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PubMed1987

Neuropsychological correlates of platelet monoamine oxidase (MAO) activity in female and male subjects.

Platelet monoamine oxidase (MAO) activity has been found to have behavioral (psychiatric and personality) correlates and is assumed to be linked to central transmitter systems and thus presumably to neuropsychological processes. In the present study, computerized neuropsychological tests, a reaction time (RT) test and a visuo-spatial problem solving test, the Perceptual Maze Test (PMT), were given to 32 female and 29 male students, each sex group divided into three subgroups on the basis of platelet MAO activity. The tests yield measures of laterality (reaction time for left- versus right-sided stimuli) and different aspects of cognitive strategy and skill, e.g. time used for inspection of the maze, for processing the stimulus pattern, and for checking the correctness of solutions. Low MAO female subjects had shorter RTs, pronounced for left-sided stimuli, and shorter inspection times in the PMT compared to other female subjects. Low and high MAO males had difficulties in inhibiting responses, when required, and low MAO males were more rapidly prepared to respond to new stimuli after short intervals than other males. In the PMT, high MAO male subjects spent a smaller part of the total time on inspection in relation to other male groups and had more rubouts than low MAO males, whose maze solving behavior indicated higher visuo-spatial ability. The results are discussed in terms of possible neurochemical bases of impulsivity and psychopathy, and of spatial skill.

Adolescent↗
PubMed2005

Borderline personality-bipolar spectrum relationship.

BACKGROUND: The relationship between borderline personality disorder (BPD) and bipolar disorders, especially bipolar-II disorder (BP-II), is unclear. Several reviews on the topic have come to opposite conclusions, i.e., that BPD is a bipolar spectrum disorder or instead that it is unrelated to bipolar disorders. Study aim was to find which items of BPD were related to BP-II, and which instead had no relationship with BP-II. METHODS STUDY SETTING: An outpatient psychiatry private practice, more representative of mood disorders usually seen in clinical practice in Italy. INTERVIEWER: A senior clinical and mood disorder research psychiatrist. PATIENT POPULATION: A consecutive sample of 138 BP-II and 71 major depressive disorder (MDD) remitted outpatients. ASSESSMENT INSTRUMENTS: The Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version (SCID-CV) was used for diagnosing, the SCID-II Personality Questionnaire was used by patients to self-assess borderline personality traits. Interview methods: Patients were interviewed with the SCID-CV to diagnose BP-II and MDD. The questions of the Personality Questionnaire relative to borderline personality were self-assessed by patients. As clinically significant distress or impairment of functioning was not assessed by the questionnaire, a diagnosis of borderline personality disorder could not be made, but borderline personality traits (BPT) could be assessed (i.e., all DSM-IV BPD items but not the impairment criterion). RESULTS: BPT items were significantly more common in BP-II versus MDD. The best combination of sensitivity and specificity for predicting BP-II was found by using a cutoff number of BPT items > or =5: specificity was 71.4%, sensitivity was 45.9%. BPT (defined by > or =5 items) was present in 29.5% of MDD and in 46.3% of BP-II (p=0.019). Logistic regression of BP-II versus BPT items number found a significant association. Principal component factor analysis of BPT items found two orthogonal factors: "affective instability" including unstable mood, unstable interpersonal relationships, unstable self-image, chronic emptiness, and anger, and "impulsivity" including impulsivity, suicidal behavior, avoidance of abandonment, and paranoid ideation. "Affective instability" was associated with BP-II (p=0.010), but "impulsivity" was not associated with BP-II (p=0.193). Interitem correlation was low. There was no significant correlation between the two factors. DISCUSSION: Study findings suggest that DSM-IV BPD may mix two sets of unrelated items: an affective instability dimension related to BP-II, and an impulsivity dimension not related to BP-II, which may explain the opposite conclusions of several reviews. A subtyping of BPD according to these dimensions is supported by the study findings.

