ABSTRACT
Abstract Introduction Irritability has both mood and behavioral manifestations. These frequently co-occur, and it is unclear to what extent they are dissociable domains. We used confirmatory factor analysis and external validators to investigate the independence of mood and behavioral components of irritability. Methods The sample comprised 246 patients (mean age 45 years; 63% female) from four outpatient programs (depression, anxiety, bipolar, and schizophrenia) at a tertiary hospital. A clinical instrument rated by trained clinicians was specifically designed to capture irritable mood and disruptive behavior dimensionally, as well as current categorical diagnoses i.e., intermittent explosive disorder (IED); oppositional defiant disorder (ODD); and an adaptation to diagnose disruptive mood dysregulation disorder (DMDD) in adults. Confirmatory factor analysis (CFA) was used to test the best fitting irritability models and regression analyses were used to investigate associations with external validators. Results Irritable mood and disruptive behavior were both frequent, but diagnoses of disruptive syndromes were rare (IED, 8%; ODD, 2%; DMDD, 2%). A correlated model with two dimensions, and a bifactor model with one general dimension and two specific dimensions (mood and behavior) both had good fit indices. The correlated model had root mean square error of approximation (RMSEA) = 0.077, with 90% confidence interval (90%CI) = 0.071-0.083; comparative fit index (CFI) = 0.99; and Tucker-Lewis index (TLI) = 0.99, while the bifactor model had RMSEA = 0.041; CFI = 0.99; and TLI = 0.99 respectively). In the bifactor model, external validity for differentiation of the mood and behavioral components of irritability was also supported by associations between irritable mood and impairment and clinical measures of depression and mania, which were not associated with disruptive behavior. Conclusions Psychometric and external validity data suggest both overlapping and specific features of the mood vs. disruptive behavior dimensions of irritability.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Irritable Mood , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Mood Disorders/diagnosis , Problem Behavior , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Outpatient Clinics, Hospital , Irritable Mood/physiology , Reproducibility of Results , Factor Analysis, Statistical , Diagnosis, Differential , Tertiary Care CentersABSTRACT
Objective: To investigate the clinical differences between intermittent explosive disorder (IED) (disorder of aggression primarily directed towards others) and nonsuicidal self-injury (NSSI) (disorder of aggression predominantly directed towards the self) in order to better understand the different clinical subtypes of aggression. Methods: We used treatment-seeking samples to compare demographic and clinical correlates between 82 participants with IED and 55 participants with NSSI. Results: The IED group was older, more likely to be male, in a relationship, and employed than the NSSI group. With respect to clinical variables, the NSSI group had more severe depressive symptoms and more social adjustment difficulties. Regarding psychiatric co-morbidities, the IED group had higher rates of generalized anxiety disorder. On the other hand, the NSSI group had higher rates of major depressive disorder, agoraphobia, substance use disorder, and bulimia nervosa. Conclusions: Individuals with NSSI may benefit from better management of psychiatric comorbidities, specifically depressive symptoms and social adjustment difficulties. Conversely, the treatment of individuals with IED may be improved by targeting comorbid generalized anxiety disorder. Our results provide important insight for the development of tailored interventions for specific subtypes of aggression.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Self-Injurious Behavior/psychology , Disruptive, Impulse Control, and Conduct Disorders/psychology , Anxiety Disorders , Socioeconomic Factors , Comorbidity , Sex Factors , Age Factors , Self-Injurious Behavior/diagnosis , Self-Injurious Behavior/therapy , Aggression/psychology , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/therapy , Impulsive Behavior , AngerABSTRACT
Introducción: La Escala de Impulsividad de Barratt (BIS) es uno de los instrumentos más frecuentemente usados para evaluar la impulsividad. Este artículo describe la confiabilidad y validez de la BIS-11 en adolescentes chilenos. Sujetos y Métodos: El estudio se efectuó en estudiantes de enseñanza media (n = 763). La confiabilidad se evaluó con análisis de consistencia interna y homogeneidad de los ítems. Para la validez se empleó coeficiente de correlación de Pearson y prueba t de student para muestras independientes. Resultados: La escala obtuvo un coeficiente alfa de Cronbach de 0,77 y su puntaje total correlacionó significativamente con impulsividad según DSM IV, impulsividad según reporte del profesor, intento de suicidio y consumo de alcohol. Conclusiones: La BIS-11 es una medida de impulsividad con adecuada confiabilidad y validez en esta población.
