Excoriation (skin picking) disorder in Israeli University students: prevalence and associated mental health correlates

ObjectiveThe purpose of the study was to examine the prevalence of excoriation (skin picking) disorder (SPD) and associated physical and mental health correlates in a sample of Israeli university students.MethodsFive thousand Israeli students were given questionnaires screening for SPD, depression, obsessive–compulsive disorder, body dysmorphic disorder and disruptive, impulse control and conduct disorders. A total of 2176 participants (43.6%) responded and were included in the analysis. Mean age was 25.1±4.8 (range 17–60) years, and 64.3% were female.ResultsThe proportion of students who were screened positive for SPD was 3.03%, with a nearly equal gender distribution (3.0% in females and 3.1% in males). There was a trend toward significantly higher rates of psychiatric problems such as generalized anxiety, compulsive sexual behavior and eating disorders in these students. Within the group of students screening positive for SPD, alcohol intake was higher in male students, while female students perceived themselves as less attractive. No association was found between depression and SPD. A high prevalence rate of skin picking was found within first-degree family members of the participants screening positive for SPD.ConclusionsClinicians and public health officials within university settings should screen for SPD as it is common and associated with psychosocial dysfunction.     

The characteristics of the comorbidity between social anxiety and separation anxiety disorders in adult patients

Abstract

Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n?=?31) and without childhood and adulthood separation anxiety disorder (SeAD) (n?=?50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables.

Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation.

Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD.

Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.     

Electroencephalographic findings in schizophreniform and affective disorders

Objective: Pathological findings in electroencephalography (EEG) are discussed as a possible marker of organic mental disorders and a therapeutic response to anticonvulsive medication under these conditions.

Methods: We compared the prevalence of EEG abnormalities in 100 patients with schizophrenia, 100 patients with schizoaffective disorder, 51 patients with acute polymorphic psychotic disorder, 100 patients with bipolar disorder, 100 patients with unipolar major depression and 76 healthy control subjects with the findings of a previous study using well-diagnosed, large control samples (13,658 pilots and aircrew personnel).

Results: We detected an increased number of pathological EEG findings with intermittent rhythmic delta or theta activity in 7% of patients with schizophrenia, 7% of patients with schizoaffective disorder, 5.9% of patients with acute polymorphic psychosis, 6% of patients with bipolar disorder, 4% of unipolar depressed patients and 3.9% of the own control group, compared to 1% of strictly controlled healthy subjects. One-sided logistic regression revealed an association between pathological EEGs and the diagnosis of schizophrenia (Wald W?=?3.466, p?=?0.0315), schizoaffective disorder (W?=?3.466, p?=?0.0315) and bipolar disorder (W?=?2.862, p?=?0.0455).

Conclusions: We suggest that the previously developed local area network inhibition model for a potential paraepileptic pathomechanism can explain the relevance of such findings in different psychiatric disorders.     

Prospective relations between alexithymia,substance use and depression: findings from a National Birth Cohort

Abstract

Purpose: This study examined a developmental model that links affect-regulation difficulties in childhood with three dimensions of alexithymia in adolescence (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking) and substance use and depression in adulthood, while accounting for cumulative contextual risk in childhood, and testing potential gender moderation.

Methods: Multiple group path analyses were conducted using data from the Northern Finland Birth Cohort 1986 (N?=?6963). Analyses used data collected during prenatal/birth, childhood, adolescence, and young adulthood periods.

Results: Our examination of early precursors for alexithymia indicated that the associations of affect-regulation problems in childhood with alexithymia were stronger for girls, potentially putting girls with affect-regulation difficulties in childhood at higher risk for developing alexithymia in adolescence. The associations of cumulative contextual risk in childhood with alexithymia, substance use disorder, and depression diagnosis in adulthood were significant for both girls and boys. Our findings in regard to substance use and depression disorders revealed that alexithymia in adolescence predicted depression diagnosis in adulthood, particularly due to a contribution from the alexithymia domain of ‘difficulties identifying feelings.’ However, none of the alexithymia domains was directly associated with substance use disorder in adulthood.

Conclusions: Our study contributes to research that links alexithymia with difficulties in affect regulation and cumulative contextual risk in childhood, yielding findings that may be relevant for preventive interventions.     

Neurocognitive markers of suicidal ideation in patients with anxiety and mood disorders

Abstract

Objective: This study aims at identifying associations between cognitive function and suicidal ideation in the sample of patients with anxiety and mood disorders (AMD).

