comorbid substance dependence often display impulsive behaviors. We assessed Axis I and II psychiatric diagnoses in their first-degree relatives in order to understand the etiological factors that may contribute to this subtype of BN. METHOD: We used contemporary family-epidemiological methodology to compare the lifetime prevalence of psychiatric disorders among 47 women with BN and 44 non-eating-disordered community control women, and their first-degree relatives (177 and 190, respectively). BN probands were stratified by the presence (n = 20) or absence (n = 27) of a lifetime history of alcohol and/or drug dependence. RESULTS: Social phobia, conduct disorder, and clusters B and C personality disorders were significantly more prevalent among BN probands with substance dependence than among BN probands without substance dependence or control women probands. Substance use disorders, social phobia, panic disorder, and cluster B personality disorders were significantly more prevalent among the relatives of BN probands with substance dependence than the relatives of the other two groups. DISCUSSION: Women with BN and substance dependence have problems with social anxiety, antisocial behavior, and a variety of personality disturbances, and come from families where there are problems with substance use disorders, anxiety, impulsivity, and affective instability. These data raise the possibility that a familial vulnerability for impulsivity and affective instability may contribute to the development of substance dependence in a subgroup of women with BN.

Adult↗
PubMed1992

The DSM-III-R impulse control disorders not elsewhere classified: clinical characteristics and relationship to other psychiatric disorders.

OBJECTIVE: The authors reviewed available studies of DSM-III-R impulse control disorders not elsewhere classified in order to determine the relationship of these disorders to one another and to other psychiatric disorders. METHOD: The review focused on the demographic and clinical characteristics, phenomenology, family history, biology, and response to treatment of individuals with intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania. Analysis was restricted to reports which either indicated use of operational diagnostic criteria or provided descriptions of the impulsive behavior detailed enough that patients could be judged as probably meeting the DSM-III-R criteria. RESULTS: Although different impulse control disorders have different sex ratios, all have similar ages at onset and courses. Studies on phenomenology, family history, and response to treatment suggest that intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania may be related to mood disorders, alcohol and psychoactive substance abuse, and anxiety disorders (especially obsessive-compulsive disorder). Biological studies indicate that intermittent explosive disorder and pyromania may share serotonergic abnormalities similar to those reported in mood disorders. CONCLUSIONS: The impulse control disorders not elsewhere classified appear to be related to one another and to mood, anxiety, and psychoactive substance use disorders. Thus, like major depression, obsessive-compulsive disorder, panic disorder, bulimia nervosa, and attention deficit hyperactivity disorder, they may represent forms of "affective spectrum disorder."

Disruptive, Impulse Control, and Conduct Disorders↗
PubMedDate not supplied

Disinhibition and negative affectivity in substance abusers with and without a gambling problem.

A cohort of 2,171 substance abusers were assessed for their gambling behavior, and divided into three groups: those with no significant gambling problem (87%); those with a probable problem (7.2%); and those with a severe problem (5.8%). Substance abusers with a gambling problem scored significantly higher on measures of: impulsivity; disinhibition of aggressive/hostile responses; and negative affectivity. They also abused more substances than the nongamblers. The results underscore the importance of assessing a wide range of impulsive behaviors in substance abusers and the potential for subtyping substance abusers based on psychological traits.

Adult↗
PubMed2000

Modeling the relationship between affective lability, impulsivity, and suicidal behavior in patients with borderline personality disorder.

This article reviews the concept of affective lability and suggests that new models are needed to characterize the relationship between affective states such as affective lability, impulsivity, and suicidal behavior. The association of affective lability, impulsivity, and suicidal behavior is most relevant to understanding the risk of suicide in individuals with borderline personality disorder. The relationship between affective lability and suicide might be explained as 1) a form of bipolarity, 2) a form of impulse dyscontrol, 3) a quantitative disorder of affect, or 4) an environmental reactivity. Our opinion of the relevant literature suggests that a quantitative disorder of affect accompanied by the inability to control these affects are the essential components leading to the risk of suicidal behavior. Characterizing the dyscontrol and high intensity of affect leads to a reconceptualization of depression in patients with borderline personality disorder and to a re-examination of the causal chain of events leading to suicidal behavior. The implications for clinical practice resulting from the proposed model are discussed.

