Disordered Aggression and Violence in the United States.

OBJECTIVE: To determine the prevalence and correlates of DSM-5 intermittent explosive disorder and related aggressive disorders in the United States. METHODS: Community survey data (collected between 2001-2004) from the National Comorbidity Survey-Replication (NCS-R) and Adolescent Supplement (NCS-AS) involving 10,148 adolescents and 9,282 adults, respectively, were reanalyzed with recurrent aggressive behavior defined as 3 serious aggressive outbursts in any given year. In addition to prevalence, assessments of aggression severity, property damage, injury to others, intimate partner assault, utilization of guns and weapons to threaten, and treatment utilization for recurrent aggressive behavior were also assessed. RESULTS: About 17% of adolescents and 8% of adults report a pattern of recurrent aggressive outbursts within at least 1 year. Such individuals are much more aggressive and impulsive than nonaggressive controls and are more likely to engage in intimate partner assault, carry and use guns and other weapons to threaten others, and be arrested by law enforcement. Few aggressive individuals speak with health care providers about this behavior, and fewer receive treatment for aggression. CONCLUSION: Recurrent aggressive behavior is common in both adolescents and adults, with clinically significant consequences to those with this pattern and to others in their environment (ie, using guns and other weapons to threaten others). While this type of behavior can be reduced though pharmacologic/psychosocial treatment intervention, the vast majority of aggressive individuals do not engage in treatment for their aggressive behavior. Screening individuals for such behavior in one's practice may do much toward identifying this problem and bringing such individuals into treatment.

Aspirations, Expectations and Delinquency: The Moderating Effect of Impulse Control.

Although prior research finds a robust link between delinquent behavior and expectations, or an adolescent's perceived likelihood of obtaining one's future goals, fewer studies have evaluated aspirations, or the perceived importance of achieving one's goals. In addition, few studies consider how individual traits such as impulsivity affect the degree to which expectations and aspirations motivate or deter delinquent behavior. We contribute to this body of research by evaluating the independent effects of expectations and aspirations, and the aspiration-expectation gap (i.e., strain) on delinquent behavior during the year following an adolescent's first arrest using a large (N = 1117), racially/ethnically diverse sample of male adolescents (46.55% Latino, 35.81% Black, 14.95% White, and 2.69% Other race). In addition, we considered how impulse control interacts with expectations, aspirations, and strain to motivate behavior. Our results indicated that both aspirations, expectations and strain uniquely influence criminal behavior. Importantly, aspirations interacted with impulse control, such that aspirations affected delinquency only among youth with higher impulse control. Our findings suggest that aspirations may only influence behavior if youth also have the psychosocial capabilities to consider their future aspirations when behaving in the present.

Individual in Context: The Role of Impulse Control on the Association between the Home, School, and Neighborhood Developmental Contexts and Adolescent Delinquency.

Social ecological theories and decades of supporting research suggest that contexts exert a powerful influence on adolescent delinquency. Individual traits, such as impulse control, also pose a developmental disadvantage to adolescents through increasing risk of delinquency. However, such individual differences may also predispose some youth to struggle more in adverse environments, but also to excel in enriched environments. Despite the prominence of impulse control in both developmental and criminological literatures, researchers are only beginning to consider impulse control as an individual characteristic that may affect developmental outcomes in response to environmental input. Using a racially diverse (Latino 46 %; Black 37 %; White 15 %; other race 2 %) sample of 1,216 first-time, male, juvenile offenders from the longitudinal Crossroads Study, this study examined key interactions between baseline impulse control and the home, school, and neighborhood contexts in relation to delinquency within the following 6 months. The results indicated that even after accounting for prior delinquency, youth in more negative home, school, and neighborhood contexts engaged in the same amount of delinquency in the following 6 months regardless of their level of impulse control. However, the effects of positive home, school, and neighborhood contexts on delinquency were stronger for youth with moderate or high impulse control and minimally affected youth with low impulse control. The findings suggest two risk factors for delinquency: low impulse control as a dispositional vulnerability that operates independently of developmental context, and a second that results from a contextual vulnerability.

Treating kleptomania: cross-cultural adaptation of the Kleptomania Symptom Assessment Scale and assessment of an outpatient program.

