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Disorder Patients (disorder + patient)
Kinds of Disorder Patients Selected AbstractsPanic Disorder Severity Scale: Reliability and validity of the Turkish version,,DEPRESSION AND ANXIETY, Issue 1 2004E. Serap Monkul M.D. Abstract We assessed the reliability and validity of the Turkish version of the seven-item Panic Disorder Severity Scale (PDSS). We recruited 174 subjects, including 104 with current DSM-IV panic disorder with (n = 76) or without(n = 28)agoraphobia, 14 with a major depressive episode, 24 with a non-panic anxiety disorder, and 32 healthy controls. Assessment instruments were Panic Disorder Severity Scale, Panic and Agoraphobia Scale, both the observer-rated (P&Ao) and self-rating (P&Asr); Clinical Global Impression Scale (CGI); Hamilton Anxiety Scale, and Beck Depression Inventory. We repeated the measures for a group of panic disorder patients (n = 51) after 4 weeks to assess test,retest reliability. The internal consistency (Cronbach's ,) of the PDSS was .92,94. The inter-rater correlation coefficient was .79. The test,retest correlation coefficient after 4 weeks was .63. In discriminant validity analyses, the highest correlation for PDSS was with P&Ao, P&Asr (r=.87 and .87, respectively) and CGI (r=.76) and the lowest with Beck Depression Inventory (r=.29). The cut-off point was six/seven, associated with high sensitivity (99%) and specificity (98%). This study confirmed the objectivity, reliability and validity of the Turkish version of the PDSS. Depression and Anxiety 00:000,000, 2004. © 2004 Wiley-Liss, Inc. [source] Review of the long-term effectiveness of cognitive behavioral therapy compared to medications in panic disorderDEPRESSION AND ANXIETY, Issue 2 2003Deepa N. Nadiga M.D. Abstract Panic disorder is a recurrent and disabling illness. It is believed that Cognitive Behavioral Therapy (CBT) has a long-term protective effect for this disorder. This would offer CBT considerable advantage over medication management of panic disorder, as patients often relapse when they are tapered off their medications. This is a review of the literature about the long-term effectiveness of CBT. We searched for follow-up studies of panic disorder using CBT. Of the 78 citations produced in the initial search, most had major methodological flaws, including ignoring losses to follow-up, not accounting for interval treatment, and unclear reporting. Three papers met strict methodological criteria, and two of these demonstrated a modest protective effect of CBT in panic disorder patients. We make recommendations for well-designed studies involving comparisons of medications and cognitive behavior therapy. Depression and Anxiety 17:58,64, 2003. © 2003 Wiley-Liss, Inc. [source] Instrument to assess depersonalization-derealization in panic disorderDEPRESSION AND ANXIETY, Issue 4 2002Brian J. Cox Ph.D. Abstract There is a long history of scholarly interest on depersonalization-derealization (DD) and its role in clinical anxiety, but there is a paucity of appropriate assessment instruments available. Our objective was to develop and evaluate a self-report measure of DD for use with clinically anxious patients. Panic disorder patients (n=169) were surveyed about DD experiences and provided data on a new item pool for psychometric development. DD episodes were common and a 28-item Depersonalization-Derealization Inventory was found to possess good reliability and validity. DD appears to be prevalent and clinically relevant in panic disorder. Continued study of DD is warranted and may be facilitated by the availability of a suitable instrument with promising psychometric properties. A 12-item version of the instrument may be appropriate as a brief screen. © 2002 Wiley-Liss, Inc. [source] Age at onset in 3014 Sardinian bipolar and major depressive disorder patientsACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010L. Tondo Tondo L, Lepri B, Cruz N, Baldessarini RJ. Age at onset in 3014 Sardinian bipolar and major depressive disorder patients. Objective:, To test if onset age in major affective illnesses is younger in bipolar disorder (BPD) than unipolar-major depressive disorder (UP-MDD), and is a useful measure. Method:, We evaluated onset-age for DSM-IV-TR major illnesses in 3014 adults (18.5% BP-I, 12.5% BP-II, 69.0% UP-MDD; 64% women) at a mood-disorders center. Results:, Median and interquartile range (IQR) onset-age ranked: BP-I = 24 (19,32) < BP-II = 29 (20,40) < UP-MDD = 32 (23,47) years (P < 0.0001), and has remained stable since the 1970s. In BP-I patients, onset was latest for hypomania, and depression presented earlier than in BP-II or UP-MDD cases. Factors associated with younger onset included: i) being unmarried, ii) more education, iii) BPD-diagnosis, iv) family-history, v) being employed, vi) ever-suicidal, vii) substance-abuse and viii) ever-hospitalized. Onset-age distinguished BP-I from UP-MDD depressive onsets with weak sensitivity and specificity. Conclusion:, Onset age was younger among BPD than MDD patients, and very early onset may distinguish BPD vs. UP-MDD with depressive-onset. [source] Is bipolar II depression phenotypically distinctive?ACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009G. B. Parker Objective:, We examine the depressive symptom profile of bipolar II disorder patients compared with a comparator (composite) group of those with unipolar depression, with stratification by melancholic and non-melancholic subtypes. Method:, Out-patients (n = 394) attending a specialist depression clinic comprised the sample. Data on severity and prototypic status of depressive symptoms were analysed. Results:, Age-matched