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PubMed2001

Substance abuse, pathological gambling, and impulsiveness.

This study evaluated behavioral and self-report indices of impulsiveness in pathological gambling substance abusers (n=27), non-pathological gambling substance abusers (n=63), and non-pathological gambling/non-substance abusing controls (n=21). The Bechara card task measured preferences for decks of cards that ranged in magnitude and probability of delayed and immediate rewards and punishers. The Stanford Time Perception Inventory (STPI) assessed orientation to the future, the Zuckerman Sensation Seeking Scale evaluated sensation seeking, and the Eysenck and Barratt scales measured impulsivity. A Principal Components analysis revealed that these personality measures comprised three distinct measures of impulsivity: impulse control, novelty seeking and time orientation. Linear contrast analyses revealed that substance abuse and pathological gambling resulted in additive effects on the impulse control and time orientation factors, but not on the novelty-seeking scale. Performance on the card task did not correlate with any of the three factors derived from the personality scale scores, but the presence of both substance abuse and pathological gambling had an additive effect on preferences for decks containing greater immediate gains but resulting in large punishers and overall net losses. These results provide further evidence of an association among substance abuse, pathological gambling, and impulsivity.

Adult↗

PubMed1998

Clinical outcome of psychopharmacologic treatment of borderline and schizotypal personality disordered subjects.

This paper reviews the biological and psychopharmacologic nature of personality disordered subjects, specifically those with borderline (BPD) and schizotypal (ScPD) personality disorder. Generally speaking, there is no agent of choice for the treatment of either BPD or ScPD. Many agents of different classes appear to offer some benefit to selected subjects depending upon their symptom presentation. For example, ScPD or BPD subjects with prominent cognitive/perceptual distortion may respond to neuroleptic agents, while some BPD subjects with depressed mood may respond best to antidepressants. The hypothesis that biological and behavioral dimensions underlie the psychopharmacologic response to treatment in personality disordered subjects, proposed over the past decade, is now being tested. The most salient example of this is the testing of serotonin-specific agents (e.g., fluoxetine) for potential antiaggressive efficacy in personality disordered subjects with prominent histories of impulsive aggressive behavior and putative reduced serotonin system function.

Anti-Anxiety Agents↗

PubMed2004

Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder.

OBJECTIVE: The authors investigated the predictive potential of a stress-diathesis model for suicidal behavior based on correlates of past suicidal acts. In this model, suicidal acts are precipitated by stressors such as life events or a major depressive episode in the setting of a propensity for acting on suicidal urges. This diathesis is expressed as the tendency to develop more pessimism in response to a stressor and/or the presence of aggressive/impulsive traits. The predictive potential of the diathesis was tested by determining whether clinical correlates of past suicidal behavior predict suicidal acts during a 2-year follow-up of patients with a major depressive episode. METHOD: Patients with DSM-III-R major depressive disorder or bipolar disorder (N=308) were assessed at presentation for treatment of a major depressive episode. Potential predictors of suicidal acts in the 2 years after study enrollment were identified on the basis of an association with previous suicidal behavior and were tested by using Cox proportional hazards regression analysis. In addition, pessimism and aggression/impulsivity factors were generated, and their predictive ability was tested by using Cox proportional hazards regression analysis. RESULTS: The three most powerful predictors of future suicidal acts were a history of suicide attempt, subjective rating of the severity of depression, and cigarette smoking, each of which had an additive effect on future risk. The pessimism and aggression/impulsivity factors both predicted suicidal acts, and each factor showed an additive effect. CONCLUSIONS: In addition to obtaining a history of suicidal behavior, clinicians may find it useful to assess patients' current level of pessimism, aggressive/impulsive traits, and comorbidity with substance use disorders, including nicotine-related disorders, to help identify patients at risk for suicidal behavior after major depression. Interventions such as aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptoms may protect such at-risk individuals from future suicidal behavior.

Adult↗

PubMed2001

Depot-leuprolide acetate for treatment of paraphilias: a report of twelve cases.

