Clinical characteristics and psychiatric comorbidity in males with exhibitionism

BACKGROUND: This study was constructed to detail the demographic and phenomenological features of males with exhibitionism. METHOD: Male subjects with DSM-IV exhibitionism were administered a semistructured interview to elicit demographic data and information on the phenomenology, age at onset, and associated features of the disorder. Subjects also underwent structured clinical interviews to assess both Axis I and Axis II comorbidities. Data were collected from September 2003 to March 2005. RESULTS: Twenty-five males with exhibitionism (mean +/- SD age = 35.0 +/-13.1 years [range, 14-68 years]) were studied. The majority of subjects were single (60% [N = 15]) and heterosexual (80% [N = 20]). The mean +/- SD age at onset for exhibitionism was 23.4 +/-13.1 years. All subjects reported urges to expose themselves with little control over these urges. Exposing oneself while driving was the most common expression of the disorder. Twenty-three (92%) suffered from a current comorbid Axis I disorder (major depressive disorder, compulsive sexual behavior, and substance use disorders were most common), and 40% (N = 10) suffered from a personality disorder. Suicidal thoughts were common (52% [N = 13]), and many (36% [N = 9]) had been arrested for exhibitionism. CONCLUSION: Exhibitionism appears to be associated with high rates of psychiatric comorbidity and impairment. Research is needed to optimize patient care for men with this disorder.     

Symptom structure and psychiatric comorbidity of combat-related post-traumatic stress disorder

The placement of the diagnostic category of post-traumatic stress disorder (PTSD) among anxiety disorders reflects the recognition that anxiety is a predominant reaction to trauma. Indeed, the symptoms of PTSD overlap considerably with those of other anxiety disorders. The nosological criteria render PTSD as quite a heterogeneous diagnosis. Two individuals with no common symptoms can be diagnosed as having PTSD. In this report we provide information on the phenomenology and psychiatric comorbidity in a sample of 33 patients with combat-related PTSD. The finding of clinical heterogeneity in subjects with combat-related PTSD and the therapy implications are discussed.     

Presence of muscle dysmorphia symptomology among male weightlifters

Limited research exists on muscle dysmorphia (MD) in men and in nonclinical populations. The current study evaluated types of body image disturbance among 237 male weightlifters. Latent class analysis of 8 measures of body image disturbance revealed 5 independent types of respondents: Dysmorphic, Muscle Concerned, Fat Concerned, Normal Behavioral, and Normal. One-way analysis of variance of independent measures of body image disturbance and associated psychopathology confirmed significant differences between groups. The Dysmorphic group reported a pattern of body image disturbance consistent with MD by displaying a high overall level of body image disturbance, symptoms of associated psychopathology, steroid use, and appearance-controlling behavior. Findings generally supported classifying MD as a subtype of body dysmorphic disorder and an obsessive-compulsive spectrum disorder. Implications for studying body image disturbance in male weightlifters, and further evaluation of the MD diagnostic criteria are discussed.     

Ageing and comorbidity among low-income psychiatric outpatients

The objective of this study was to determine if non-psychiatric morbidity increases with age in a group of low-income psychiatric outpatients. Data on demographics, presenting complaints, DSM-III diagnoses and use of psychiatric services were collected on all individuals (N = 382) admitted to a psychiatric outpatient clinic serving low-income population. Non-psychiatric morbidity was identified on the basis of medical history, physical examination, and laboratory investigations. Bivariate analyses were done to determine the significance of the associations of comorbidity with other variables. A logistic regression was done using the presence or absence of comorbidity as the dependent variable. Age was the only variable which was significantly predictive of comorbidity. Additional resources should be allocated for the diagnosis and treatment of comorbidity among low-income elderly.     

Clinical characteristics and psychiatric comorbidity in children with trichotillomania.

