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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↗
PubMed1992

Factorial structure of traits delineating personality disorders in clinical and general population samples.

Categorical and dimensional models for classifying personality disorders were evaluated by comparing the structure of personality pathology in a clinical sample (n = 158) with the structure in a general population sample (n = 274). Subjects completed 100 personality scales. Separate factor analyses revealed similar structures in the 2 samples. An underlying structure in a combined sample showed limited agreement with the concepts of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987). Fifteen factors were retained: Generalized Distress, Rejection, Restricted Expression, Compulsivity, Stimulus Seeking, Insecure Attachment, Diffidence, Intimacy Problems, Oppositionality, Interpersonal Disesteem, Conduct Problems, Cognitive Dysfunction, Affective Reactivity, Narcissism, and Social Apprehensiveness. The results are consistent with a dimensional representation of personality disorder.

Adult↗
PubMed1998

Diagnosis of obsessive-compulsive illness.

Obsessive-compulsive illness has long been subject to diagnostic neglect. Moreover, obsessive-compulsive features often underlie or are intercurrent with other symptom pictures and may be quite debilitating. Diagnostic dilemmas are discussed regarding obsessive-compulsive illness and its relation to eating disorders, generalized anxiety disorder, mood disorders, alcohol abuse, and adult attention deficit disorder. Some difficulties in eliciting and recognizing obsessive-compulsive illness are presented. These include patient secrecy, shame, and social and personality features of health professionals. Specific pharmacologic and therapeutic interventions are effective when directed at the intercurrent or underlying obsessive-compulsive illness.

Adult↗
PubMedDate not supplied

Vomiting as a manifestation of borderline personality disorder in primary care.

BACKGROUND: Patients with borderline personality disorder often are found and treated in psychiatric settings following episodes of self-mutilation, such as wrist-slashing. Family physicians care for many patients with borderline personality disorder, but in primary care settings wrist-slashing or other physical mutilation is a less common presenting problem. Frequently these patients complain of such symptoms as nausea and vomiting that do not so obviously suggest psychopathology. METHODS: Three primary care patients with borderline personality disorder in whom episodic vomiting was the chief complaint are presented. Hypotheses from the literature about the neurobiology of vomiting and self-mutilation are discussed. RESULTS: Vomiting is a primary care analogue of self-mutilation in some patients with borderline personality disorder. CONCLUSIONS: Family physicians should include careful history taking to corroborate other features of borderline personality disorder in evaluating patients with persistent, episodic vomiting. Obtaining a history of early sexual abuse or chronic interpersonal problems as an adult should not only mitigate the compulsion for extensive, costly, and invasive gastrointestinal system evaluations in such patients, but also suggest more effective treatment strategies.

Adult↗
PubMed2026

Causal Relationship of Polyunsaturated Fatty Acids With Mental Disorders: A Systematic Review and Meta-analysis.

CONTEXT: Mental disorders (MDs) pose a important global health challenge, with a complex pathogenesis complicating treatment development. Nutritional interventions, particularly polyunsaturated fatty acids (PUFAs), have gained attention as potential therapeutic options. OBJECTIVE: This Mendelian randomization (MR) meta-analysis aimed to evaluate the potential causal relationship between PUFAs and MDs. DATA SOURCES: Genome-wide association study data were utilized to analyze the association between PUFAs (including omega-3, omega-3 percentage [omega-3%], omega-6, omega-6 percentage [omega-6%], and omega-6 to omega-3 ratio) and 12 major MDs. DATA EXTRACTION: Two-sample MR technology was used to assess the role of PUFAs in MDs. DATA ANALYSIS: The MR analysis revealed that genetically predicted omega-3 was causally linked to MDs, such as obsessive-compulsive disorder, bipolar disorder, schizophrenia, and major depressive disorder. Omega-3% exhibited protective effects against emotional personality disorder. Conversely, omega-6 was inversely correlated with attention-deficit/hyperactivity disorder risk, while a high omega-6 to omega-3 ratio was associated with an increased risk of depression and other mood disorders. CONCLUSION: High omega-3 levels and omega-3% may reduce the risk of MDs, whereas a high omega-6:omega-3 ratio may elevate the risk. These findings highlight the potential of PUFAs, particularly omega-3, in MD prevention and treatment, while underscoring the need for further research into the complex interactions between omega-3 and omega-6. The study provides a scientific foundation for future clinical trials and dietary intervention strategies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO no. CRD42024598472.