analyses revealed minimal differentiation between bipolar II and composite unipolar groups. Stratified analyses suggested that ,bipolar II depression' more closely approximated melancholic depression in terms of psychomotor and cognitive slowing. Severity-based analyses and prototypic symptom patterns yielded differing results, suggesting that definition of bipolar II depression is influenced by rating strategies, and age. Conclusion:, We found limited differentiation of bipolar II depression from unipolar, melancholic and non-melancholic depression. Differences suggested previously may reflect age, gender and severity differences, highlighting the need for appropriately matched groups in defining bipolar II depression. [source] Memory and prefrontal functions in earthquake survivors: differences between current and past post-traumatic stress disorder patientsACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2009E. Eren-Koçak Objective:, Many studies reported deficits in cognitive functions in post-traumatic stress disorder (PTSD). Most were, however, conducted on man-made trauma survivors. The high comorbidity of alcohol use and depression with PTSD in these studies further complicated the interpretation of their results. We compared prefrontal lobe functions and memory in three earthquake survivor groups: current PTSD, past PTSD and no PTSD. We hypothesized that prefrontal performances of the current and past PTSD groups would be worse than that of control group. Method:, Survivors of the 1999 earthquakes in Turkey were evaluated for current and lifetime PTSD. Memory and prefrontal functions were assessed by a neuropsychological test battery. Results:, Current PTSD patients performed worse on attention, verbal memory, verbal fluency, and psychomotor speed. Past PTSD group was similar to the controls on most cognitive measures, except for their vulnerability to proactive interference and low performance in verbal fluency for animal names. Conclusion:, Our findings indicate that the prefrontal organization and monitorization of verbally processed information are defective in earthquake-related PTSD patients, more so in the current PTSD group. [source] Early detection of relapse in panic disorderACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2004M. R. Mavissakalian Objective:, To explore predictive models of relapsing based on change in symptoms at a time when panic disorder patients are still in remission following discontinuation of antidepressants. Method:, Forty-seven subjects, who were randomized to double-blind placebo and who had valid data at four time points: pretreatment, randomization to placebo substitution, an assessment on placebo prior to the last assessment or relapse and their last assessment (relapsers n = 15, non-relapsers n = 32) were studied using descriptive, growth curve analysis and logistic regression methodologies. Results:, Measures of generalized anxiety, fearfulness and disability at work and at home were better predictors of relapse than measures of panic and anxiety sensitivity. Logistic regression models using any one of these four general variables and its linear change correctly predicted relapse for 78.7,84.4% of the study subjects. Conclusion:, It is possible to gauge, with a fair degree of accuracy, the probability of relapsing in panic disorder patients who have discontinued serotonergic antidepressants 2 months prior to the return of panic. [source] Rapid-cycling bipolar disorder: effects of long-term treatmentsACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2003L. Tondo Objective: To compare responses to long-term treatment of rapid-cycling (RC) vs. non-RC bipolar disorder patients and assess relative effectiveness of specific agents in RC patients. Method: Studies identified by literature searching were analyzed for effects of RC status and treatment-type on clinical outcome (recurrence or non-improvement per exposure-time), using random-effects methods to estimate pooled rates and their 95% CI for quantitative meta-analytic modeling. Results: Data were obtained from 16 reports with 25 trial-arms involving 1856 (905 RC and 951 non-RC) patients treated with carbamazepine, lamotrigine, lithium, topiramate, or valproate, alone or with other agents over an average of 47.5 months (7347 total patient-years). Estimated RC prevalence was 15.4%. Crude rates (%/month) of recurrence (2.31/1.20) and clinical non-improvement (1.93/0.49) averaged 2.9-fold greater in RC vs. non-RC subjects. The pooled RC/non-RC risk ratio (RR) for inferior treatment-response (in 13 direct comparisons) was 1.40 (CI 1.26,1.56; P < 0.0001). Pooled crude recurrence and non-improvement rates suggested no clear advantage for any treatment, nor superiority for anticonvulsants over lithium. However, only lithium vs. carbamazepine could be directly compared (in four treatment-arms) meta-analytically in RC patients (RR = 0.93, CI 0.74,1.18, indicating no difference in effectiveness). Conclusion: As expected, RC was associated with lower effectiveness of all treatments evaluated. Direct comparisons of specific treatment alternatives for RC patients were rare, and provided no secure evidence of superiority of any treatment. Additional long-term studies comparing RC/non-RC patients randomized to specific treatments are required. [source] Let eating disorder patients decide: Providing choice may reduce early drop-out from inpatient treatmentEUROPEAN EATING DISORDERS REVIEW, Issue 3 2009Walter Vandereycken Abstract Premature drop-out from treatment is a highly prevalent phenomenon among eating disorder (ED) patients. In a specialized inpatient treatment unit a major change was made in the admission strategy in 2001, giving a maximum of personal choice to the patients. A quasi-experimental research was carried out comparing 87 patients treated till 2000 (,old' strategy) with 87 patients treated from 2001 on (,new' strategy). The results indicate that the provision of choice at the beginning of treatment significantly reduced drop-out during the first weeks of inpatient treatment. No differences between both strategies on later drop-out and weight change (in anorexia nervosa patients) during inpatient treatment were found. The results are discussed in the light of the importance placed on dynamics of personal choice, autonomy and volition within the framework of the self-determination theory (SDT). Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Group motivational enhancement therapy as an adjunct to inpatient treatment for eating disorders: a preliminary study,EUROPEAN EATING DISORDERS REVIEW, Issue 4 2008Helen Y. Dean Abstract Difficulties in fostering eating disorder (ED) patients' motivations to overcome their illness are widely considered to be a major hurdle in the course of successful treatment. However, no previous study has assessed the use of interventions specifically designed to target poor motivation amongst patients with illnesses that are severe enough to warrant hospitalisation. Objective A brief Motivational Enhancement Therapy (MET) group programme for inpatient ED sufferers was developed and evaluated. Method Forty two consecutive inpatients were sequentially allocated to treatment groups. Twenty three inpatients completed a four session MET group programme in addition to routine hospital care. A control group of 19 participants completed treatment as usual (TAU). Results Despite an absence of significant differences between the MET and the TAU groups on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer term motivation and engagement, and to promote treatment continuation. Conclusion The results tentatively suggest that MET could be valuable for the treatment of inpatient eating disorder patients and further research is warranted. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Personality traits and self-injurious behaviour in patients with eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 4 2008Jennie Ahrén-Moonga Abstract The interest in different aspects of personality and the neuropsychological basis for behaviour in eating disorder patients has increased over the last decade. The present study aims at exploring personality traits, self-injurious behaviour (SIB) and suicide attempts in a group of severely ill eating disorder patients. Patients with eating disorders (N,=,38) and age-matched controls (N,=,67) were examined concerning self-reported personality traits by means of the Karolinska scales of personality (KSP). Psychosocial history and SIB was collected from medical records. Depression was rated by means of the Beck Depression Inventory (BDI). Results indicated significantly higher anxiety-related and detachment traits in both anorexia nervosa (AN) and bulimia nervosa (BN) patients and higher hostility in BN patients than controls. No specific personality traits could be defined as typical for self-injurious or suicidal behaviour. The AN group was lower than the BN group on scales measuring impulsivity, guilt and anxiety. Furthermore, presence of SIB and suicide attempts was more frequent among the BN patients. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Adults with chronic eating disorders.EUROPEAN EATING DISORDERS REVIEW, Issue 4 2005Two-year follow-up after inpatient treatment Abstract Objective The aims of this prospective study were (1) to report on the 2-year outcome of chronically ill adult eating disorder patients, (2) to investigate whether a specialized inpatient treatment might influence the course of the illness, and (3) to search for prognostic factors. Method Seventy-two patients were treated in a 4,5-month specialized group treatment programme for chronically ill adults with eating disorders. Sixty-five (90%) with mean age of 30 years were available for the follow-up assessment. Results Forty-six (71%) patients had improved at the 2-year follow-up and 17 (26%) did not meet diagnostic criteria for an eating disorder. The symptom reductions per time were statistically significantly larger during the inpatient period compared to the waiting-list and follow-up periods. No significant predictors of treatment outcome were found. Patients with avoidant personality disorder had a higher level of distress at all times, but improved at the same rate as the others. Conclusion At the 2-year follow-up, there were substantial reductions in eating disorder symptoms and general psychiatric symptoms. Most of the improvement occurred during inpatient treatment, which might be an option for chronic eating disorders. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] The impact of physical and sexual abuse on body image in eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 2 2005Tamás Treuer Abstract Objective The role of childhood sexual abuse as a risk factor for the development of eating disorders has gained considerable attention in the literature in the last few years, especially its role in bulimia nervosa. Although physical abuse was also frequently explored in the history of patients with eating disorders, its role was unclear in the aetiopathogenesis of these disorders. The goal of our study was to test the hypothesis, based on our clinical experience, that physical abuse is more frequent in eating disorders than thought previously and that the patient's distortion in body image is more severe in these cases. Method A standardized interview method was used to elicit details of physical and sexual abuse in a group of 63 patients with eating disorders. The frequency of laxative use and the severity of body image distortion was also examined with the Body Attitude Test. These clinical data were analysed on the whole sample and also on the subgroups of eating disorders. Results We found significantly more severe body image distortions in those patients who had been physically abused (p,<,0.05) and there were significantly more severe body image distortions in those patients who had a history of laxative abuse (p,<,0.001). Sexual abuse occured in 29%, physical abuse in 57% and laxative abuse in 46% within the whole sample of examined eating disorder patients. Physical abuse and laxative abuse were the most frequent in the binge eating/purging type of anorexia nervosa (92% and 69%). Also, these patients had the worse rates on sexual abuse and body image distortion items. According to our results, the presence of sexual abuse was not associated with more severe body image distortion in eating disorder patients. Conclusions Childhood physical abuse seems to be a more important factor in the development of body image distortion than had been thought before; its importance in this aspect may be greater than sexual abuse. Physical abuse, laxative abuse and the binge,purge subtype in anorexia nervosa are a considerable risk factor for the severity of the distortion in body image and their presence makes the prognosis of the eating disorder worse. Further studies of the nature of these relationships are warranted. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Further genetic evidence implicates the vasopressin system in childhood-onset mood disordersEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 8 2009Emma L. Dempster Abstract Studies in both animals and humans advocate a role for the vasopressin (AVP) system in the aetiology of depressive symptoms. Attention has particularly focused on the role of AVP in the overactivation of the hypothalamic-pituitary-adrenal (HPA)-axis in mood disorders. Elevated AVP plasma levels have been found in mood disorder patients, which are often positively correlated with the severity of symptoms. We recently reported an association between childhood-onset mood disorders (COMD) and polymorphisms in the receptor responsible for the AVP-mediated activation of the HPA-axis (AVPR1B). As genetic variation in the vasopressinergic system could provide a mechanism to explain the endocrine alterations observed in mood disorders, we investigated other genes in this system. The gene encoding AVP is the strongest candidate, particularly as genetic variation in this gene in rodents is associated with anxiety-related behaviours. Six single-nucleotide polymorphisms (SNPs) were genotyped across the AVP gene in a sample comprised of 586 Hungarian nuclear families ascertained through affected probands with a diagnosis of COMD. In addition, AVP coding and putative regulatory regions were screened for mutations using denaturing high-performance liquid chromatography. One SNP, 3, to the AVP, gene reached significance (P = 0.03), as did the overtransmission of a five-marker haplotype with a frequency of 22% (P = 0.0001). The subsequent mutation screen failed to identify any putative functional polymorphisms. The outcome of this study, combined with our previous association between COMD and AVPR1B, implicates genetic variation in vasopressinergic genes in mediating vulnerability to COMD. [source] Hepatitis A and B immunization for individuals with inherited bleeding disordersHAEMOPHILIA, Issue 2 2009M. STEELE Summary., Hepatitis A and B vaccines are highly effective tools that can greatly reduce infection risk in the bleeding disorder population. Although hepatitis A and B immunization for individuals with bleeding disorders is universally recommended, various advisory bodies often differ with respect to many practical aspects of vaccination. To review the published literature and guidelines and form a practical, comprehensive and consistent approach to hepatitis A and B immunization for individuals with bleeding disorders. We reviewed published immunization guidelines from North American immunization advisory bodies and published statements from North American and international haemophilia advisory bodies. A search of the MEDLINE database was performed to find original published literature pertaining to hepatitis A or B immunization of patients with haemophilia or bleeding disorder patients that provided supporting or refuting evidence for advisory body guidelines. Various advisory bodies' immunization guidelines regarding individuals with bleeding disorders have contradictory statements and often did not clarify issues (e.g. post vaccination surveillance). Published literature addressing immunization in bleeding disorder patients is sparse and mostly examines route of vaccine administration, complications and corresponding antibody response. Although the risk of hepatitis A and B infection is low, the use of simple measures such as vaccination is reasonable and advocated by haemophilia advisory bodies. Following our review of the available literature and North American guidelines, we have developed comprehensive and practical recommendations addressing hepatitis A and B immunization for the bleeding disorder population that may be applicable in Bleeding Disorder clinics. [source] Factors associated with treatment nonadherence among US bipolar disorder patients,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2008Ross J. Baldessarini Abstract Objective Since sustained treatment-adherence is often problematic and may