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PubMed2001

[Psychiatric disorders in juvenile myoclonic epilepsy].

Mild personality problems have been described in patients with juvenile myoclonic epilepsy (JME), but clinical practice shows that JME can be diagnosed in patients with more or less severe psychiatric disorders (PD). The presence in JME patients of personality disorders has been described repeatedly, but never quantified. We thus decided to evaluate, using the DSM IV, the current prevalence and types of PD in a large series of consecutive, newly referred patients with JME. Among 170 consecutive JME cases referred to two departments of epileptology (Marseilles and Nice) between 1981 and 1998 (66 males, 104 females; aged 11.7-70; mean+/-SD 32.4+/-10.4 follow-up 12.7+/-10 [0.5-52]), we found 45 patients (26.5p.100) with PD. According to the DSM IV, they could be classified as severe mental retardation (main diagnosis) (one case); pervasive developmental disorders (2 cases); tic disorder (1 case); enuresis (1 case); psychotic disorders (5 cases, including schizophrenia paranoid type (1 case), disorganized type (1 case), delusional disorder (1 case), unspecified (2 cases)); depressive disorders (3 cases); generalized anxiety (6 cases); anorexia nervosa (2 cases); personality disorders (24 cases, including borderline personality (11 cases), dependent personality (5 cases), histrionic personality (2 cases), obsessive-compulsive personality (1 case), not specified (5 cases)). Sudden unexplained death occurred in 2 cases (borderline personality and pervasive developmental disorder not otherwise specified, respectively) and death due to pneumonia in 1 cases (anorexia). Although uncommonly severe cases of JME may have been selected in our referral centers, it appears that JME may be associated with PD. Comparatively mild personality disorders are the most common finding, and may be part of the clinical picture to some extent, while severe PD are less common, and probably coincidental. The presence of PD does not exclude the diagnosis of JME, and PD may represent a further challenge in the comprehensive care of these patients.

Adolescent↗
PubMed1997

[Mental problems in the dental practice: a compulsive disorder].

The aim of the present paper is to inform the reader about individuals who are suffering from severe mental disorders, such as obsessive-compulsive disorder (OCD). A case story enlightens the fact that anxiety disorders like OCD can have profound implications for the dental treatment plan.

Dental Anxiety↗
PubMed1996

Patients with personality disorders: functional status, health care utilization, and satisfaction with care.

BACKGROUND: Personality disorders are believed to occur in approximately 10% of the adult population, yet they are rarely diagnosed in primary care settings. This study compares the functional status, health care utilization, and satisfaction with care for patients who were at high risk for a personality disorder with those who were at low risk. METHODS: Patients at high risk for personality disorders were identified using a standardized psychometric instrument, the Structured Clinical Inventory for DSM-III Axis II (SCID-II). After assigning patients to risk categories, responses were compared on the Medical Outcomes Study Short Form-36, the Beck Depression Inventory, the CAGE alcohol use questionnaire, and an adapted version of the RAND Patient Satisfaction Questionnaire. RESULTS: Patients who were at high risk for any personality disorder had lower functional status, higher risk for depression or alcohol abuse, and lower levels of satisfaction with care. These differences could not be explained by demographic or socioeconomic differences between high- and low-risk patients. Being at high risk for specific personality disorders, such as borderline, schizoid, and dependent disorders, was associated with higher degrees of functional impairment and greater risk for depression and alcohol abuse. Patients at high risk for other disorders, such as obsessive-compulsive, narcissitic, and schizotypal, consistently showed no appreciable degree of impairment as compared with patients at low risk for any personality disorder. Medical care utilization was no higher when personality disorders were examined in aggregate, but a marked increase in utilization was noted among patients at high risk for histrionic and dependent disorders. CONCLUSIONS: Among primary care patients, having a personality disorder is associated with lower functional status, lower satisfaction with health care, and higher risk for depression and alcohol abuse.

Adult↗
PubMed1983

Sex differences in medical students requesting psychiatric intervention.