Ten children with trichotillomania (hair pulling) were systematically evaluated with structured psychiatric interviews and rating scales assessing anxiety, depression, life events, self-esteem, and family functioning. Six of the subjects met diagnostic criteria for overanxious disorder on the Diagnostic Interview for Children and Adolescents--Revised--Child or Adolescent Version and/or Diagnostic Interview for Children and Adolescents--Revised--Parent Version. Two met the criteria for dysthymia, including one of the subjects with overanxious disorder. No children reported associated obsessions or compulsions. Only one subject experienced tension before hair pulling and relief associated with hair pulling. The DSM-III-R criteria for trichotillomania, which currently require an increasing sense of tension before hair pulling and gratification with hair pulling, may be overly restrictive and in need of redefinition. Additional research with increased sample size is necessary to define diagnostic criteria for trichotillomania and clarify its relationship with other psychiatric diagnoses.     

Substance use disorder comorbidity among inpatient youths with psychiatric disorder

OBJECTIVE: Substance abuse/dependence has been reported to show significant association with psychopathology, and is likely to influence the course and outcome of psychiatric illness. The aim of this study was to determine the rate of substance use disorders (other than alcohol) comorbidity among inpatient adolescents with severe Axis 1 psychiatric disorder. METHOD: A retrospective analysis of systematically collected data was carried out. The subjects were 16-18-year-old youths, admitted to an inpatient unit for severe psychiatric disorder. The data collection process utilized the DSM-IV criteria for diagnostic categorization of psychiatric disorder and substance use disorder. Demographic data, and data on suicide attempts were also collected. RESULTS: Over a period of one year (March 2001-March 2002), 62 patients were admitted to the Christchurch Youth Inpatient Unit; 40 (64.5%) had a comorbid Substance Abuse Disorder (SAD) according to DSM-IV criteria and none had a Substance Dependence Disorder. The vast majority involved cannabis and stimulants. Sixty per cent of those with mood disorder, 63% of those with anxiety disorder and 80% of those with schizophrenia spectrum disorder had a comorbid SAD. Internalizing problems, especially mood disorders, pre-dominated among those with SAD reflecting the Unit's admission criteria. There were no differences in attempted suicide rates between those with SAD and those without SAD, but those with SAD were more likely to have unstable accommodation/living arrangements than those without SAD. CONCLUSIONS: Our findings confirm previous reports suggestive of high rates of SAD comorbidity among youth with severe psychiatric illness. There are clinical and process implications for these findings particularly identification of substance use disorders and their treatment as well as resource availability and staff training.     

Psychosocial functioning and psychiatric comorbidity among substance-abusing Icelandic adolescents

Abstract

Background: Physical inactivity is an independent risk factor for cardiovascular diseases and Type 2 diabetes, both being highly prevalent in patients with severe mental illness. Though physical activity has become an important issue in psychiatric treatment and rehabilitation in the past decade, systematic evaluations of physical activity level in psychiatric populations could be more disseminated. Aim: The primary aim of the study was to investigate the physical activity level of psychiatric patients in comparison with healthy controls. Methods: Patients with severe mental illness (n =47) and a group of healthy controls (n =28) matched on sex and age reported their physical activity level using the Physical Activity Scale (PAS). PAS was administered as an interview in relation to patients and as a questionnaire in relation to healthy controls. Results: Patients had statistically significant lower levels of physical activity compared with healthy controls (P <0.0001) and the level of physical activity among patients was hazardously low. Conclusion: The study confirmed previous studies and clinical experience that patients with severe mental illness are physically inactive and emphasize the importance of physical activity in psychiatric treatment and rehabilitation. The PAS is an applicable and relevant method for evaluating physical activity levels in psychiatric patients.     