Methods: In sum, 186 (age = 39?±?12.3 years; 142 [76.3%] females) patients with AMD were enrolled in the study. Assessment included evaluation of socio-demographic information, medication use, anxiety and depression symptoms. Cognitive tests included measures of psychomotor performance and incidental learning using the Digit Symbol Test. Trail Making Tests respectively measured perceptual speed, task-switching and executive control. Additionally, 21 patients completed tests from the Cambridge Automated Neuropsychological Test Battery measuring set shifting (Interdimensional/extradimensional set-shift), executive planning (Stockings of Cambridge), and decision making (Cambridge Gamble Task [CGT]).

Results: Almost half (45.0%, n?=?86) of the study sample patients had experienced suicidal ideations. In multivariable regression analysis, suicidal ideation was associated with a greater overall proportion of bet and risk taking on the CGT task (β?=?0.726, p?=?.010 and β?=?0.634, p?=?.019), when controlling for socio-demographic characteristics, medication use, anxiety and depression symptoms.

Conclusions: Outpatients with AMD and suicidal ideation could be distinguished by the presence of cognitive deficits in the executive function domain, particularly in impulse-control and risk taking.     

Mental health problems of second generation children and adolescents with migration background

Objective: Despite the growing number of young second-generation immigrant (SGI) children and adolescents, studies about their mental health are rare. The objective of this study was to investigate the mental health problems of SGI children and adolescents in Istanbul, Turkey.

Methods: In a clinical sample the mental health of 54 SGIs and 50 native children and adolescents were examined using the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) and Children’s Global Assessment Scale. The assessments were carried out by a blinded rater.

Results: SGI children had higher rates of psychiatric disorders such as depression (p?=?0.001), post-traumatic stress disorder (PTSD) (p?=?0.011) and anxiety disorders (p?=?0.013), more comorbid disorders and lower functionality scores compared to their native counterparts (p?=?0.001).

Conclusions: SGI children seem to have higher rates of psychiatric disorders most probably due to migration-induced burdens. The professionals treating SGI children should have more awareness for these problems to be able to approach them in a culture and language sensitive way.     

Anxiety in adolescent epilepsy. A clinimetric analysis

Background Anxiety and depression have been considered to be neglected disorders in epilepsy. Because panic disorder is one of the most important anxiety disorders, it has been problematic to use very comprehensive anxiety questionnaires in epilepsy patients, as panic attacks and epileptic seizures, although two distinct clinical entities from a diagnostic point of view, show a significant overlap of symptoms.

Aims We have focused on single items for anxiety and depression as screening candidates in adolescent epilepsy.

Methods The individual panic attack item in the Screen for Children Anxiety Related Emotional Disorders Scale (SCARED) and the single depression item in the Kellner Symptom Questionnaire were tested. Our samples consisted of adolescent patients with epilepsy and a matched control group with healthy participants, as well as two numerical groups acting as controls.

Results The single panic attack item identified panic anxiety in 24.1% in the group of patients with epilepsy and 0.0% in the matched control group (p?=?0.01). The single depression item identified 52.2% with depression in the epilepsy group and 6.2% in the matched control group (p?=?0.001).

Conclusion As screening instruments, single items of panic attack and depression are sufficient to screen for these affective states in adolescent epilepsy. The clinical implications are that it is important to be quite specific when screening for depression and panic attacks in adolescent patients with epilepsy.     

Psychopathological,temperamental, and characteristic factors in adults with remaining childhood attention-deficit hyperactivity symptoms

Objectives: To investigate differences in psychopathological, temperamental and characteristic factors between young adults with and without persistent Attention-Deficit Hyperactivity disorder (ADHD) symptoms.

Methods: A total of 429 university students were divided into three groups: persistent adult ADHD (n?=?53), only childhood ADHD (n?=?56) and healthy controls (n?=?320). The Korean Adult ADHD Scale, Korean Wender-Utah Rating Scale, Beck Depression Inventory-II, Beck Anxiety Inventory, Barratt Impulsiveness Scale, Korean Young Internet Addiction Scale, and Temperament Character Inventory-Revised (TCI-R; based on Cloninger’s seven factor model of temperament and character) were used to evaluate psychopathological factors.