BACKGROUND: Kleptomania is characterized by repetitive stealing and has severe consequences for patients. Stigma, a lack of standardized therapy and a limited number of assessment tools hinder advances in treatment. This study provides preliminary data on the Portuguese-language version of the Kleptomania Symptom Assessment Scale (P-K-SAS) and preliminary data on an outpatient program. METHODS: Experts in the field analyzed an initial P-K-SAS version, produced through translation/back-translation, in order to arrive at a final version. Eight patients currently on cognitive-behavioral therapy (CBT) and 10 patients under maintenance CBT were initially assessed, then re-assessed 6months later. RESULTS: The mean P-K-SAS score was higher among patients initiating CBT than among those under maintenance CBT (21.1±8.0 vs. 11.3±7.5; Mann-Whitney U=15.0, P=.024). The final version of the P-K-SAS presented excellent reliability (Cronbach's alpha=0.980; inter-item correlation, 0.638-0.907). CONCLUSIONS: The P-K-SAS presented solid psychometrics and seems ready for use in assessing the effectiveness of treatments for kleptomania. The findings suggest that kleptomania patients need follow-up treatment that goes beyond the traditional 12-session structure.

Relationship of Internet addiction with impulsivity and severity of psychopathology among Turkish university students.

The previous studies have found a relationship between IA and both impulsivity and psychopathology when they were considered separately. The aim of this study was to investigate the relationship of Internet addiction (IA) with impulsivity and severity of psychopathology among Turkish university students. We also wanted to control the effect of impulsivity dimensions on the relationship between IA and psychopathology. A total of 319 university students from two universities in Ankara participated to the study. Students were assessed through the Internet Addiction Scale (IAS), the Symptom Checklist-Revised (SCL-90-R) and the Barratt Impulsiveness Scale-11 (BIS-11). Correlational analyses revealed that severity of IA was related to both SCL-90-R and BIS-11 scores. Among SCL-90-R subscales, severity of obsessive-compulsive symptoms (OCS) was the only predictor for IAS score. Hierarchical regression analysis indicated that interpersonal sensitivity, additional to attentional and motor impulsiveness, was the predictor of IAS score. Although severity of IA is associated with wide range of psychopathology, particularly OCS, interpersonal sensitivity seems to be the main dimension that predict severity of IAS additional to impulsiveness (attentional and motor). Impulsivity seems to be an important construct when considering IA and its treatment among Turkish university students.

[Validation of the dialectal Arabic version of Barratt's impulsivity scale, the BIS-11]. / Validation de la version en arabe dialectal de l'échelle d'impulsivité de Barratt, la BIS-11.

INTRODUCTION: Impulsivity is a symptom of several disorders such as personality disorder, bipolar disorder, suicidal behaviour, substance use disorders, schizophrenia...Forensic psychiatry is particularly concerned with impulsivity. It increases the risk of violence among clinical populations and figures in various instruments such as the HCR-20, the VRAG and the PCL-R to assess violence risk. It is one of many dimensions that can lead to aggressive behaviour among psychiatric patients. The Barratt Impulsiveness Scale (BIS), in its 11th version, is a 30-item self-report instrument that helps assessing impulsivity trait among normal and clinical populations. The BIS is the most commonly administered self-assessment of impulsiveness. As of March 2009, there have been 551 citations of the BIS-11 among many publications. The purpose of the present study is to examine the psychometric properties of the Arabic translation of the BIS-11th version in a sample of the general population and to identify an eventual correlation between impulsivity and socio-demographic characteristics. PATIENTS AND METHODS: This is a prospective study conducted over a five-month period, from June to October 2010, and including 134 persons from the general population having provided their informed consent. The dialectal Arabic version was carried out by translation from English to dialectal Arabic followed by a back translation to English. Some questions were modified to be understood by a population with low education. After giving their verbal informed consent, the participants filled in the Arabic version of the BIS-11. For the illiterate, responses and quotations were performed by the interviewer. The persons were also asked to fill in socio-demographic data. Cronbach's coefficient was calculated, and then we assessed impulsivity prevalence and a correlation between demographic features and impulsivity scores. For the analyses, the statistical software SPSS 11 was used. RESULTS: The sex ratio is 1.02. Most of the interviewed persons were 20 to 49 years old. Around 25.4% of the sample were analphabets, 32.1% had primary education, 29.1% had secondary education and 13.4% were undergraduates. The Cronbach's alpha was respectively 0.66 for attention, 0.72 for motor impulsivity, 0.61 for lack of planning and 0.78 for total impulsivity. Factor analysis identified three factors explaining the total variance of 32.6%. Impulsivity prevalence was 9%. We did not find significant correlation between demographic features and impulsivity scores. DISCUSSION: Limits of the study: scale stability over time was not verified. This was due to the difficulty in re-inviting the same persons to fulfil the scale a second time. Because no instrument for assessing exists in Arabic, comparison was not possible between the translated Barratt's scale and the reference. Our sample represents the general population. This choice was justified in order to study an eventual correlation between impulsiveness and socio-demographic characteristics. We must mention difficulties when asking persons with low education to complete the scale, what may have caused a poorer performance of the scale due to difficulties in understanding some questions. Moreover, we had chosen a non-clinical sample. The validation of the scale could be performed in a clinical population. The measure of internal consistency (Cronbach's alpha) fell within an acceptable range (0.61-0.78), suggesting that the Arabic version of the BIS-11 is reliable. Exploratory factor analysis of the current version identified three factors, but these factors differed from those of other translated versions. CONCLUSION: There is growing interest in the impulsivity concept. Forensic psychiatry is particularly concerned by impulsivity. In fact, it is related to psychiatric patients' violence. Impulsivity also reveals the problem of responsibility assessment in psychiatric expertise and the dangerousness of psychiatric patients. The Arabic version of the BIS-11 has a good apparent and internal consistency. This version could be useful in assessing psychiatric patient's dangerousness.