Although recent reports suggest that women choosing a medical career encounter unique stressors, little attention has been given to whether this additional stress places them at greater psychological risk than men. This investigation delineates sex differences in the psychopathology of medical students seeking treatment. Men and women did not differ in primary diagnosis, type of complaint, problem areas, or type of termination. However, women reported more depressive and total symptomatology, and men were more likely to receive a secondary diagnosis of personality disorder and evidenced a particular excess of obsessive-compulsive disorders. Men often requested treatment following a relationship loss or when school performance fell short of expectations. Women were frequently struggling to reconcile career desires with a feminine identification and with affiliation needs. Conflict about deviating from a traditional role was exacerbated by expressed disapproval from significant others.

Achievement↗
PubMedDate not supplied

Temperament and personality features in patients with major depression, panic disorder and mixed conditions.

METHOD: Forty-two patients with Panic Disorder (P), 18 with Major Depression (MD), 35 with both conditions (MIX) and 45 healthy subjects (C) were tested with the Tridimensional Personality Questionnaire and the Structured Interview for DSM-III-R Personality Disorders. RESULTS: A different prevalence of Dependent (P = 16.7%, MD = 5.6%, MIX = 41.4%, C = 2.1%) (P < 0.001), Obsessive-Compulsive (P = 4.8%, MD = 27.8%, MIX = 3.4%, C = 0%) (P < 0.001) and Histrionic (P =23.8%, MD = 0%, MIX = 31%, C = 4.2%) (P = 0.001) personality disorders (PD) was found among groups. Harm Avoidance (HA) (P < 0.001) and Reward Dependence (RD) (P <0.001) were higher in patients than in controls. As expected the patients with comorbid conditions (MIX) showed higher HA levels (P < 0.01) and a greater prevalence of PDs, particularly of Cluster C compared to patients with pure disorders. CONCLUSIONS: This study suggests that high HA and RD scores are associated with P, MD and MIX, and the former dimension is even higher in MIX patients.

Adolescent↗
PubMed2001

Factorial structure of the German version of the dimensional assessment of personality pathology-basic questionnaire in clinical and nonclinical samples.

The Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) assesses 18 traits to provide a systematic representation of the overall domain of personality disorders. We tested the cross-cultural stability of the prediction that four higher-order factors (Emotional Dysregulation, Dissocial Behavior, Inhibitedness, and Compulsivity) underlie the 18 basic traits. A total of 81 patients who were primarily treated for an Axis II personality disorder and N = 166 healthy control patients completed the German version of the DAPP-BQ. Results clearly confirmed cross-cultural stability of the postulated four-factor structure in both samples, accounting for 74.7% (clinical sample), and 65.7% (nonclinical sample) of the total variance. All four higher-order factors showed specific correlational relationships with dimensional assessments of DSM-IV personality disorders.

Adult↗
PubMed1991

Adult disorders predicted by childhood conduct problems: results from the NIMH Epidemiologic Catchment Area project.

Children with conduct disorder have long been known to be at high risk for developing externalizing disorders, alcohol and drug abuse, and antisocial personality. Relationships of conduct disorder to other adult psychiatric disorders, on the other hand, have not been definitively shown. Taking advantage of the large community sample (N = 19,482) interviewed in the NIMH Epidemiologic Catchment Area Program, the authors examined the effects of childhood conduct problems on ten DSM-III psychiatric disorders: somatization, phobia, panic, obsessive-compulsive, depression, mania, alcohol use disorder, drug use disorder, schizophrenia and antisocial personality. Each of the ten adult disorders showed an increase in prevalence with an increasing number of conduct problems, although effects were stronger for externalizing disorders. The predictive power of conduct problems was similar for males and females. The effect of conduct problems on nonexternalizing disorders was found to be largely mediated through externalizing disorders, particularly for men but direct effects also occurred for both sexes. These findings raise questions about the conventional view of psychiatric disorders as divisible into externalizing and internalizing disorders. They also suggest that the increasing rates of conduct problems in younger cohorts may be responsible in part for the rising rates of other disorders. Thus, prevention of and early intervention with conduct disorder may hold promise for reducing rates of a broad range of disorders.

Adolescent↗
PubMed2001

[The result of testing psychotic disorder patients in general hospital with Minnesota Multiphasic Personality Inventory].