Humans↗
PubMed1992

Potential indications for the selective serotonin reuptake inhibitors.

The selective serotonin reuptake inhibitors (SSRIs) include fluoxetine, fluvoxamine, citalopram, paroxetine and sertraline. These medications may be effective for a variety of indications. The literature clearly supports their efficacy in some of these conditions in major depression. Data concerning their use in other areas is clearly preliminary but promising. These include reports of treatment of obsessive-compulsive disorder, atypical depression, panic disorder, premenstrual tension, eating disorders, substance use disorders, chronic pain, dementia, and personality disorders with aggressive or impulsive features. The variety of clinical uses for the SSRIs may compel re-examination of traditional diagnostic categories and theories of how antidepressants work.

Depressive Disorder↗
PubMed2000

Psychopathology and the initiation of disability payments.

OBJECTIVE: Longitudinal prospective data from the multisite Epidemiologic Catchment Area (ECA) survey were examined to determine relationships between mental disorders, alcohol abuse or dependence, and transfer payments for disability. METHODS: ECA respondents who were not receiving disability benefits at baseline but who were receiving them at the one-year follow-up were identified. The effects of six psychiatric disorders on the risk of starting payments were examined. They were major depressive disorder, panic disorder, alcohol abuse or dependence, phobic disorder, obsessive-compulsive disorder, and schizophrenia. The odds of starting to receive payments were calculated for persons with these disorders, any mental or addictive disorder, or any two or more disorders, while the analysis controlled for sociodemographic characteristics. RESULTS: A total of 15,567 people were interviewed at baseline; 7 percent received disability payments. Among the 11, 981 people interviewed at one year, 261 had begun to receive payments that year, for a starting rate of 2.2 percent. Significant predictors of the initiation of payments were little education (odds ratio=3.7) and low household income (OR=2.6). Respondents with panic disorder were 5.2 times more likely to begin receiving benefits than those without this disorder; respondents with schizophrenia were 4.5 times more likely and those with two or more disorders were 2.8 times more likely to start benefits than those without these disorders. CONCLUSIONS: Differences in social class influenced the initiation of disability payments. However, having a mental or addictive disorder was a more significant predictor, strongly increasing the risk of receiving payments. Given the economic burden to society and potential loss of earnings and opportunity costs for persons with disability and their families, intervening to prevent or alleviate mental disorders should be considered as one alternative to reducing disability payments.

Adult↗
PubMed1988

Obsessive-compulsive disorder: a treatment review.

Obsessive-compulsive disorder, which may affect 2% to 3% of the U.S. population, can be severely disabling, permeating an individual's personal, social, and work life. Only within the past 2 decades have effective treatments been proposed and tested. Specific behavior therapies such as exposure in vivo and response prevention have proved successful in decreasing compulsive rituals in 70% to 80% of patients who accept and comply with treatment. For those patients who do not respond to behavior therapy, medications should be used. To date the tricyclic clomipramine is the only medication that has been consistently effective in controlled studies. However, for certain patients other medications may be of benefit. For the minority of patients who do not respond to either behavior therapy or medication, psychosurgery--specifically stereotactic limbic leucotomy--should be considered a viable option.

Anti-Anxiety Agents↗
PubMed2000

Public attitudes towards the mentally ill: a cross-cultural study between Bali and Tokyo.

