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PubMedDate not supplied

Family studies of borderline personality disorder: a review.

This paper reviews the literature examining the psychopathology found in relatives of individuals with borderline personality disorder (BPD). Reflecting changes in how BPD has been conceptualized, researchers have investigated the prevalence of schizophrenia, then mood disorders, and more recently, impulse spectrum disorders in these relatives. This literature does not support a link between BPD and schizophrenia, is ambiguous about a link between BPD and major depressive disorder, and suggests a familial aggregation of impulse spectrum disorders and BPD, as well as of BPD itself. Because of significant methodological problems, most notably indirect assessments and inadequate sample size, major questions persist about the familial aggregation of this disorder that require more definitive methods.

Borderline Personality Disorder↗
PubMed2005

Acute tryptophan depletion. Part II: clinical effects and implications.

OBJECTIVE: This is the second of two articles reviewing the modern dietary technique of acute tryptophan depletion (ATD), a method of transiently reducing central serotonin levels in both healthy volunteers and clinical populations. This article details the clinical studies to date and discusses the implications of this research methodology. METHOD: The authors present a review of clinical ATD studies collated from a MEDLINE search, unpublished communications and the authors' considerable experience with this paradigm. RESULTS: Following from the initial use of ATD in subjects with depressive illness, studies of anxiety disorders and other psychiatric illnesses have been reported. Sleep, aggressive and cognitive effects are also active areas of research and are reviewed here. CONCLUSIONS: Acute tryptophan depletion remains a useful psychiatric research tool. The findings from the clinical studies reviewed here are summarized and implications for future research detailed.

Alleles↗
PubMed2006

Brain activation during craving for alcohol measured by positron emission tomography.

OBJECTIVE: Craving for alcohol is probably involved in acquisition and maintenance of alcohol dependence to a substantial degree. However, the brain substrates and mechanisms that underlie alcohol craving await more detailed elucidation. METHOD: Positron emission tomography was used to map regional cerebral blood flow (CBF) in 21 detoxified patients with alcohol dependence during exposure to alcoholic and non-alcoholic beverages. RESULTS: During the alcohol condition compared with the control condition, significantly increased CBF was found in the ventral putamen. Additionally, activated areas included insula, dorsolateral prefrontal cortex and cerebellum. Cerebral blood flow increase in these regions was related to self-reports of craving assessed in the alcoholic patients. CONCLUSIONS: In this investigation, cue-induced alcohol craving was associated with activation of brain regions particularly involved in brain reward mechanisms, memory and attentional processes. These results are consistent with studies on craving for other addictive substances and may offer strategies for more elaborate studies on the neurobiology of addiction.

Adult↗
PubMedDate not supplied

Psychosocial correlates of problem gambling in Australian students.

OBJECTIVE: This study examined the relationship between problem gambling and psychological and social adjustment in Australian adolescents. METHOD: A sample of 926 adolescents (mean age = 14.46 years) in the Australian Capital Territory were administered a standardized series of measures relating to gambling and psychosocial adjustment. Young people were asked to indicate how often they gambled, to report any difficulties that they might have been experiencing with gambling, and to complete a variety of measures of psychosocial health, including: the GHQ-12, Rosenberg's self-esteem scale and other measures of social functioning. RESULTS: The results were generally consistent with previous international studies. Those adolescents classified as problem gamblers were found to have poorer scores on all psychosocial measures. Although many in the problem gambling group reported being part of a socially active peer group, they also reported being more alienated and unpopular among their classmates. CONCLUSIONS: The results suggest that problem gambling appears to be a significant risk factor for poorer mental health among Australia adolescents. Given previous adult research indicating a link between early gambling and long-term gambling problems and poorer life outcomes (e.g. Abbott, McKenna and Giles, 2000 in New Zealand), these findings suggest a need to enhance existing educational initiatives and services specifically designed to assist adolescents with gambling problems.

Adolescent↗
PubMed2001

Gender differences in cocaine craving among non-treatment-seeking individuals with cocaine dependence.

