Adaptation and validation of a German version of the Dickman impulsivity inventory for the assessment of functional and dysfunctional impulsivity.

Impulsive behavior tends to have a negative connotation in the sense that it is usually associated with detrimental or dysfunctional outcomes. However, under certain circumstances, impulsive behaviors may also have beneficial or functional outcomes. Dickman's Impulsivity Inventory (DII) measures these two distinct aspects of impulsivity, namely, dysfunctional impulsivity (the tendency to act with less forethought than do most people which leads to difficulties) and functional impulsivity (the tendency to act with little forethought when the situation is optimal). In the present study, we translated the DII into German and validated the German version in a sample of 543 adults. The original 23-item model was considered unsuitable for the German version as suggested by fit indices of a confirmatory factor analysis. Exploratory factor analyses rather supported a 16-item version. Further psychometric analyses and inferential statistical analyses on the final German DII indicated its appropriateness for use in German-speaking populations and support a two-factor solution of the DII. Finally, exploratory analyses on the German DII suggest differential relationships between dysfunctional and functional impulsivity and self-reported lifestyle-related variables (smoking, alcohol usage, and sports behavior).

Prolactinomas.

Hyperprolactinemia, defined by a level of serum prolactin above the standard upper limit of normal range, is a common finding in clinical practice and prolactinomas are the main pathological cause. Prolactinomas lead to signs and symptoms of hormone oversecretion, such as galactorrhea and hypogonadism, as well as symptoms of mass effect, including visual impairment, headaches and intracranial hypertension. Diagnosis involves prolactin measurement and sellar imaging, but several pitfalls are involved in this evaluation, which may difficult the proper management. Treatment is medical in the majority of cases, consisting of dopamine agonists, which present high response rates, with a very favorable safety profile. Major adverse effects that should be monitored consist of cardiac valvulopathy and impulse control disorders. Other treatment options include surgery and radiotherapy. Temozolomide may be used for aggressive or malignant carcinomas. Finally, pregnancy outcomes are similar to general population even when dopamine agonist treatment is maintained.

Differentiating irritable mood and disruptive behavior in adults

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.

Screening for Problematic Internet Use.

Problematic Internet use (PIU) by adolescents is of growing concern among both parents and pediatricians. Early controversies may have contributed to challenges in defining and measuring PIU. A variety of screening tools have evolved, aligned with different constructs of PIU, although a validated screening tool does exist. Current data and American Academy of Pediatrics policy reflect evidence-driven screening for PIU for all youth.

Aggression directed towards others vs. aggression directed towards the self: clinical differences between intermittent explosive disorder and nonsuicidal self-injury

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.

Screening for Problematic Internet Use May Help Identify Impulse Control Disorders in Parkinson's Disease.

BACKGROUND: Impulse control disorders in Parkinson's disease (PD) represent emerging problems with potentially devastating consequences. The standard screening methods for impulse control disorders are clinically imperfect. Although it is rarely reported, many patients utilize the Internet to fulfill their compulsive behaviors because of its easy accessibility. We designed a study to test the hypothesis that an active screening for excessive Internet use and Internet addiction might improve the sensitivity of identification of impulse control disorders. METHODS: The standard screening method included the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease and the modified Minnesota Impulsive Disorders Interview. In the second round, the Problematic Internet Use Questionnaire was also assessed for detecting excessive Internet use. RESULTS: While the standard approach identified 19 patients out of 106 (17.9%) with any type of impulse control disorders, screening for the problematic Internet use detected 29 patients with impulse control disorders (27.4%) having significantly better efficacy over the standard method (p = 0.004, the McNemar test). CONCLUSIONS: Our study suggests that the screening for problematic Internet use by the Problematic Internet Use Questionnaire is an effective, feasible, and easy-to-use add-on method for identifying PD patients with impulse control disorders more efficiently and probably at earlier stages.

Dopamine Agonist-Induced Impulse Control Disorders in Patients With Prolactinoma: A Cross-Sectional Multicenter Study.

