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The perfectionistic patient.

Family members, residents, and care givers often react negatively when perfection is demanded by the geriatric patient. This type of reaction presents a challenge to the nurse providing care. When a geriatric patient is perfectionistic, it is important to step back, to observe and assess, and to plan appropriate strategies that will facilitate the patient's adjustment. When the behavior is related to situational stressors, it may be appropriate to respond to the stressors and ignore the behavior. When the behavior results from a feeling of loss of control and powerlessness, intervention should be directed in that direction. In any case, actions of the nurse should respond to the patient's need for self-esteem and improved ability to cope with the environment. Responding to the perfectionistic geriatric patient presents a particular challenge to the nurse in long-term care, and the nurse's strategic intervention can significantly increase the patient's ability to adjust to the ongoing changes that accompany the aging process.

Aged↗

Naloxone attenuates drinking behavior in a schizophrenic patient displaying self-induced water intoxication.

This study was performed to examine the effect of naloxone on drinking behavior in a schizophrenic inpatient with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). His body weight was checked five times daily, and the maximum and minimum weight gains during a day were chosen as an index of polydipsia. Both daily (0.6 mg) and repeated (0.6 mg for 6 days) injections of naloxone suppressed his weight gain significantly for 2 weeks. Withdrawal of the drug for 4 weeks resulted in weight gain recovering to control level. Thereafter, a second trial was performed to examine the long-term effect of this treatment. A daily naloxone (0.6 mg) injection series was performed once every 2 weeks for six series (12 weeks). This drug regimen also suppressed his weight gain in a continuous fashion. The study showed that naloxone seems to be a potential treatment for PIP syndrome and that endogenous opioid systems play a part in the compulsive drinking behavior of the PIP syndrome.

Drinking Behavior↗

Obsessive-compulsiveness and impulsivity in a non-clinical population of adolescent males and females.

Obsessive-compulsive and impulsive behaviors co-occur in certain psychiatric conditions. Some have suggested that these disturbances constitute a spectrum of altered psychologies and behaviors that share an underlying neuropathology. We investigate here whether obsessive-compulsiveness and impulsivity reflect related psychological dimensions in a non-clinical adolescent population. Out of 720 high-school students, 672 and 682 completed a questionnaire interview with a Chinese version of the Maudsley Obsessive-Compulsive Inventory (MOCI) and the Barratt Impulsiveness Scale (BIS-11), respectively. Both MOCI and BIS-11 demonstrated good overall internal consistency, each with three major factors identified with Principal Component Analysis. In the 638 participants who completed both questionnaires, the total MOCI and BIS-11 scores did not correlate with each other. However, the MOCI factor "repetitive checking and attention to details" correlated negatively with the BIS-11 factor "inability to plan and look ahead" for all participants, and for males and females separately. The same MOCI factor also correlated negatively with the BIS-11 factors "lack of perseverance and self-control" and "novelty-seeking and acting without thinking" for all participants, and for females but not for males. The MOCI factor "doubt and intrusive thoughts" correlated positively with the BIS-11 factor "lack of perseverance and self-control" for all participants, and for males but not for females. These results suggested that the relationship between obsessive-compulsiveness and impulsivity as measured by the MOCI and the BIS-11 is complicated, with gender playing an important modulatory role. We discuss the relevance of these findings to developing a conceptual scheme to characterize and study the neurobiological basis of obsessive-compulsive and impulsive behaviors.

Adolescent↗

Hypersexuality and paraphilia induced by selegiline in Parkinson's disease: report of 2 cases.

While hypersexuality and paraphilia are known side effects of anti-Parkinson medications, it is seldom reported. Furthermore, selegiline is rarely implicated in such behaviors. We report two cases of early onset PD who experienced paraphilia and hypersexuality when selegiline was initiated, and later developing obsessive-compulsive and punding behavior with the addition of dopamine agonists. Social repercussions may prohibit patients and/or their families from volunteering such information.

Antiparkinson Agents↗

Personal and parental alcohol abuse, and victimization in obese binge eaters and nonbingeing obese.

Current obesity research has begun to emphasize the importance of pretreatment assessment and more individually tailored treatment protocols. Obese binge eaters have been identified as a subgroup of the obese who do not respond well to standard behavioral treatment programs. We were interested in identifying variables that are important to consider when assessing and treating obese binge eaters. The present study assessed the prevalence of personal alcohol abuse, parental alcohol abuse, and victimization in 62 males and 274 females seeking treatment for obesity. Obese binge eaters (OBE) had significantly greater rates of personal alcohol abuse, parental alcohol abuse, and victimization than the nonbingeing obese (NBO) in our sample. Further studies of the OBE population are recommended.

