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PubMed2001

Suicidal behavior: is there a genetic predisposition?

OBJECTIVES: To review the data that support the role of genetic factors in the predisposition to suicidal behavior and to examine whether or not these factors are part of the genetic liability to mood disorders. To review molecular genetic studies carried out in suicidal behavior. METHODS: A review of the literature was carried out by means of systematic bibliographic database searches and complemented by searches in the references of relevant publications. RESULTS: There is consistent evidence suggesting that genetic factors play an important role in the predisposition to suicide and suicidal behaviors. Although there is important overlap between suicide and mood disorders, a common genetic liability seems unlikely. It is possible that part of the predisposition to suicide may be transmitted via the presence of impulsive and impulsive-aggressive behaviors. An increasing number of molecular genetic studies have been carried out in subjects with suicidal behavior. There is some support for a role of some genes that code for components of the serotonergic pathway in the etiology of suicidal behavior, but these studies are still preliminary. CONCLUSIONS: Further studies are needed at the epidemiological, clinical and molecular level to better characterize the genetics of suicide. These should control for the presence of behaviors that are considered as part of the phenotypic spectrum of suicide.

Major Depressive Disorder↗
PubMed1984

Psychobiology of the borderline disorders--a heuristic approach.

A psychophysiologic approach to understanding borderline behavior is presented in which psychological and biological explanations complement, rather than exclude, one another. Descriptive-objective diagnoses or a target symptom approach are not sufficient to explain borderline behaviors. Phenomena are described that suggest underlying pathophysiologic processes, although they are usually accorded ego psychological explanations. Their underlying common denominator may be inadequate limbic system "filtering" of irrelevant stimuli. Each patient must be seen as an individual, rather than be fitted to a chosen model. Though the borderline constitutes a unique descriptive category, borderline behaviors result from processes generalizable across a broad range of psychopathology.

Arousal↗
PubMed1990

Fluoxetine trial in borderline personality disorder.

Borderline personality disorder (BPD) is defined by many of the symptoms associated with serotonin dysregulation, including affective lability, suicidal behaviors, and impulsive aggression, providing an ideal clinical model for studying the treatment of these serious disorders. The recent development of selective serotonin re-uptake inhibitors such as fluoxetine makes it possible to study the role of serotonin in the etiology of affective and behavioral dyscontrol in BPD. In this preliminary medication trial, 5 patients with BPD were treated openly with 20 mg to 40 mg of fluoxetine for 8 weeks, with weekly ratings of symptoms. The findings from this work suggested efficacy for fluoxetine in treating the depressive and impulsive symptoms of patients with BPD. The findings were mixed concerning the efficacy of fluoxetine in treating the hostility and psychotic symptoms of BPD. No evidence for effectiveness was found in the treatment of the anxiety, phobic anxiety, or interpersonal sensitivity of BPD.

Adult↗
PubMed2001

Intention to return for papanicolaou smears in adolescent girls and young women.

OBJECTIVE: Sexually active adolescent girls have high rates of abnormal cervical cytology. However, little is known about factors that influence intention to return for Papanicolaou screening or follow-up. The aim of this study was to determine whether a theory-based model that assessed knowledge, attitudes, and behaviors predicted intention to return. METHODS: The study design consisted of a self-administered, cross-sectional survey that assessed knowledge, beliefs, perceived control over follow-up, perceived risk, cues for Papanicolaou smears, impulsivity, risk behaviors, and past compliance with Papanicolaou smear follow-up. Participants were recruited from a hospital-based adolescent clinic that provides primary and subspecialty care, and the study sample consisted of all sexually active girls and young women who were aged 12 to 24 years and had had previous Papanicolaou smears. The main outcome measure was intention to return for Papanicolaou smear screening or follow-up. RESULTS: The enrollment rate was 92% (N = 490), mean age was 18.2 years, 50% were black, and 22% were Hispanic. Eighty-two percent of participants intended to return. Variables that were independently associated with intention to return included positive beliefs about follow-up (odds ratio [OR]: 1.07; 95% confidence interval [CI]: 1.02-1.11), perception that important others believe that the participant should obtain a Papanicolaou smear (OR: 1.93; 95% CI: 1.38-2.74), perceived control over returning (OR: 1.24; 95% CI: 1.06-1.46), and having received cues to obtain a Papanicolaou smear (OR: 1.31; 95% CI: 1.08-1.60). CONCLUSIONS: Analysis of this novel theoretical framework demonstrated that knowledge and previous behaviors were not associated with intention to return for Papanicolaou smear screening and follow-up in this population of young women. However, modifiable attitudinal components, including personal beliefs, perception of others' beliefs, and cues to obtaining Papanicolaou smears, were associated with intention to return.