The purpose of this pilot study was to evaluate potential gender differences in cocaine craving among non-treatment seekers with cocaine dependence. We examined 10 female and 11 male individuals matched by demographic characteristics and severity of drug use; we used a multidimensional questionnaire that assesses various aspects of craving: (a) current intensity, (b) projected intensity, (c) resistance to use cocaine, (d) responsiveness to drug-related conditioned stimuli, and (e) imagined likelihood of use if in a setting with access to drugs. Other instruments utilized were the Hamilton Rating Scale for Depression and Addiction Severity Index. Female subjects had higher total craving scores (p < .05), with post hoc tests showing more present desire to use cocaine and responsivity to drug-conditioned stimuli, along with lower scores on the desire not to use cocaine. In exploratory analyses, we found greater depressive symptomatology (p = .02) and severity of family/social problems (p = .02) in females than their males counterparts. These results suggest that gender may influence different aspects of cocaine craving. As estrogen is purported to modulate craving-related dopaminergic systems, further studies will be needed to confirm these observed gender differences and to investigate their possible mechanisms, particularly estrogen-dopamine interactions and their effect on craving and mood.

Adult↗
PubMed2005

A comparison of the Yale-Brown Obsessive Compulsive Scale for "heavy drinking" with a single item craving measure: construct validity and clinical utility.

The measurement of alcohol "craving" began with single-item scales. Multifactorial scales developed with the intention to capture more fully the phenomenon of craving. This study examines the construct validity of a multifactorial scale, the Yale-Brown Obsessive Compulsive Scale for heavy drinking (Y-BOCS-hd). The study compares its clinical utility with a single item visual-analogue craving scale. The study includes 212 alcohol dependent subjects (127 males, 75 females) undertaking an outpatient treatment program between 1999-2001. Subjects completed the Y-BOCS-hd and a single item visual-analogue scale, in addition to alcohol consumption and dependence severity measures. The Y-BOCS-hd had strong construct validity. Both the visual-analogue alcohol craving scale and Y-BOCS-hd were weakly associated with pretreatment dependence severity. There was a significant association between pretreatment alcohol consumption and the visual-analogue craving scale. Neither craving measure was able to predict total program abstinence or days abstinent. The relationship between obsessive-compulsive behavior in alcohol dependence and craving remains unclear.

Adult↗
PubMed1997

Emergence of kleptomania during treatment for depression with serotonin selective reuptake inhibitors.

Kleptomania, one of the rare impulse-control disorders, is characterized by an irresistible impulse to steal objects not needed for personal use or monetary value. There is a comorbidity between mood disorders, eating disorders, anxiety disorders, personality disorders, and kleptomania. Several recent case reports have suggested that serotonin reuptake inhibitors could be effective in the treatment of obsessive-compulsive spectrum disorders and specifically in kleptomania. We describe three depressed patients who paradoxically experienced kleptomanic behavior during treatment with serotonin selective reuptake inhibitors.

Aged↗
PubMed1989

Elevated platelet MAO is related to impulsivity in disruptive behavior disorders.

Platelet monoamine oxidase (MAO) activity was measured in 32 drug-free prepubertal boys with externalizing symptoms of disruptive behavior disorders and 47 boys with no DSM-III-R diagnoses, and correlated to questionnaire and laboratory performance measures of impulsivity. A subgroup of boys with high MAO activity exhibited significantly poorer performance (i.e., more impulsivity) than a subgroup of low MAO activity on laboratory tasks requiring response inhibition. High MAO patients were more impulsive than high MAO controls on some performance tasks and elevated platelet MAO was unrelated to personality questionnaire measures of impulsivity or to patient status. These data suggest that biological markers such as MAO activity may correlate better with performance than clinical questionnaire measures. Abnormally high platelet MAO activity may not be sufficient to produce externalizing symptoms in children, perhaps interacting with an underlying behavioral dimension of impulsivity.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Callous/unemotional traits and social-cognitive processes in adjudicated youths.