The present study investigates the differences in public attitudes towards the mentally ill in Bali (Indonesia) and Tokyo (Japan), the former being a non-industrialized society and the latter an industrialized society in Asia. Seventy-seven residents of Bali and 66 residents from Tokyo were examined by a devaluation-discrimination measure and a self-assessment questionnaire to gauge their reactions to five imaginary case study vignettes consisting of three cases of schizophrenia, one case of a depressive episode, and one case of obsessive-compulsive disorder. Balinese respondents had significantly lower devaluation-discrimination measure scores, indicating a more favorable global attitude towards persons with a history of psychiatric treatment than did respondents in Tokyo. However, the extent to which people were prejudicial against mental patients in the two societies varied with the kinds of mental disorders, with Balinese having a more positive attitude to schizophrenics but more negative to depressive and obsessive-compulsive patients.

Adult↗
PubMed2000

Candidate gene polymorphisms in eating disorders.

Anorexia nervosa and bulimia nervosa are complex disorders characterized by disordered eating behaviour. Attitudes towards weight and shape as well as the perception of body shape are disturbed. A substantial genetic influence on these disorders has been suggested by formal genetic studies. Obsessive-compulsive behaviour, perfectionism and anxious personality traits seem to occur premorbidly in several patients. Disturbances of neurotransmitter, neuropeptide and neuroendocrine systems have been reported in acutely ill and followed-up patients. Hence, these systems might be involved in the etiology of these eating disorders.Genetic studies on candidate genes have mainly focussed on the serotonergic system and on genes involved in body weight regulation. Up to now, polymorphisms and variations in various genes (e.g. genes for 5-HT receptors, leptin gene, melanocortin MC(4) receptor gene) have been assessed for association and transmission disequilibrium pertaining to anorexia nervosa and/or bulimia nervosa. Most of the studies yielded negative results. Four studies of a polymorphism (-1438 G/A) within the promoter of the 5-HT(2A) gene (5-HT(2A)) revealed an association of the A-allele to anorexia nervosa. However, three studies could not confirm this result. Furthermore, a meta-analysis did not support the positive association. Currently, combined efforts within the European Union will answer the question of whether or not the A-allele is involved in the predisposition to anorexia nervosa. A transmission disequilibrium test is being performed in about 300 trios consisting of a patient with anorexia nervosa and both parents. As candidate gene approaches did not unequivocally identify susceptibility genes (alleles) for anorexia nervosa or bulimia nervosa, systematic model-free genome-wide screenings should also be performed in order to identify currently unknown genes involved in eating disorders. This kind of approach has already been initiated for anorexia nervosa. Genetic research on eating disorders will hopefully lead to new pharmacological treatment strategies.

Animals↗
PubMed1998

Personality patterns in patients with myotonic dystrophy.

BACKGROUND: Myotonic dystrophy (DM) is a multisystemic disease. The central nervous system is affected by cognitive, affective, and personality disturbances. A characteristic behavior was noted from the first clinical descriptions, but no definitive conclusions have been drawn despite extensive debate. As DM is a genetic disease of well-defined abnormality, it may be a good model for understanding the relative contributions of nature and nurture in the building of personality traits. OBJECTIVE: To investigate the possibility that there is a personality pattern that is characteristic of patients with DM. SUBJECTS AND METHODS: The personalities of 15 adult (age range, 20-53 years) patients with DM with no, or minimal, muscle weakness were studied by means of the International Personality Disorder Examination. The results were compared with those from 14 matched healthy subjects (age range, 20-54 years) and 12 patients (age range, 22-50 years) with a mild form of facioscapulohumeral dystrophy. SETTING: The Department of Neuromuscular Diseases, Hôpital de la Salpêtrière, Paris, France. RESULTS: Patients with DM exhibited a homogeneous personality profile, with statistically significant differences (P<.005) for avoidant, obsessive-compulsive, passive-aggressive, and schizotypic traits. In both groups of controls, the personality profiles were extremely heterogeneous. Personality disorders (avoidant personality) were found in 4 of 15 patients with DM. CONCLUSIONS: The findings of this study suggest that the personality pattern of patients with DM is related to their disease. Their personality disorders are not attributable to their adjustment to a disabling condition. By contrast, among the patients with DM, the high incidence of avoidant personality, a phenotype poorly represented in the general population, supports the idea that it is the expression of a primary phenomenon related to a genetic mutation.

