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PubMed1985

The subclassification of child firesetters.

The possibility that child firesetters are a heterogeneous group was investigated in a cross-sectional case note and item sheet study of all children referred to an Inner London clinic between 1973 and 1981. Firesetters were most usefully subdivided by age, and secondarily by reason for referral. There were no links between enuresis and dangerousness or cruelty to animals. Methodological issues and the implications of the findings are discussed, with particular reference both to the development of the disorder and to the subclassifications drawn for conduct disturbance.

Adolescent↗
PubMed2006

Gambling level and psychiatric and medical disorders in older adults: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: This study examined the association between gambling level and psychiatric and medical disorders in a nationally representative sample of older adults. METHOD: Data on 10,563 U.S. older adults (age 60 or older) were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS: A total 28.74% of older adults were lifetime recreational gamblers and 0.85% were lifetime disordered gamblers. Compared with older adults without a history of regular gambling, recreational gamblers had significantly elevated rates of alcohol (30.1% versus 12.8%), nicotine (16.9% versus 8.0%), mood (12.6% versus 11.0%), anxiety (15.0% versus 11.6%), and personality disorders (11.3% versus 7.3%) and obesity (25.6% versus 20.8%), but were less likely to have past-year diagnoses of arteriosclerosis (4.7% versus 6.0%) or cirrhosis (0.2% versus 0.4%). Disordered gamblers were significantly more likely than older adults without a history of regular gambling to have alcohol (53.2% versus 12.8%), nicotine (43.2% versus 8.0%), drug (4.6% versus 0.7%), mood (39.5% versus 11.0%), anxiety (34.5% versus 11.6%), and personality (43.0% versus 7.3%) disorders, and to have past-year diagnoses of arthritis (60.2% versus 44.3%) or angina (22.7% versus 8.8%). These results remained significant even after controlling for demographic, psychiatric, and behavioral risk factors. CONCLUSIONS: Lifetime recreational gamblers were more likely than nonregular gamblers to have psychiatric disorders but were less likely to have some medical conditions. Lifetime disordered gamblers had a range of lifetime psychiatric disorders and were more likely than nonregular gamblers to have past-year diagnoses of angina and arthritis.

Adaptation, Psychological↗
PubMed2005

What is attention-deficit hyperactivity disorder (ADHD)?

Attention-deficit hyperactivity disorder (ADHD) is described as the most common neurobehavioral condition of childhood. We raise the concern that ADHD is not a disease per se but rather a group of symptoms representing a final common behavioral pathway for a gamut of emotional, psychological, and/or learning problems. Increasing numbers of children, especially boys, are diagnosed with ADHD and treated with stimulant medications according to a simplified approach. Methodical review of the literature, however, raised concerning issues. "Core" ADHD symptoms of inattentiveness, hyperactivity and impulsivity are not unique to ADHD. Rates of "comorbid" psychiatric and learning problems, including depression and anxiety, range from 12 to 60%, with significant symptom overlap with ADHD, difficulties in diagnosis, and evidence-based treatment methods that do not include stimulant medications. No neuropsychologic test result is pathognomic for ADHD, and structural and functional neuroimaging studies have not identified a unique etiology for ADHD. No genetic marker has been consistently identified, and heritability studies are confounded by familial environmental factors. The validity of the Conners' Rating Scale-Revised has been seriously questioned, and parent and teacher "ratings" of school children are frequently discrepant, suggesting that use of subjective informant data via scale or interview does not form an objective basis for diagnosis of ADHD. Empiric diagnostic trials of stimulant medication that produce a behavioral response have been shown not to distinguish between children with and without "ADHD." In summary, the working dogma that ADHD is a disease or neurobehavioral condition does not at this time hold up to scrutiny of evidence. Thorough evaluation of symptomatic children should be individualized, and include assessment of educational, psychologic, psychiatric, and family needs.

Affective Symptoms↗
PubMed1998

Impulse-control disorders in alcoholics are related to sensation seeking and not to impulsivity.