limit clinical outcomes among bipolar disorder (BPD) patients, we sought risk factors to guide clinical prediction of nonadherence. Methods Data were from a 2005 US national sample providing questionnaire responses by 131 randomly selected prescribing psychiatrists and their adult BPD patients. We contrasted demographic and clinical factors in treatment-adherent versus nonadherent patients (strictly defined as missing ,1 dose within 10 days) in univariate analyses followed by multivariate logistic-regression modeling. Results Of 429 DSM-IV BPD patients (79% type-I; 62% women; 17% minorities), 34% reported missing,,,1 dose of psychotropic medication within 10 days, 20% missed entire daily doses at least once, and only 2.5% missed all doses for 10 days. However, their prescribing psychiatrists considered only 6% as treatment-nonadherent. Factors significantly associated with nonadherence in multivariate modeling ranked: alcohol-dependence,>,youth,>,greater affective morbidity,>,various side effects,,,comorbid obsessive-compulsive disorder,,,recovering from mania-hypomania. Unrelated were sex, diagnostic subtype, and other comorbidities. Since most patients received,,,2 psychotropics, potential relationships between treatment-complexity and adherence were obscured. Conclusions Prevalent treatment-nonadherence among American BPD patients, and striking underestimation of the problem by prescribing clinicians may encourage increasingly complex treatment-regimens of untested value, but added expense, risk of adverse effects, and uncertain impact on treatment-adherence itself. Copyright © 2007 John Wiley & Sons, Ltd. [source] The efficacy of reboxetine in the treatment-refractory patients with panic disorder: an open label studyHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 7 2002P. N. Dannon Abstract Background and Objective Selective serotonin reuptake inhibitors (SSRIs) are currently the first-line treatment for panic disorder, although up to 30% of patients either do not respond to SSRIs or withdraw due to adverse events. Reboxetine, a selective norepinephrine reuptake inhibitor (selective NRI), is effective in treating depression and may alleviate depression-related anxiety. This study aimed to investigate the efficacy of reboxetine in the treatment of patients with panic disorder who did not respond to SSRIs. Method In this 6-week, open-label study, 29 adult outpatients with panic disorder who had previously failed to respond to SSRI treatment received reboxetine 2,mg/day, titrated to a maximum of 8,mg/day over the first 10 days. Efficacy was assessed using the Panic Self-Questionnaire (PSQ), the Hamilton Rating Scale for Anxiety (HAM-A), the 17-item Hamilton Rating Scale for Depression (HRSD) and the Global Assessment of Functioning (GAF) Scale. Results The 24 patients who completed the study responded well to reboxetine treatment. Significant improvement (p,<,0.001) was observed in the number of daily panic attacks, and on the scales measuring anxiety, depression and functioning. Reboxetine was generally well tolerated. Five patients withdrew due to adverse events. Conclusions Reboxetine appears to be effective in the treatment of SSRI-refractory panic disorder patients and warrants further clinical investigation. Copyright © 2002 John Wiley & Sons, Ltd. [source] The changing profile of eating disorders at a tertiary psychiatric clinic in Hong Kong (1987,2007)INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2010Sing Lee MBBS Abstract Objective: To examine the clinical profile of Chinese eating disorder patients at a tertiary psychiatric clinic in Hong Kong from 1987 to 2007. Method: Data on 195 consecutive patients were retrieved from a standardized intake interview by an eating disorder specialist. Patients seen between 1987,1997 (n = 67) and 1998,2007 (n = 128) and fat-phobic (n = 76) and nonfat-phobic (n = 39) anorexic patients were compared. Results: Patients were predominantly single (91.8%), female (99.0%), in their early-20s and suffered from anorexia (n = 115; 59.0%) or bulimia (n = 78; 40.0%) nervosa. The number of patients increased twofold across the two periods. Bulimia nervosa became more common while anorexia nervosa exhibited an increasingly fat-phobic pattern. Nonfat-phobic anorexic patients exhibited significantly lower premorbid body weight, less body dissatisfaction, less weight control behavior, and lower EAT-26 scores than fat-phobic anorexic patients. Discussion: The clinical profile of eating disorders in Hong Kong has increasingly conformed to that of Western countries. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [source] The role of vascular risk factors in late onset bipolar disorder,INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2007Hari Subramaniam Abstract Background The association between late life depression and cerebro-vascular risk and cerebro-vascular disease is well established. Do similar links exist with late onset bipolar disorder? Aims and Objectives Patients with early onset (less than 60 years of age) bipolar disorder were compared with those of late onset (aged 60 and above) in relation to cognitive function, physical health and vascular risk factors. Method Cross-sectional survey of elderly bipolar disorder patients (above 65 years) involved with secondary care mental health services. Thirty patients with early onset were compared with 20 patients with a late onset bipolar disorder. Diagnosis of bipolar disorder was according to ICD-10 criteria and without an associated clinical diagnosis of dementia. Assessment of cognition included tests of frontal-executive function, and cerebro-vascular risk was quantified with the Framingham stroke