A new class of antiandrogen medications, gonadotropin-releasing hormone agonists, offers promise in the treatment of the paraphilias, with substantially less side effects than medroxyprogesterone acetate or cyproterone acetate. This paper reports the results of treatment using a depot suspension of leuprolide acetate on 12 patients with paraphilic disorders or with sexual disorders not otherwise specified to suppress or help these individuals control their deviant sexual behavior or impulses. The method involved uncontrolled observations of individuals treated with depot-leuprolide acetate for various lengths of time, from 6 months to 5 years, with the follow-up intervals ranging from 6 months to 6 years. Leuprolide acetate resulted in a significant suppression of deviant sexual interests and behavior as measured by self-report and was well tolerated. However, the three patients who were on long-term therapy developed bone demineralization, suggesting that this is a significant side effect of prolonged therapy. Leuprolide acetate shows promise as a treatment for the paraphilias.

Adult↗

PubMed2005

Correlates and predictors of self-reported suicide attempts among incarcerated youths.

The correlates and predictors of suicidal behaviors among 900 young offenders in detention centers in South Australia are investigated. That young offenders are a high-risk population is confirmed, with a quarter of the youths reporting recent suicidal ideation and more than a quarter reporting having made a suicide attempt. Past suicide attempts are significantly predictive of future suicide attempts. Other variables both concurrently and prospectively associated with suicidal behaviors (even after controlling for prior suicide attempt status) are substance use, prolonged dysphoric mood, attention deficit hyperactivity disorder signs, and having a bad temper. These variables not only have predictive value but should also be considered as appropriate targets when intervening to reduce suicide risk. It is suggested that impulsiveness is an underlying common factor.

Adolescent↗

PubMed2000

Suicidal behavior in bipolar mood disorder: clinical characteristics of attempters and nonattempters.

OBJECTIVE: Bipolar Disorder is associated with a higher frequency of attempted suicide than most other psychiatric disorders. The reasons are unknown. This study compared bipolar subjects with a history of a suicide attempt to those without such a history, assessing suicidal behavior qualitatively and quantitatively, and examining possible demographic, psychopathologic and familial risk factors. METHODS: Patients (ages 18 to 75) with a DSM III-R Bipolar Disorder (n = 44) diagnosis determined by a structured interview for Axis I disorders were enrolled. Acute psychopathology, hopelessness, protective factors, and traits of aggression and impulsivity were measured. The number, method and degree of medical damage was assessed for suicide attempts, life-time. RESULTS: Bipolar suicide attempters had more life-time episodes of major depression, and twice as many were in a current depressive or mixed episode, compared to bipolar nonattempters. Attempters reported more suicidal ideation immediately prior to admission, and fewer reasons for living even when the most recent suicide attempt preceded the index hospitalization by more than six months. Attempters had more lifetime aggression and were more likely to be male. However, attempters did not differ from nonattempters on lifetime impulsivity. LIMITATIONS: The generalizability of the results is limited because this is a study of inpatients with a history of suicide attempts. Patients with Bipolar I and NOS Disorders were pooled and a larger sample is needed to look at differences. We could not assess psychopathology immediately prior to the suicide attempt because, only half of the suicide attempters had made attempts in the six months prior to admission. Patients with current comorbid substance abuse were excluded. No suicide completers were studied. CONCLUSIONS: Bipolar subjects with a history of suicide attempt experience more episodes of depression, and react to them by having severe suicidal ideation. Their diathesis for acting on feelings of anger or suicidal ideation is suggested by a higher level of lifetime aggression and a pattern of repeated suicide attempts.

Adult↗

PubMed1985

Symptomatic correlates of alcohol abuse as a presenting problem.

This investigation examined a large number of self-reported symptoms of psychopathology. Its specific purpose was to assess their relationship to alcohol abuse as a self-indicated problem behavior. Participants in the study were 72 adults of both sexes who sought mental health services at a Veterans Administration outpatient Mental Hygiene Clinic. The self-reporting instrument was a behavioral problem checklist that was administered as part of a routine psychological test battery given at the time of each client's intake assessment at the Clinic. A correlational analysis of these data revealed that several broad areas of psychopathology were related significantly to alcohol abuse: Social/interpersonal skill deficits, anxiety, addiction proneness, impulse dyscontrol, and self-destructive ideation. These findings support a social learning theory of alcohol abuse. The results also imply that future treatment approaches to excessive drinking should include social skill and relaxation training as well as attention to traditional clinical concerns with self-destructive thinking and impulse control.

Adaptation, Psychological↗

PubMed2007

HTR2C and HTR1A gene variants in German and Italian suicide attempters and completers.