Impulse-control disorders (ICD) include intermittent explosive disorder, kleptomania, trichotillomania, pyromania and pathological gambling. Several studies have suggested that the incidence of pathological gambling and impulsive violent behavior is substantially higher in alcohol-dependent patients than in the general population. The association between ICD and alcoholism, as well as personality characteristics such as sensation seeking and impulsivity, has never been systematically studied. The present study compared the levels of impulsivity and sensation seeking in age- and sex-matched groups of alcohol-dependent patients with concomitant ICD (ICD+, n = 30), alcohol-dependent patients without ICD (ICD-; n = 30) and control subjects (n = 30). All the alcohol-dependent patients (ICD+ and ICD-) were hospitalized for alcohol detoxification. Diagnoses of ICD were based on DSM-IV criteria and the Minnesota Impulsive Disorders Interview. All patients completed the Zuckerman Sensation-Seeking Scale (SSS) and the Barratt Impulsiveness Rating Scale (BIS). Mean scores on the SSS general factor, the SSS disinhibition subscale, and the SSS experience-seeking scale were significantly higher in ICD+ patients than in either ICD- patients or control subjects. By contrast, total scores and subscale scores on the BIS showed no significant differences among the three groups. Thus, it appears that measures of sensation seeking, rather than impulsivity, are relevant in distinguishing between alcohol-dependent patients with and without concomitant impulse control disorders.

Adult↗
PubMed2006

Medication management of pathological gambling.

Pathological gambling has received little attention from clinicians and researchers despite prevalence rates similar to or greater than those of schizophrenia and bipolar disorder. This article summarizes the phenomenology and associated psychopathology of this public health problem and presents results of studies of 3 types of pharmacological agents used to treat this disorder: serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers.

Disruptive, Impulse Control, and Conduct Disorders↗
PubMed2006

A computerized test of self-control predicts classroom behavior.

We assessed choices on a computerized test of self-control (CTSC) for a group of children with features of attention deficit hyperactivity disorder (ADHD) and a group of controls. Thirty boys participated in the study. Fifteen of the children had been rated by their parents as hyperactive and inattentive, and 15 were age- and gender-matched controls in the same classroom. The children were observed in the classroom for three consecutive mornings, and data were collected on their activity levels and attention. The CTSC consisted of two tasks. In the delay condition, children chose to receive three rewards after a delay of 60 s or one reward immediately. In the task-difficulty condition, the children chose to complete a difficult math problem and receive three rewards or complete an easier problem for one reward. The children with ADHD features made more impulsive choices than their peers during both conditions, and these choices correlated with measures of their activity and attention in the classroom.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Sex-related differences in spatial divided attention and motor impulsivity in rats.

The acquisition and performance of a self-paced test of spatial divided attention linked with frontal cortex function were assessed in postpubertal (> 60 days) normal or gonadectomized male and female rats. Males were more accurate at detecting relatively brief visual stimuli than females, but this difference was eliminated by increasing the target stimulus duration, indicating an attentional basis for this effect. Premature errors were, however, greater in males than in females, suggesting greater impulsivity in males. Subsequent experiments in gonadectomized rats suggest that circulating hormones influence attention and impulsivity, but not necessarily sex differences. These results demonstrate a double dissociation between components of impulse control and divided attention in male and female rats and may have implications for sex differences in disorders of attention and cognition.

Animals↗
PubMedDate not supplied

Temperament and early environmental influences in kleptomania.

The purpose of this investigation was to shed light on the temperament and early life experiences of people suffering from kleptomania. Twelve outpatients (five men [41.6%]; seven women [58.3%]; mean age, 39.6 +/- 11.0 years) who met DSM-IV criteria for kleptomania and had no other axis I disorders by Structured Clinical Interview for DSM-IV (SCID) completed the Tridimensional Personality Questionnaire (TPQ) and the Parental Bonding Instrument (PBI). Patients with kleptomania had significantly higher novelty-seeking scores (P =.001), higher harm-avoidance scores (P =.005), and lower reward-dependence scores (P =.023) than normal controls. The kleptomania subjects had significantly lower maternal and paternal care scores, and lower maternal protection scores, than the normative values (P <.05). Neither TPQ nor PBI scores correlated with illness severity. These findings suggest that an understanding of early parenting behavior and a dimensional approach to the personality of kleptomaniacs may offer insight into this disorder and provide clues to treatment strategies.

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↗
PubMed2006

Medication in the treatment of the behavioural sequelae of traumatic brain injury.

