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PubMed2000

Decreased platelet monoamine oxidase activity in female bulimia nervosa.

UNLABELLED: The involvement of brain serotonin systems in the pathophysiology of eating disorders has been repeatedly demonstrated in recent studies. Platelet MAO activity is an index of brain serotonin activity and lowered platelet MAO levels have been found in association with impulsive behaviors. In addition, some preliminary reports indicate that platelet MAO could be lowered in eating disorder patients. METHODS: 47 patients with DSM-IV eating disorders were studied, including 30 with bulimia nervosa and 17 with anorexia nervosa binge eating-purging type. Platelet MAO activity was measured by isotopic methods using C-14 benzylamine and compared with a control group of 30 healthy subjects. Impulsive personality features were studied with specific rating scales. RESULTS: Platelet MAO activity was significantly lower (4.4+/-2.4 nmol/h/10(8) platelets) in the bulimic patients than in the control group (6.9+/-2.5) (p<0.001). No significant differences were found between pure bulimics and binge eating-purging anorectics. Platelet MAO was inversely and significantly correlated with scores on impulsivity scales and with borderline personality disorder characteristics. CONCLUSIONS: Platelet MAO activity is lowered in patients with bulimia, which may reflect dysfunction in impulse control mechanisms. Since platelet MAO has a predominant genetic component, there is need for studies on the association of low platelet MAO and higher risk for developing eating disorders.

Adult↗
PubMed2006

Alcohol use in congenital central hypoventilation syndrome.

Congenital central hypoventilation syndrome (CCHS) is a rare disorder where there is failure of automatic control of breathing. With improved recognition of CCHS, more children are appropriately diagnosed and treated in infancy, allowing survival into adult years. Because most of these children are able to participate in regular school, they are exposed to common adolescent behaviors, such as abusing alcohol and drugs. Alcohol and many illicit substances are known respiratory depressants. We report on 3 cases of adolescents/young adults with CCHS who had severe adverse events related to alcohol, including coma and death. This series illustrates the dangers of alcohol abuse in CCHS. We speculate that adolescents with CCHS may be less able to perceive the risks of substance abuse and impulsive behavior, leading to increased morbidity and mortality. Patients with CCHS appear to lack anxiety and the awareness that their inability to perceive physiologically dangerous levels of hypercarbia and hypoxia deprives them of important protective mechanisms.

Adolescent↗
PubMedDate not supplied

Are impulse-control disorders related to bipolar disorder?

We reviewed available evidence regarding a possible relationship between impulse-control disorders (ICDs) and bipolar disorder. Studies examining the phenomenology, course, comorbidity, family history, biology, and treatment response of ICDs were compared with similar studies of bipolar disorder. Although no studies directly compare a cohort of ICD patients with a cohort of mood disorder patients, available data suggest that ICDs and bipolar disorder share a number of features: (1) phenomenologic similarities, including harmful, dangerous, or pleasurable behaviors, impulsivity, and similar affective symptoms and dysregulation; (2) onset in adolescence or early adulthood and episodic and/or chronic course; (3) high comorbidity with one another and similar comorbidity with other psychiatric disorders; (4) elevated familial rates of mood disorder; (5) possible abnormalities in central serotonergic and noradrenergic neurotransmission; and (6) response to mood stabilizers and antidepressants. However, ICDs and bipolar disorder differ in important respects. In particular, some ICDs may be more closely related to obsessive-compulsive disorder (OCD) than is bipolar disorder. Although the similarities between ICDs and bipolar disorder may be coincidental, they suggest that the two conditions may be related and thus may share at least one common pathophysiologic abnormality. To explain this possible relationship, we hypothesize that impulsivity and bipolarity (or mania) are related, that compulsivity and unipolarity (or depression) are similarly related, and that each state may represent opposing poles of related, or even a single, psychological dimension.

Adolescent↗
PubMed1994

Neurobiological factors in aggressive behavior.

OBJECTIVE: The author's aim was to review literature in the neurosciences and psychiatric clinical research reports about biological factors in aggression and the pathophysiological mechanisms that accompany aggression in neuropsychiatric syndromes. METHOD: Studies were located through computer searches of relevant experimental reports and review articles mainly from the last 25 years. RESULTS: Several studies using neuroimaging and neurophysiological and neuropathological research techniques have identified lesions in the limbic structures, temporal lobes, and frontal lobes of the brain in abnormally aggressive individuals. Several reports have associated deficiency or dysregulation of serotonin with homicidal, suicidal, and impulsive behavior. However, few studies have focused on polypeptides or second messenger systems, although abnormalities in these systems have been reported in patients with neuropsychiatric syndromes who have shown aggressive behavior. Even fewer studies focus on the correlation of brain structures and metabolic markers. CONCLUSIONS: The understanding of aggressive behavior in psychiatric patients is fragmented. Some explanations are speculative and extrapolated to clinical psychiatric syndromes from experimental data on the neurophysiology of cats, rats, and other mammals. Identification of biochemical markers that can be used in predicting patients' response to pharmacological interventions may be the next step in developing more rational treatment of violent patients.