Adult↗
PubMedDate not supplied

[Value of fluoxetine in obsessive-compulsive disorder in the adult: review of the literature].

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) with demonstrated efficacy in the treatment of major depressive episodes. Since 1985, it has been evaluated for the treatment of obsessive-compulsive disorder (OCD). The orbitofrontal cortex and caudate nucleus are cerebral structures believed to be involved in the pathogenesis of OCD, since hyperactivation of these territories in the basal state is corrected upon remission of symptoms induced by therapy with an SSRI or by behavioral psychotherapy. Furthermore, several studies have found abnormalities in serotoninergic transmission in the orbitofrontal cortex and SSRIs can increase serotonin release by desensitizing 5HTID autoreceptors. OCD is a severe, chronic psychiatric disorder frequently complicated by depressive episodes. Here we review the clinical trials of fluoxetine listed in the Medline and Embase computerized databases. Fluoxetine was found to be effective in OCD in all the published open-label studies as well as in placebo-controlled trials with an effective dose range of 40 to 60 mg daily. Clinical evaluation was carried out by using specific scales such as the Y-BOCS or NIMH-OC and improvement was observed after several weeks of therapy. These studies comprising an extended phase showed that efficacy was maintained--for three years in the longest study--resulting in a higher percentage of responders relative to the treatment initiation phase. A comparison of fluoxetine and clomipramine showed comparable efficacy and a superior safety profile, both in terms of anticholinergic side effects and cardiotoxicity or overdosage. The relapse rate was similar with both drugs. In the four meta-analyses appearing in the databases, two studies found similar efficacy for clomipramine and fluoxetine. There are few studies which directly compare the different SSRIs, apart from a comparison of fluoxetine and sertraline showing that both drugs have similar efficacy. With clomipramine, the SSRIs represent the first-line treatment recommended by the experts, in association with behavioral therapy to improve and maintain the clinical response over the long term. The guidelines recommend an optimal fluoxetine dose of 40 to 60 mg daily with a minimum treatment duration of 1 to 2 years. Efficacy should not be evaluated before 8 weeks to allow for onset of the therapeutic effects. Fluoxetine was found to have a good safety profile in these studies and the adverse effects described (insomnia, headache, diminished libido) rarely led to discontinuation of the treatment. Adverse effects such as nervousness or insomnia at the start of therapy were predictors of a good response to fluoxetine, as were the presence of remissions, the absence of prior pharmacologic therapy and a high impulsiveness score. A long history of the disorder, severity of the symptoms, collection obsessions, washing compulsions, obsessional slowness and comorbidity with a schizotypic personality or vocal or motor tics were associated with a poorer response. Fluoxetine also alleviates collateral depressive symptoms by significantly reducing suicidal ideation and impulsiveness in OCD patients. Our study indicates that fluoxetine is effective and well tolerated in OCD, placing it among the first-line treatments recommended by consensus conference guidelines.

Clinical Trials as Topic↗
PubMed1996

Treatment of obsessive-compulsive disorder in children and adolescents. A review of the literature.

The literature on treatment of childhood and adolescent obsessive-compulsive disorder is reviewed. Most studies concerning treatment of obsessive-compulsive disorder has been based on experience from adult patients. Only a few controlled trials using medication with obsessive-compulsive children have been produced. No controlled study has as yet documented the effect of behavioural therapy alone. The most effective treatment seems to be a combination of behavioural therapy and medication with a serotonin reuptake inhibitor. In the treatment of children with OCD, it is important to consider the child's personality and comorbid disorders.

Adolescent↗
PubMedDate not supplied

[Study of the remission period (between crises) of unipolar and bipolar manic depressive disorders. Personal study of 95 patients].