Background: The Barratt Impulsivity Scale (BIS) is one of the most commonly used scales for the assessment of impulsiveness. This report describes the reliability and validity of the BIS-11. Subjects and Methods: The study was conducted in high school students (n = 763). The reliability was evaluated with analysis of internal consistency and homogeneity of the items. For the validity Pearson coefficient of correlation and the student t-test for independent sample were used. Results: The scale obtained a Cronbach alpha coefficient of 0,77, and the total scores of the scale correlated significantly with impulsivity according to DSMIV, impulsivity according to the teacher, suicide attempt and alcohol consumption. Conclusions: The BIS-11 is a valid and reliable measure of impulsivity in this population.
Subject(s)
Humans , Male , Adolescent , Female , Impulsive Behavior , Surveys and Questionnaires , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Chile , Psychometrics , Reproducibility of ResultsSubject(s)
Adult , Cognitive Behavioral Therapy , Combined Modality Therapy , Compulsive Behavior/diagnosis , Compulsive Behavior/psychology , Compulsive Behavior/therapy , Female , Fluvoxamine/therapeutic use , Humans , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/psychology , Disruptive, Impulse Control, and Conduct Disorders/therapy , Treatment OutcomeABSTRACT
OBJETIVO: Com a inclusão das novas tecnologias contemporâneas, a Internet e os jogos eletrônicos tornaram-se ferramentas de uso amplo e irrestrito, transformando-se em um dos maiores fenômenos mundiais da última década. Diversas pesquisas atestam os benefícios desses recursos, mas seu uso sadio e adaptativo progressivamente deu lugar ao abuso e à falta de controle ao criar severos impactos na vida cotidiana de milhões de usuários. O objetivo deste estudo foi revisar de forma sistemática os artigos que examinam a dependência de Internet e jogos eletrônicos na população geral. Almejamos, portanto, avaliar a evolução destes conceitos no decorrer da última década, assim como contribuir para a melhor compreensão do quadro e suas comorbidades. MÉTODO: Foi feita uma revisão sistemática da literatura através do MedLine, Lilacs, SciELO e Cochrane usando-se como parâmetro os termos: "Internet addiction", pathological "Internet use", "problematic Internet use", "Internet abuse", "videogame", "computer games" e "electronic games". A busca eletrônica foi feita até dezembro de 2007. DISCUSSÃO: Estudos realizados em diferentes países apontam para prevalências ainda muito diversas, o que provavelmente se deve à falta de consenso e ao uso de diferentes denominações, dando margem à adoção de distintos critérios diagnósticos. Muitos pacientes que relatam o uso abusivo e dependência passam a apresentar prejuízos significativos na vida profissional, acadêmica (escolar), social e familiar. CONCLUSÕES: São necessárias novas investigações para determinar se esse uso abusivo de Internet e de jogos eletrônicos pode ser compreendido como uma das mais novas classificações psiquiátricas do século XXI ou apenas substratos de outros transtornos.