CONTEXT: Dopamine agonist (DA)-induced impulse control disorder (ICD) in patients with prolactinomas is not sufficiently known. OBJECTIVE: To evaluate the prevalence of DA-induced ICDs and possible risk factors related to these disorders in patients with prolactinoma. DESIGN, SETTING, AND PARTICIPANTS: This is a cross-sectional multicenter study involving 308 patients with prolactinoma followed up in tertiary referral centers who received at least three months of DA therapy. DA-induced ICDs (pathological gambling, hypersexuality, compulsive shopping, and compulsive eating) and impulsivity were assessed using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson Disease and the Barratt Impulsiveness Scale-11, respectively. Patients were evaluated in terms of parameters related to ICD development. RESULTS: Any ICD prevalence was 17% (n = 51). Hypersexuality was most common (6.5%). Although any ICD and hypersexuality were more common in male patients (P = 0.009, P < 0.001, respectively), compulsive eating was more common in female patients (P = 0.046). Current smoking, alcohol use, and gambling history were more frequent (P = 0.033, P = 0.002, P = 0.008, respectively) in patients with any ICD. In Barratt Impulsiveness Scale-11 total, attentional, motor, and nonplanning scores were higher in patients with any ICD (P < 0.001). Current smoking and alcohol use were more frequent (P = 0.007, P = 0.003, respectively) and percentage increase of testosterone levels at last visit was higher (P = 0.021) in male patients with prolactinomas with hypersexuality. CONCLUSION: Any ICD may be seen in one of six patients with prolactinoma who are receiving DA therapy. Endocrinology specialists should be aware of this side effect, particularly in male patients with a history of gambling, smoking, or alcohol use.

[What nosographic framework for excessive tanning?]. / Quel cadre nosographique pour le bronzage excessif ?

BACKGROUND: Socially valorised tanning, like other forms of behaviour, can take on an addictive aspect. Excessive tanning, defined by the presence of impulsivity and repetition of tanning that leads to personal distress, is a psychiatric disorder that has only recently been recognized. This finding is based on the observations of many dermatologists who report an addictive relationship in their patients with tanning cabins despite announcement of the diagnosis of malignant melanoma. OBJECTIVE: This article attempts to synthesize the existing literature on excessive tanning and addiction to investigate possible associations. This review focuses on the prevalence, clinical features, aetiology, and treatment of this disorder. METHODS: The literature review was conducted from 1983 to 2012, using PubMed, Google Scholar, EMBASE, and PsycInfo, using the following keywords alone or combined: Tanning, Addiction, Sunbeds, Skin cancer prevention, and Treatment. We investigated different models to determine how excessive tanning met these criteria. RESULTS: Excessive Tanning was described in the 2000s by an American dermatologist, Carolyn Heckman. Wartham et al. were the first to have proposed a theoretical framework for addiction to sunbathing, as well as two scales (m CAGE and m DSM IV) for the diagnosis and to assess the degree of addiction. These diagnostic criteria describe the craving like-symptoms, the feeling of losing control, or the continuation of the behavior despite knowledge of negative consequences. Excessive Tanning is not present in the classifications of the DSM or ICD, but may be related to Addiction, Obsessive-Compulsive Disorder, Impulse control disorders, Anorexia, or Body Dysmorphic Disorder. CONCLUSION: Excessive tanning can be included in the spectrum of behavioural addictions due its clinical characteristics in common with classics addictive disorders. They are a variety of other models, which may offer an explanation for or insight into tanning behaviour. Further studies must be controlled, notably on clinical psychopathology, neurobiology and management to improve our understanding of excessive tanning.

Confiabilidad y validez de la escala de impulsividad de Barratt (BIS-11) en adolescentes / Reliability and validity of Barratt impulsiveness scale (BIS-11) in adolescents

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.

Reliability and validity of the SPAID-G checklist for detecting psychiatric disorders in adults with intellectual disability.

SPAID (Psychiatric Instrument for the Intellectually Disabled Adult) is the first Italian tool-package for carrying out psychiatric diagnosis in adults with Intellectual Disabilities (ID). It includes the "G" form, for general diagnostic orientation, and specific checklists for all groups of syndromes stated by the available classification systems. SPAID was established to provide an easy and quick tool for daily practice of the personnel working with ID. The present study was aimed at evaluating psychometric and psychodiagnostic characteristics of the SPAID-G and at supplying new data on the prevalence rate of psychiatric disorders in a multicentric Italian sample of people with ID living in different settings. The SPAID-G was randomly applied to 304 participants with ID attending residential facilities or assessment services across Italy. A part of the sample was also consecutively assessed through the use of DASH, PDD-MRS and by the clinical application of the DSM-IV TR criteria. The correlation between SPAID-G scores and those provided by other evaluation tools was over 60%. Additionally, the internal consistency and inter-rater reliability resulted to be good. Psychopathological symptoms were detected in approximately 40% of the sample. Respectively, autistic spectrum disorders, impulse control disorders, mood disorders, and dramatic personality disorders were the diagnostic orientations providing the most prevalent over-threshold scores. SPAID-G seems to be a valid diagnostic tool, quick and easy to use in psychiatric disorders assessment within the Italian population with ID.

[Prevalence of pathological gambling in the general population around Paris: preliminary study]. / Prévalence du jeu pathologique en Île de France. Étude préliminaire.