Bipolar Disorder↗
PubMed1993

Serotonin: neurotransmitter "a la mode". Report on the Third International I.T.E.M.-LABO symposium on strategies in psychopharmacology: serotonin: animal models and clinical targets.

The recently held Symposium "Serotonin: Animal Models and Clinical Targets" (Paris, 26-28th February 1992) reviewed the present status of new serotonergic drugs. Specific serotonin-uptake inhibitors (citalopram, fluoxetine, fluvoxamine, paroxetine) are now clearly accepted as antidepressants with apparently specific effects on obsessive-compulsive disorder. Available 5-HT1a agonists (buspirone, gepirone, ipsapirone) are somewhat disappointing as anxiolytics but more specific compounds (flesinoxan, S 20499, E 4424) are now in development. Neuroleptics with 5-HT2 antagonist properties (amperozide, clozapine, risperidone), appear to have lower EPS potential than classic neuroleptics but the role of 5-HT2 antagonism in the control of psychotic symptoms remains unclear. 5-HT3 antagonists (ondansetron, tropisetron, zacopride) may have anxiolytic and possibly cognition-enhancing properties but more clinical work is needed. Finally, in the preclinical sphere, electrophysiological, neurochemical, and behavioral approaches have been useful in elucidating mechanisms of action but have been less impressive, particularly behavioral techniques, in predicting clinical activity.

Aggression↗
PubMed2000

Applied behavior management and acquired brain injury: approaches and assessment.

Individuals who have acquired brain injury (ABI) may express themselves through the use of challenging behaviors, such as aggression, withdrawal, disinhibition, and self-destructive behaviors. This article describes the effectiveness of behavior interventions derived from the assessment of behavior in a community-based setting. The premise is that behavior, no matter how difficult, has function, purpose, and meaning for the individual. A therapeutic model of behavior assessment is presented that bases its strength on behavior assessment and well-trained staff. A well-formulated behavior management plan is developed, reinforcing alternative behaviors teaching skills, and reducing unwanted behaviors. Through the use of data collection methods, the treatment team identifies variables related to unwanted behavior and outcomes of consequences as they relate to the behavior. Illustrated through a case study, the behavioral treatment model is defined through behavior identification, initial assessments, treatment approaches, and tracking outcomes.

Aggression↗
PubMed2000

Sleep and psychiatric symptoms in school-age children.

OBJECTIVE: To assess associations between the quantity and quality of children's sleep and parent- and teacher-reported psychiatric symptoms. METHOD: Forty-nine physically healthy 7- to 12-year-old children from normal classes participated. They were monitored for 72 consecutive hours with belt-worn activity monitors (actigraphs) to obtain objective data on their daytime and nighttime activity and sleep. In addition, Child Behavior Checklists and Teacher's Report Forms were filled out by the parents and teachers, respectively. RESULTS: Quantity of sleep was significantly associated with total symptom score on the Teacher's Report Form. The highest associations were found between low true sleep time and teacher-reported externalizing symptoms such as aggressive and delinquent behavior and attention and social problems. Sleep parameters were not associated with parent-reported psychiatric symptoms, except for the association found between delayed sleep latency and aggressive, delinquent behavior. CONCLUSIONS: The objectively measured amount of school-age children's sleep was associated with teacher-reported psychiatric symptoms. Parents may be unaware of their child's sleep deficiencies as the behavioral problems may be more evident at school than at home. Sensitive and objective measurements are needed to rule out the possibility of inadequate sleep underlying behavioral problems.

Attention↗
PubMed2003

Decision making in adolescents with behavior disorders and adults with substance abuse.