OBJECTIVE: With the introduction of the new technologies to our daily lives, the Internet and electronic games have become widely and unrestrictedly used tools and one of the major global phenomena in the last decade. Several investigations have attested the benefits from such resources; however, their healthy, adaptive use progressively gave place to their abuse and the lack of control, which have severely impacted on the daily life of millions of users. The objective of this study was to systematically review the articles looking into Internet and electronic games addiction in the general population. We intend, therefore, to evaluate the progression of these concepts in the course of the last decade, as well as contributing to better understand this condition and its comorbidities. METHOD: A systematic literature review was conducted by means of MedLine, Lilacs, SciELO, and Cochrane using the following terms as a parameter: "Internet addiction", "pathological internet use", "internet abuse", "videogame" , "computer games" and "electronic games". The electronic search was done up to December 2007. DISCUSSION: Studies conducted in distinct countries still indicate very different prevalence rates; this is probably due to the absence of consensus and the use of diverse names, which brings about the adoption of distinct diagnostic criteria. Many patients reporting abusive use and dependence show significant consequences to their professional, academic (school), social and family lives. CONCLUSIONS: Further investigations are needed to determine whether this abusive Internet and electronic game use should be understood as one of the newest psychiatric classifications of the 21st century or just substrates of other disorders.
Subject(s)
Humans , Behavior, Addictive/psychology , Disruptive, Impulse Control, and Conduct Disorders/psychology , Internet , Video Games/psychology , Behavior, Addictive/diagnosis , Behavior, Addictive/epidemiology , Comorbidity , Diagnostic and Statistical Manual of Mental Disorders , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , International Classification of Diseases , PrevalenceABSTRACT
O jogo patológico é um transtorno do controle do impulso que está ganhando mais e mais atenção. Este artigo revisa os critérios diagnósticos e os instrumentos de rastreamento para o jogo patológico, bem como os índices de prevalência desse transtorno ao redor do mundo, com ênfase na situação do jogo de azar no Brasil. Os tratamentos para o jogo patológico são também descritos, incluindo tanto as abordagens psicossociais como as farmacológicas. O jogo patológico é altamente comórbido com outros transtornos psiquiátricos, incluindo abuso de substâncias e depressão e poucos jogadores patológicos buscam tratamento para seus problemas com o jogo de azar. Portanto, recomenda-se a procura direta de problemas com o jogo de azar. É necessário melhorar a educação sobre o transtorno, tanto sob a perspectiva do cuidador como da sociedade, a fim de reduzir as conse-qüências pessoais e sociais desse transtorno.
Pathological gambling is a disorder of impulse control that is gaining more and more attention. This paper reviews diagnostic criteria and screening instruments for pathological gambling, as well as the prevalence rates of this disorder worldwide, with an emphasis on gambling in Brazil. Treatments for pathological gambling are also described, including both psychosocial and pharmacological approaches. Pathological gambling is highly comorbid with other psychiatric disorders, including substance abuse and depression, and few pathological gamblers seek treatment for their gambling problems. Therefore, direct screening for gambling problems is recommended. Increasing education about the disorder, from both the provider and societal perspective, is necessary to reduce the personal and societal consequences of this disorder.
Subject(s)
Humans , Gambling , Antidepressive Agents/therapeutic use , Comorbidity , Cross-Cultural Comparison , Diagnostic and Statistical Manual of Mental Disorders , Gambling/psychology , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Disruptive, Impulse Control, and Conduct Disorders/therapy , Narcotic Antagonists/therapeutic use , Prevalence , Psychotherapy , Risk FactorsABSTRACT
OBJETIVO: O transtorno do comprar compulsivo foi descrito pela primeira vez como uma síndrome psiquiátrica no começo do século XX. Sua classificação permanece incerta e os investigadores têm debatido uma correlação potencial com transtornos do humor, transtorno obsessivo-compulsivo e transtornos do impulso. O objetivo deste estudo é apresentar uma revisão de transtorno do comprar compulsivo e um relato de caso. MÉTODO: Duas bases de dados foram investigadas (Medline e PsycINFO) em busca de artigos publicados nos últimos 40 anos. Os unitermos selecionados foram "oniomania" e "compras compulsivas". Outros artigos relevantes também foram identificados por meio das listas de referências. RESULTADOS: O transtorno do comprar compulsivo é uma condição crônica e prevalente encontrada ao redor do mundo, que divide características comuns com transtornos do controle do impulso. Em amostras clínicas, mulheres perfazem mais de 80 por cento dos sujeitos. Sua etiologia é desconhecida, mas mecanismos neurobiológicos e genéticos têm sido propostos. O transtorno apresenta altas taxas de comorbidade com transtornos do humor, abuso de substâncias, transtornos alimentares e transtornos do controle do impulso. CONCLUSÃO: As recomendações terapêuticas derivadas da literatura e da experiência clínica sugerem que compradores compulsivos podem se beneficiar de intervenções psicossociais. Modelos de intervenção cognitivo-comportamental de grupo parecem promissores. Ensaios farmacológicos relatam resultados conflitantes. A identificação e o tratamento das comorbidades psiquiátricas são também um aspecto chave do tratamento. Para determinar a validade do transtorno do comprar compulsivo, os futuros trabalhos devem enfocar os achados psicopatológicos e neurobiológicos específicos à síndrome.