Journal Article↗
PubMedDate not supplied

A follow-up study of attentional behavior in 6-year-old children exposed prenatally to marihuana, cigarettes, and alcohol.

Attentional behavior was examined in one hundred twenty-six 72-month-old children for whom prenatal exposure to marihuana, cigarettes, and alcohol has previously been ascertained. Discriminant Function Analysis revealed a dose-response association between prenatal cigarette exposure and impulsive behavior as manifest on poorer performance on a response inhibition task and increased errors of commission on a sustained vigilance task. Performance on a series of memory tasks particularly those requiring verbal recall was also negatively associated with maternal cigarette use. Prenatal marihuana habits were associated with increased omission errors in the vigilance task, possibly reflecting a deficit in sustained attention. In addition, Discriminant Function Analysis revealed a dose-response relationship between prenatal marihuana use and a higher rating by the mothers on an impulsive/hyperactive scale. Relatively low levels of maternal alcohol consumption was related to decreased impulsive responding both in the response inhibition task and in terms of the mothers' perception of the child's behavior. The multifaceted approach of examining attentional behavior was essential to reveal the differential associations with the three prenatally used drugs. The implications of the observations and how the findings relate to and extend the existing literature is discussed.

Adult↗
PubMed2002

Assessment of impulsivity among psychiatric inpatients.

Routine assessment of impulsivity and accompanying coping skills is essential for planning care and appropriate management of patients identified as impulsive. Impulsivity can be defined in many ways, and many perspectives exist. Impulsivity is associated with several adult psychiatric disorders. In an inpatient psychiatric setting, nurses are more likely than members of other disciplines to encounter impulsive behavior due to the amount of time spent in direct patient care. As the primary caregivers in hospitals, nurses are responsible for the management of impulsive individuals. It is critical for treatment plans to incorporate interventions specifically targeting impulsivity.

Adaptation, Psychological↗
PubMed2005

Treatment of comorbidity in conduct disorder with attention-deficit hyperactivity disorder (ADHD).

Conduct disorder (CD) is one of the most common psychiatric disorders in childhood and adolescence. It is characterized by a variety of chronic antisocial behaviors, a repetitive and persistent pattern of behavior that violates the basic rights of others, major age-appropriate societal norms, or both. Aggressive behavior, lying, stealing, fire-setting, and running away from home and school are the most frequent manifestations of CD and are often accompanied by hyperactivity, impulsive behavior, explosiveness, cognitive and learning problems, and poor social skills. The rate of comorbidity is high, with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) being the most common; comorbid anxiety and depressive disorders are also seen, especially in adolescents. The diagnostic process should include the use of structured interviews, and scores from reliable and valid rating scales that cover all psychiatric disorders must be considered in the differential diagnosis, because CD alone is an extreme rarity and multiple disorders are almost always the rule rather than exception. Treatment should include parenting skills training combined with training of the child to improve his or her relationships with peers, academic performance, and compliance with legitimate demands of authority figures. The appropriate use of medications and integration of patient/parent education and support, as well as individual, group, family, residential, and inpatient treatment may be beneficial for patients with CD and ADHD. The article describes a number of psychopharmacological agents that are used in patients with CD with ADHD and other comorbid disorders. Drugs that may be useful include psychostimulants; atomoxetine (Strattera); antidepressants (imipramine [Tofranil], desipramine [Norpramin]); Selective Serotonin Reuptake Inhibitors (SSRIs); atypical antipsychotics such as risperidone (Risperdal); or mood regulators including lithium (Eskalith).

Adolescent↗
PubMed2003

Deaf adults without attention deficit hyperactivity disorder display reduced perceptual sensitivity and elevated impulsivity on the Test of Variables of Attention (T.O.V.A.).

