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PubMedDate not supplied

[Shopping disorder and the abnormal use of attire].

Eight women and one man affected by the denominated "Dressing Disorder" are described. We show, analyze and discuss their social and demographic features, antecedents, onset and course, acquiring behaviours and its consequences, diagnosis, gnosographic features, results of the psychodiagnostic tests, evolutive relationships with the psychiatric diagnosis and treatment undergone. By the light of these data we propose a pathogenic scheme which remarks the importance of the Depression and Bulimia as precipitations or causative factors, because they give use to a low self-esteem and a use of anomalous defense mechanisms which origin the altered acquiring behaviours. Criteria for its diagnosis are proposed and more appropriate denominations are discussed.

Adolescent↗

PubMed2005

Hoarding and its relation to obsessive-compulsive disorder.

Although hoarding is observed in some patients with obsessive-compulsive disorder (OCD), it has not been shown to share a specific relation with OCD. Across two studies, we found that (a) whereas the classic OCD symptoms of checking, rituals, and contamination intercorrelated consistently strongly with one another, hoarding related only moderately to both these OCD symptoms and to depression; (b) OCD patients were distinguished from both other patients and non-patients by classic OCD symptoms, but not by hoarding; and (c) whereas OCD symptoms showed consistent relations with Negative Affect, hoarding largely was uncorrelated with this dimension. These results do not support a specific OCD-hoarding relation but rather call into question the trend of considering it a specific symptom of OCD.

Adolescent↗

PubMedDate not supplied

Impulsive personality traits in male pedophiles versus healthy controls: is pedophilia an impulsive-aggressive disorder?

Pedophilia is characterized by sexual attraction to prepubescent children. Despite the extensive literature documenting the pervasive and pernicious effects of childhood sexual abuse, there is surprisingly little psychiatric literature on pedophilia and its etiology remains enigmatic. In recent years, the psychiatric literature on the phenomenology, neurobiology, and treatment of impulsive-aggressive disorders has grown significantly. As some investigators have conceptualized pedophilia as an impulsive-aggressive disorder, it is of interest whether recent advances in the study of impulsive-aggressive disorders might shed light on pathological mechanisms underlying pedophilia. In the following study, 20 male subjects with a DSM-IV diagnosis of pedophilia, heterosexual type were recruited from an outpatient facility for sexual offenders and compared to 24 demographically similar control subjects. Groups were compared on three personality instruments--the Millon Clinical Multiaxial Inventory-II (MCMI-II), the Temperament and Character Inventory (TCI), and the Dimensional Assessment of Personality Impairment-Questionnaire (DAPI-Q)--to assess for select impairment in impulsive-aggressive personality traits. Pedophiles showed severe and pervasive personality impairment relative to controls. Although there was evidence of impulsivity, the findings do not suggest a predominance of impulsive-aggressive traits, and in fact provide evidence of inhibition, passive-aggression, and harm avoidance. The notion of "compulsive-aggression" in pedophilia is proposed.

Adolescent↗

PubMed2006

Impulse control disorders in Parkinson's disease.

There is an increasing awareness that impulse control disorders (ICDs), including pathologic gambling and compulsive sexual behavior, can occur as a complication of Parkinson's disease (PD). Anecdotal experience and case reporting have suggested an association between ICDs in PD and the use of dopamine agonists. Lacking established treatments for ICDs in PD, clinical management should initially consist of modifications to or discontinuation of dopamine replacement therapy, particularly dopamine agonists. It is important that PD patients be aware that dopamine agonist use may lead to the development of an ICD, and that clinicians monitor patients as part of routine clinical care. As empirically validated treatments for ICDs are emerging, it will be important to examine their efficacy and tolerability in individuals with co-occurring PD and ICDs.

Disruptive, Impulse Control, and Conduct Disorders↗

PubMed1985

Comprehensive treatment of chronic fire setting in a severely disordered boy.

A comprehensive, multidimensional treatment strategy was designed for a severely behaviorally disordered 10-year-old boy with a 7-year history of setting fires. The study replicates a previous study designed to suppress fire setting, teach appropriate substitute behavior and increase awareness of the consequences of fire setting. Three additional components were added to the original treatment program: relaxation training, a response cost for fire setting, and a visit to a hospital burn unit (overt sensitization). Follow-up data 1 year later indicate that treatment was successful in extinguishing all fire-setting behaviors. The additional treatment components presented in this paper may add to the efficacy and sustained durability of treatment gains in difficult, low frequency fire setting behavior.