INTRODUCTION: Pathological gambling is characterized in the DSM IV-TR as one of the disorders of impulse control. Problem gambling is also part of what is considered as behavioural addictions, the criteria of which have been defined by Goodman, with intrusive thoughts about the game, spending more and more to play, unable to control, reduce or stop gambling despite negative consequences, etc. AIM OF THE STUDY: There is no epidemiological study in France on the prevalence of pathological gambling. We wanted to study the prevalence of pathological gambling in a sample of 529 persons: 368 gamblers of Pari Mutuel Urbain and La Française des Jeux, and 161 persons in the general population. The study took place between January 2008 and June 2009. METHODS: As instruments, we used: the South Oaks Gambling Scale (SOGS) for screening of pathological gambling and the BIS-10 for impulsiveness' evaluation, the HAD scale to assess anxiety and depression and the ASRS for the evaluation of attention deficit disorder/hyperactivity disorder (ADHD). RESULTS: The rate of pathological gambling in the general population is 1.24% (this result is similar to those found in other places, such as in Quebec). In the general population, the rate of play at risk is of 5.59%. Among the population of gamblers, the rate for pathological gambling (JP) amounted to 9.23% and risk gambling to 10.86%. Men are overrepresented in the group of pathological gamblers (88.9%), also with consumption of alcohol and tobacco. Suicide attempts are more important than in the general population, but the difference was statistically significant. Depression and anxiety are particularly high, 40% of gamblers with an anxiety score significantly higher. DISCUSSION: The results indicate rates close to those of other countries, such as Canada. It would be necessary to establish follow-up studies of populations and patients, as well as specific studies on people who frequent casinos, racetracks and internet gambling. The importance of the phenomenon is obvious, because almost 20% of players have a gambling problem or risk and these people do not consult despite their psychological problems, family, work, debts.

Lifetime history of cigarette smoking associated with aggression and impulsivity in both healthy and personality disordered volunteers.

Cigarette smoking has been associated with several personality and behavioral traits including impulsivity and aggression, primarily in adolescents and/or pregnant women. In this study, the authors tested the hypothesis that history of cigarette smoking is also associated with dimensional measures of aggression and impulsivity in adult subjects. Subjects were 179 personality disordered (PD), and healthy volunteer control (HV), subjects in whom history of cigarette smoking and measures of both aggression and impulsivity were collected. Scores on measures of both aggression and impulsivity were elevated as a function of personality disorder status and history of cigarette smoking status; no interaction between these two factors were noted on these measures. Including socio-economic status and global psychosocial functioning in the model eliminated the difference associated with diagnostic grouping and impulsivity but not the difference in aggression associated with lifetime history of smoking. These data suggest that lifetime history of cigarette smoking is associated with elevations in life history of aggression regardless of the presence of psychiatric disorder in nontreatment seeking individuals.

Impulse control disorders and dopaminergic treatments in Parkinson's disease.

A group of disorders sharing a failure to resist an impulse to perform a typically pleasurable activity that is finally harmful to the person or to others are known under the common denomination of impulse control disorders (ICDs). These behaviors, possibly previously neglected by lack of awareness, are increasingly reported among PD patients. Compelling evidence has stressed the relation between dopaminergic replacement and development of ICDs in PD, especially but not exclusively, with dopamine agonist therapy. Besides dopaminergic replacement, younger age, smoking habit, presence of familiar gambling problems and alcohol abuse can increase the risk. ICDs in PD may greatly affect patients and caregivers quality of life, stressing the importance of their screening. Management strategies include a careful use of dopaminergic therapy using the lowest effective doses.

Stealing among high school students: prevalence and clinical correlates.

Although stealing among adolescents appears to be fairly common, an assessment of adolescent stealing and its relationship to other behaviors and health problems is incompletely understood. A large sample of high school students (n = 3,999) was examined by self-report survey with 153 questions concerning demographic characteristics, stealing behaviors, other health behaviors including substance use, and functioning variables, such as grades and violent behavior. The overall prevalence of stealing was 15.2 percent (95% confidence interval (CI), 14.8-17.0). Twenty-nine (0.72%) students endorsed symptoms consistent with a diagnosis of DSM-IV-TR kleptomania. Poor grades, alcohol and drug use, regular smoking, sadness and hopelessness, and other antisocial behaviors were all significantly (p < .05) associated with any stealing behavior. Stealing appears to be fairly common among high school students and is associated with a range of potentially addictive and antisocial behaviors. Significant distress and loss of control over this behavior suggest that stealing often has significant associated morbidity.

Subtyping study of a pathological gamblers sample.