Adolescent↗

Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior.

OBJECTIVE: Sociodemographic features, phenomenology, and psychiatric comorbidity of 30 subjects reporting pathological gambling behavior were examined. METHODS: Twenty-three men and seven women were recruited by advertisement and word-of-mouth. They all scored higher than 5 points on the South Oaks Gambling Screen, indicating problematic gambling behaviors. They completed structured and semistructured assessments, including the Diagnostic Interview Schedule for DSM-III-R disorders (DIS), the Personality Diagnostic Questionnaire, Fourth Revision (PDQ-IV), and the Minnesota Impulsive Disorders Interview. RESULTS: The typical subject was a 44-year-old white married man with a mean income of $34,250 who visited a casino once or more weekly. All 30 subjects reported gambling more money than they intended to. Twenty subjects (67 percent) reported gambling as a current problem, and nine (30 percent) reported it as a past problem. Twenty-one subjects (70 percent) wanted to stop gambling but did not feel they could. According to DIS results, 18 subjects (60 percent) had a lifetime mood disorder, 19 (64 percent) a lifetime substance use disorder, and 12 (40 percent) a lifetime anxiety disorder. Based on the PDQ-IV, 26 subjects (87 percent) had a personality disorder, the most common being obsessive-compulsive, avoidant, schizotypal, and paranoid personality disorders. The sample also had a relatively high rate of antisocial personality disorder. Impulse control disorders were common, especially compulsive buying and compulsive sexual behavior. CONCLUSIONS: The results confirm that individuals with pathological gambling suffer substantial psychiatric comorbidity. They support continued inclusion of pathological gambling in the diagnostic category of impulse control disorders.

Adult↗

Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior.

Relationships of impulsive and nonimpulsive violent behavior to cerebrospinal fluid (CSF) monoamines and their metabolic concentrations were studied in thirty-six violent offenders. A relatively low 5-hydroxyindoleacetic acid (5HIAA) concentration was found in the CSF of impulsive violent offenders. This was not true for the offenders who had premeditated their acts. Other CSF monoamine or metabolite concentrations were not significantly different between the two groups. Of the groups studied, impulsive violent offenders who had attempted suicide had the lowest 5HIAA levels. A low CSF 5HIAA concentration may be a marker of impulsivity rather than violence.

3,4-Dihydroxyphenylacetic Acid↗

Experiencing release: sex environments and escapism for HIV-positive men who have sex with men.

There are nonsexual reasons that may motivate people to seek out sexual activity with others. Some men who have sex with men may seek out sex environments to engage in sexual behavior. Among the nonsexual reasons that exist for men who have sex with men is a desire to escape from distressing thoughts and feelings. The amplified sexuality and other unique characteristics of sex environments allow men to have more intense emotional experiences around sex. Using the cognitive escape model as a theoretical foundation, this analysis focuses on the emotional vulnerability that some of the men who visit these venues may be avoiding and how their experiences at these venues might act as releasing mechanisms to alleviate dissonant thoughts and feelings. Implications for public health services and future research are discussed.

Adult↗

Hoarding by elderly people.

Although hoarding has been studied in adults, little is known about problems of hoarding by elderly people. This study used a structured telephone interview with elder services providers to investigate hoarding behaviors in relation to functional impairment, cognitive deficits, and physical and psychological conditions in 62 elderly clients. Most elderly hoarders were female, unmarried, and lived alone. Extensive clutter was associated with significant impairment, interfering with basic hygiene, and posing a serious physical threat for many elderly clients. Clients were rarely insightful about their collecting and often resisted change, rendering interventions generally ineffective. Never-married status was associated with more severe hoarding and greater impairment and possibly with worse outcomes of intervention efforts. Health and mental health implications of hoarding by elderly people and implications for treatment are discussed.

Activities of Daily Living↗

A personal recovery program for codependent nurse practitioners.