Adolescent↗
PubMed1991

A preliminary trial of fluoxetine in refractory borderline patients.

Borderline personality disorder is characterized by many of the symptoms associated with serotonin dysregulation, including affective lability, suicidal behaviors, and impulsive aggression. These provide an ideal clinical model for studying the treatment of these serious symptom presentations. The recent development of selective serotonin reuptake inhibitors such as fluoxetine makes it possible to study the role of serotonin in the etiology of affective and behavioral dyscontrol in borderline personality disorder. In this preliminary medication trial, 5 borderline personality disorder patients with severe symptoms resistant to phenelzine and neuroleptics were treated openly with fluoxetine 20 to 40 mg for 8 weeks, with weekly ratings of symptoms. The findings from this work suggested efficacy for fluoxetine in treating the depressive and impulsive symptoms of refractory patients with borderline personality disorder.

Adult↗
PubMed2003

A hierarchy of gambling disorders in the community.

AIMS: To help refine the definition and diagnosis of gambling disorders, we investigated the distribution among US gamblers of the 10 DSM-IV criteria for Pathological Gambling. DESIGN: We drew data from two stratified random surveys (n = 2417, n= 530) of gambling behavior and consequences among community-based samples of US adults. A fully structured questionnaire, administered by trained lay interviewers, screened for the life-time prevalence of problem and Pathological Gambling. Per DSM-IV definitions, anyone meeting five or more of 10 itemized criteria was considered a pathological gambler. We analyzed these criteria among all gamblers who met one or more criteria (n = 399). FINDINGS: Most gamblers who met only one or two criteria reported 'chasing their losses'. At subclinical levels (three to four criteria), gamblers also reported elevated rates of gambling-related fantasy: lying, gambling to escape and preoccupation. Pathological gamblers with five to seven criteria reported marked elevations of loss of control, withdrawal symptoms and tolerance (internalizing dimensions of dependence); risking their social relationships and needing to be bailed out financially (externalizing dimensions). Most of the highest-level pathological gamblers (eight to 10 criteria) reported committing illegal acts to support gambling. CONCLUSION: Dependence in a biobehavioral sense appears to be a hallmark of Pathological Gambling, but it marks only one threshold in a qualitative hierarchy of disorders beginning with a common subclinical behavior, 'chasing'. Epidemiological assessments and future DSM revisions might consider explicit recognition of a problem gambling disorder, identifying people presenting some cognitive symptoms of Pathological Gambling but not clear signs of dependence. Pathological gamblers in turn appear to have two distinct levels of severity.

Adolescent↗
PubMed2006

Prevalence of sleep problems and their association with inattention/hyperactivity among children aged 6-15 in Taiwan.

This study investigated the 6-month prevalence rates of sleep-related problems and their association with daytime inadvertent napping, inattention, hyperactivity/impulsivity, and oppositional symptoms in children and adolescents. A representative school-based sample of 2463 first to ninth graders was recruited using a multistage sampling method. The instruments included the Sleep Habits Questionnaire (including dyssomnia, parasomnia, sleep schedules, and sleep-disordered breathing), the Chinese Health Questionnaire, and the Chinese versions of the Conners' Parent and Teacher Rating Scales-Revised: Short forms. The informants were mothers and teachers. The linear and nonlinear mixed models were used for statistical analyses and sex and age were controlled in the model. Results showed that the rates of middle insomnia, disturbed circadian rhythm, mouth breathing, and daytime inadvertent napping increased with age; whereas those of bedwetting, bruxism, sleep terrors decreased with age. Dyssomnia, sleep-disordered breathing problems, daytime inadvertent napping, and sleep schedules were related to attention-deficit/hyperactivity disorder (ADHD)-related symptoms as assessed by mothers' and teachers' ratings. Parasomnia was associated with ADHD-related symptoms as assessed by mothers' ratings. Our findings suggest an age trend of sleep problems similar to those found in the literature and the association of daytime inadvertent napping, inattention, hyperactivity/impulsivity, and oppositional symptoms with sleep-related problems.