OBJECTIVE: The study assessed the validity of the Gambling Task as a test of decision-making ability in adolescents and examined whether adolescents with behavior disorders, who are at risk for substance abuse, have deficits in decision making similar to those exhibited by adults with substance abuse. METHOD: Performance on the Gambling Task in two testing sessions separated by 1 week was assessed in 64 12-14-year-old adolescents (31 healthy, 33 with externalizing behavior disorders) and 52 adults (22 healthy, 30 with substance abuse). RESULTS: The healthy adolescents and the healthy adults had similar performance on the Gambling Task. Adolescents with behavior disorders performed more poorly than healthy adolescents, but only in the second testing session. In adults, overall Gambling Task performance did not differ between the healthy and substance abuse groups at either testing session, indicating no difference in learning of decision-making strategies between groups. However, adults with substance abuse performed more poorly than healthy adults during an early stage of the task, when participants presumably begin to understand the rewards and penalties involved in the task but are not yet sure of the actual risk of incurring penalities. CONCLUSIONS: The Gambling Task can be used with adolescents. Testing with the Gambling Task revealed a deficit in decision making in adolescents with behavior disorders, who are at risk for substance abuse. This deficit may represent a vulnerability factor for the development of substance abuse.

Adolescent↗
PubMed1989

Adolescence. What is normal?

We present in some detail what constitutes normal behavior, or mental health, among teenagers. Our data are based on the results of a specially devised psychological questionnaire by one of us (D.O.). This questionnaire has been shown to reliably distinguish mentally healthy from psychiatrically disturbed populations. Results are presented across three decades (1960s, 1970s, and 1980s), across genders, and across the high school years. A conceptual framework is presented to help the clinician working with adolescents to understand the fluctuation in psychopathology among youth. Adolescent density in the total population is shown to be a significant factor in determining the rate of disturbance among teenagers. Our research findings demonstrate that the rate of behavioral disturbance among adolescents is the same as in other parts of the life cycle. The clinician working with adolescents tends to underestimate the severity of adolescent problems because of the near-universal belief that all adolescents undergo "adolescent turmoil." We have found that adolescents who are experiencing turmoil need professional help.

Adolescent↗
PubMed1986

Components of attention, methylphenidate dosage, and blood levels in children with attention deficit disorder.

In this study we analyzed some of the cognitive components that may constitute attention deficit disorder. It consisted of a double-blind, drug-placebo study of 12 children being treated with three doses of methylphenidate and placebo. Results of an attentional test battery, teacher and parent ratings, and blood levels of methylphenidate are reported. In general, performance was best with 0.6 mg/kg of methylphenidate (the highest dose tested) and worst with placebo. It is argued that no single test provides a complete assessment of attentional deficits and that methylphenidate can improve performance by affecting the allocation of cognitive resources to a task.

Adolescent↗
PubMed1994

A cognitive understanding of adolescent suicide.

Suicide ultimately requires a decision. In this article, I review a number of cognitive concepts--decision making, the development of a suicide schemata, covert rehearsal, cognitive rigidity, and time perspective--and I propose a model suggesting that suicide can be understood as an essentially cognitive act affected by these elements. The model highlights the importance of distortions of time perspective as a precursor for suicidal behavior. I propose this model as an additional set of explanatory factors to those commonly in use, such as family and peer estrangement and life events.

Adolescent↗
PubMed1994

Indicators of changes in weight and eating behaviour in severely obese patients treated in a nursing behavioural program.

To assess some possible reasons for the changes of weight and eating behaviour at a one year follow up in 33 severely obese subjects (mean BMI, 39.9 s.d. 5.2) treated in a nursing behavioural-treatment program, three instruments were used; the Self Motivation Inventory (SMI), the Sense of Coherence Scale (SOC) and the Karolinska Scales of Personality (KSP). The Three Factor Eating Questionnaire (EI) measuring restrained eating, disinhibition and hunger, was used to register the change of eating behaviour. The weight lost at the one year follow-up was significantly (P < .01) correlated to the restrained eating score at the time for the follow-up as well as to the difference value (P < .01) of the restraint score before and one year after treatment and to the number of participated booster sessions (P < .05). The SMI score, as measured before treatment, correlated significantly to all the EI subscales scores at the one-year follow-up (P < .05, P < .01, P < .01). Thus, the greater the self motivation, the more restraint and the less disinhibition and hunger. In turn, the SOC score correlated significantly (P < .01) to the SMI score. Thus, the stronger the sense of coherence, the more perceived self-motivation. Finally, there was a significant negative correlation between the KSP subscales Somatic Anxiety (P < .01), Muscular Tension (P < .05), Psychic Anxiety (P < .001), Psychasthenia (P < .01), Hostility (P < .001), and Inhibition of Aggression (P < .001) and a positive correlation between Socialization (P < .05) and the SOC score.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Frontotemporal dementia: treatment response to serotonin selective reuptake inhibitors.