Codependence is a progressive emotional and behavioral disease that makes life painful. Because of nursing's historical roots and the present role of advance-practice nurses in the health care system, nurse practitioners are at risk for developing this disease. Codependence interferes with nurse practitioner's job performance by causing dysfunctional interactions with supervisors, peers and subordinates. A personal program of recovery is the only way to halt the progress of this syndrome and to re-establish healthy work patterns. The stages of recovery from codependence are identification, awareness, reintegration and genesis. Tools of recovery include involvement in a 12 Step program, connecting with other recovering people, daily affirmations and meditations, and attending programs and workshops on codependence.

Compulsive Behavior↗

Correlates of obesity.

Designed to create composites of eating behavior questionnaire items and determine their relationship to an obesity index within three subsamples of participants in three Navy-sponsored weight-reduction programs (N = 1,878). After item and scale analyses were performed on questionnaire items that pertained to eating behaviors, history of weight problems, activities, and feelings about food and dieting, scores for the resultant composites were computed for individuals within the three subsamples. Results of multiple-regression analyses indicated that the strongest correlates of obesity within each subsample were the Overweight History, Food Obsession, and Activities composites; the multiple R was .49 for Marine recruits, .46 for the other male subsample, and .32 for women. The Emotional Eater composite was included in the multiple regression for the women's subsample. Personality characteristics also were found to be associated with the obesity index in the men's and women's subsamples. Future studies will examine the value of these variables as predictors of weight loss and maintenance of weight loss.

Adolescent↗

[Symptom specificity of adolescents with self-injurious behavior].

As an introductory part of the paper, authors give a short overview of existing results in the literature related to self-injurious behaviour and adolescents' deliberate self-harm. In their own random sample study, authors organized a self-report screen (provincial town, 3 educational facilities, 470 pupils aged between 14 and 18 years) by means of the translated version of Ottawa Self Injury Inventory (OSI) used widely in community-based studies in Canada. The Beck Depression Inventory was introduced to measure the key symptoms of depression among youngsters. 26 youngsters were found to have had at least one self-injurious action in their life-time. The authors describe the characteristics of these subjects on the basis of symptom occurrence statistics. Although the depressive symptoms have an expected correlation with the self-injurious ideas, depression does not seem to have the same relationships with the actual self-harm action. The authors attempt to give an explanation of this contradiction.

Adolescent↗

Development of the body checking questionnaire: a self-report measure of body checking behaviors.

OBJECTIVE: The purpose of this study was to develop a brief self-report inventory to assess body checking behaviors. METHOD: Using exploratory and confirmatory factor analyses, the 23-item Body Checking Questionnaire (BCQ) was developed. The BCQ measures the global construct of body checking behaviors with three correlated subfactors that assess checking related to overall appearance, checking of specific body parts, and idiosyncratic checking rituals. RESULTS: The BCQ was found to have good test-retest reliability (.94) and the subfactors had good internal consistency (.88, .92, and .83). The measure correlated highly with other measures of negative body image and eating disorders, demonstrating its concurrent validity. Additionally, the BCQ was found to differentiate normal controls and eating disorder patients, as well as nonclinical participants scoring high and low on a measure of concern with body size and dieting. DISCUSSION: Due to the potential role of ritualistic body checking in the maintenance of body dissatisfaction by directing excessive attention to body shape/weight, the BCQ may prove to be a useful clinical tool in the assessment and treatment of eating disorder patients.

Adolescent↗

Personal use of work computers: distraction versus destruction.

To explore definitions, frequencies, and motivation for personal use of work computers, we analyzed 329 employees' responses to an online survey, which asked participants to self-report frequencies for 41 computer behaviors at work. This sample (65% female, 74% European ethnicity, mean age of 36 years) was formed by soliciting participants through Internet Usenet groups, emails, and listservs. Results support a distinction between computer use that is counterproductive and that which is merely not productive. Nonproductive Computer Use occurred more when employees were younger (r = -0.31, p < 0.01), had Internet access at work longer (r = +0.16, p < 0.01), and had faster Internet connections at work than at home (r = +0.14, p < 0.01). Counterproductive Computer Use occurred more when Internet access was newer (r = -0.16, p < 0.01) and employees knew others who had been warned about misuse (r = +0.11, p < 0.05). While most employees who engaged in computer counterproductivity also engaged in computer nonproductivity, the inverse was uncommon, suggesting the need to distinguish between the two when establishing computer policies and Internet accessibility.

Adult↗

A neurological model for childhood autism.