Psychiatric comorbidity more common among adolescent females with CD/ODD than among males

Clinicians and researchers have been increasingly concerned on conduct problems among adolescent females. Yet, most research on the issue has been conducted among males. The aim of this study was to characterize conduct disorder (CD) among adolescent females in comparison with males. Family background, symptoms and severity of CD, and psychiatric comorbidity were assessed among Finnish 12–18-year-old females (n=40) with conduct disorder/oppositional defiant disorder (CD/ODD) compared with males (n=37). Data were collected via structured interviews with the subjects and interviews with parents. Lifetime and current Axis I diagnoses (DSM-IV) were assessed using the Structured Clinical Interview (SCID-I) interview. No gender differences were found in the number of CD symptoms or aggressive symptoms. Family adversities, comorbid major depression, anxiety disorders and substance use disorders as well as suicidality were more common, while reading disorder was less common among girls compared with boys. The varied problems and comorbid disorders among females with CD/ODD are important to recognize.     

Posttraumatic stress disorder and psychiatric comorbidity among detained youths

OBJECTIVE: This study examined the prevalence of posttraumatic stress disorder (PTSD) and comorbid psychiatric disorders among juvenile detainees. METHODS: The sample consisted of a stratified random sample of 898 youths aged ten to 18 years who were arrested and detained in Chicago. RESULTS: Among participants with PTSD, 93% had at least one comorbid psychiatric disorder; however, among those without PTSD, 64% had at least one comorbid psychiatric disorder. Over half (54%) of the participants with PTSD had two or more types of comorbid disorders--that is, affective, anxiety, behavioral, or substance use disorders--and 11% had all four types of comorbid disorders. Among males, having any psychiatric diagnosis significantly increased the odds of having comorbid PTSD. Among females, alcohol use disorder and both alcohol and drug use disorders significantly increased the odds of having PTSD. No significant difference in prevalence rates of PTSD was found between males and females with specific psychiatric disorders. The prevalence of any comorbid psychiatric disorder was significantly greater for males with PTSD than that for females with PTSD (OR=3.4, CI=1.1-10.6, p<.05). CONCLUSIONS: Detection of comorbid PTSD among detained youths must be improved. PTSD is often missed because traumatic experiences are rarely included in standard screens or volunteered by patients. When planning treatment, clinicians must consider ramifications of comorbid PTSD.     

Psychosocial functioning and psychiatric comorbidity among substance-abusing Icelandic adolescents

Our objectives were to compare behaviour problem scores (BPS) for Icelandic adolescents admitted for detoxification treatment for alcohol and narcotic abuse as compared with the general population, in accordance with the Youth Self Report (YSR), and to describe psychosocial functioning and psychiatric comorbidity for the treated adolescents. The case series consisted of 103 adolescents, ages 12-18 years, who completed the YSR at the end of a 10-day stay at the National Hospital of Addiction Medicine. The total BPS tallied from the YSR items was compared with scores for the general population. The psychiatric comorbidity and psychosocial functioning of the case series were assessed through diagnostic interviews in accordance with DSM-IV and ICD-10 criteria. The BPS for the 36 treated girls was significantly higher than for the general population (104 versus 36) and higher than for the 56 treated boys (82 versus 56) with 2 standard deviations above the norm for the population. Three-quarters of the adolescents had psychiatric comorbidity: conduct disorder (44%), depression (28%), or posttraumatic stress disorder (11%). The findings support the discriminative validity of the YSR as part of a structured global assessment of substance-abusing adolescents, in particular to identify the frequently present psychiatric comorbidities.     

Police-registered offenses and psychiatric disorders among young males

OBJECTIVE: To study associations between crime and psychiatric disorders among adolescent males in a representative population-based cohort study. METHOD: The sample includes 2,712 Finnish boys born in 1981. Information on criminality consists of offenses registered in the Finnish National Police Register 1998-2001. Crime was classified according to frequency and type (drug, violent, property, traffic, and drunk driving offenses). Information on psychiatric diagnoses between 1999 and 2004 was collected from the Finnish National Military Register. RESULTS: Of the 2,712 boys, 22% had a crime registration during the 4-year period, and 10% had at least one psychiatric disorder according to the Military Register. Those with psychiatric disorders accounted for 49% of all crimes. Of those with more than five crimes (n = 98), 59% had psychiatric diagnoses. After adjusting for other crime types and childhood socio-economic status, property crime was independently associated with several diagnoses: antisocial personality (APD), substance use (SUD), psychotic, anxiety, and adjustment disorders. Drug offending was independently associated with APD, SUD, and psychotic disorder, and traffic offenses with APD. CONCLUSIONS: Youth crime is predominantly associated with antisocial personality and substance use disorders. Crime prevention efforts should focus on boys showing a risk for antisocial and substance use problems. In particular, property, drug, and repeat offenders need mental health and substance use assessment. There is a need to develop integrated mental health and substance use treatment services for young offenders within or alongside the criminal justice system.     