The serotonin 2C (HTR2C) and 1A (HTR1A) receptors have been involved in suicide-related behaviors. We studied gene variants of both receptors in suicide attempters and completers. The sample was composed of 167 German suicide attempters (affective spectrum n = 107, schizophrenia spectrum n = 35, borderline personality disorder n = 25), 92 Caucasian individuals who committed suicide, 312 German healthy subjects, 152 Italian suicide attempters (major depression n = 68 and bipolar disorder n = 84), and 131 Italian healthy volunteers. HTR2C (SNP: rs547536, rs2192372, rs6318, rs2428707, rs4272555, rs1801412) and HTR1A (SNP: rs1423691, rs878567, and rs6295) variants were analyzed in the German sample. HTR2C rs6318 and HTR1A rs6295 were analyzed in the Italian sample. Haplotype analysis in relation to suicidal behaviors did not reveal any significant association. Single markers and haplotypes were not or only marginally associated with other related features, such as violence of suicide attempt, family history for suicide attempt or State-Trait Anger Expression Inventory (STAXI) and Questionnaire for Measuring Factors of Aggression (FAF) scores. In conclusion, our study does not support the notion that HTR2C and HTR1A gene variants are major contributors to suicide-, anger-, or aggression-related behaviors in our sample.

Adolescent↗

PubMed2004

[Association between the functional monoamine oxidase A gene polymorphism and aggressively driving behavior].

OBJECTIVE: This study is purposed to explore the relationship between aggressively driving behavior and functional polymorphism in the promoter region of the monoamine oxidase-A (MAOA) gene. METHODS: A total of 348 automobile drivers were investigated with Deffenbacher's driver anger scale, driving vengeance questionnaire (DVQ) and driver aggression behavior questionnaire. Eighty-eight drivers were selected as more, medium and less aggressive group, each. Polymerase chain reaction (PCR) and 2.5% agarose gel electrophoresisi were adopted to detect the polymorphism of functional 30 bp-uVNTR in the promoter region of the X-chromosomal MAOA gene and their frequencies of varied genotypes were estimated. RESULTS: Two alleles with 3 and 4 repeats of 30 bp-uVNTR were detected in the drivers. Among the more aggressive group, number of the allele with 3 repeats of 30 bp-uVNTR (63/88) was significantly more than that with 4 repeats (25/88) (chi(2) = 10.21, P < 0.01), and number of the allele with 4 repeats of 30 bp-uVNTR was more in the less aggressive group, indicating that persons with allele of 3 repeats of 30 bp VNTR were more aggressive in their driving than those with 4 repeats. CONCLUSIONS: Aggressively driving behavior in drivers possibly related to their functional MAOA-uVNTR polymorphism. Effect of the gene on aggressively driving behavior should be further studied.

Adult↗

PubMed2000

Anger and bulimic psychopathology among nonclinical women.

OBJECTIVE: Although there are well-established links between bulimic psychopathology and some affective states, the role of anger is not clearly understood. This is likely to be a product of the diverse nature of anger. The present study examines the association of different components of anger with bulimic attitudes and behaviors among a nonclinical group of women. METHODS: Eighty-three nonclinical women completed standardized measures of anger and bulimic attitudes/behaviors. RESULTS: Bulimic attitudes and behaviors were correlated specifically with state anger and anger suppression, rather than with trait anger. The pattern of results suggests that binging and vomiting behaviors may serve different functions with regard to anger. CONCLUSIONS: Bulimic attitudes and behaviors appear to reduce immediate anger states, particularly when the individual has a strong tendency to avoid expressing that emotion. Potential therapeutic implications are considered.

Adolescent↗

PubMed1988

Heterogeneity of peer-rejected boys: aggressive and nonaggressive subtypes.

Cluster analyses were employed in 2 studies to explore the possibility that discernible subtypes exist within the population of peer-rejected boys. In Study 1, 41 rejected 9- and 10-year-old boys were identified using nomination sociometrics. 8 teacher rating, behavior observation, and social problem solving interview measures were entered into the analysis. In Study 2, 48 9-, 10-, and 11-year-old rejected boys were identified using rating sociometrics. 9 teacher rating and peer rating measures were entered into the cluster analysis. 2 large clusters emerged in each of the 2 samples. Consistent patterns were seen across both studies when children within each cluster were compared with each other and with those in a popular comparison group. Boys in one cluster exhibited high aggression, low self-control, behavior problems, and withdrawn behavior. Boys in the other cluster exhibited withdrawal but did not obtain elevated scores on measures of aggression, behavior problems, or self-control. Findings of rejected-child heterogeneity have significant implications for the design of treatment programs and further research on peer relationship difficulties of children.