The personality abnormalities observed during unipolar and bipolar manic-depressive disorders are known for years by german psychiatry as depressive temperament. In USA many works based on DSM III criteria have studied personality abnormalities coexisting with depression. The most frequently abnormalities are dependent, avoidant, compulsive, border line personality, observed with a frequency of 48% (P.A. Pilkonis) to 74% of patients (T.M. Shea et al.). But the personality traits or disorders are not the disorders only observed during remissions and intercrisis. Our personal work have studied the other disorders. This work concern pre-morbid period and intercrisis of 95 manic-depressed patients (45 unipolar and 50 bipolar patients). The time of remission is at least three months. Remission is certified by maximum scores of 10 on MADRS, 12 on Bech-Rafaelsen scale. The study of personality traits and other mental disorders is based on DSM III-R criteria. It is completed by Hamilton-Anxiety-Scale, Eysenck Personality Inventory and Beth-Israel Questionnaire of Sifneos. This study shows the following results. In pre-morbid period, the anxiety disorders are statistically more frequent in unipolar patients: generalized anxiety (35%), panic disorder (27%), psychosomatic disorders (30.5%). During intercrisis, the anxiety disorders are statistically more frequent in unipolar patients: generalized anxiety (51.1%), agoraphobia (31.1%) obsessive disorders (26.6%), panic disorder (18.2%). But this co-morbidity with anxious disorders is highly correlated with the incomplete characteristic of remission. During remission the personality abnormalities are similar to american studies, more frequent in unipolar patients, particularly obsessive personality (22.2 to 4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMedDate not supplied

Dental management considerations in children with obsessive-compulsive disorder.

Children suffering from obsessive-compulsive disorder frequently manifest bizarre behaviors that contribute to the development of oral pathology. The medications used in management of the disorder can cause profound xerostomia and compound the magnitude of oral disease. An understanding of the diagnosis and treatment of the disorder will better prepare the dentist to meet the needs of this unique group of patients.

Child↗
PubMedDate not supplied

[Epidemiology of obsessive-compulsive disorder].

In the article the problems of prevalence of obsessive-compulsive disorder (OCD), comorbidity with other mental disorders and the most commonly used diagnostic instruments were presented. Epidemiological data indicate OCD as the fourth most common mental disorder, which appears as frequent as asthma or diabetes. In an international study from 1994 the year's prevalence of OCD was from 1.1% to 1.8%. In each country obsessions and compulsions appear with different intensity, what can testify for certain cultural conditionings of disorder. Men suffer from OCD equally often as women, however both first symptoms and full symptom disorder appear several years earlier in men than in women. The prevalence of OCD among children is from 2% to 4%. At least half of the patients suffer from OCD also in maturity. OCD should be differentiated from generalized anxiety disorder, panic disorder, phobias, anancastic personality and hypochondria.

Cultural Characteristics↗
PubMed2001

[Stress response system and personality in rheumatoid arthritis patients]

Various factors such as immunogenetic determinants, sex, age and stress play an important role in the pathogenesis of rheumatoid arthritis (RA). The relationship between stress and RA is still unclear and undefined; however, various lines of research are developing in order to evaluate environmental, psychologic, and biologic stressors as predisposing factors. The aim of our study was to evaluate whether stress-related psychologic factors and personality disorders might be involved in the development of RA, by using a psychometric investigation-methodology in a series of patients. Twenty-three patients underwent a clinical interview and other specific psychometric tests. Macro and microstressful life-events preceded RA in 83% of the cases. Sixty percent of the patients showed a correlation between flare-ups of the disease and appearance of microevents. An obsessive-compulsive personality was found in 26% of the patients. Anxia was detected in 40% of the patients. Among the group of patients with borderline disorder's was also detected alexithymia. The high prevalence of major life-events preceding the onset of RA and the presence of personality disorders support the role of the altered stress response system as an important pathogenetic factor in the disease.

Journal Article↗