Clinical and prognostic characteristics associated with addictive comorbidity in hospitalized psychiatric patients

The aims of this study were to estimate: 1) the prevalence of substance use disorder, 2) the social and clinical characteristics associated to such a comorbid disorder in patients hospitalised in psychiatry. METHOD: Patients consecutively hospitalised for a non-addictive disorder were included in the present survey. A standardised method was used to collect information on clinical and social characteristics. DSM IV diagnoses, including those of substance use, were made using a structured diagnostic interview and all available clinical and historical informations collected during the hospital stay. RESULTS: We have included 127 patients fulfilling the diagnostic criteria for affective disorders (n = 61), non-affective psychotic disorder (schizophrenia, schizoaffective disorder, delusional disorder, other psychotic disorders, n = 50) and personality disorder (n = 16). Among these patients, 11.8% presented with a current abuse/dependence to alcohol (lifetime prevalence: 25.2%), 11% to cannabis (lifetime prevalence: 22.8%). The lifetime prevalence for any other substance disorder was 2.4%. The subjects presenting with an abuse/dependence to alcohol had a higher rate of psychiatric hospitalisation (OR = 2.9; 95% CI 1.0-8.1; p = 0.04) and had more frequently a history of attempted suicide (OR = 2.6; 95% CI 1.0-6.5; p = 0.04). The cannabis misuse was associated with medication noncompliance (OR = 3.1; 95% CI 1.1-9.1; p = 0.04) and more frequent penal problems (OR = 15.0; 95% CI 2.9-78.7; p = 0.001). CONCLUSION: Cannabis and alcohol misuse have a negative, but different, impact on social adaptation and clinical outcome in subjects with psychiatric disorder. These results confirm the necessity to systematically assess this type of comorbid disorder and to distinguish the different substances.     

Current comorbidity among consecutive adolescent psychiatric outpatients with DSM-IV mood disorders

OBJECTIVE: To compare selected characteristics (age, sex, age of onset for depression, impairment, severity of depression, somatic comorbidity, and treatment status) of adolescents with currently comorbid and non-comorbid depression. METHOD: A sample of 218 consecutive adolescent (13-19 years) psychiatric outpatients with depressive disorders, and 200 age- and sex-matched school-attending controls were interviewed for DSM-IV Axis I and Axis II diagnoses. RESULTS: Current comorbidity, most commonly with anxiety disorders, was equally frequent (>70%) in outpatients and depressed controls. Younger age (OR 0.20; 95% CI 0.08, 0.51) and male gender (OR 0.02; 95% CI 0.09, 0.55) were associated with concurrent disruptive disorders. Current comorbidity with substance use disorders (SUD) was independent of age (OR 1.13; 95% CI 0.51, 2.49) and sex (OR 0.51; 95% CI 0.22, 1.17). Personality disorders associated with older age (OR 2.06; 95% CI 1.10, 3.86). In multivariable logistic regression analysis, impairment (GAF 相似文献   

Childhood-onset pathologic skin picking: clinical characteristics and psychiatric comorbidity