risk score. Results The late onset group had a higher stroke risk score than the early onset group, this difference persisting despite taking age and gender differences into account. However, late onset patients' cognitive function (including frontal lobe tests) and physical health status was no different to the early onset group. Conclusion There is higher ,cerebrovascular risk' in elderly patients with late onset bipolar disorder, compared to patients with an early onset. This suggests that cerebrovascular risk may be an important factor for the expression of bipolar disorders in later life, and has significant management implications for older bipolar patients. Copyright © 2006 John Wiley & Sons, Ltd. [source] Behaviour guidance in dental treatment of patients with autism spectrum disorderINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 6 2009CHEEN Y. LOO Background., Autism spectrum disorder (ASD) is a neurodevelopmental disorder categorized into autism, pervasive developmental disorder , not otherwise specified (PDD-NOS) and Asperger syndrome. Aims., To identify factors associated with the behaviour of patients with ASD in a dental setting, use of general anaesthesia (GA), and protective stabilization. Design., The dental charts of 395 patients with ASD patients and 386 unaffected patients were reviewed. The following data were analysed: ASD diagnosis, age, gender, residence, seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behaviour or pica), medications, caries prevalence and severity, dental treatment history, behaviour, and behaviour guidance technique(s) used. Results., Within both groups, younger patients were more uncooperative. ASD patients with autism were more uncooperative than patients with PDD-NOS; patients with an additional diagnosis were also more uncooperative. ASD patients with higher caries severity, who were uncooperative or female, were more likely to require GA. Use of protective stabilization was associated with lower caries severity, presence of seizure disorder, uncooperative behaviour, male gender, or residency in a group home/institution. Conclusions., Autism spectrum disorder patients with autism, younger age and an additional diagnosis were more uncooperative. Factors associated with the use of GA and protective stabilization in patients with ASD were also identified. [source] Evaluation of minimum interdental threshold ability in dentate female temporomandibular disorder patientsJOURNAL OF ORAL REHABILITATION, Issue 5 2010E. M. KOGAWA Summary, Minimum interdental threshold is the smallest thickness that can be detected between teeth during an occlusion and has an influence on the occlusal force and on the control of mandibular movements. The aim of this study was to assess the possible association of the signs and symptoms of temporomandibular disorders (TMD) with the ability to detect a minimum interdental threshold. Two hundred women were equally divided into four groups: asymptomatic (control), subjects with masticatory muscle pain, with articular [temporomandibular joint (TMJ)] pain and mixed (muscular and articular pain). Evaluation of the ability to detect a minimum interdental threshold was performed using aluminium foils with 0·010, 0·024, 0·030, 0·050, 0·080 and 0·094 mm of thickness in the premolar region. A total of 20 tests with each thickness for each patient were performed, starting with the thickest foil (0·094 mm) and ending with the thinnest one. The myogenic pain and articular groups presented significantly higher threshold values (0·020 and 0·022 mm, respectively), when compared to the control. Both groups reached the level of certain perceptiveness only at 0·030 mm. No significant correlation was found between minimum interdental threshold and age. These results suggest that discrimination of thicknesses can be disturbed as a consequence of TMD manifestations and not the cause of it. Clinicians should, therefore, be aware that changes on muscles and TMJ can secondarily lead to occlusion changes. The mechanisms involved in this process, however, are not well understood and warrant further investigation. [source] Characteristics of a jaw reflex in humans with temporomandibular disorders: a preliminary reportJOURNAL OF ORAL REHABILITATION, Issue 5 2007P. MAILLOU summary, Electromyography was used to compare characteristics of an inhibitory jaw reflex in 10 temporomandibular disorder patients and 10 age- and sex-matched healthy controls. The methodology was novel in that the reflex was that evoked in the active masseter muscle, by electrical stimulation of perioral skin. This response has advantages over those previously studied as it avoids problems associated with stimulating in the moist intra-oral environment and it is monophasic, thus permitting easy quantification. The results have shown that (i) with the stimulation parameters employed, the reflex was present in all 10 control subjects, but in only eight of 10 temporomandibular disorder patients. (ii) When stimulation intensities were expressed as multiples of sensory threshold, there was no significant difference in the minimum level of stimulation required to evoke the reflex between the groups, although there was a trend for the patients with temporomandibular disorders to require higher intensities. (iii) Comparison of data from subjects giving responses at the same stimulus intensity (6 × sensory threshold: seven temporomandibular disorder patients, eight controls), showed no significant differences in the latencies or magnitudes of the reflex between the groups. However, the overall duration of the reflex was significantly shorter for the patients with temporomandibular disorders, with