Behavior Therapy↗

PubMed2000

Stress coping strategy in Japanese patients with eating disorders: relationship with bulimic and impulsive behaviors.

Although maladaptive coping strategies in eating disorder patients have been reported, the relationship between impulsivity and coping strategy has not previously been studied. Subjects consisted of 43 patients with anorexia nervosa restricting type (AN-R), 42 patients with anorexia nervosa binge eating/purging type (AN-BP), 71 patients with bulimia nervosa purging type (BN), and 97 controls. The Coping Inventory for Stressful Situations was used to evaluate coping strategies. Only AN-BP patients had a significantly lower task oriented-coping score than controls, and AN-R and BN patient groups used significantly less social diversion-avoidance coping strategies than controls. Emotion-oriented coping scores of AN-BP and BN patients were significantly higher than those of controls. In addition, impulsive BN patients had significantly higher emotional coping scores than less impulsive BN patients. These results suggest that maladaptive coping strategies may be a perpetuating factor even for impulsive patients and emphasizing a change in maladaptive coping strategies may be a useful treatment strategy even for highly impulsive patients.

Adaptation, Psychological↗

PubMed2004

The associations between childhood dance participation and adult disordered eating and related psychopathology.

OBJECTIVE: To examine the relationship between childhood dance participation and adult eating behavior and psychological health. METHODS: A total of 546 undergraduate females at a large Midwestern university completed questionnaires regarding eating behavior and associated features, depression, self-esteem, and body image. RESULTS: Women who participated in childhood dance are more likely to score higher on measures of bulimic behaviors than nondancers. In addition, childhood dancers indicated greater drive for thinness and poorer impulse control compared to nondancers. Furthermore, there was a statistical trend for childhood dancers to report greater perfectionism and a smaller ideal body mass than nondancers. There were no significant differences between dance groups on measures of depression and self-esteem. CONCLUSION: These findings suggest that participating in dance as a child may influence one's eating behavior as an adult, including associated factors such as drive for thinness and impulse control and potentially perfectionism and preferred body size.

Adolescent↗

PubMed2005

Stages of change in treatment-seeking pathological gamblers.

The transtheoretical model has been applied to many addictive disorders. In this study, psychometrics properties of the University of Rhode Island Change Assessment (URICA) scale were evaluated in 234 pathological gamblers initiating treatment. Four components were identified--reflective of precontemplation, contemplation, action, and maintenance stages--with internal consistency from .74 to .88. Cluster analyses identified 4 patterns of responding, ranging from ambivalent to active change. The 4 clusters differed with respect to baseline gambling variables and treatment engagement and outcomes assessed 2 months later. A continuous measure of readiness to change was also correlated with gambling severity and predictive of reductions in gambling. This study provides initial support for reliability and validity of the URICA in treatment-seeking gamblers, and it suggests that stage of change may have an impact on outcomes.

Cognitive Behavioral Therapy↗

PubMed2000

Nefazodone and the treatment of nonparaphilic compulsive sexual behavior: a retrospective study.

BACKGROUND: Recent reports suggest that individuals with nonparaphilic compulsive sexual behavior can be treated pharmacologically with selective serotonin reuptake inhibitors (SSRIs) to control sexual obsessions and compulsions. However, these medications have produced sexual side effects that may limit long-term use, particularly as individuals strive to reestablish healthy sexual relationships. Nefazodone is an antidepressant that is not associated with the sexual side effects of other SSRIs. We examined retrospective data from our clinic to investigate whether nefazodone has utility in the treatment of nonparaphilic compulsive sexual behavior. METHOD: Fourteen subjects who met DSM-IV criteria for sexual disorder NOS as well as criteria used by our research group for nonparaphilic compulsive sexual behavior and who had been treated with nefazodone were selected from patient charts at our clinic. The treating physician abstracted information from the charts regarding comorbid psychiatric conditions, medication, dosage, treatment response, and side effects. RESULTS: In this study, the mean dosage of nefazodone was 200 mg/day. Of the subjects who remained on long-term nefazodone therapy, 6 (55%) reported good control of sexual obsessions and compulsions, and 5 (45%) reported a remission of sexual obsessions and compulsions. CONCLUSION: Results from this preliminary retrospective study suggest that nefazodone decreases the frequency of sexual obsessions and compulsions but does not produce the undesired sexual side effects caused by SSRI treatment.