A significant proportion of children who sustain traumatic brain injury will go on to experience disturbance in their academic, emotional, and social functioning. There is a role for medication in the treatment of these late onset changes. This review will focus on the recognition and pharmacological treatment of the most common and most problematic presentations that may follow head injury, and supports the use of stimulant medication for secondary attention-deficit-hyperactivity disorder despite the small evidence base for use in children.

Adolescent↗
PubMedDate not supplied

Gender differences in adolescent gambling.

BACKGROUND: Although adolescent gambling has been linked to a wide array of risk behaviors, little is known regarding the correlates of gambling in adolescent girls as compared with adolescent boys. METHODS: We examined by logistic regression a nationally representative U.S. sample (n = 534) of 16- and 17-year-olds from the 1998 Gambling Impact and Behavior Study (GIBS) (1) to investigate the influence of gender on: 1) the association between gambling and psychiatric symptomatology; and, 2) gambling attitudes and behaviors. RESULTS: Gambling was associated with elevated rates of alcohol use and abuse/dependence in both boys and girls, and dysphoria/depression in girls only. Boy gamblers reported heavier gambling and higher rates of gambling problems than did girl gamblers. CONCLUSIONS: Adolescent gambling may be associated with more severe psychiatric symptoms in girls than in boys, though future research will be needed to replicate and extend these findings. Gender considerations are important in understanding youth gambling and the relationship between gambling and psychiatric disorders in adolescents.

Adolescent↗
PubMed2005

Clinical characteristics and psychiatric comorbidity in males with exhibitionism.

BACKGROUND: This study was constructed to detail the demographic and phenomenological features of males with exhibitionism. METHOD: Male subjects with DSM-IV exhibitionism were administered a semistructured interview to elicit demographic data and information on the phenomenology, age at onset, and associated features of the disorder. Subjects also underwent structured clinical interviews to assess both Axis I and Axis II comorbidities. Data were collected from September 2003 to March 2005. RESULTS: Twenty-five males with exhibitionism (mean +/- SD age = 35.0 +/-13.1 years [range, 14-68 years]) were studied. The majority of subjects were single (60% [N = 15]) and heterosexual (80% [N = 20]). The mean +/- SD age at onset for exhibitionism was 23.4 +/-13.1 years. All subjects reported urges to expose themselves with little control over these urges. Exposing oneself while driving was the most common expression of the disorder. Twenty-three (92%) suffered from a current comorbid Axis I disorder (major depressive disorder, compulsive sexual behavior, and substance use disorders were most common), and 40% (N = 10) suffered from a personality disorder. Suicidal thoughts were common (52% [N = 13]), and many (36% [N = 9]) had been arrested for exhibitionism. CONCLUSION: Exhibitionism appears to be associated with high rates of psychiatric comorbidity and impairment. Research is needed to optimize patient care for men with this disorder.

Adolescent↗
PubMed1995

Kleptomania, compulsive buying, and binge-eating disorder.

Although recognized since at least the early 19th century, kleptomania, compulsive buying, and binge-eating disorder are poorly understood conditions that have received little systematic study. In this article, we review the available studies of these three conditions, which suggest that they are more common than realized, occur more frequently in women than in men, cause significant morbidity, are related to other psychiatric disorders (especially to one another, impulse control disorders, obsessive-compulsive disorder, and mood disorders), and often respond to available psychopharmacologic and psychological treatments. We hypothesize that these three conditions might best be viewed as impulse control disorders that belong to an extended family of compulsive-impulsive spectrum disorders. The compulsive-impulsive spectrum disorders may, in turn, belong to the larger family of affective spectrum disorder.

Adolescent↗
PubMedDate not supplied

Comparison of ego defenses among physically abused children, neglected, and non-maltreated children.

The nature and level of ego functioning were assessed in 41 recently detected physically abused children, and in two control groups of 38 neglected and 35 non-abused/non-neglected children (aged 6 to 12 years), using the Child Suicidal Potential Scales (CSPS). The results obtained in this study support the hypothesis that the influences of parental violence on the child's ego functions are detrimental, as reflected by significantly higher impairments in affect regulation (like irritability, anger, passivity, depression), low levels of impulse control, distortions in reality testing, and extensive operation of immature defense mechanisms in the physically abused children in comparison to the controls. Significant differences between the physically abused and the non-abused/non-neglected children were found for all mechanisms except displacement. The differences between the physically abused and neglected children for regression, denial and splitting, projection, and introjection (high scores for the physically abused children), and for compensation and undoing (higher scores for the neglected children) were also significant. It is suggested that physically abused children should be distinguished as a high-risk population for future personality disorders.