OBJECTIVE: Compulsive buying disorder was first described as a psychiatric syndrome in the early twentieth century. Its classification remains elusive, and investigators have debated its potential relationship to mood, substance use, obsessive-compulsive, and impulse control disorders. The objective of this study is to present a review of compulsive buying disorder and present a case vignette. METHOD: Two databases were reviewed (Medline and PsycINFO) in search for articles published in the last 40 years. Selected terms included oniomania, compulsive buying, and compulsive shopping. Other relevant articles were also identified through reference lists. RESULTS: Compulsive buying disorder is a prevalent and chronic condition that is found worldwide, sharing commonalities with impulse control disorders. In clinical samples, women make up more than 80 percent of subjects. Its etiology is unknown, but neurobiologic and genetic mechanisms have been proposed. The disorder is highly comorbid with mood, substance use, eating and impulse control disorders. CONCLUSIONS: Treatment recommendations derived from the literature and clinical experience suggest that problem shoppers can benefit from psychosocial interventions. Cognitive-behavioral group models appear promising. Medication trials have reported mixed results. The identification and treatment of psychiatric comorbidity is also a key aspect of treatment. In order to determine the validity of compulsive buying disorder, future work should focus on psychopathology and neurobiological findings unique to the syndrome.
Subject(s)
Female , Humans , Male , Middle Aged , Commerce , Obsessive-Compulsive Disorder , Chronic Disease , Cognitive Behavioral Therapy/methods , Comorbidity , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Disruptive, Impulse Control, and Conduct Disorders/psychology , Disruptive, Impulse Control, and Conduct Disorders/therapy , Narcotic Antagonists/therapeutic use , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/epidemiology , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/therapy , Psychotropic Drugs/therapeutic useABSTRACT
OBJECTIVES: Kleptomania, a disabling impulse control disorder, is characterized by the repetitive and uncontrollable theft of items that are of little use to the afflicted person. Despite its relatively long history, kleptomania remains poorly understood to the general public, clinicians, and sufferers. METHOD: This article reviews the literature for what is known about the clinical characteristics, family history, neurobiology, and treatment options for individuals with kleptomania. RESULTS: Kleptomania generally has its onset in late adolescence or early adulthood and appears to be more common among women. Lifetime psychiatric comorbidity is frequent, mainly with other impulse control (20-46 percent), substance use (23-50 percent) and mood disorders (45-100 percent). Individuals with kleptomania suffer significant impairment in their ability to function socially and occupationally. Kleptomania may respond to cognitive behavioral therapy and various pharmacotherapies (lithium, anti-epileptics, and opioid antagonists). CONCLUSIONS: Kleptomania is a disabling disorder that results in intense shame, as well as legal, social, family, and occupational problems. Large scale treatment studies are needed.