Adult↗

PubMed2004

Associations among aspects of impulsivity and eating factors in a nonclinical sample.

OBJECTIVE: Impulsivity has been well documented as a factor in the behavior of eating-disordered populations and is likely to influence normal eating patterns as well. The current study attempted to clarify the relationship between the three elements of impulsivity (nonplanning, attentional, and motor) and the three factors of eating (cognitive restraint, disinhibition, and hunger) in a nonclinical sample. METHOD: Data were collected from a sample (N = 112) of volunteer participants from the community who answered two self-report instruments related to impulsivity (the Barratt Impulsiveness Scale, Version 11) and eating (the Eating Inventory). Partial correlations were performed on the data to control for age, sex, and education. Cognitive restraint did not correlate with any element of impulsivity. Disinhibition was positively correlated with both attentional impulsivity (r = .40, p < .001) and motor impulsivity (r = .32, p < .01). Attentional impulsivity was also positively correlated with hunger (r = .24, p < .05). DISCUSSION: The lack of association between cognitive restraint and impulsivity suggests that they are functionally distinct. Disinhibition is most closely associated with impulsivity, consistent with findings from clinical samples. Further clarification of the relationship between impulsivity and eating in nonclinical populations could facilitate a better understanding of the relationship between personality variables and normal eating behavior.

Adolescent↗

PubMed2005

Aggression and psychopathology in treatment-resistant inpatients with schizophrenia and schizoaffective disorder.

Positive psychotic symptoms, such as threat/"control-override" delusions or command hallucinations, have been related to aggression in patients with schizophrenia. However, retrospective data collection has hampered evaluation of the direct influence of psychopathology on aggressive behavior. In this study, we monitored aggressive behavior and psychopathology prospectively and in close temporal proximity in 157 treatment-resistant inpatients diagnosed with chronic schizophrenia or schizoaffective disorder participating in a 14-week double-blind clinical trial. Aggressive behavior was rated with the overt aggression scale (OAS). Psychopathology was assessed using the positive and negative syndrome scale (PANSS). At baseline, subjects who would be aggressive during the study had higher scores on only two PANSS items: hostility and poor impulse control. During the study PANSS positive subscale scores were significantly higher in aggressive subjects. Total PANSS scores were higher within 3 days of an aggressive incident, as were positive and general psychopathology subscale scores. However, in a smaller subsample for whom PANSS ratings were available within 3 days before aggressive incidents, only scores on the PANSS positive subscale were significantly higher. These findings in chronic, treatment resistant inpatients support the view that positive symptoms may lead to aggression.

Aggression↗

PubMed2003

Clinical phenomenology of episodic rage in children with Tourette syndrome.

OBJECTIVE: Episodic rage of unknown etiology causes significant morbidity in children with Tourette's syndrome (TS). Using modified Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for intermittent explosive disorder (IED), we developed a screen and symptom questionnaire to explore rage attack phenomenology and to preliminarily investigate whether symptom clusters can identify clinical subgroups of TS children with rage attacks. METHODS: 48 children with TS between ages 7 and 17 years consecutively presenting with rage attacks completed the Rage Attacks Screen and Questionnaire. Data was subjected to factor analysis. Cluster analytic procedures were used to identify clinical subgroups. RESULTS: Final cluster solution revealed four homogeneous subgroups of TS children with rage who were differentiated by predominant clinical characteristics: specific urge resolution, environmentally secure reactivity, nonspecific urge resolution or labile nonresolving. CONCLUSION: Episodic rage in TS has stereotypic features, but diverse and complex etiologies. Identifying particular symptom clusters may facilitate improved treatment strategies.

Adolescent↗

PubMed2006

Impulse control disorders in eating disorders: clinical and therapeutic implications.