Adolescent↗
PubMed1993

Diagnostic issues in self-mutilation.

OBJECTIVE: Pathological self-mutilation--the deliberate alteration or destruction of body tissue without conscious suicidal intent--was examined both as a symptom of mental disorders and as a distinct syndrome. METHODS: Data from more than 250 articles and books were reviewed, as well as data obtained by the authors from their extensive clinical experience in treating self-mutilating patients. RESULTS AND CONCLUSIONS: The diverse behaviors that constitute pathological self-mutilation can be categorized into three basic types: major--infrequent acts that result in significant tissue damage, usually associated with psychoses and acute intoxications; stereotypic--fixed, rhythmic behavior seemingly devoid of symbolism, commonly associated with mental retardation; and superficial or moderate--behavior such as skin cutting, burning, and scratching associated with a variety of mental disorders. The authors propose that a syndrome of repetitive superficial or moderate self-mutilation should be regarded as an axis I impulse disorder. In most cases, the syndrome coexists with character pathology.

Humans↗
PubMed1995

[Impulse activity of cortical neurons in systemic organization of behavior quanta].

By using the time course of changes in the level of cortical neuronal freedom, the author determined the reflection of intracerebral processes of systemic behavioral quanta in the neural impulse activity during cyclic instrumental behavior of cats. A direct relationship was found between the duration of behavioral stages determining the final operant activity of the animals and the number and duration of cerebral integrative performance quanta, the number of decision-making stages, the durations of afferent and efferent synthesis stages. The study indicated that afferent synthesis predominated over efferent one.

Animals↗
PubMed2006

Offender characteristics in lethal violence with special reference to antisocial and autistic personality traits.

The objective of the study is to assess the relationships between personality traits, lifetime psychosocial functioning, and crime scene behavior. Thirty-five male offenders referred for forensic psychiatric assessment in Sweden (1996-2001) and assigned a main diagnosis of either antisocial personality disorder (APD) or autism spectrum disorder (AUT) were retrospectively studied. APD were subcategorized into impulsive (APDi) and controlled (APDc). Those in the AUT group were less intoxicated at the time of the crime and did not often use knives or guns compared to the APD group. Males in the APDi group were older and had a higher proportion of abuse of alcohol and drugs in biological parents, physical abuse during childhood, psychiatric contacts, and suicide attempts compared to the APDc group. In the APDi group, knives were used in the homicide compared to the use of guns in the APDc group. The results suggest differences in psychosocial functioning and crime scene characteristics related to personality traits.

Adolescent↗
PubMed1997

Children's ability to delay gratification: longitudinal relations to mother-child attachment.

Concurrent and longitudinal mother-child attachment qualities were studied in relation to children's ability to postpone gratification at age 6 years. A sample of 32 children (at ages 12 months and 18 months) and their mothers participated in the strange situation procedure. At age 6 years, they were observed in an attachment situation and administered a standard delay of gratification task. The length of time that children were able to delay gratification at age 6 was predicted both by concurrent attachment quality and by a longitudinal attachment measure. Children with secure attachment were able to wait the longest periods of time, whereas those with insecure-disorganized attachment had the most difficulties in waiting. The effects of longitudinal, but not concurrent, attachment quality on children's total waiting time remained significant when other important variables were considered, including gender and children's cognitive functioning. An interactive effect was found between attachment quality and cognitive functioning. Insecure-avoidantly attached children with high cognitive functioning did not differ in their overall waiting times from securely attached children, but insecure-avoidantly attached children with average or low cognitive functioning did have shorter waiting times. The study provides a basis for the further investigation of mother-child attachment quality as a factor that is linked to children's delay behavior.

Attention↗
PubMed1986

Positive effects of carbamazepine on behavioral dyscontrol in borderline personality disorder.