the reflex finishing significantly earlier. Thus even within the limitations of this study, it appears that an inhibitory jaw reflex evoked from stimulation around the mouth, may be weaker in temporomandibular disorder patients. This conclusion is consistent with previous studies on more complex jaw reflexes evoked by intra-oral stimuli. [source] Immediate effect of a stabilization splint on masticatory muscle activity in temporomandibular disorder patientsJOURNAL OF ORAL REHABILITATION, Issue 9 2002V. F. FERRARIO Summary Surface electromyography (EMG) allows the quantification of the occlusal equilibrium in dysfunctional patients, for instance in those with temporomandibular disorders (TMD). Fourteen patients (ten women, four men) with internal derangement type I were selected among the TMD patients referred to a private practice in Milan. A stabilization splint with posterior contacts was made for each patient. To verify the static neuromuscular equilibrium of occlusion, EMG activity of left and right temporal and masseter muscles was recorded in all patients and the activity (ratio between the activities of the temporal and masseter muscles) index was computed over a maximum voluntary clench test of 3 s. Muscular waveforms were also analysed by computing a percentage overlapping coefficient (POC, an index of the symmetric distribution of the muscular activity determined by the occlusion). The total electrical activity was measured by calculating the area under the entire muscular waveforms. In all patients EMG was performed just before and immediately after the insertion of the splint and data were compared by paired Student's t -tests. Overall, the splint reduced the electrical activity of the analysed muscles (P < 0·005) and made it more equilibrated both between the left and right side (larger symmetry in the masseter muscle POC, P < 0·05) and between the temporal and masseter muscles (activity index, P < 0·01). [source] A Randomized, Double-Blind, Placebo-Controlled Pilot Study of Naltrexone in Outpatients With Bipolar Disorder and Alcohol DependenceALCOHOLISM, Issue 11 2009E. Sherwood Brown Background:, Alcohol dependence is extremely common in patients with bipolar disorder and is associated with unfavorable outcomes including treatment nonadherence, violence, increased hospitalization, and decreased quality of life. While naltrexone is a standard treatment for alcohol dependence, no controlled trials have examined its use in patients with co-morbid bipolar disorder and alcohol dependence. In this pilot study, the efficacy of naltrexone in reducing alcohol use and on mood symptoms was assessed in bipolar disorder and alcohol dependence. Methods:, Fifty adult outpatients with bipolar I or II disorders and current alcohol dependence with active alcohol use were randomized to 12 weeks of naltrexone (50 mg/d) add-on therapy or placebo. Both groups received manual-driven cognitive behavioral therapy designed for patients with bipolar disorder and substance-use disorders. Drinking days and heavy drinking days, alcohol craving, liver enzymes, and manic and depressed mood symptoms were assessed. Results:, The 2 groups were similar in baseline and demographic characteristics. Naltrexone showed trends (p < 0.10) toward a greater decrease in drinking days (binary outcome), alcohol craving, and some liver enzyme levels than placebo. Side effects were similar in the 2 groups. Response to naltrexone was significantly related to medication adherence. Conclusions:, Results suggest the potential value and acceptable tolerability of naltrexone for alcohol dependence in bipolar disorder patients. A larger trial is needed to establish efficacy. [source] Social comparison as a coping strategy among caregivers of eating disorder patientsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 9 2010I. JÁUREGUI LOBERA md phd Accessible summary ,,The paper describes social comparisons among caregivers of eating disorder patients as a coping strategy. ,,Different social comparison strategies were assessed in a sample of 96 caregivers as well as their self-esteem, characteristics of personality and perceived quality of life. ,,The use of unfavourable strategies was correlated to neuroticism and low self-esteem. ,,Women adopted worse strategies and the fact that having obtained different subgroups regarding the use of those strategies could have prognostic repercussions. Abstract The aim of the study was to determine any gender differences in the social comparisons made by caregivers of eating disorder patients and to analyse the relationship between social comparison and personality, age of caregivers, self-esteem, duration of illness, duration of treatment and perceived health and quality of life. We also explored the possibility of classifying caregivers according to these variables. Comparison strategies were analysed in a sample of 96 caregivers of eating disorder patients. The social comparison during illness scale, visual analogue scales of health and quality of life, self-esteem scale of Rosenberg and Eysenck Personality Questionnaire were used. In order to explore possible groupings a cluster analysis was performed. A significant correlation between the use of more unfavourable strategies, neuroticism and low self-esteem was found. Women adopted worse strategies and the cluster analysis revealed two sub-groups with respect to comparisons, personality, self-esteem, self-perceived health status and quality of life. The finding of subgroups associated with worse comparison strategies, higher neuroticism, lower self-esteem and a poorer self-perception of health and quality of life could have repercussions as regards