Aggression↗

PubMed1984

An evaluation of the validity of the diagnostic category of attention deficit disorder.

Attention Deficit Disorder (ADD) replaced Hyperkinetic Reaction of Childhood as a category in DSM-III. This study evaluates the validity of the new terminology by determining whether clinical diagnoses of ADD could be predicted from scores on a number of widely used psychometric and behavioral instruments. Results suggest that ADD is an inadequately specified category. Some implications of this finding are considered.

Achievement↗

PubMed1999

Toward a clinical model of suicidal behavior in psychiatric patients.

OBJECTIVE: Risk factors for suicide attempts have rarely been studied comprehensively in more than one psychiatric disorder, preventing estimation of the relative importance and the generalizability of different putative risk factors across psychiatric diagnoses. The authors conducted a study of suicide attempts in patients with mood disorders, psychoses, and other diagnoses. Their goal was to determine the generalizability and relative importance of risk factors for suicidal acts across diagnostic boundaries and to develop a hypothetical, explanatory, and predictive model of suicidal behavior that can subsequently be tested in a prospective study. METHOD: Following admission to a university psychiatric hospital, 347 consecutive patients who were 14-72 years old (51% were male and 68% were Caucasian) were recruited for study. Structured clinical interviews generated axis I and axis II diagnoses. Lifetime suicidal acts, traits of aggression and impulsivity, objective and subjective severity of acute psychopathology, developmental and family history, and past substance abuse or alcoholism were assessed. RESULTS: Objective severity of current depression or psychosis did not distinguish the 184 patients who had attempted suicide from those who had never attempted suicide. However, higher scores on subjective depression, higher scores on suicidal ideation, and fewer reasons for living were reported by suicide attempters. Rates of lifetime aggression and impulsivity were also greater in attempters. Comorbid borderline personality disorder, smoking, past substance use disorder or alcoholism, family history of suicidal acts, head injury, and childhood abuse history were more frequent in suicide attempters. CONCLUSIONS: The authors propose a stress-diathesis model in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis. This diathesis may be reflected in tendencies to experience more suicidal ideation and to be more impulsive and, therefore, more likely to act on suicidal feelings. Prospective studies are proposed to test this model.

Adolescent↗

PubMed1999

Persistent Klüver-Bucy syndrome after bilateral thalamic infarction.

OBJECTIVE: To describe a patient who exhibited a partial Klüver-Bucy syndrome after small bilateral ischemic lesions in the thalami. BACKGROUND: Previously reported patients with Klüver-Bucy syndrome had very large, mostly bilateral lesions in the limbic system and could not provide sufficient information about its anatomo-functional correlate. METHOD: Behavioral assessments and clinical examinations, including magnetic resonance imaging and positron emission tomography, were conducted. RESULTS: The patient was severely amnestic, distractible, hyperoral, and affectively dyscontrolled, and she behaved socially inappropriately. Magnetic resonance imaging showed bilateral infarctions in the territories of both thalamoperforating arteries, and positron emission tomography revealed bilaterally decreased fluorodeoxyglucose uptake in the anterior parts of the ventral thalami and, to a lesser extent, in the fronto-temporal cortices. CONCLUSIONS: This behavioral syndrome has not yet been reported with isolated diencephalic lesions, but it has been observed after bilateral temporal lobe lesions. The authors conjecture that this syndrome resulted from a disruption of the pathways connecting the dorsomedial thalami with the prefrontal cortices and with other limbic areas, systems essential for memory and the regulation of impulses and emotions.

Aged↗

PubMed2005

Personality traits as intermediary phenotypes in suicidal behavior: genetic issues.