Results: Participants with persistent adult ADHD symptoms had significantly higher levels of childhood ADHD, depression, anxiety and the Internet addiction symptoms than did the only-childhood ADHD and control groups. The adult ADHD group also had significantly higher tendencies toward novelty seeking, harm avoidance, and self-transcendence, as well as low self-directedness and cooperativeness.

Conclusions: Results suggest that persistent ADHD is associated with several unfavourable psychopathological, temperamental and characteristic factors. Therefore, thorough evaluation of these factors for childhood ADHD could help predict prognoses and provide treatment plans for preventing persistent ADHD into adulthood.     

Losing control: Assaultive behavior as a predictor of impulse control disorders in young adults

Objective

Assaultive behaviors are common among young people and have been associated with a range of other unhealthy, impulsive behaviors such as substance use and problem gambling. This study sought to determine the predictive ability of single assaultive incidents for impulse control disorders, an association that has yet to be examined, especially in young adults.

Methods

The authors conducted a university-wide email survey in the spring of 2011 on 6000 university students. The survey examined assaultive behavior and associated mental health variables (using a clinically validated screening instrument, the Minnesota Impulsive Disorders Interview), stress and mood states, and psychosocial functioning.

Results

The rate of response was 35.1% (n = 2108). 109 (5.9%) participants reported that they had assaulted another person or destroyed property at some time in their lives. Compared with respondents without lifetime assaultive behavior, those with a history of assaultive or destructive behavior reported more depressive symptoms, more stress, and higher rates of a range of impulse control disorders (intermittent explosive disorder, compulsive sexual behavior, compulsive buying, and skin picking disorder).

Conclusions

Assaultive behavior appears fairly common among college students and is associated with symptoms of depression and impulse control disorders. Significant distress and diminished behavioral control suggest that assaultive behaviors may often be associated with significant morbidity. Additional research is needed to develop specific prevention and treatment strategies for young adults attending college who report problems with assaultive behaviors.     

The effect of individual enabling and support on empowerment and depression severity in persons with affective disorders: outcome of a randomized control trial

Purpose: To evaluate the effect of Individual Enabling and Support (IES) on empowerment and depression severity as compared to Traditional Vocational Rehabilitation (TVR) in people with affective disorders at 12?months follow-up. Additionally, longitudinal changes within the intervention groups and the correlation over time between empowerment and depression severity were evaluated.

Method: A single-blind randomized controlled trial of two intervention groups, IES (n?=?33) and TVR (n?=?28), was performed with measurement points at baseline, 6, and 12?months. Individuals with affective disorders, including depression and bipolar disorder diagnoses were included. The Empowerment Scale and Montgomery–Åsberg Depression Self-Rating Scale were administered, and Intention-To-Treat analysis was applied. The study was registered with the trial number ISRCTN93470551.

Result: There was a statistically significant difference between the intervention groups on empowerment and depression severity at 12?months. Within-group analysis showed that IES-participants increased their perceived empowerment and decreased their depression severity between measurement points, this was not seen among TVR-participants. A moderate, inverse relationship was detected between empowerment and depression.

Conclusion: IES is more effective in increasing empowerment and decreasing depression severity after a 12-month intervention than is TVR. This study was limited by a small sample size and larger trials in different contexts are needed.     

Anxiety disorders and CRP in a population cohort study with 54,326 participants: The LifeLines study

Objectives: Growing evidence indicates that inflammatory processes may play a role in the pathogenesis of anxiety disorders. Nevertheless, much remains to be learned about the involvement of inflammation, including C-reactive protein (CRP), in specific anxiety disorders. This study examines the relation between anxiety disorders and CRP.

Methods: Associations of serum CRP with anxiety disorders were determined in a large population study (n?=?54,326 participants, mean age?=?47 years; 59% female), the LifeLines cohort. Depressive and anxiety disorders (generalized anxiety disorder, social anxiety phobia, panic disorder with or without agoraphobia and agoraphobia without panic disorder) were assessed using the Mini-International Neuropsychiatric Interview.

Results: Anxiety disorders, with the exception of social anxiety disorder, were significantly associated with increased CRP. After adjusting for demographics, life style factors, health factors, medication use, depression, and psychological stressors, CRP remained significantly associated with panic disorder with agoraphobia (β?=?0.01, P?=?.013). Moreover, CRP levels were significantly higher in people with panic disorder with agoraphobia compared to other anxiety disorders, independent of all covariates (F?=?3.00, df?=?4, P?=?.021).