OBJECTIVE: To study the psychological characteristics of patients with psychotic disorder in general hospital. METHODS: 92 male and 158 female patients with psychotic disorder were tested with Minnesota multiphasic personality inventory (MMPI). They consist of 215 cases with neurosis (hypochondriasis, depression, anxiety, obsessive-compulsive disorder, hysteria, neurasthenia); 4 cases with schizoaffective disorder; 3 cases with manic-depressive insanity. 5 cases with schizophrenia and 23 cases of somatoform disease with affective disorder. RESULTS: The scores of F, K, Hs, D, Hy, Pd, Pa, Pt and Si scales in the patients were significantly higher than those in normal controls. The scores of Mf were significantly higher in the male han those in the female patients and the scores of F lower in the male than those in the female patients. CONCLUSIONS: The psychotic disorders as well as seen in patients in general hospital are hypochondriasis and somatoform disorder, and depression of the female.

Adult↗
PubMedDate not supplied

Differences in DSM-III-R and DSM-IV diagnoses in eating disorder patients.

Two hundred eighty-eight eating disorder patients were administered the DSM-III-R Structured Clinical Interview (SCID) and the DSM-IV SCID for axis I and II. Concordance between DSM-III-R and DSM-IV was excellent for the axis I affective and anxiety disorders, bulimia nervosa, and substance abuse/dependence. It was also excellent for axis II paranoid, schizoid, borderline, and antisocial personality disorders. Agreement between the two nosological systems was lower for alcohol abuse/dependence with a kappa of.63. Kappas were also poor for the following personality disorders: schizotypal (.44), histrionic (.29), dependent (.54), obsessive-compulsive (.62) and not otherwise specified (.63). There was a substantial difference in the diagnosis of anorexia nervosa between DSM-III-R and DSM-IV. Fourteen patients were diagnosed with anorexia nervosa, binge/purge type, using DSM-IV criteria, while only six received the diagnoses of anorexia nervosa and bulimia nervosa using DSM-III-R criteria. Kappa was.49 and the percent agreement was 79%. While there are considerable areas of overlap in DSM-IV and DSM-III-R, there are also areas of substantial differences. Clinicians and researchers must be very cautious when attempting to compare data from the different nosologies.

Adult↗
PubMed2003

[Obsessive-compulsive disorders in general practice. How the obsessive-compulsive neurotic is revealed by skin and hair].

Obsessive-compulsive disorder (OCD) is characterized by obsessions, compulsions, or both, which cause significant personal distress or social dysfunction. OCD is a common psychiatric illness with a prevalence of 1-2%. Because most people have regular contact with primary health care services, the patient with OCD is likely to see their general practitioner even though psychological problems may not be the main reason for consultation. Early recognition of the disorder facilitates early intervention. This reduces distress, disability and burden of illness. Pharmacological treatment with serotonin reuptake inhibitors (SRI) and cognitive-behavioral therapy have both been proven to be effective and are evidence based.

Adolescent↗
PubMed1994

Personality traits in subclinical and non-obsessive-compulsive volunteers and their parents.

Theorists from a variety of perspectives have asserted that obsessive compulsives are more risk-aversive, perfectionistic and guilt-ridden than non-obsessive compulsives, and that these characteristics are central features of the disorder. Furthermore, several have hypothesized that the parents of obsessive compulsives are characterized by risk-aversion, perfectionism, and high levels of criticism. Little research exists which corroborates these hypotheses, however. The present investigation examined these hypotheses among subclinical obsessive compulsives. In two different samples, subclinical obsessive compulsives were found to be more risk-aversive, perfectionistic, and guilt-ridden. Subclinical obsessive compulsives also perceived their parents to be more overprotective. The findings regarding other parental traits were less clear. There was some support for the hypothesis that the parents of subclinical obsessive compulsives are more risk-aversive, and that fathers are more critical and perfectionistic.

Female↗
PubMed1989

The biology of obsessions and compulsions.

Samuel Johnson kept darting through doorways; a teen-ager named Sergei is unable to stop washing. Such repetitive, ritualistic behavior can make a person unable to function. The author thinks obsessive-compulsive disorder has biological roots in specific brain structures; she has treated it with certain drugs initially developed as antidepressants.