OBJETIVOS: A cleptomania, um transtorno incapacitante do controle dos impulsos, caracteriza-se pelo furto repetitivo e incontrolável de itens que são de pequena utilidade para a pessoa acometida por esse transtorno. Apesar de seu histórico relativamente longo, a cleptomania continua sendo pouco entendida pelo público geral, pelos clínicos e pelos que dela sofrem. MÉTODO: Este artigo revisa a literatura sobre o que se sabe a respeito das características clínicas, histórico familiar, neurobiologia e opções de tratamento para indivíduos com cleptomania. RESULTADOS: A cleptomania geralmente tem seu início no final da adolescência ou no início da vida adulta, e parece ser mais comum em mulheres. A comorbidade psiquiátrica ao longo da vida com outros transtornos de controle de impulsos (20-46 por cento), de uso de substâncias (23-50 por cento) e de humor (45-100 por cento) é freqüente. Indivíduos com cleptomania sofrem de prejuízo significativo em sua capacidade de funcionamento social e ocupacional. A cleptomania pode responder ao tratamento com terapia cognitivo-comportamental e com várias farmacoterapias (lítio, antiepilépticos e antagonistas de opióides). CONCLUSÕES: A cleptomania é um transtorno incapacitante que resulta em uma vergonha intensa, bem como problemas legais, sociais, familiares e ocupacionais. São necessários estudos de tratamento em ampla escala.
Subject(s)
Female , Humans , Middle Aged , Disruptive, Impulse Control, and Conduct Disorders , Antidepressive Agents/therapeutic use , Chronic Disease , Comorbidity , Diagnostic and Statistical Manual of Mental Disorders , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/psychology , Disruptive, Impulse Control, and Conduct Disorders/therapy , Narcotic Antagonists/therapeutic use , Psychotherapy/methods , Selective Serotonin Reuptake Inhibitors/therapeutic useABSTRACT
Jogo patologico e uma transtorno psiquiatrico cujo diagnostico operacional foi formalizado recentemente. Tambem chamado de jogo compulsivo, esse transtorno e hoje classificado dentre os transtornos do impulso e como tal ainda aguarda melhor caracterizacao psicopatologica. Em decorrencia da exploracao comercial do jogo, a expressao do jogo patologico deve aumentar na populacao, o que impoe a necessidade de superacao da atual falta de informacao e desconhecimento em relacao a esse diagnostico...
Subject(s)
Humans , Gambling/psychology , Disruptive, Impulse Control, and Conduct Disorders/therapy , Cognitive Behavioral Therapy , Comorbidity , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/pathologyABSTRACT
Os autores relatam um caso de impulso sexual excessivo em comorbidade com ciclotimia e transtorno alimentar sem outra especificacao. Ressalta-se a importancia do diagnostico desse transtorno sexual na evolucao do caso por meio de uma breve revisao sobre o tema e de uma comparacao com as descricoes e propostas terapeuticas da literatura
Subject(s)
Humans , Female , Adult , Comorbidity , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Sexual Dysfunctions, Psychological/diagnosis , Psychotherapy , Histrionic Personality Disorder/diagnosisABSTRACT
Se revisan las patologías incluidas en este grupo de trastornos, sus antecedentes históricos y principales teorías etiológicas. Se destacan los aspectos forenses y se incluyen algunos antecedentes nacionales
Subject(s)
Humans , Trichotillomania/diagnosis , Firesetting Behavior/diagnosis , Gambling/psychology , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Self-Help Groups , Trichotillomania/etiology , Trichotillomania/psychology , Trichotillomania/epidemiology , Age of Onset , Firesetting Behavior/etiology , Firesetting Behavior/psychology , Firesetting Behavior/epidemiology , Disruptive, Impulse Control, and Conduct Disorders/etiologyABSTRACT
En este trabajo se presenta una escala diseñada para evaluar la dimensión impulsividad en la prueba de Rorschach, que predicen dificultad o pérdida en el control de los impulsos y los pondera en 5 categorías: ausente, leve, moderada, severa y muy severa. se aplicó la EIR a 20 protocolos Rorschach, correspondientes a 10 pacientes impulsivos, de acuerdo a criterios clínicos. Se encontró concordancia entre la impulsividad evaluada clínicamente en 19 de los protocolos estudiados. Se concluye que la EIR puede ser un instrumento útil para evaluar la impulsividad