OBJECTIVE: Few studies have explored impulse control disorders (ICDs) in women with bulimia nervosa (BN). We explored the prevalence of lifetime ICDs in women with BN, compared the severity of eating disorder symptoms in women with BN with and without ICD, and compared their personality profiles to females with one form of ICD, namely, pathologic gambling. METHOD: A total sample of 269 female patients consecutively admitted to our unit participated in the current study (173 BN without comorbid ICD [BN - ICD]; 54 BN with comorbid ICD [BN + ICD]; and 42 pathologic gamblers [PG]). All participants were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. EVALUATION: Assessment measures included the Symptom Checklist-90 revised and the Temperament and Character Inventory-revised, as well as a number of other clinical and psychopathologic indices. RESULTS: In BN, the observed lifetime prevalence of ICD was 23.8%. Lifetime compulsive buying (17.6%) and intermittent explosive disorder (13.2%) were the most frequently reported ICD. Bulimia nervosa subtype was not significantly associated with lifetime ICD (P = .051) or with ICD subtype (P = .253). After using multinomial regression models, we observed that BN + ICD and PG showed the highest scores on novelty seeking (P < .0001). But BN + ICD women had the lowest scores on self-directedness (P < .03) and higher scores on general psychopathology (P < .01) and drug abuse (P < .01). CONCLUSIONS: Individuals with BN + lifetime ICD presented more extreme personality profiles, especially on novelty seeking and impulsivity, and general psychopathology than individuals with BN without ICD. On some personality traits, those BN + ICD more closely resembled individuals with PG than those with BN without ICD.

Adult↗

PubMedDate not supplied

Comparison of obsessive-compulsive disorder patients with and without comorbid putative obsessive-compulsive spectrum disorders using a structured clinical interview.

Increasing attention has been paid to the possibility that a range of disorders, the putative obsessive-compulsive spectrum disorders (OCSDs), may share overlapping phenomenological and neurobiological features with obsessive-compulsive disorder (OCD). The development of a structured clinician-administered interview for the putative OCSDs (SCID-OCSD) is described. This instrument was used to investigate differences between OCD patients with a comorbid putative OCSD and OCD patients without a comorbid putative OCSD. A sample of 85 adult patients (38 men and 47 women) presenting for treatment of OCD was interviewed with the SCID-OCSD. OCD patients without comorbid putative OCSDs (n = 36) were compared to patients with comorbid OCSDs (n = 49) in terms of demographic features, clinical characteristics, and associated comorbidity with other non-OCSD DSM-IV axis I disorders. Of the OCD patients, 57.6% currently met criteria for at least one putative OCSD and 67.1% had a lifetime history of at least one comorbid OCSD. The OCSDs with the highest prevalence rates were compulsive self-injury (22.4%), compulsive buying (10.6%), and intermittent explosive disorder (10.6%). There was a significantly larger proportion of women in the group with comorbid OCSDs. Although the two groups did not differ in terms of severity of OCD symptoms, the group with comorbid OCSDs had significantly more obsessions and compulsions. The two groups did not differ significantly in terms of associated psychopathology other than OCSDs. We conclude that the SCID-OCSD provides clinicians and researchers with an instrument for the diagnosis of putative OCSDs. Our findings suggest that putative OCSDs have a relatively high prevalence rate in OCD patients. In addition, OCD patients with comorbid OCSDs differ with regard to certain demographic and clinical features. Further research, particularly genetic and neuroimmunological work, may ultimately be useful in validating the obsessive-compulsive spectrum.

Adult↗

PubMed2003

Impulsive aggressive behavior: open-label treatment with citalopram.

BACKGROUND: Results from open-label and placebo-controlled trials suggest that the selective serotonin reuptake inhibitors reduce impulsive aggressive behavior. The objective of this open-label study was to investigate whether citalopram treatment has anti-aggressive effect on impulsive aggressive subjects meeting DSM-IV criteria for a cluster B personality disorder or intermittent explosive disorder. METHOD: In this 8-week trial, subjects were initiated on 20 mg/day of citalopram and titrated up to 60 mg/day by the fourth week, if tolerated. The primary outcome measure was the Overt Aggression Scale-Modified (OAS-M), a scale used to quantify verbal and physical aggression, subjective irritability, and overt irritability. Secondary outcome measures included the Barratt Impulsiveness Scale and Buss-Durkee Hostility Inventory. RESULTS: Of 25 subjects enrolled, 20 completed the study. The mean daily dose was 45.5 mg, and citalopram was generally well tolerated. Statistically significant decreases were found in the OAS-M aggression scores (32.82 +/- 19.76 to 4.73 +/- 7.57, p =.000), subjective irritability scores (3.50 +/- 0.60 to 1.45 +/- 1.18, p =.000), and overt irritability scores (3.23 +/- 0.81 to 0.91 +/- 1.02, p =.000). CONCLUSION: These results suggest that citalopram is an effective treatment for reducing impulsive aggressive behavior.