the prognosis of eating disorders and, at all events, should be taken into account during therapeutic work with families. [source] Screen for expanded FMR1 alleles in patients with essential tremorMOVEMENT DISORDERS, Issue 8 2004Dolores Garcia Arocena MS Abstract Fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disorder, was described recently among male carriers of expanded alleles (55,200 CGG repeats; premutation range) of the fragile X mental retardation 1 (FMR1) gene. Major features of the syndrome include intention tremor, gait ataxia, and parkinsonism in men over 50 years of age. This disorder is believed to be relatively common, possibly affecting 1 in 3,000 men over the age of 50 years in the general population. This raises the possibility that some patients presenting with essential tremor (ET) may harbor expanded FMR1 alleles. We screened 81 ET patients (40 males, 41 females) for expanded FMR1 alleles to determine whether ET is associated with such alleles. None of the ET cases had the premutation genotype. CGG repeat sizes ranged from 5 to 47 repeats within this study population, suggesting that expanded FMR1 alleles are uncommon among patients with ET. Screening of movement disorder patients with other clinical features of FXTAS (e.g., ataxia and parkinsonism) may be more likely to yield expanded FMR1 alleles. © 2004 Movement Disorder Society [source] A novel approach to treating eating disorders in a day-hospital treatment programNUTRITION & DIETETICS, Issue 3 2010Mellisa ASHLEY Abstract Aim:, The aim of the present study was to evaluate the short-term effectiveness of an adult day-hospital program that uses a novel approach to delivering nutritional interventions. Methods:, Fifty-six adult eating disorder patients of the Sydney West Area Eating Disorders Day Treatment Program participated in the study. Participants completed standardised self-reported questionnaires designed to measure eating disorder symptoms, at the commencement of treatment and after 12 weeks. Results:, Participation in day-hospital treatment was associated with increases in weight, reductions in number of binge-eating and purging episodes, and frequency of exercise sessions. Participants also experienced improvements in their eating attitudes, drive for thinness, bulimia, depression and anxiety symptoms. Conclusion:, These findings add to the growing body of literature supporting the use of day-hospital programs in the treatment of eating disorders. A number of strategies are suggested for the effective delivery of nutritional interventions in day-hospital programs, such as methods that assist with integrating new information, having an experiential focus and the use of collaborative education processes. [source] Association study between cannabinoid receptor gene (CNR1) and pathogenesis and psychotic symptoms of mood disorders,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 3 2001Shih-Jen Tsai MD Abstract Cannabis can induce mood change and sometimes psychotic symptoms in normal persons. In brain, the main active ingredient of cannabis acts via the cannabinoid CB1 receptor (CNR1) which is located on chromosome 6q14-15. Linkage studies have suggested the presence of a bipolar disorder susceptibility locus on chromosome 6q. In this population based association study, we tested the hypothesis that a microsatellite polymorphism in the promoter region of the CNR1 gene confers susceptibility to mood disorders and psychotic features. We genotyped the CNR1 gene is 154 mood disorder patients and 165 normal controls. The results showed that the triplet repeat polymorphism in the promoter region of the CNR1 gene was not likely to be involved in the pathogenesis or in the psychotic symptoms of mood disorders. © 2001 Wiley-Liss, Inc. [source] Specific panic attack symptoms in panic disorder patients with putative genetic factorPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2009Yukika Nishimura phd No abstract is available for this article. [source] Lifetime substance abuse, family history of alcohol abuse/dependence and novelty seeking in eating disorders: Comparison study of eating disorder subgroupsPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 1 2009Isabel Krug phd Aim:, To assess lifetime substance abuse, family history of alcohol abuse/dependence, and novelty seeking in three different eating disorder groups (anorexia nervosa,restrictive; anorexia nervosa,binge eating/purging; anorexia nervosa to bulimia nervosa). Method:, A total sample of 371 eating disorder patients participated in the current study. Assessment measures included the prevalence of substance abuse and family history of alcohol abuse/dependence as well as the novelty-seeking subscale of the Temperament and Character Inventory,Revised. Results:, Significant differences across groups were detected for lifetime substance abuse, with anorexia nervosa,restrictive individuals exhibiting a significant lower prevalence than the anorexia nervosa to bulimia nervosa and anorexia nervosa,binge eating/ purging patients (P < 0.01). For family history of alcohol abuse/dependence the same pattern was observed (P = 0.04). Novelty seeking was associated with substance abuse (P = 0.002), with the anorexia nervosa to bulimia nervosa group exhibiting significantly higher scores on the novelty-seeking scale than the other two groups (P < 0.001). But family history of alcohol abuse/dependence was not related to novelty seeking (P = 0.092). Conclusion:, Lifetime substance abuse appears to be more prevalent in anorexia nervosa patients with bulimic features. Higher novelty-seeking scores may be associated with diagnosis cross-over. [source] | ||||||||||||||||