Conclusions: Panic disorder with agoraphobia is associated with increased CRP, although the effect size of this association is small. This indicates that neuroinflammatory mechanisms may play a potential role in its pathophysiology.     

Early age of onset of mood,anxiety and alcohol use disorders is associated with sociodemographic characteristics and health outcomes in adults: results from a cross-sectional national survey

Purpose

This cross-sectional study investigated distribution, sociodemographic correlates, and health outcomes in early versus late age of onset (AOO) of mood, anxiety, and alcohol use disorders in Singapore.

Methods

The Composite International Diagnostic Interview established lifetime diagnoses of major depressive, bipolar, generalized anxiety, obsessive compulsive and alcohol use disorders in a representative sample of residents aged 18 years and over (n = 6126). The AOO of the individual and any mental disorders were classified into early and late onset using median values as cut-offs. Data included socio-demographic and health background, health utility score, and productivity losses. Multivariable logistic regression analysis was conducted to assess sociodemographic correlates of early versus late AOO of any mental disorder while linear regression analysis investigated the associations between AOO of individual disorders with health utility score and productivity loss.

Results

Respondents’ mean (SD) age was 45.6 (16.5) years, comprising 50.5% women and majority of Chinese ethnicity (75.8%). The median AOO for any of the five studied disorders was 21 years (IQR: 15–29). Lowest AOO was observed for obsessive compulsive disorder (Median: 14, IQR: 11–26). Those aged 35 years and over (versus 18–34) were less likely to have earlier AOO [35–49 years (OR: 0.287; 95% CI: 0.154–0.534); 50–64 years (OR:0.156; 95% CI: 0.068–0.361) and 65 and over (OR:0.112; 95% CI:0.027–0.461)], while Malay ethnicity (versus Chinese) (OR: 2.319; 95% CI: 1.384–3.885) and being never married (versus married) (OR: 2.731; 95% CI: 1.493–4.993) were more likely to have early AOO for any mental disorder. Sample with early (versus late) AOO had a lower health utility score (β =  − 0.06,95% CI: − 0.08 to − 0.03) and higher number of days cut down on the type of work (β = 1.61,95% CI: 0.12–3.10) in those with any mental disorders.

Conclusion

This study showed that half of the adults with mood, anxiety or alcohol use disorders in Singapore experienced their illness onset by 21 years of age. Early AOO is associated with sociodemographic background and poor health outcomes. Prevention, early detection, and interventions to improve health outcomes in mental disorders should consider the sociodemographic profile and age at first onset of symptoms in the population.

     

Anxiety and depression are associated with long-term outcomes of hepatocellular carcinoma: A nationwide study of a cohort from Taiwan

Objectives: A natural experimental design was coupled with propensity score matching to assess the risks of anxiety and depression and to assess the longitudinal effects of anxiety and depression on healthcare utilisation and mortality in hepatocellular carcinoma (HCC) patients.

Methods: This nationwide population-based cohort study retrospectively analysed 7304 patients treated for HCC during 1996–2010. Generalised estimating equations were used to estimate differences-in-differences models for examining the effects of anxiety and depression disorders.

Results: Independent risk factors for anxiety and depression in the HCC patients were female gender (hazard ratio (HR) 1.45; P?P?=?0.005), and liver cirrhosis (HR 1.35; P?=?0.004). Anxiety and depression (differences-in-differences value) had a significant (P?P?=?0.003).

Conclusions: Anxiety disorders and depression disorders are associated with a significantly increased overall survival rate in HCC patients. However, further studies are needed to investigate this association.     

Misophonia and comorbid psychiatric symptoms: a preliminary study of clinical findings

Abstract

Objective: Misophonia is a neurophysiological disorder, phenotypically characterized by heightened autonomic nervous system arousal which is accompanied by a high magnitude of emotional reactivity to repetitive and pattern-based auditory stimuli. This study identifies the prevalence of psychiatric symptoms in misophonia sufferers, the association between severity of misophonia and psychiatric symptoms, and the association between misophonia severity and gender.

Methods: Fifty-two misophonia sufferers, 30 females (mean age?=?40.93 ± 15.29) and 22 males (mean age?=?51.18 ± 15.91) were recruited in our study and they were diagnosed according the criteria proposed by Schröder et al. The participants were evaluated by the A-MISO-S for the severity of misophonia and the MINI to assess the presence of psychiatric symptoms.