Animals↗
PubMed1986

DSM-III diagnoses in chronic pain. Confusion or clarity?

The assessment of patients with chronic pain is receiving increasing attention by psychiatrists. Recent publications have put forward the concept of the "pain-prone disorder" as a variant of depressive illness. This study describes a series of 50 consecutive patients with chronic pain in terms of the five axes of the DSM-III nosology. Diagnoses were made after a 90- to 120-minute psychiatric interview, and a check on diagnostic reliability was made on a small subsample. Psychological factors affecting physical condition were diagnosed in 34% and dysthymic disorder was diagnosed in 28%, while major depression, psychogenic pain disorder, somatization disorder, and anxiety disorders were each respectively diagnosed in 8%. Only 6% had no diagnosis on axis I and 4% had no diagnosis on axis III. Personality disorder was diagnosed in 40%, and traits of dependence, compulsiveness, and anxiety were common. Overall, the patients had experienced a high degree of psychosocial stress with fair to poor adaptive functioning. The notion of chronic pain as a variant of depressive disease is questioned on the basis of these findings. The author suggests that although pain-proneness is a useful psychodynamic concept, the case for its establishment as a new psychobiological disorder is not proven. Furthermore, the concepts of pain-proneness, depression, and psychogenic pain have become confused. The author argues that the current classification is adequate to deal with the varieties of depression associated with chronic pain and that psychogenic pain disorder should be remerged with conversion disorder for the sake of clarity.

Adolescent↗
PubMed2003

Basal Ganglia volumes in patients with Gilles de la Tourette syndrome.

BACKGROUND: Despite strong circumstantial evidence that the pathophysiology of Gilles de la Tourette syndrome (TS) involves structural and functional disturbances of the basal ganglia, inconsistent findings from relatively small in vivo TS imaging studies have supported contradictory conclusions concerning the role of abnormal anatomical characteristics of the basal ganglia in the pathophysiology of TS. METHODS: Basal ganglia volumes were measured on high-resolution magnetic resonance images acquired for 154 children and adults with TS and 130 healthy control subjects. Repeated-measures analyses tested hypotheses concerning regional specificity, age effects, and abnormal asymmetries in the basal ganglia of subjects with TS. Subjects with prior neuroleptic exposure had larger basal ganglia volumes and were excluded from further statistical analyses. RESULTS: Caudate nucleus volumes were significantly (P =.008) smaller in children and adults with TS. Lenticular nucleus volumes also were smaller in adults with TS and in children with TS who were diagnosed as having comorbid obsessive-compulsive disorder. Regional anatomical asymmetries did not differ across groups. Regional volumes did not correlate significantly with the severity of tic, obsessive-compulsive disorder, or attention-deficit/hyperactivity disorder symptoms. CONCLUSIONS: Reduced caudate nucleus volumes may be a good candidate marker for a trait abnormality in the structure of the basal ganglia in persons with TS. Smaller lenticular nucleus volumes may be an additional marker for the presence of comorbid obsessive-compulsive disorder and for the persistence of tic symptoms into adulthood. Brain regions other than the basal ganglia may have greater clinical relevance in determining the severity of tic symptoms.

Adolescent↗
PubMed1998

Personality traits and personality disorders.

The structure of personality disorder traits was examined in a sample of 400 undergraduates who completed the personality disorder questionnaire from the Structured Clinical Interview for DSM-III-R (SCID-II). The relations between personality disorder and normal personality traits indexed by the Eysenck Personality Questionnaire-Revised (EPQ-R) were examined. The three-cluster model of personality traits--as described in the DSM scheme--found equivocal support. Exploratory principal components analysis and confirmatory factor analysis found four broad factors of personality disorder that overlapped with normal personality traits: an asthenic factor related to neuroticism; an antisocial factor associated with psychoticism; an asocial factor linked to introversion-extraversion; and an anankastic (obsessive-compulsive) factor. There is growing agreement about the number and type of broad personality disorder dimensions; similar dimensions may be found in clinical and non-clinical samples, suggesting that those people with personality disorders differ quantitatively rather than qualitatively from others; and there is substantial overlap between normal and abnormal personality dimensions.

Adult↗