There has been little research examining clinical correlates of childhood-onset pathologic skin picking in a sample of individuals with a primary diagnosis of pathologic skin picking. Using a sample of 40 consecutive subjects with current pathologic skin picking, we compared subjects with childhood-onset (before 10 years of age) pathologic skin picking to those with later onset on a variety of clinical measures. Symptom severity was examined by assessing time spent picking per day, intensity and frequency of thoughts and urges to pick, and social and occupational functioning. Of the 40 subjects, 19 (47.5%) reported onset of skin picking before 10 years of age. Subjects with childhood-onset had significantly longer durations of illness before receiving treatment and were more likely to pick unconsciously. Symptom severity, comorbidity, and social functioning did not differ between groups. These preliminary results suggest that although onset before 10 years of age is fairly common among people with pathologic skin picking, individuals developing this behavior earlier in life have similar clinical characteristics as those with later onset but may be less likely to seek treatment.     

Late-onset obsessive compulsive disorder: clinical characteristics and psychiatric comorbidity

There has been little research examining clinical correlates of late-onset OCD in a large sample of individuals with a primary diagnosis of OCD. Using a sample of 293 consecutive subjects with lifetime DSM-IV OCD, we compared subjects with late-onset (after age 30 years) OCD to those with earlier onset on a variety of clinical measures. Symptom severity was examined using the Yale-Brown Obsessive Compulsive Scale. Thirty-three (11.3%) of the 293 subjects with OCD reported onset of OCD on or after age 30 years (mean age of OCD onset of 38.8+/-9.7 years). Subjects with late-onset had significantly shorter durations of illness prior to receiving treatment, less severe obsessinality, and a trend demonstrating a greater likelihood of responding to cognitive behavioral therapy (CBT). Late-onset OCD subjects were also significantly less likely to report contamination, religious, or somatic obsessions. Comorbidity, insight, depressive symptoms, quality of life, and social functioning did not differ between groups. These preliminary results suggest that although onset on or after age 30 years is fairly uncommon among people with OCD, individuals developing OCD later in life have similar clinical characteristics as those with earlier onset and may respond better to CBT.     

Reduced hippocampal volume among adolescents with alcohol use disorders without psychiatric comorbidity

Studies have suggested that teens with alcohol use disorder (AUD) can demonstrate memory deficits, but the underlying neuroanatomical substrates are unclear. The hippocampus is crucial to intact memory functioning, and it actively develops during adolescence. The current study attempted to replicate and extend previous findings suggesting that adolescents with AUD show smaller hippocampal volumes than healthy adolescents. Manual tracings of bilateral hippocampi were performed on structural magnetic resonance images of 14 adolescents (ages 15 to 17 years) with AUD and 17 healthy comparison teens. Intracranial, white, and gray matter volumes, as well as memory abilities, were also measured. Results revealed that adolescents with AUD had significantly smaller left hippocampal volumes than healthy teens, even after removal of teens with comorbid conduct disorder from the analyses. In contrast the groups did not differ in right hippocampal, intracranial, gray or white matter volumes, or memory performance. Hippocampal volumes were not related to alcohol-consumption rates. These findings indicate that adolescents with AUD, but free from other psychiatric comorbidities, have reduced left hippocampal volume. Because hippocampal volume did not relate to alcohol use characteristics, it is possible that premorbid volumetric differences could account for some of the observed group differences in hippocampal volume.     

Substance abuse prevalence and comorbidity with other psychiatric disorders among adolescents with severe emotional disturbances

Among 547 adolescents with serious emotional disturbances, ages 12 to 18, this study assessed (1) prevalence of DSM-III substance use disorders (i.e., alcohol and marijuana abuse/dependence), and (2) comorbidity with DSM-III Axis I disorders. Factors of age, sex, state location, and type of treatment program also were examined. Data were analyzed by logistic regression. Significant factors (p less than 0.05) associated with severe alcohol or marijuana abuse/dependency diagnosis included (1) residential mental health treatment program, 2.37 Odds Ratio (OR); (2) conduct disorder diagnosis, 2.18 OR; (3) depression diagnosis, 1.75 OR; (4) states, 1.43 OR; (5) age, 1.29 OR; and (6) a depression x facility interaction, 1.91 OR.