In a double-blind crossover trial, carbamazepine, an anticonvulsant with primary effects on subcortical limbic structures, decreased the severity of behavioral dyscontrol in 11 women with borderline personality disorder significantly more than placebo. The authors emphasize the preliminary nature of their findings and discuss alternative hypotheses regarding mechanisms by which carbamazepine might influence behavioral dyscontrol.

Adult↗
PubMed2004

Impulsivity as a risk factor for eating disorder behavior: assessment implications with adolescents.

OBJECTIVE: The aims of the current study were to determine if impulsivity serves as a risk factor for eating disorder behavior and to examine whether different risk outcomes are obtained depending on the assessment strategy used to measure impulsivity. METHOD: Three independent studies are reported, each of which examined the relationship of impulsivity and eating disorder behavior in a prospective longitudinal design with adolescent subjects recruited from both public and private schools. Individuals displaying eating disorder behavior at initial assessments were not included in the analyses, to ensure that we were testing the role of impulsivity in the onset of eating disorder behavior. RESULTS: Trait impulsivity, measured with traditional personality scales, failed to predict the onset of eating disorder behavior in all three studies. However, when behavioral constructs associated with impulsivity, such as delinquency or substance abuse, were examined, they significantly predicted the onset of eating disorder behavior in most of the analyses conducted. DISCUSSION: These results provide moderate support for the idea that impulsivity serves as a risk factor for the onset of eating disorder behavior. However, this is only true when more objective behavioral measures were utilized.

Adolescent↗
PubMed1976

Suicide attempts by hospitalized medical and surgical patients.

To characterize siucidal behavior among hospitalized medical and surgical patients, all suicide attempts in the Peter Bent Brigham Hospital were surveyed for seven years. Seventeen attempts occurred, non of them fatal. Only four patients were seriously ill, two with neoplasia. All the attempts were impulsive and were associated with stress and disturbances of impulse control. Anger, not depression, was the effect most often seen before the attempts. In all cases the precipitating stress was loss of emotional support. However, patient vulnerability to suicide seemed to be the key determinant. Fifteen patients had mental disorders, including eight with personality disorders, three with schizophrenia, three with organic brain syndromes, and one with manic depressive psychosis. Seven were psychotic, and six had made prior suicide attempts. These findings suggest that the characteristics of impulsive suicide should be considered when a suicide prevention program is being developed for a general hospital.

Adult↗
PubMed1997

Serotonin function and antiaggressive response to fluoxetine: a pilot study.

BACKGROUND: The reported inverse relationship between indices of central serotonin (5-HT) function and indices of impulsive aggression in human subjects suggests the possibility that enhancement of 5-HT activity will reduce impulsive aggressive behavior. Although evidence for this hypothesis is emerging, the relationship between baseline central 5-HT system function and antiaggressive responses to treatment with 5-HT agents has not yet been examined in human subjects. METHODS: In this pilot study, we examined the relationship between: a) pretreatment prolactin responses to d-fenfluramine (PRL[d-FEN]) challenge; and b) antiaggressive responses to 12 weeks of treatment with either fluoxetine or placebo in 15 impulsively aggressive personality disordered subjects as observed in a 12-week, double-blind, placebo-controlled trial. RESULTS: Among all subjects there were positive correlations between the pretreatment PRL[d-FEN] response and the percent improvement in Overt Aggression Scale-Modified scores for "Aggression" and "Irritability." These correlations were present in the fluoxetine (n = 10), but not in the placebo (n = 5), treated subjects. CONCLUSIONS: These data suggest the possibility that the antiaggressive response to fluoxetine is directly, rather than inversely, dependent on the responsiveness of central 5-HT synapses in the brain of impulsive aggressive personality disordered subjects.

Adolescent↗
PubMed1980

The adolescent antisocial behavior check list.

Described the development and validation of a behavioral checklist that focuses on adolescent inpatient (N = 55) antisocial behavior. Reliability data and three sub-studies that tend to establish the validity of this instrument as a measure of antisocial behavior were presented. The implications for the study of adolescent antisocial behavior as a dependent variable were discussed.

Adolescent↗