Case-Control Studies↗
PubMed2001

Obsessive-compulsive features in pathological lottery and scratch-ticket gamblers.

The results of this study support the notion that pathological gamblers drawn from the community would score higher on all three scores from the YBOCS than light gamblers. Consistent with hypotheses, pathological gamblers (lottery and scratch ticket) reported more obsessions, compulsions, and avoidance behavior than the light gamblers, and also reported having more urges to engage in injurious behaviors to themselves and others. These findings provide evidence that pathological gambling falls in a spectrum or family of disorders which have obsessive-compulsive disorder at its core. These findings support McElroy, Hudson, Philips, et al.'s (1993) suggestions of similarities between OCD and Impulse Control Disorders, and extend Blaszczynski (1999) findings of overlap between pathological gamblers and OCD in a treatment population. Heavy gamblers also reported significantly more hoarding symptoms and compulsive buying than light gamblers. More research in this area may show further evidence of a spectrum of disorders with obsessive compulsive disorder at its core, and show further links between impulse control disorders (such as pathological gambling) and OCD.

Adult↗
PubMedDate not supplied

The relationship between stealing and eating disorders: a review.

The literature exploring stealing behavior in individuals with an eating disorder is reviewed. Although epidemiological data are lacking, clinical observations and preliminary studies suggest an association between stealing behavior and eating disorders. Stealing appears to be strongly associated with bulimic symptoms in patients with eating disorders, and the presence of stealing behavior may serve as a marker of eating-disorder severity. The apparent connection between the two problems is discussed, and nine putative explanatory factors are examined: starvation-induced mental dysfunction, effects of medications, affective spectrum disorder, personality disorder, psychodynamic features, dissociative phenomena, tension reduction, pseudopubertal impulsivity, and sociocultural influences. Various combinations of these factors may operate in any particular patient. One of the challenges to our current understanding is the scarcity of information regarding the prevalence and distribution of stealing behavior in the general population. Areas for future research are suggested and include epidemiological surveys to investigate the proposed connection between stealing and eating disorders, examination of the effects of legal intervention, systematic study of the treatment of stealing in patients with eating disorders, and longitudinal studies exploring prognostic implications of stealing behavior.

Adolescent↗
PubMed1998

DSM-IV intermittent explosive disorder: a report of 27 cases.

BACKGROUND: The authors' objective was to provide data regarding the demographic, phenomenological, course of illness, associated psychiatric and medical comorbidity, family history, and psychiatric treatment response characteristics of rigorously diagnosed subjects who met DSM-IV criteria for intermittent explosive disorder. METHOD: Twenty-seven subjects meeting DSM-IV criteria for a current or past history of intermittent explosive disorder were given structured diagnostic interviews. The subjects' medical histories, family histories of psychiatric disorders, and responses to psychiatric treatments were also assessed. RESULTS: Most subjects described their intermittent explosive disorder symptoms as very distressing and/or highly problematic. All 27 subjects described aggressive impulses prior to their aggressive acts. Of 24 subjects who were systematically queried, 21 (88%) experienced tension with the impulses; 18 (75%), relief with the aggressive acts; and 11 (48%), pleasure with the acts. Most subjects stated that their aggressive impulses and acts were also associated with affective symptoms, particularly changes in mood and energy level. Twenty-five (93%) subjects had lifetime DSM-IV diagnoses of mood disorders; 13 (48%), substance use disorders; 13 (48%), anxiety disorders; 6 (22%), eating disorders; and 12 (44%), an impulse-control disorder other than intermittent explosive disorder. Subjects also displayed high rates of comorbid migraine headaches. First-degree relatives displayed high rates of mood, substance use, and impulse-control disorders. Twelve (60%) of 20 subjects receiving monotherapy with an antidepressant or a mood stabilizer reported moderate or marked reduction of their aggressive impulses and/or episodes. CONCLUSION: Intermittent explosive disorder appears to be a bona fide impulse-control disorder that may be related to mood disorder and may represent another form of affective spectrum disorder.

Adolescent↗