Aggression↗
PubMed2004

Adapting supportive psychotherapy for individuals with Borderline personality disorder who self-injure or attempt suicide.

We have utilized supportive therapy (ST) with an outpatient population with borderline personality disorder (BPD) who also engage in nonsuicidal self-injurious and suicidal behavior. In recent years, ST has been described as an active psychotherapeutic approach that may have efficacy comparable to other psychotherapies. ST emphasizes the mobilization of strengths to enhance self-esteem and utilize adaptive defenses and positive coping skills. Patients with BPD who self-injure and attempt suicide require integration of tangible solution-focused approaches with standard ST in order to address negative thinking patterns, impulsive behavior, and affective dysregulation, along with crisis intervention during periodic crisis states. ST appears to be well tolerated by patients with BPD who have self-injurious behavior and may be efficacious in engaging BPD patients in treatment and in minimizing the frequency and intensity of self-injurious and suicidal behavior.

Affect↗
PubMed1975

Symposium on behavioral pediatrics. Juvenile delinquency.

The pediatrician's first step in responding to delinquent behavior is to make a differential diagnosis between sociological, characterological and neurotic delinquency. Sociological delinquency consists of subculturally sanctioned illegal activity by youngsters who are psychologically well-adjusted members of their peer group, and its treatment depends primarily on prevention through social action programs rather than on the intervention of the clinical practitioner. Characterological delinquency reflects a serious and long-standing personality disorder marked by aggressive and impulsive behavior and a lack of attachment to or consideration for others, and its treatment requires extensive psychotherapy, often in a residential setting. Neurotic delinquency involves uncharacteristic misbehavior of recent origin that represents an attempt to communicate unrecognized needs for attention or help, and it can often be treated effectively with short-term psychotherapy.

Adolescent↗
PubMed2006

Neural signatures of economic preferences for risk and ambiguity.

People often prefer the known over the unknown, sometimes sacrificing potential rewards for the sake of surety. Overcoming impulsive preferences for certainty in order to exploit uncertain but potentially lucrative options may require specialized neural mechanisms. Here, we demonstrate by functional magnetic resonance imaging (fMRI) that individuals' preferences for risk (uncertainty with known probabilities) and ambiguity (uncertainty with unknown probabilities) predict brain activation associated with decision making. Activation within the lateral prefrontal cortex was predicted by ambiguity preference and was also negatively correlated with an independent clinical measure of behavioral impulsiveness, suggesting that this region implements contextual analysis and inhibits impulsive responses. In contrast, activation of the posterior parietal cortex was predicted by risk preference. Together, this novel double dissociation indicates that decision making under ambiguity does not represent a special, more complex case of risky decision making; instead, these two forms of uncertainty are supported by distinct mechanisms.

Adolescent↗
PubMed1983

Psychological and behavioral characteristics of normal-weight bulimics and normal-weight controls.

This study compares psychological traits, physical traits, behavior, demographic data, incidence of family pathology, incidence of life stress, and scores on eating disorder scales in a sample of normal-weight female bulimics with a sample of normal-weight female controls. The groups, matched for age, socioeconomic status, and I.Q. were found to have comparable physical traits, family demographics, incidence of family pathology, and incidence of life stress. However, bulimics demonstrated significantly higher levels of psychological pathology and impulsive behavior. There were significantly more suicide attempts, psychiatric hospitalizations, episodes of stealing, use of drugs, and menstrual disturbances among the bulimics than the controls. The bulimics consistently rated themselves sicker than the controls on all psychometric scales. Most notable were the depression, anxiety, obsessive-compulsive, and interpersonal sensitivity factors on the Symptom Checklist 90, and the internal control score on the Nowicki-Strickland Locus of Control Scale. The discussion includes a brief description of weight set-point theory and its role in the maintenance of bulimia.

Adult↗
PubMedDate not supplied

[Epidemiologic research, disorders of eating behavior and addictive behavior].