OBJECTIVE: To classify into subgroups a sample of pathological gambling (PG) patients according to personality variables and to describe the subgroups at a clinical level. METHOD: PG patients (n = 1171) were assessed with the South Oaks Gambling Screen; the Temperament and Character Inventory-Revised; the Symptom Checklist-90-Revised; Eysenck's Impulsivity Scales, a diagnostic questionnaire for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) PG criteria; and the Structured Clinical Interview for the DSM-IV, Axis I disorders, substance use module. Clinical measures were collected through a semi-structured interview. We performed a 2-step cluster analysis based on the above-mentioned personality variables. Clinical data were compared across clusters. RESULTS: Four clusters were generated. Type I (disorganized and emotionally unstable) showed schizotypic traits, high impulsiveness, substance and alcohol abuse, and early age of onset, as well as psychopathological disturbances. Type II (schizoid) showed high harm avoidance, social aloofness, and alcohol abuse. Type III (reward sensitive) showed high sensation seeking and impulsiveness but no psychopathological impairments. Type IV (high-functioning) showed a globally adaptive personality profile, low level of substance and alcohol abuse or smoking, and no psychopathological disturbances. CONCLUSIONS: At least 4 types of PG patients may be identified. Two types showed a response modulation deficit, but only one of them had severe psychopathological disturbances. Two other types showed no impulsiveness or sensation seeking and one of them even exhibited good general functioning. The different personality and clinical configuration of these clusters might be linked to different therapeutic approaches.

Episodic dyscontrol syndrome.

Episodic dyscontrol syndrome (EDS) or intermittent explosive disorder (IED) is a clearly identified category in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). It affects children and adults. Children are often considered to have epilepsy or a mental health problem. The episodes comprise of recurrent attacks of uncontrollable rage, usually after minimal provocation, and may last up to an hour. Following an episode, children are frequently exhausted, may sleep and will usually have no recall. These features often raise the possibility of epilepsy, and children may be referred for an electroencephalogram (EEG). An abnormal EEG may subsequently lead to a diagnosis of epilepsy and the prescription of an anticonvulsant. Five patients with EDS are described, all referred to a single neurology clinic with a possible diagnosis of epilepsy, one of whom was being treated with an anticonvulsant. Four had an EEG, which was normal in two patients and showed "abnormalities" in two, leading to an incorrect diagnosis of temporal lobe epilepsy in one patient. All five children responded to psychological (behavioural) intervention. Recognition of the clinical features of IED/EDS should preclude the need for EEG and other investigations in these patients and prompt referral to psychological services.

Unhealthy aggression: intermittent explosive disorder and adverse physical health outcomes.

OBJECTIVE: To examine the relationship between Intermittent Explosive Disorder (IED; a psychiatric diagnosis characterized by episodes of affective aggression) and adverse physical health outcomes. DESIGN: A large epidemiological sample drawn from the Collaborative Psychiatric Epidemiological Surveys (N = 10,366), was used to compare participants with a lifetime diagnosis of IED (n = 929) to those without any history of IED (n = 9,437) on demographic variables (age, education, gender, race) common risk factors (smoking status, body mass index, substance use disorders, past accident or injury requiring treatment, major depression) and the presence of 12 adverse health outcomes. MAIN OUTCOME MEASURES: History of heart attacks, coronary heart disease, hypertension, stroke, lung disease, diabetes, cancer, arthritis, back/neck pain, ulcer, headaches, and other chronic pain. RESULTS: Logistic regression analysis controlling for demographic and other risk factors indicated that IED was associated with 9 of the 12 adverse physical health outcomes (coronary heart disease, hypertension, stroke, diabetes, arthritis, back/neck pain, ulcer, headaches, and other chronic pain). Only cancer, heart attacks, and lung disease were not significantly related to IED. CONCLUSION: IED may be a risk factor for several significant adverse physical health outcomes.

Mutations in LGI1 gene in Japanese families with autosomal dominant lateral temporal lobe epilepsy: the first report from Asian families.

Autosomal dominant lateral temporal lobe epilepsy (ADLTE) caused by LGI1 (leucine-rich gene, glioma-inactivated-1) mutations is a rare familial epileptic syndrome characterized by the auditory ictal manifestation and rare nocturnal generalized seizures. We have examined the sequence of the LGI1 gene in four Japanese families with lateral temporal lobe epilepsy having characteristic auditory features, and identified one novel (1421G>A), and one reported (1418C>T) point mutation each in two families. These two mutations were 3 bp apart in the LGI1 gene and caused adjoining amino acid substitutions. The two families presented different clinical phenotypes and seizure control to drug treatment. These findings suggest that LGI1 mutations in Japanese ADLTE families may not be uncommon, and that diverse clinical phenotypes make adequate diagnosis of ADLTE difficult when only based on clinical information.