OBJECTIVE: There seem to be two dimensions associated with psychopathic traits in youths: a callous/unemotional factor (C/U) and an impulsivity/conduct problems factor (I/CP). This study sought to clarify the nature of these two factors and examine their relation with social-cognitive problems in incarcerated adolescents. METHOD: One hundred sixty-nine male and female adjudicated youths were recruited for participation. Self-report measures and archival data were used to assess psychopathic traits, emotional distress, behavioral dysregulation, social-cognitive processes, and delinquency severity. RESULTS: Analyses demonstrated that the I/CP factor is associated with increased levels of dysregulated behavior, while the C/U dimension is related to deficits in empathy. The two factors exhibited differential relations with measures of emotional distress and fearfulness. C/U traits were associated with an increased focus on the positive aspects of aggression and a decreased focus on the negative aspects of hostile acts. Findings remained after controlling for demographic characteristics, abuse history, intellectual abilities, and delinquency severity. CONCLUSIONS: Results provide support for the two-dimensional nature of psychopathy in youths and suggest that C/U traits are associated with lower emotional distress and a specific social information-processing pattern. The potential implications for working with adjudicated youths exhibiting C/U traits are noted.

Adolescent↗
PubMed1992

Serotonin and psychiatric disorders.

One of the ongoing problems in biological psychiatry lies in relating clinical laboratory findings to specific symptoms or behaviour patterns. In recent years it has become clear that serotonin (5-HT) is involved in a wide range of psychiatric disorders and in quite specific behaviour patterns, mainly characterized by a poor control of impulses. Psychopharmacotherapy with substances able to enhance the metabolism of serotonin (mainly antidepressants) is able to clinically improve what appear to be very dissimilar conditions. Moreover, antidepressants with serotonergic activity are the only class of drugs able to relieve the symptoms of obsessive compulsive disorder (OCD), which are characterized by a high control of impulses or, more precisely, by a dysfunctional, non-adaptive control of impulses. Recent neurochemical data suggest that a hypersensitivity to 5-HT exists in this condition. Therefore, the hypothesis that serotonin is important for efficient control of impulses is a key to the interpretation of many laboratory findings and to the penetration of the complex field of biological substrates of psychopathology.

Anxiety Disorders↗
PubMed2002

Impulse control disorders and depression.

This study assessed the frequency of impulse control disorders (ICDs) and their association with bulimia, compulsive buying, and suicide attempts in a population of depressed inpatients. We investigated ICDs using the Minnesota Impulsive Disorders Interview. Patients answered the Zuckerman Sensation-Seeking Scale and the Barratt Impulsivity Rating Scale. Among the 31 depressed patients who met criteria for ICD (ICD+ group), we found 18 cases of intermittent explosive disorder, three cases of pathological gambling, four cases of kleptomania, three cases of pyromania, and three cases of trichotillomania. Patients with co-occurring ICDs were significantly younger (mean age = 37.7 versus 42.8 years). Patients with kleptomania had a higher number of previous depressive episodes (5.7 versus 1.3), and patients with pyromania had a higher number of previous depressions (3.3 versus 1.3, p =.01). Bipolar disorders were more frequent in the ICD+ group than in the ICD- group (19% versus 1.3%, p =.002), whereas antisocial personality was not (3% versus 1%, p = ns). Bulimia (42% versus 10.5%, p =.005) and compulsive buying (51% versus 22%, p =.006) were significantly more frequent in the ICD+ group. Patients from the ICD+ group had higher scores of motor impulsivity assessed with the Barratt Impulsivity rating scale (p =.01).

Adult↗
PubMed2003

Effectiveness of autogenic relaxation training on children and adolescents with behavioral and emotional problems.