The Test of Variables of Attention (T.O.V.A.; R. A. Leark, T. R. Dupuy, L. M. Greenberg, C. L. Corman, & C. L. Kindeschi, 1996) is a continuous performance test used widely to help diagnose attention deficit hyperactivity disorder (ADHD) in both hearing and deaf people. The T.O.V.A. previously has been normed only on the hearing population. The T.O.V.A. performance of 38 prelingually and severely-to-profoundly deaf young adults and 34 hearing young adults who did not have ADHD was examined in this study. Deaf and hearing participants did not differ on the T.O.V.A. omission variables. However, deaf participants had significantly lower d' scores than hearing participants, indicating reduced perceptual sensitivity to the distinction between target and distractor stimuli. Consistent with the existing literature on attentional reorganization in the deaf population, this result was interpreted as indicating a deafness-related reduction in attention to centrally presented stimuli. Deaf participants also showed 2 to 3 times more commission errors than hearing participants and displayed a higher incidence of anticipatory errors. These results suggest a deafness-related increase in impulsivity at the time of response initiation. Beta score analysis confirmed that deaf participants adopted an overall less conservative (more impulsive) response criterion that contributed to their total elevated commission errors. However, a portion of the commission errors was secondary to their reduced d', not to increased behavioral impulsivity. Separate factor analyses of the standard T.O.V.A. variables revealed highly similar factor structures for deaf and hearing participants, indicating similar construct validity of the T.O.V.A. for both groups. The evidence for increased inattention and impulsivity in a non-ADHD deaf sample are interpreted in the context of an adaptive attentional reorganization due to deafness. Along with the factor analytic results, these considerations suggest that separate T.O.V.A. norms must be developed for the deaf population to avoid overdiagnosis of ADHD in deaf individuals.

Adult↗
PubMed1999

5-HT receptor knockout mice: pharmacological tools or models of psychiatric disorders.

The molecular diversity of cloned serotonin receptor subtypes in the brain makes it difficult to understand the specific modulatory roles played by different receptors. In order to understand the role of the 5-HT1B receptor subtype in behavior and neuropsychiatric disorders, we have been studying genetic knockout mice lacking the 5-HT1B receptor. The 5-HT1B knockout mice show evidence of increased aggression and impulsivity, behavioral patterns that are also associated with reduced 5-HT function. They also show reduced or absent locomotor stimulation to some serotoninergic drugs, indicating that the locomotor effects of these drugs require the 5-HT1B receptor. However, in some cases, data obtained with knockout mice conflicts with the pharmacological data. The 5-HT1B receptor knockout mice show a phenotype of increased vulnerability to drugs of abuse such as cocaine. However, pharmacological studies suggest that 5-HT1B stimulation enhances the effects of cocaine, while 5-HT1B blockade can attenuate some of the effects of cocaine. Compensations that enhance dopamine function appear to be responsible for the drug-vulnerable phenotype of 5-HT1B receptor knockout mice. By studying these compensations and changes in neural function, we can learn more about the fundamental mechanisms underlying addiction. The 5-HT1B knockout mice should be considered a model for the disease state of vulnerability to drugs of abuse, rather than a direct pharmacological model of 5-HT1B receptor function.

3,4-Dihydroxyphenylacetic Acid↗
PubMed2002

[Features of nursing of the autistic children].

Due to the behavioral and communication difficulties autistic children need individualized approaches providing them medical help. Aspects of nursing of autistic children were not investigated in our country. Thirty seven mothers of autistic children and 74 mothers of children without developmental disorders (control group) were interviewed orally and filled the questionnaire. The age of children was 3-12 years old. The aim of the research was to analyze peculiarities of behavior, communication and social adaptation of children with autism disorder together with troubles they face in medical services (outpatient and inpatient), and prepare practical recommendations to the pediatric and mental health nurses. It appeared that families with autistic children come across the great difficulties in various areas of the daily life. Autistic children tended to have severe behavioral and emotional difficulties while being examined by the medical staff. Adaptation difficulties in medical services were very prominent, especially at the in-patient departments (unpredictable and impulsive behavior, anxiety, decrease of appetite, sleep disturbances). Possibilities of home visit of the nurses are underestimated and could provide more useful and constructive help to the families. The data showed existing difficulties for the pediatric nurses and medical staff to establish good contact with the autistic children and their parents and lack of knowledge about the children with pervasive developmental disorders and their needs. Practical recommendations are provided.

Age Factors↗
PubMed2006

[The relationship between gene polymorphism of catechol-O-methyltransferase and survival of oral pesticides suicide attempters].

