Caffeine use and dependence in adolescents: one-year follow-up

The objectives were to conduct a 1-year follow-up of daily caffeine-using adolescents to further describe caffeine dependence symptoms and to determine whether caffeine dependence is associated with other substance dependence disorders. Twenty-one of 36 (58.3%) adolescents who participated in a study of caffeine dependence returned for follow-up. The previous study was a case series of adolescents who consumed caffeine daily and met some Diagnostic and Statistical Manual of Mental Disorders (fourth edition) substance dependence criteria as applied to caffeine. At follow-up, caffeine consumption from beverages was 179.9 +/- 151.8 mg/day. Of the 21 teenagers, 23.8% (n = 5) met criteria for caffeine dependence. Four of these participants developed caffeine dependence during the follow-up period. Other substance dependence disorders were not overrepresented in the caffeine dependent group compared to the caffeine nondependent group. The most commonly reported withdrawal symptoms in dependent teenagers (at baseline and follow-up combined) were feeling drowsy/tired, fatigued, or sluggish/slowed down (83.3% each) and headache (75.0%). Caffeine dependence occurs in some adolescents who drink caffeine daily and is marked by symptoms similar to those found in adults.     

Alcohol, nicotine, caffeine, and mental disorders

Alcohol, nicotine, and caffeine are the most widely consumed psychotropic drugs worldwide. They are largely consumed by normal individuals, but their use is even more frequent in psychiatric patients, Thus, patients with schizophrenia tend to abuse all three substances. The interrelationships between depression and alcohol are complex. These drugs can all create dependence, as understood in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Alcohol abuse is clearly deleterious to the brain, provoking acute and chronic mental disorders, ranging from intoxication with impairment of cognition, to delirium tremens, halluosis, and dementia. In contrast, the main health consequences of nicotine, notably cancer and cardiovascular disases, lie outside the realm of psychiatry However, the mes of nicotine dependence and motivation to smoke or quit are of concern to psychiatrists.     

Somatoform disorders: before and after DSM-III

The somatoform disorders were included as a new category of mental disorders in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The authors review the major features of somatization disorder, conversion disorder, psychogenic pain disorder, and hypochondriasis and present a survey of the recent literature about each.     

Late luteal phase dysphoric disorder (premenstrual syndromes): clinical implications

The authors present an overview of current knowledge about premenstrual syndrome (PMS), most recently classified as late luteal phase dysphoric disorder in the revision of the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. A review of historical reports about the occurrence of PMS, pertinent diagnostic issues, and theories about etiology and treatment are presented. The article concludes with a discussion of the overlap of and relationship between PMS and specific psychiatric disorders, new research directions, and clinical implications of the syndrome.     

ICD-11与DSM-5关于躯体症状及相关障碍诊断标准的异同

本文目的是对躯体症状及相关障碍的诊断标准在《国际疾病分类(第11版)》(ICD-11)和《精神障碍诊断与统计手册(第5版)》(DSM-5)中的异同进行比较。躯体症状及相关障碍的临床特征是有显著的躯体症状,造成了明显的功能损害和痛苦。本文通过探讨躯体症状及相关障碍在两套诊断系统中的异同,以提高精神医学工作者对相应内容的掌握。     

ICD-11与DSM-5关于焦虑障碍诊断标准的异同

本文目的是对《国际疾病分类(第11版)》(ICD-11)和《精神障碍诊断与统计手册(第5版)》(DSM-5)这两套诊断系统中焦虑障碍诊断标准的异同进行比较。焦虑障碍以过度恐惧、担忧以及有相关行为紊乱为临床表现。本文通过对焦虑障碍在两个诊断系统中的诊断要点进行讨论,以期增进临床工作者对两套诊断系统相应内容的理解。     

Trauma and posttraumatic stress disorder symptomatology: patterns among American Indian adolescents in substance abuse treatment

In this study the authors examined the prevalence and correlates of posttraumatic stress disorder (PTSD) and trauma symptomatology among a sample of 89 American Indian adolescents in a residential substance abuse treatment program. These youths reported an average of 4.1 lifetime traumas, with threat of injury and witnessing injury being most common; molestation, rape, and sexual attack were least common. Approximately 10% of participants met the Diagnostic and Statistical Manual IV Text Revision (DSM-IV-TR) criteria for full PTSD, and about 14% met the criteria for subthreshold PTSD. Molestation (including rape and sexual attack), experiencing 6 or more traumas, and a diagnosis of abuse of or dependence on stimulants were significantly associated with PTSD. Findings indicated that trauma was a pervasive phenomenon among this population, with sexual traumas being particularly stigmatizing, resulting in high rates of posttraumatic symptomatology, specifically PTSD.     