A genetic contribution to the risk of suicidal behavior is now supported by many studies. It probably involves specific factors acting on their own, independently of the genetic transmission of associated psychiatric disorders. A history of childhood maltreatment, adverse events, psychosocial stress, psychological traits and major psychiatric disorders all appear to contribute to the global risk of suicide attempt or completion. The interplay between previously identified risk factors, different as they are in nature and degree of complexity, still remains to be clarified. A stress-diathesis model has been proposed, where trait-like genetic and developmental risk factors (the diathesis) interact through still unknown mechanisms with actual (stress-related) factors to create the conditions for a suicidal gesture. Disentangling the effects of these risk factors, and specifically the effects of the genetic factors influencing these different pathological conditions, appears to be a difficult task. Indeed the results of candidate gene association studies suggest that genetic vulnerability factors for various related psychiatric phenotypes (major psychiatric disorders and personality traits) partly overlap with more specific factors predisposing to suicidal behavior. Personality traits are partly under genetic control and may be closer to the genetic effects than psychiatric syndromes. We review here the available data on the genetics of personality traits presumably involved in suicidal behavior, focusing on the association studies carried out with serotonin-related genes. We suggest that future studies on the genetic vulnerability to suicidal behavior should include the investigation of endophenotypes, with the aim of deciphering the mechanisms underlying the genetic susceptibility to these closely associated phenotypes.

Aggression↗

PubMed2005

The monoamine oxidase A gene may influence the means used in suicide attempts.

OBJECTIVE: Compelling evidence suggests that serotonin system dysfunction is associated with certain behavioral disorders, including suicidal behavior and impulsive aggression. A functional polymorphism in the promoter region of the monoamine oxidase A gene (uVNTR) was recently identified and the presence of the 2-3 alleles was found to be associated with a higher level of transcription, central nervous system serotonergic responsivity and impulsive aggression. A dinucleotide repeat in intron 2 of the gene (monoamine oxidase A-CAn) has been described previously, and is in linkage disequilibrium with the variable number of tandom repeats (VNTR). The aim of the study was to investigate, in a large sample, whether the monoamine oxidase A gene was involved in the susceptibility to suicidal behavior. METHODS: We genotyped 738 West European Caucasians, who had made suicide attempts, and 222 controls of the same ethnic origin, with no history of suicidal behavior. The two variants of the monoamine oxidase A gene have been tested. RESULTS: We did not find any association between the two monoamine oxidase A gene variants and suicidal behavior. However, the frequency of the uVNTR 2-3 alleles was significantly higher in men who had attempted suicide by violent means than in men who had used non-violent means. The odds ratio for the uVNTR 2-3 alleles versus the uVNTR 1-4 alleles was 2.17 [95% confidence interval (1.08-4.35)]. Haplotypes did not allow strengthening the effect observed with the uVNTR. CONCLUSION: These results suggest that an excess of high-activity monoamine oxidase A gene promoter alleles may be associated with traits orienting suicidal behavior towards a violent act.

Adult↗

PubMed2004

Suicide attempts and impulsivity.

Impulsivity in suicidal behavior can describe the attempt (state) or the attempter (trait). There are no studies simultaneously measuring attempt impulsivity and attempter impulsivity in representative samples of suicide attempts. A one-year study of 278 suicide attempts in a general hospital tested the continuous versus dichotomous relationship between attempter impulsivity (Barratt Impulsiveness Scale) and attempt impulsivity (low scores in the planning subscale of Beck's Suicidal Intent Scale). Attempter impulsivity was not a good predictor of attempt impulsivity independently of how both dimensions were measured (continuous or dichotomous ways). Impulsive attempts were associated with low lethality and lack of depression. Opportunities for prevention of suicide attempts in major depression and some personality traits may exist but require attentive monitoring of suicidal ideation and intent.

Adjustment Disorders↗

PubMed2006

Schema therapy for borderline personality disorder.

This article presents the Schema Therapy (Young, Klosko, & Weishaar, 2003) approach to the treatment of borderline personality disorder. Schema therapy draws on the cognitive-behavioral, attachment, psychodynamic, and emotion-focused traditions and conceptualizes patients who have borderline personality disorder as being under the sway of five modes or aspects of the self. The goal of the therapy is to reorganize this inner structure. To this end, there are four core mechanisms of change that are used in this therapy: (1) limited reparenting, (2) experiential imagery and dialogue work, (3) cognitive restructuring and education, and (4) behavioral pattern breaking. These interventions are used during the three phases of treatment: (1) bonding and emotional regulation, (2) schema mode change, and (3) development of autonomy.

Affect↗