OBJECTIVE: To understand the association between gene polymorphism of catechol-O-methyltransferase (COMT) and suicide attempters taking pesticides orally and to provide a scientific base for the prevention of suicidal behavior. METHODS: 107 suicide attempters taking pesticides orally were collected from The People's Hospitals in Shandong Province from January 2003 through December 2003. The informations of all the attempters were obtained and 1 ml whole blood from of them were collected. Molecular biological techniques were used to study the gene type of each subject. RESULTS: In the 107 suicide attempters, the ratio of male to female is 1:1.55; 67.3% of them were in age range of 20 - 44 years; 59.8% of them had education level of elementary school or lower. 13 suicide attempters (12.1% of all the attempters) had psychiatric disorders. 84 suicide attempters (78.5% of all the attempters) had affective conflicts with others in the recent year. 30 suicide attempters (28.0% of the suicide attempters) had impulsive behavior. Multivariate logistic regression model analysis showed that suicide impulsion and psychiatric disorders were significantly associated with COMT Val/Val, their OR values were 0.052 (95% CI: 0.006 - 0.437), 2.917 (95% CI: 1.097 - 7.760). CONCLUSION: In this population, more attention should be paid to young female people with psychiatric disorders or having affective conflicts with others in the recent year so as to prevent suicide. This study supported that there is heterogeneity in COMT gene in suicide attempters and there is interaction between COMT Val/Val and suicide impulsion and psychiatric disorders.

Adolescent↗
PubMed2006

Algorithmically designed peptides ameliorate behavioral defects in animal model of ADHD by an allosteric mechanism.

This study exemplifies the use of three ADHD-relevant methodological innovations. (1) The use of novel, patented, computational peptide design techniques to generate peptides targeting the extra-cellular and para-transmembrane amino acid loops of the putatively ADHD-involved, D(2) dopamine receptor, D(2)DAR; (2) experimental evidence that these peptides in L-amino acid/ortho ordered or D-amino acid/reverse ordered (retro-inverso), D(2)DAR, hydrophobic eigenmode matched forms, evoked positive allosteric and indirect agonist influences on in vitro stably receptor transfected CHO and LtK cells and on in vivo, brain mediated activity; (3) a representative 15 residue all-D-amino acid, D(2) mode matched peptide, given parenterally, was found to "repair" a key aberrant ADHD behavioral characteristic in a standard animal model of ADHD, the Spontaneously Hypertensive Rat, SHR, relative to its progenitor species control, the Wistar-Kyoto rat, WKY. The representative, retro-inverso peptide, all-D-LLYKNKPRYPKRNRE, reversed SHR's relative deficiency in sensory motor gating (pre-pulse inhibition, PPI) while leaving SHR's nonselective attention (rearings), impulsive behavior (time in center), and activity level (timed total motor behavior) unchanged. Amphetamine also reversed SHRs sensory gating defect, but with significant increases in nonselective attention, impulsivity and hyperactivity. These preliminary results suggest the possibility of a new, "softer" pharmacological approach to ADHD: hydrophobic mode matched peptide allosteric augmentation of the activity of indigenous dopamine with respect to D(2)DAR mediated function, in place of stimulant drug-induced presynaptic dopamine release or impairment of dopamine uptake.

Acoustic Stimulation↗
PubMed1994

Determinants of early alcohol and drug use among young women in alcoholism treatment.

Substance abuse experimentation may be one of several types of problem behaviors. Data from 99 Caucasian women interviewed in alcoholism treatment (19-29 years old) were used to test a developmental model of substance experimentation. Respondents were classified into three groups based on their use prior to age 15: nonusers, users of alcohol only, and users of alcohol and other drugs. Family history of alcoholism was not related to childhood anxiety and impulse control problems. Childhood anxiety and impulse control problems predicted adolescent emotional and impulse control problems but did not differentiate early experimenters. Whereas adolescent emotional problems were not related to early experimentation, early drug and alcohol users were significantly more likely to have engaged in other impulsive behaviors (e.g., running away from home, trouble with school authorities) than were nonusers or users of alcohol only. Alcoholism prevention programs, therefore, would do well to target youth who exhibit acting-out behaviors as a high-risk group for early alcohol and drug use.

Acting Out↗
PubMed2003

Interaction of nitric oxide and serotonin in aggressive behavior.