CNS changes in Usher''s syndrome with mental disorder: CT, MRI and PET findings.

CNS changes in a case of Usher's syndrome associated with schizophrenia-like mental disorder were observed by CT, MRI and PET. The neuro-radiological findings of the case demonstrate the degenerative and metabolic alterations in various regions of cortex, white matter and subcortical areas in the brain. Mental disorder of the case is almost indistinguishable from that of schizophrenia, but the psychotic feature is regarded as an atypical or mixed organic brain syndrome according to the classification in the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III).     

Is substance abuse in schizophrenia related to impulsivity, sensation seeking, or anhedonia?

OBJECTIVE: The authors compared impulsivity, sensation seeking, and anhedonia in a group of schizophrenic patients with and without lifetime substance abuse or dependence. METHOD: Patients (N=100) with schizophrenia or schizoaffective disorder (per DSM-III-R criteria) were assessed with the Composite International Diagnostic Interview's section on psychoactive substance use disorder, the Positive and Negative Syndrome Scale, the Barratt Impulsivity Scale, the Zuckerman Seeking Sensation Scale, and the Chapman Physical Anhedonia Scale. RESULTS: The mean scores for impulsivity and sensation seeking were higher in the group with substance abuse (N=41) than in the group without substance abuse (N=59). No significant difference between groups was found regarding physical anhedonia. CONCLUSIONS: As in the general population, high levels of impulsivity and sensation seeking are associated with substance abuse in patients with schizophrenia.     

Should caffeine abuse, dependence, or withdrawal be added to DSM-IV and ICD-10?

OBJECTIVE: The authors reviewed basic science and clinical data on caffeine abuse, dependence, and withdrawal in order to make a conclusion about whether these disorders exist and should be included in DSM-IV and ICD-10. METHOD: Studies were located through computerized searches, reference sections of published articles, and written requests. RESULTS: The studies show that abstinence from caffeine induces a withdrawal syndrome of headache, fatigue, and drowsiness which begins within 12-24 hours and lasts about 1 week. The syndrome can be severe and appears to be one reason for continued use of coffee. The prevalence of this caffeine withdrawal syndrome is unknown. Use of caffeine may aggravate some common behavioral and medical disorders. In double-blind tests, a subset of coffee and soda drinkers reliably self-administered caffeinated beverages in preference to uncaffeinated beverages. Clinical indicators of dependence, such as difficulty stopping use of caffeine and use despite harm, have not been documented. CONCLUSIONS: Caffeine withdrawal but not caffeine abuse or dependence should be included as a diagnosis in DSM-IV and ICD-10. Future research should focus on whether some caffeine users exhibit clinical indicators of drug dependence.     

The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey

Objective: There has been ongoing clinical controversy dating back to the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders concerning the boundaries and extent of overlap between Axis I generalized social phobia (GSP) and Axis II avoidant personality disorder (APD). This study sought to examine the relationship between the fourth edition of Diagnostic and Statistical Manual of Mental Disorders GSP and APD in a large nationally representative sample of the United States population. Method: We used the National Epidemiologic Survey on Alcohol and Related Conditions (n=43,093; age 18+; response rate=81%) to study fourth edition of Diagnostic and Statistical Manual of Mental Disorders Axes I and II psychiatric disorders, assessed by a reliable semi‐structured in‐person interview. Results: The lifetime prevalence was 2.8% for GSP and 2.4% for APD. The overlap between GSP and APD varied according to the number of GSP social situations feared. Although 36.4% of individuals with GSP were diagnosed with APD, the majority (57.3%) of individuals with GSP who feared all 13 social situations assessed were diagnosed with APD. Nearly 40% of individuals with APD also had GSP. Compared to individuals with GSP alone, individuals with comorbid GSP and APD showed significantly lower mental health‐related quality of life on the Medical Outcomes Study Short Form, more interaction and observation fears, and an increased likelihood of having other psychiatric disorders such as major depression. Conclusions: APD and GSP show a high degree of overlap (16–57%), depending on the number of social situations feared. Overall, results suggest that APD and GSP appear to be highly related, but potentially separable constructs. Further research is needed to identify the determinants and consequences of having either or both diagnoses. Depression and Anxiety, 2009. Published 2008 Wiley‐Liss, Inc.     

Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions

The objective of this study was to present nationally representative findings on sociodemographic and psychopathologic predictors of first incidence of Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) substance, mood and anxiety disorders using the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. One-year incidence rates of DSM-IV substance, mood and anxiety disorders were highest for alcohol abuse (1.02), alcohol dependence (1.70), major depressive disorder (MDD; 1.51) and generalized anxiety disorder (GAD; 1.12). Incidence rates were significantly greater (P<0.01) among men for substance use disorders and greater among women for mood and anxiety disorders except bipolar disorders and social phobia. Age was inversely related to all disorders. Black individuals were at decreased risk of incident alcohol abuse and Hispanic individuals were at decreased risk of GAD. Anxiety disorders at baseline more often predicted incidence of other anxiety disorders than mood disorders. Reciprocal temporal relationships were found between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. Borderline and schizotypal personality disorders predicted most incident disorders. Incidence rates of substance, mood and anxiety disorders were comparable to or greater than rates of lung cancer, stroke and cardiovascular disease. The greater incidence of all disorders in the youngest cohort underscores the need for increased vigilance in identifying and treating these disorders among young adults. Strong common factors and unique factors appear to underlie associations between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. The major results of this study are discussed with regard to prevention and treatment implications.     

Behavioral addiction--quo vadis?

Behavioral addiction is a new class of psychiatric disorders being considered for inclusion in the next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this article, pathological model railroading disorder is introduced as a vehicle for highlighting and discussing the foreseeable risks and benefits of legitimizing behavioral addiction as a diagnostic class in DSM-5.     

Clinical criteria for psychiatric diagnosis and DSM-III.

The authors identify the differences in formal inclusion and exclusion criteria used to classify patient data into diagnoses as the largest source of diagnostic unreliability in psychiatry. They describe the efforts that have been made to reduce these differences, particularly the specified criteria approach to defining diagnostic categories, which was developed for research purposes. On the basis of studies showing that the use of specified criteria increases the reliability of diagnostic judgments, they suggest that including such criteria in the next edition of APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) would improve the reliability and validity of routine psychiatric diagnosis.     

Abuse of and dependence on alcohol in Swedish women: role of education, occupation and family structure

The present study, which is part of a multipurpose study on alcohol use among women, focuses on the association between education, occupation, family structure and development of alcohol dependence or abuse in women. A total of 316 women were selected by stratified random sampling from all women in a defined part of Gothenburg, Sweden. In a face to face interview, questions were asked about occupation, education, family structure and other variables reflecting socio-economic conditions and relations within the family. As outcome measures we used alcohol dependence and abuse (ADA), diagnosed in a clinical interview according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R). We found that never having been married, or having poor communication with the spouse, as well as having no children at home to take care of, were strongly associated with ADA in women. The role of social class depended on whether education or occupation was used as a measure. Our findings are compatible with the hypothesis that development of alcohol-related problems among women to a large extent is influenced by matters that relate to home and private life. Accepted: 29 January 1998     

Diagnosing schizophrenia circa 2005: How and why?

Since the introduction of the third edition of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition in 1980, schizophrenia has been widely diagnosed with good to excellent levels of reliability. This is no small feat, as prior to the 1970s the reliability of this diagnosis over time and place was very poor. Although there have been some changes in the diagnostic algorithm for schizophrenia with subsequent revisions of the Diagnostic and Statistical Manual of Mental Disorders, there has been little change in the overall classification scheme. However, there has also been relatively little movement toward enhancing the validity of this diagnosis. Although there is broad consensus that what we now call schizophrenia is probably very heterogeneous with respect to underlying etiology and pathophysiology, attempts to identify more valid subtypes or dimensions have not progressed to the point that they are likely to be incorporated into diagnostic systems any time soon. The limited progress in defining more valid disease categories has increasingly important clinical implications as the field moves more and more to treatment by preset algorithms that are typically driven by diagnosis.     