The tremendous increase in interest in eating disorders, and especially in bulimia nervosa, that has occurred since the last 1970s has resulted in a large and contradictory literature about the relationships between eating disorders and addictive disorders, especially alcohol and drug abuse. At first sight, according to the differences observed between these disorders in most of their phenomenological characteristics (age, sex, socio-cultural factors), it may seem difficult to draw a parallel between them. However, studies showed that eating behavior problems, alcohol and drug abuse nowadays shared some common features in adolescents and young people. However that may be, epidemiological studies demonstrated a high prevalence of substance abuse among patients with bulimia. In anorexia nervosa, this prevalence seemed to be lower. However, significant differences have been observed between bulimic and restricting anorexics: substance abuse occurred significantly more frequently in bulimic anorexics than in restricting anorexics and this characteristic was associated with a higher prevalence of impulsive behaviors (i.e. stealing, self-mutilation and suicide attempt), laxative or diuretic use and impairments in social relationships. These clinical features are quite similar to those observed in bulimic patients with substance abuse problems. Follow-up studies also showed that substance abuse problems in anorexia nervosa were associated with the occurrence of bulimic behaviors. On the other hand, family studies reported that a high prevalence of patients with bulimia had at least one first degree relatives with substance abuse problems or an affective disorder. In anorexia nervosa, the prevalence of substance abuse or depression among the family members seemed to be higher in bulimic anorexics than in restricting anorexics.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Predictive validity of four factors derived from an 'hyperactivity/MBD' questionnaire.

Two studies were conducted to evaluate the differential predictive validity of four factors--hyperactivity/impulsivity, attention/socialization problems, antisocial behavior, learning problems--derived from Tarter's 'hyperactivity/MBD' questionnaire. One hundred forty five inpatient alcoholic men were evaluated in the first study and 34 first or second year college men in the second study. Our previous research had revealed significant relationships between the total hyperactivity/MBD score and psychopathology (MMPI, Psychopathic State Inventory), alcohol use patterns and consequences/and several areas of life functioning (Addiction Severity Index). Factor 1 was revealed in both studies to be associated with hypomania and impulsive behaviors. Factor 2 was associated with many of the same MMPI scales as the total hyperactivity/MBD score, including psychopathic deviate, psychasthenia and social introversion, as well as other measures of sociopathy and criminal behavior. A subsequent breakdown of Factor 2 into its attention and socialization components provided further meaningful differentiations. Factor 3 was found in both studies to be predictive of antisocial and criminal personality and behavior. Both factors 2 and 3 were also closely associated with difficulties in interpersonal relations. Factor 4 bore few relationships with personality, but was found to be related to visuospatial performance deficits. The research therefore supported the differential predictive validity of the four factors. The examination of the individual relationships of these factors enabled a more precise delineation of underlying relationships than was achieved by the total hyperactivity/MBD score.

Adult↗
PubMed2001

The 5-HT1B receptor: behavioral implications.

5-HT1B receptors are expressed throughout the mammalian central nervous system. These receptors are located in the axon terminals of both serotonergic and nonserotonergic neurons, where they act as inhibitory autoreceptors or heteroreceptors, respectively. 5-HT1B receptors inhibit the release of a range of neurotransmitters, including serotonin, GABA, acetylcholine, and glutamate. These receptors have been difficult to study because of the diversity of their cellular localization and the absence of highly selective agonists and antagonists. There has been accumulating evidence, however, that 5-HT1B receptors modulate drug reinforcement, stress sensitivity, mood, anxiety, and aggression. The general results of a number of studies suggest that reduced 5-HT1B heteroreceptor activity may increase impulsive behaviors, whereas reduced 5-HT1B autoreceptor activity may have an antidepressant-like effect. This review focuses on the evidence from animal studies and human genetics that suggest that 5-HT1B receptors may be involved in the mechanism of action of antidepressants and may become important targets of drug therapy in the future.

Aggression↗
PubMed2000

Childhood abuse and platelet tritiated-paroxetine binding in bulimia nervosa: implications of borderline personality disorder.