BACKGROUND: Patients with frontotemporal dementia (FTD) present initially with primarily behavioral rather than cognitive symptoms. Decreased serotonin receptor binding has been reported in the frontal lobes, temporal lobes, and hypothalamus in autopsy-proven FTD cases. This study tests the hypothesis that many of the behavioral symptoms of FTD (including disinhibition, depressive symptoms, carbohydrate craving, and compulsions) will respond to serotonin selective reuptake inhibitors (SSRIs). METHOD: Eleven subjects meeting the Lund-Manchester clinical, neuropsychological, and neuroimaging criteria for FTD were treated with SSRIs (fluoxetine, sertraline, or paroxetine). After 3 months, treatment responses for disinhibition, depressive symptoms, carbohydrate craving, and compulsions were evaluated prospectively without placebo control. RESULTS: After treatment, disinhibition, depressive symptoms, carbohydrate craving, and compulsions all showed improvement in at least half the subjects in which they had been present. One subject stopped sertraline treatment because of diarrhea, while another stopped paroxetine treatment due to increased anxiety. The presence of individual behavioral symptoms and also the response of each symptom to SSRIs were unrelated to cognitive impairment as measured by baseline Mini-Mental Status Examination (.07 < or = p < or = 1.00) [corrected]. CONCLUSION: The behavioral symptoms of FTD may improve after treatment with SSRIs. Future neurochemical studies and controlled pharmacologic trials may improve available treatments.

1-Naphthylamine↗
PubMed2006

Orbitofrontal correlates of aggression and impulsivity in psychiatric patients.

The association between orbital frontal cortex (OFC) volume and aggression and impulsivity was investigated among a heterogeneous group of non-psychotic psychiatric clients. Fifteen non-psychotic subjects from two different psychiatric clinics (New England Medical Center and Lemuel Shattuck Hospital) with a variety of diagnoses were sequentially referred for magnetic resonance imaging (MRI) for clinical purposes. This convenience sample, clinically stable at the time of evaluation, received a standardized psychiatric diagnostic interview, aggression and impulsivity psychometrics (Barratt Impulsivity, Lifetime History of Aggression, and Buss-Perry Aggression scales), and an MRI protocol with image analysis. OFC gray matter volume, total as well as left and right, was significantly and positively associated with motor impulsivity. OFC asymmetry was associated with aggression, though total, left, and right OFC volume measurements were not. For subjects without affective disorder, there was a strong and positive association of the OFC to motor and no-planning subscales of the Barratt Impulsivity Scale. For subjects with affective disorder, there was a strong association of OFC asymmetry to both of the aggression psychometrics. Consistent with expectation, results are suggestive of OFC involvement in the neural circuitry of impulsivity and aggression. The findings suggest a dissociation of the role of the OFC in relation to aggression and impulsivity, such that the OFC may play a part in the regulation of aggressive behavior and a generative role in impulsive behavior.

Adult↗
PubMed1978

Sexual abuse of children: a clinical spectrum.

This paper suggests that incest has been underestimated as a significant determinant of emotional disturbance, and that misuse of sexuality between parents and children can have detrimental consequences that parallel those resulting from other forms of child abuse. The spectrum of parent-child sexuality is classified into ten categories as a guide to the diagnosis, management, and prognosis of sexually abusive behavior.

Affective Symptoms↗