OBJECTIVE: To investigate the effectiveness of autogenic relaxation training in a mildly disturbed outpatient population of children and adolescents with mostly internalizing symptoms, and/or some aggressive, impulsive, or attention deficit symptoms. METHOD: Fifty children and adolescents from southern Germany (mean age 10.2 years; range 6-15 years; mostly intact middle class family background) participated in a group intervention program. Fifteen patients were randomly assigned to a waiting-list control group. Behavior symptoms (Child Behavior Checklist), psychosomatic complaints (Giessen Complaint List), and level of stress were assessed before and after the intervention or after the waiting phase. Individual goal attainment was evaluated at the end of the intervention and in a 3-month follow-up. RESULTS: The parent report on CBCL reflected reduced symptoms compared with control. The child report indicated reduced stress and psychosomatic complaints both in the intervention and control group, and no significant group x time interaction effects occurred on these scales. Effect sizes of 0.49 in the CBCL and 0.36 in the complaint list indicated clinically relevant effects of the intervention compared with the control group. At the end of the intervention, 56% of the children and 55% of the parents reported partial goal attainment, 38% of the children and 30% of the parents reported complete goal attainment; 71% of the parents confirmed partial goal attainment 3 months postintervention. CONCLUSIONS: Autogenic relaxation training is an effective broadband method for children and adolescents.

Adolescent↗
PubMed2007

Relationship satisfaction and psychological distress among concerned significant others of pathological gamblers.

This study explores correlates of psychological distress and relationship satisfaction among concerned significant others (CSOs) of pathological gamblers. CSOs often seek help in dealing with the gambling problem and are influential in recovery, but little is known about the sources of their distress. A sample of 186 CSOs responded to media announcements offering telephone and bibliotherapy support. In multivariate models, CSOs who were spouses and who were younger reported more personal distress, and higher distress was associated with a greater number of CSO emotional and behavioral consequences. Lower relationship satisfaction was associated with more CSO emotional consequences, fewer gambler consequences, and greater severity of gambling problem. Implications for treatment are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Patients with carcinoid syndrome exhibit symptoms of aggressive impulse dysregulation.

OBJECTIVE: Carcinoid tumors can produce excessive amounts of biogenic amines, notably serotonin. We assessed psychiatric symptoms in carcinoid patients and peripheral metabolism of tryptophan, the precursor of serotonin. METHODS: Twenty consecutive patients with carcinoid syndrome underwent a structured psychiatric interview applying DSM-IV (Diagnostical Statistical Manual) criteria. Tumor activity was measured by determination of 24-hour urine excretion of 5-hydroxyindoleacetic acid (5-HIAA) and platelet serotonin levels. Plasma tryptophan levels were measured and compared with sex- and age-matched references. RESULTS: Fifteen patients (75%) fulfilled diagnostic DSM-IV criteria for a disorder of impulse control. Tryptophan plasma levels were lower in patients compared with controls (p =.031) and were correlated negatively with urinary 5-HIAA excretion (p =.001). CONCLUSIONS: Impulse control disorders are prevalent in patients with carcinoid syndrome. The serotonin production by the tumor possibly decreases the tryptophan pool in the cerebrospinal fluid, which is the essential substrate for the production of brain serotonin as a pivotal neurotransmitter.

Aged↗
PubMedDate not supplied

Kleptomania after head trauma: two case reports and combination treatment strategies.

The purpose of this paper is to add to the growing number of reports about kleptomania occurring in relation to brain injury as well as to present the authors' findings regarding treatment strategies. The authors present two case reports of patients who developed the new onset of kleptomania after closed head trauma. Both patients had comorbid psychiatric symptoms associated with the kleptomania. Antidepressant monotherapy was not beneficial in reducing kleptomania in either patient. Kleptomanic behavior was successfully treated in both patients, however, through combination treatment using an antidepressant agent together with adjunctive cognitive behavioral therapy or adjunctive naltrexone. In one patient, single photon emission tomography showed a perfusion deficit in the left temporal lobe. Various hypotheses regarding this finding and the etiopathology of kleptomania are discussed. Review of current work in the field suggests that kleptomania is a heterogeneous disorder that shares features of both impulse and addiction disorders as well as affective spectrum disorders.

Adult↗