Results: The most common comorbid symptoms reported by the misophonia patients were respectively PTSD (N?=?8, 15.38%), OCD (N?=?6, 11.53%), MDD (N?=?5, 9.61%), and anorexia (N?=?5, 9.61%). Misophonia severity was associated with the symptoms of MDD, OCD, and PTSD as well as anorexia. There was an indication of a significant difference between men and women in the severity of misophonic symptoms.

Conclusion: Our findings highlight the importance of recognizing psychiatric comorbidity among misophonia sufferers. The presence of these varying psychiatric disorders’ features in individuals with misophonia suggests that while misophonia has unique clinical characteristics with an underlying neurophysiological mechanism, may be associated with psychiatric symptoms. Therefore, when assessing individuals with misophonia symptoms, it is important to screen for psychiatric symptoms. This will assist researchers and clinicians to better understand the nature of the symptoms and how they may be interacting and ultimately allocating the most effective therapeutic strategies.     

Resting state vagal tone in attention deficit (hyperactivity) disorder: A meta-analysis

Objectives: To quantify evidence on resting-state vagal activity in patients with attention deficit hyperactivity disorder (ADHD) relative to controls using meta-analysis.

Methods: Three electronic databases (PubMed, PsycINFO, CINAHL Plus) were reviewed to identify studies. Studies reporting on any measure of short-term, vagally mediated heart rate variability during resting state in clinically diagnosed ADHD patients as well as non-ADHD healthy controls were eligible for inclusion.

Results: Eight studies reporting on 587 participants met inclusion criteria. Random-effect meta-analysis revealed no significant main effect comparing individuals with ADHD (n?=?317) and healthy controls (n?=?270) (Hedges’ g?=?0.06, 95% CI: 0.18–0.29, Z?=?0.48, P?=?0.63; k?=?8). Sub-group analysis showed consistent results among studies in adults (k?=?2) and children (k?=?6) with ADHD.

Conclusions: Unlike a variety of internalising psychiatric disorders, ADHD is not associated with altered short-term measures of resting-state vagal tone.     

Age-related characteristics of outpatients with anxiety disorders: the Leiden routine outcome monitoring study

Objective: It has been hypothesised that clinically important age-related differences between adults with anxiety disorders exist; this study aims to elucidate these differences.

Methods: We analysed data from 1950 outpatients diagnosed with DSM-IV-TR anxiety disorders treated at a Dutch hospital or affiliated mental healthcare centres. Three age-groups (young- (18–25; n?=?435), mid- (26–40; n?=?788) and older adult (41–65; n?=?727)) were compared with regard to social demographic characteristics, diagnostic characteristics, anxiety symptom profile, general psychiatric symptom profile and generic health status, in addition, linear analyses were carried out with age as a continuous variable.

Results: Average age was 36.48 years (SD 11.71), 62.8% were female. Significant associations with age emerged for gender, employment, education level, living situation, observed depression, agoraphobia (AP), social phobia, aches and pains, inner tension, sleep, interpersonal sensitivity, observed hostility, physical functioning, role limitations due to physical problems, vitality and bodily pain in categorical and continuous analyses. Self reported hostility was only significant in group-wise comparisons; role limitations due to emotional problems were only significant in linear analyses (all at p?Conclusions: This study identified clinically relevant differences between younger and older adult outpatients with anxiety disorders. Clinicians should take these findings into account, as they may support treatment.     

Changes in cortical protein markers of iron transport with gender,major depressive disorder and suicide

Abstract

Objectives: The objective of this study was to determine whether a breakdown in proteins regulating cortical iron homeostasis could be involved in the pathophysiology of mood disorders.

Methods: Levels of select proteins responsible for cortical iron transport were quantitated by Western blotting of Brodmann’s (BA) areas 6 and 10 from patients with major depressive disorder (n?=?13), bipolar disorder (n?=?12) and age/sex matched controls (n?=?13).

Results: We found the inactive form of ceruloplasmin was lower in BA 6 from males compared to females. Levels of copper containing ceruloplasmin was lower in BA 6 from suicide completers whilst levels of amyloid precursor protein, TAU and transferrin were higher in BA 10 from those individuals. The level of prion protein was lower in BA 6 from subjects with major depressive disorder.

Conclusions: Our data suggests that perturbation in cortical iron transport proteins is not prevalent in mood disorders. By contrast, our data suggests changes in iron transport proteins in BA 6 and BA 10 are present after suicide completion. If these changes were present before death, they could have had a role in the genesis of the contemplation and completion of suicide.     