Nitric oxide (NO) modulates many behavioral and neuroendocrine responses. Genetic or pharmacological inhibition of the synthetic enzyme that produces NO in neurons evokes elevated and sustained aggression in male mice. Recently, the excessive aggressive and impulsive traits of neuronal NO synthase knockout (nNOS-/-) mice were shown to be caused by reductions in serotonin (5-HT) turnover and deficient 5-HT1A and 5-HT1B receptor function in brain regions regulating emotion. The consistently high levels of aggression observed in nNOS-/- mice could be reversed by 5-HT precursors and by treatment with specific 5-HT1A and 5-HT1B receptor agonists. The expression of the aggressive phenotype of nNOS-/- knockout mice requires isolated housing prior to testing. The effects of social factors such as housing condition and maternal care can affect 5-HT and aggression, but the interaction among extrinsic factors, 5-HT, NO, and aggression remains unspecified. Taken together, NO appears to play an important role in normal brain 5-HT function and may have significant implications for the treatment of psychiatric disorders characterized by aggressive and impulsive behaviors.

Aggression↗
PubMed2002

Delay of gratification and delay discounting in rats.

Delay discounting (DD) and delay of gratification (DG) are two measures of impulsive behavior often viewed as reflecting the same or equivalent processes. However, there are some key differences in the contingencies of reinforcement between the procedures that may have implications for understanding impulsivity. This study used DD and DG procedures to determine if differences in contingencies of reinforcement specified by DD and DG alters how much organisms discount the value of delayed reinforcers. Twenty-four water-deprived rats performed one of two Adjusting Amount procedures, which consisted of repeated choices between a fixed amount of water (250 &mgr;l) delivered after a delay (0, 4, 8, 16, or 32 s) and an adjusting, usually lesser amount delivered immediately. Half of the rats (n=12) performed a DD procedure designed to assess preference for immediate over delayed reinforcers in which they had discrete choices between the immediate and delayed amounts of water. A DG procedure was used for the other half of the rats (n=12). In the DG procedure rats also selected between immediate and delayed alternatives, but if they chose the delayed alternative they could switch to and receive the immediate alternative at any time during the delay to the larger reward. In the DD procedure switching responses were not reinforced but were still recorded and used for analyses. The DD functions of the two groups did not differ significantly. However, at the longer delays, the DG group made significantly fewer switching responses than the DD group. A possible role of response inhibition in the DG procedure is discussed.

Journal Article↗
PubMed1999

Behavioral disinhibition and the development of substance-use disorders: findings from the Minnesota Twin Family Study.

One variant of substance-use disorder is characterized by behavioral disinhibition. In this report, we martial evidence for a model for the development of this variant. We hypothesize that genetic liability for this variant is reflected in a spectrum of risk indicators linked to the inability or unwillingness to inhibit behavioral impulses. Included in this spectrum are personality traits suggesting low constraint, and externalizing psychopathology, including conduct, oppositional defiant, and attention-deficit disorder in children and antisocial personality disorder and behavior in adults. We further hypothesize that these individual differences in behavioral disinhibition are manifestations of underlying central nervous system processes associated with various psychophysiological anomalies, some of which may index genetic risk for substance abuse. Support for the model is derived from the analysis of findings from the Minnesota Twin Family Study, an epidemiological investigation of approximately 2,700 adolescent twins and their parents.

Adolescent↗
PubMed2006

Regulation of 5-HT2A/C receptors and DOI-induced behaviors by protein kinase Cgamma.

Protein kinase Cgamma (PKCgamma) null mutant mice demonstrate increased behavioral impulsivity and ethanol consumption. Pharmacological studies have shown that 5-HT(2A/C) receptors modulate impulsivity and ethanol consumption in rodents and that PKC can regulate 5-HT(2A/C) receptors. To determine whether PKCgamma plays a selective role in 5-HT(2A/C) receptor regulation, biochemical and behavioral experiments were performed in PKCgamma mutant and wild-type mice. DOI-stimulated phosphoinositol hydrolysis and [(125)I]-DOI saturation binding in the PFC, and quantitative autoradiography of [(125)I]-DOI binding sites in 15 brain regions were analyzed. DOI-induced head twitch responses (HTR) were measured in naive mice after an acute 2.5 mg/kg injection of DOI. Results indicated that DOI-induced HTR was significantly greater in mutant mice compared to wild-type mice. Results of the phosphoinositol hydrolysis, membrane binding, and autoradiography experiments indicated that in mutant mice, increased HTR was associated with increased 5-HT(2A/C) receptor function in the PFC, but not increased receptor number or affinity suggesting that PKCgamma regulates receptor function but not receptor number. These data support a role for 5-HT(2A/C) receptors in the PFC in mediating some of the behavioral differences observed between PKCgamma mutant and wild-type mice.

Alcohol Drinking↗