BACKGROUND: Co-occurrence of bulimia nervosa and borderline personality disorder has been attributed to shared factors, including childhood abuse and disturbances in central serotonin (5-hydroxytryptamine; 5-HT) mechanisms. To explore this notion, we conducted a controlled assessment of childhood abuse and 5-HT function in bulimics with and without borderline personality disorder. METHOD: Forty patients with bulimia nervosa, confirmed with the Eating Disorders Examination interview (14 with borderline personality disorder and 26 without), and 25 normal-eater controls were assessed for clinical symptoms (eating disturbances, mood lability, impulsivity, and dissociation) and childhood sexual and physical abuse. We also conducted tests of platelet tritiated-paroxetine binding in blood samples from 27 of the bulimics (11 with borderline personality disorder and 16 without) and 16 of the controls. RESULTS: Relative to normal eaters, bulimics showed greater affective instability, overall impulsivity, and a history of physical abuse. However, borderline bulimics alone showed elevated motor impulsivity, dissociation, and rates of sexual abuse. Paroxetine-binding tests indicated no differences attributable to comorbid borderline personality disorder, instead linking bulimia nervosa with or without borderline personality disorder to substantially reduced 5-HT transporter density. CONCLUSION: Results suggest relatively autonomous pathologic entities: one, relevant to bulimia nervosa, being associated with abnormal 5-HT transporter function and affective instability, but relatively independent of childhood sexual abuse; another, relevant to borderline personality disorder, onto which sexual abuse, dissociative symptoms, and behavioral impulsivity converge. We propose that abnormal 5-HT function may, however, constitute one basis for the frequent co-occurrence of bulimic and borderline disturbances.

Adolescent↗
PubMedDate not supplied

Continuity and change in levels of externalizing behavior in school of children from economically disadvantaged families.

This study used a person-centered approach to understand continuity and change in the externalizing behavior of children from economically disadvantaged families (N = 134). Groups of children differed in showing high levels of externalizing behavior in first grade (7 years old) that persisted (persistent problem) or decreased (improver) in third grade (9 years old) and low levels in first grade that were stable (unproblematic) or increased (new problem) in third grade. The results showed that verbal ability, behavioral impulsivity, parent maladjustment, and harsh parenting distinguished the persistent problem and unproblematic groups. Family instability was associated with change for the improver and new problem groups. The results suggest the importance of examining changes in the early adjustment to school for children from economically disadvantaged families.

Child↗
PubMed1979

The assessment of impulsivity and mediating behaviors in hyperactive and nonhyperactive boys.

Twenty boys (6-8 years) rated by their teachers as hyperactive and a matched sample of nonhyperactive boys performed a task that required them to withhold responding for a set time interval in order to be rewarded (DRL 6-second schedule). Half of each group worked on a one-button console while the other half was provided with additional collateral buttons. Results indicated that hyperactive children were relatively unable to perform efficiently on the task, and that this deficit endured regardless of age, IQ, or experimental condition. DRL was thus found to discriminate accurately between teacher-rated and parent-rated hyperactive and nonhyperactive children. Furthermore, a wide variety of self-generated mediating behaviors was observed, and it was determined that a child's DRL performance was related to the kind of mediating behaviors he displayed. Results are discussed in terms of the clinical assessment of hyperactivity and the training of impulsive children.

Behavior Therapy↗
PubMed2005

Experimental restriction of sleep opportunity in children: effects on teacher ratings.

STUDY OBJECTIVE: To determine the effects of experimental restriction of sleep opportunity on teacher ratings of academic performance and behavior in healthy normal children. DESIGN: Home-based, within-subjects design in which participants followed 3 week-long sleep schedules-Baseline (self-selected), Optimized, and Restricted-while attending school, with order of conditions counter-balanced (Optimized and Restricted). PARTICIPANTS: Seventy-four children (39 boys; aged 6 to 12 years, mean = 10) screened for medical and psychological health. MEASUREMENTS AND RESULTS: Teachers masked to assigned hours of sleep completed paper-and-pencil questionnaires at the end of each study condition. Questionnaire items were selected from several published measures. Summary scores included Academic Problems, Hyperactive-Impulsive Behaviors, Internalizing, Oppositional-Aggressive, Sleepiness, Total Attention Problems, and Mean Severity of Attention Problems. Main effects of sleep condition were found forAcademic Problems, Sleepiness, Total Attention Problems, and Mean Severity of Attention Problems. Restricting sleep increased ratings of Academic Problems (medium effect) relative to both Baseline (P < .01, eta(p)2 = .11) and Optimized (P < .05, eta(p)2 = .10) conditions and increased the Mean Severity of Attention Problems (medium effect) relative to Baseline (P < .01, eta(p)2 = .12). CONCLUSIONS: These findings provide experimental support for widely held beliefs about the importance of sufficient time-in-bed for academic functioning in children. Reducing sleep opportunity had a direct effect on academic performance, as rated by teachers, even among healthy students with no history of behavioral problems or academic difficulty. Findings also support insufficient sleep as a direct source of variability in the manifestation of attention problems but not hyperactivity.

Achievement↗