The predictive value of early response in patients with depressive disorders

Objective: Several randomized controlled trials have identified early response to psychotherapy as a predictor for later treatment outcome among patients with depressive disorders. However, supporting evidence under routine conditions is rare. This study evaluated the predictive value of early improvement for final outcomes in psychotherapy among depressive patients in the naturalistic setting of a German university outpatient clinic. Method: We used the method of percent symptom reduction to classify 639 patients with major depression or dysthymic disorder who underwent an average of 40.0 sessions (SD?=?16.3) of naturalistic cognitive–behavioral therapy (CBT) as having either an early response or an early nonresponse. Results: Early response was a good predictor for final response and remission regarding depressive symptoms (OR?=?8.75 and OR?=?5.32, respectively), as well as overall psychological distress (OR?=?3.95 and OR?=?3.16, respectively). Early nonresponse was distinctly associated with later deterioration of both depressive (OR?=?9.56) and general psychological symptomatology (OR?=?4.92). Conclusions: Early response to psychotherapy has high predictive qualities for positive later treatment outcome in depressive patients under routine CBT. Therefore, early treatment effects should be considered in clinical decision-making and treatment planning in everyday clinical practice.     

Impulsivity in body-focused repetitive behavior disorders: Disparate clinical associations between three distinct measures

Objective: Research on trichotillomania (TTM) and excoriation (skin-picking) disorder (SPD) has suggested that impulsivity may be an important cognitive underpinning of the behavior, but many studies have produced mixed results. This analysis assessed impulsivity in TTM and SPD using three measures: the Barratt Impulsiveness Scale (BIS), the Eysenck Impulsiveness Questionnaire (EIQ), and the Stop-Signal Task (SST). Methods: Two hundred and eighty three subjects with TTM or SPD completed measurement of impulsivity as a part of participation in several research studies. Subjects scoring one standard deviation above or below measure means were included in the analysis for that scale (SST: N?=?45; EIQ: N?=?32; BIS: N?=?34). High and low impulsive groups were compared within measures on demographic, clinical, and behavioral variables. Results: Results differed by group, with domains of the BIS showing associations with clinical severity, quality of life, and anxiety, and the SST showing several differences, but not clinical severity. The EIQ domains showed no significant differences. No groups differed demographically. Conclusions: These results suggest that the EIQ, BIS, and SST assess distinct characteristics. Notably, only the attentional domain from the BIS predicted higher severity scores. Future research needs to clarify the ideal utility for these scales as they relate to TTM and SPD.

• Key points

• The BIS, EIQ, and SST domains are associated with distinct clinical differences between high and low impulsivity groups.

• Only the subjects in the high attentional impulsivity domain of the BIS showed significantly elevated symptom severity.

• The high and low impulsivity groups within the EIQ domains did not show any significant differences.

• These disparate associations may indicate the need for better subtyping of impulsivity, as different measures of specific domains appear to show associations with distinct features.

     

Psychiatric services for preschoolers: an emerging need

Objective: To describe clinical presentation and service requirements for those under six years of age referred to a specialised child and adolescent psychiatry unit.

Method: This study used a retrospective review of preschoolers, six years and younger, assessed at a child, family and adolescent psychiatric unit (January 2006 to 31 December 2010). Data analysis established predominant diagnoses (prevalence percentages) and correlations and associations (diagnoses and a range of clinical variables — Fischer's exact test and chi-square test).

Results: The sample comprised 149 subjects. Males predominated (77.2%; N = 115). Mean age of presentation was 54 months (SD=12.59). Children were referred predominantly by health professionals (36.9%; N = 55) and schools (20.8%; N = 31). Attention-deficit hyperactivity disorder (ADHD) was the most common diagnosis (52.8%; N = 70), and was not over-represented amongst boys. Girls mostly presented with anxiety disorders (44.1%; 15/34) and reactive attachment disorder (RAD) (35.3%; 12/34), and boys mostly with pervasive developmental disorders (PDD) (26%; 30/115). Psychometric testing was frequent (68.5%; N = 102). Pharmacological intervention was common (46.3%; N = 69). The defaulting rate after initial assessment was high (42.1%; 48/114).

Conclusion: The study demonstrates the existence of psychiatric illness in this sample, highlighting service needs. Vulnerability of this age group and limited sub-specialist resources emphasise the need for the development of community services leading to early recognition and intervention.