Adult↗

PubMed1998

5-hydroxytryptamine and impulse control: prospects for a behavioural analysis.

Impulsiveness is a significant clinical problem associated with a variety of psychiatric and neuropsychiatric disorders. Clinical and experimental studies have provided evidence that individuals displaying impulsive behaviour tend to show signs of deficient functioning of the ascending 5-hydroxytryptaminergic (5-HTergic) pathways of the brain. A persistent problem in investigations of the biological basis of impulsive behaviour has been the lack of a satisfactory definition of 'impulsiveness', as distinct from other behavioural features, such as aggression, which are often apparent in 'impulsive' individuals. Research in the experimental analysis of behaviour suggests that two important characteristics of 'impulsiveness' are (i) deficient tolerance of delay of gratification and (ii) inability to inhibit or delay voluntary behaviour; both of these characteristics are amenable to study in laboratory animals. We describe some delayed reinforcement and delayed response paradigms which purport to capture these behavioural characteristics, and review recent evidence that manipulation of 5-HTergic function alters behaviour in these paradigms. It is argued that the two characteristics of 'impulsiveness' are themselves the product of disturbance of more fundamental behavioural processes; the nature of these processes is considered.

Animals↗

PubMed2000

Nurse behavioural psychotherapy and pathological gambling: an Australian perspective.

Nurses have been employed as behavioural psychotherapists for over 25 years. The first training in this field was established at The Maudsley Hospital (Marks et al. 1977). Since then there have been a number of courses producing many specialist nurse behavioural psychotherapists (NBTs) (Duggan et al. 1993). Nurse behavioural therapy is taken to mean nurses working as behavioural psychotherapists. This title does not mean they are practising a separate form of therapy from other professionals such as psychologists. In Australia there is no such training, with nurse behavioural psychotherapists working here having trained first in UK. Initially NBTs were trained to treat people with anxiety disorders. Over the past 25 years this emphasis has remained, but many NBTs have gone on to provide help to people with other problems. This paper will demonstrate the practical application of behavioural psychotherapy with problem gamblers, and how specialist trained nurses can provide such treatment. The paper will look briefly at nurse behavioural psychotherapy from its initial inception to its current status in Australia. The outcomes of the treatment programme carried out at Flinders Medical Centre for Problem Gamblers will be discussed with a view to nurses carrying out therapy. Finally, the future of nurse behavioural psychotherapy in Australia and how nurses can apply such skills across a wide range of problems, including gambling, will be reviewed. Aspects of this paper were first presented to the 7th NAGS conference, Adelaide 1996.

Adult↗

PubMed1996

Personality traits and psychiatric and somatic morbidity among kleptomaniacs.

Although the behaviour of kleptomania has been identified for decades, very little is known about the reasons, prevalence, course and treatment of this disorder. Current knowledge about kleptomania is generally derived from case reports or from material collected from highly selected groups. There are no published systematic studies of personality traits among kleptomaniacs, and knowledge of somatic and psychiatric co-morbidity is limited. The purpose of the present study was to describe personality characteristics, psychiatric disorders and somatic illness among kleptomaniacs. A total of 37 patients (two-thirds of whom were female) who fulfilled the DSM-IV criteria for kleptomania were recruited by advertising in a daily newspaper. Monotony avoidance was a prominent personality trait, as was a low degree of socialization. Depression and anxiety were also very common, as was a history of attempted suicide. Somatic illness was commonly reported, and a high proportion of the kleptomaniacs were regularly receiving pharmacological treatment for either psychiatric or somatic illness. The representativeness of this group of kleptomaniacs is as yet unknown. However, the present study is based on the largest sample of patients fulfilling DSM-III-R/DSM-IV criteria for kleptomania to date who were not primarily recruited through the medical or legislative systems.

Adolescent↗