The DSM-IV-TR 'Glossary of Technical Terms': a reappraisal

Many of the entries in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition - Text Revision (DSM-IV-TR) are problematic along multiple axes, including, but not limited to, clarity, logical coherence, factual content, redundancy, and ambiguity. These problems pose multiple barriers to clear, efficient, and accurate communication among those who work in clinical contexts or among those involved in psychological or psychiatric research. These barriers to communication, accurate concept formation, and clinical clarity affect diagnostic validity and reliability in a manner that imperils progress in psychiatry and psychology on a grand scale. This essay focuses on some of the most egregious problematic entries in the DSM-IV-TR's 'Glossary of Technical Terms'. It is meant to be a prolegomenon to a thorough revision of the Glossary in preparation for the projected 5th edition of the DSM.     

Association between tobacco smoking and bipolar affective disorder: clinical, epidemiological, cross-sectional, retrospective study in outpatients

PurposeAlthough high rates of smoking have been reported among psychiatric patients, only a few studies examined the prevalence of smoking in bipolar disorder, and findings are inconsistent. We investigated smoking among bipolar patients.MethodsWe examined the prevalence of smoking in of 102 patients that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for bipolar I disorder in Israel and evaluated the relationship between smoking and demographic and clinical data.ResultsFifty-five of the bipolar patients (53.9%) smoked, with a rate that is 2.36 times higher than among the general population in Israel (22.8%). Significant relationships were revealed between smoking and lifetime history of alcohol dependence/abuse (P = .02), between smoking and history of drug use (P ≤ .01), and between smoking and age of illness onset (P = .04).LimitationsThe cross-sectional nature of the study and the relatively small sample size preclude generalization of the findings. Nicotine levels were not measured; thus, the information regarding smoking was subjective.ConclusionsBipolar patients smoke more than the general population. Bipolar patients that are moderate or heavy smokers are more likely than nonsmokers to consume alcohol and abuse psychoactive substances. Contrary to findings of previous studies, no association was found between clinical variables of bipolar patients and smoking.     

Are we dependent upon coffee and caffeine? A review on human and animal data

Caffeine is the most widely used psychoactive substance and has been considered occasionally as a drug of abuse. The present paper reviews available data on caffeine dependence, tolerance, reinforcement and withdrawal. After sudden caffeine cessation, withdrawal symptoms develop in a small portion of the population but are moderate and transient. Tolerance to caffeine-induced stimulation of locomotor activity has been shown in animals. In humans, tolerance to some subjective effects of caffeine seems to occur, but most of the time complete tolerance to many effects of caffeine on the central nervous system does not occur. In animals, caffeine can act as a reinforcer, but only in a more limited range of conditions than with classical drugs of dependence. In humans, the reinforcing stimuli functions of caffeine are limited to low or rather moderate doses while high doses are usually avoided. The classical drugs of abuse lead to quite specific increases in cerebral functional activity and dopamine release in the shell of the nucleus accumbens, the key structure for reward, motivation and addiction. However, caffeine doses that reflect the daily human consumption, do not induce a release of dopamine in the shell of the nucleus accumbens but lead to a release of dopamine in the prefrontal cortex, which is consistent with caffeine reinforcing properties. Moreover, caffeine increases glucose utilization in the shell of the nucleus accumbens only at rather high doses that stimulate most brain structures, non-specifically, and likely reflect the side effects linked to high caffeine ingestion. That dose is also 5-10-fold higher than the one necessary to stimulate the caudate nucleus, which mediates motor activity and the structures regulating the sleep-wake cycle, the two functions the most sensitive to caffeine. In conclusion, it appears that although caffeine fulfils some of the criteria for drug dependence and shares with amphetamines and cocaine a certain specificity of action on the cerebral dopaminergic system, the methylxanthine does not act on the dopaminergic structures related to reward, motivation and addiction.     

SCAN. Schedules for Clinical Assessment in Neuropsychiatry

After more than 12 years of development, the ninth edition of the Present State Examination (PSE-9) was published, together with associated instruments and computer algorithm, in 1974. The system has now been expanded, in the framework of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration Joint Project on Standardization of Diagnosis and Classification, and is being tested with the aim of developing a comprehensive procedure for clinical examination that is also capable of generating many of the categories of the International Classification of Diseases, 10th edition, and the Diagnostic and Statistical Manual of Mental Disorders, revised third edition. The new system is known as SCAN (Schedules for Clinical Assessment in Neuropsychiatry). It includes the 10th edition of the PSE as one of its core schedules, preliminary tests of which have suggested that reliability is similar to that of PSE-9. SCAN is being field tested in 20 centers in 11 countries. A final version is expected to be available in January 1990.