We analyze the behavioral and motor disturbances in childhood autism. On the basis of analogy to signs and conditions seen in adult neurology, we propose that the syndrome results from dysfunction in a system of bilateral neural structures that includes the ring of mesolimbic cortex located in the mesial frontal and temporal lobes, the neostriatum, and the anterior and medial nuclear groups of the thalamus. The mesolimbic cortex is cytoarchitectonically, angioarchitectonically, and neurochemically distinct and, along with the striatum, forms the entire target area of dopaminergic mesencephalic neurons. This raises the possibility that autism is related to neuromediator imbalance in those structures. Such dysfunction might be the result of macroscopic or microscopic changes in the target area or in structures functionally influencing them, consequent to a variety of causes such as perinatal viral infection, insult to the periventricular watershed area, or genetically determined neurochemical abnormalities.

Attention↗

Attention-Deficit Hyperactivity Disorder (ADHD) symptoms and smoking patterns among participants in a smoking-cessation program.

Previous research has suggested an increased liability to smoking among individuals with Attention-Deficit Hyperactivity Disorder (ADHD). This link is thought to be attributable, in part, to nicotine's beneficial effects on attention and performance. In the present study, we examined the association of ADHD symptoms of inattention and hyperactivity with smoking behavior in a sample of 226 male and female smokers ages 18 and older who were enrolled in a smoking-cessation program. Prior to treatment, they completed measures of ADHD symptoms and standardized measures of smoking patterns. Hierarchical linear regression models were used to characterize the smoking patterns associated with ADHD inattention and hyperactivity symptoms, controlling for potential confounder variables. Smoking for stimulation purposes and the urge to smoke to minimize withdrawal symptoms were the primary patterns associated with ADHD inattention symptoms, while hyperactivity symptoms were not associated with smoking patterns. Consistent with a self-medication hypothesis, these results suggest that smokers with frequent symptoms of inattention may use nicotine as a stimulant drug to help manage these symptoms. Future studies of the role of inattention symptoms in response to smoking treatment are warranted.

Adolescent↗

Medroxyprogesterone acetate (MPA) treatment of sexual acting out in men suffering from dementia.

Four demented male patients who manifested disruptive sexual behavior, including public masturbation and attempts to molest female patients, and who could not be managed by other means received a therapeutic trial of medroxyprogesterone acetate (MPA) for 1 year and were followed up for an additional year. Their sexual activities were recorded before, during, and after the study, and serum testosterone, luteinizing hormone (LH), and prolactin were monitored regularly. Within 2 weeks of the start of MPA therapy, the sexual acting out had stopped; this was associated with a 90% and a 60% decline, respectively, of serum testosterone and LH. When MPA treatment was stopped, testosterone and LH returned to pretrial levels in all four men. One showed a return of sexual acting out, but this was at a reduced level and was successfully managed by firm nursing. MPA was used without adverse effects. Because of its safety and efficacy, the drug should be considered as a first-line treatment for sexual acting out in demented men.

Acting Out↗

Mood, personality disorder symptoms and disability in obsessive compulsive hoarders: a comparison with clinical and nonclinical controls.

Hoarding is a symptom of obsessive compulsive disorder (OCD), as well as a diagnostic criterion for obsessive compulsive personality disorder (OCPD). One recent study suggests that people who suffer from compulsive hoarding report more general psychopathology than people who do not [Frost, R.O., Krause, M.S., & Steketee, G. (1996). Hoarding and obsessive compulsive symptoms. Behavior Modification, 20, 116-132]. The present study addressed whether persons with OCD hoarding exhibit more depression, anxiety, OCD and personality disorders symptoms than community controls, OCD nonhoarders, or other anxiety disorder patients. Disability was also examined. Hoarding subjects were older than the other three groups, but age did not account for any of the differences observed among the groups. Compared to controls, OCD hoarding, nonhoarding OCD and anxiety disorder patients showed elevated YBOCS scores, as well as higher scores on depression, anxiety, family and social disability. Compared to nonhoarding OCD and anxiety disorder patients, OCD hoarding patients scored higher on anxiety, depression, family and social disability. Hoarding subjects had greater personality disorder symptoms than controls. However, OCD hoarding subjects differed from OCD nonhoarding and anxiety disorder subjects only on dependent and schizotypal personality disorder symptoms. The findings suggest that hoarding is associated with significant comorbidity and impairment compared to nonhoarding OCD and other anxiety disorders.

Adult↗