Impulse control disorders in Chinese Parkinson's disease patients: the effect of ergot derived dopamine agonist.

OBJECTIVE: We studied the prevalence and related risk factors of impulse control disorders in Chinese Parkinson's disease patients. METHOD: We screened all non-demented Parkinson's disease patients attending our Parkinson's disease clinic from August 2009 to March 2010. The clinical characteristics of patients with impulse control disorders and those without were compared. RESULTS: Of the 213 PD subjects screened, 15 (7.0%) with impulse control disorders were identified. Fourteen of these subjects were on both a dopamine agonist and Levodopa, and one was on Levodopa alone. Of the fourteen subjects on both a dopamine agonist and Levodopa, eleven were on bromocriptine and Levodopa; 10.5% of the subjects exposed to bromocriptine had impulse control disorder. Upon multivariate analysis, dose of dopamine agonist used, young age at onset of Parkinson's disease and a history of anxiety or depression were independent predictors for developing impulse control disorders. CONCLUSIONS: 7% of our Chinese PD subjects had impulse control disorders. When young Parkinson's disease patients with a history of anxiety or depression are treated with high dose of DA, they are at risk of developing impulse control disorders.

Psychometric properties of the Dickman Impulsivity Instrument in suicide victims and living controls of rural China.

BACKGROUND: We are not aware of any of impulsivity trait for Chinese rural youths. This study evaluated the psychometric properties of Dickman Impulsivity Instrument in suicide cases and living controls in rural China. METHODS: The participants, 392 suicide victims and 416 controls were respectively selected, and the psychological autopsy method was used to collect information. The Exploratory Factor Analysis was processed to evaluate the construct validity. The Cronbach's alpha was computed to evaluate the internal consistency, and the Spearman rank correlation coefficients between STAI Trait Anxiety Inventory, Coping Responses Inventory and Dickman Impulsivity Instrument were calculated to evaluate the convergent validity. RESULTS: Dysfunctional and Functional impulsivity were extracted for both samples. The mean of DI scores in suicide cases was larger than that in controls, but it was reversed for FI. There were no significant differences between DI and FI in suicide cases, but in controls the mean of DI scores was significantly smaller than that of FI. The Cronbach's alpha was around .863 and .779 respectively for DI and FI scales in suicides, and it was around .746 and .680 in controls. The DI and FI were significantly correlated with each other. Both the DI and FI were correlated with Approach and Avoidance Coping Response Inventory, and both of the scales were grossly independent with Trait Anxiety Inventory in two samples. CONCLUSION: The results indicated that the Dickman Impulsivity Instrument was adequate to measure impulsivity trait for suicide victims and living controls through proxy data in rural China.

Psychiatric disorders, comorbidity, and suicidality in Mexico.

BACKGROUND: Prior studies have reported that psychiatric disorders are among the strongest predictors of suicidal behavior (i.e., suicide ideation, plans, and attempts). However, surprisingly little is known about the independent associations between each disorder and each suicidal behavior due to a failure to account for comorbidity. METHODS: This study used data from a representative sample of 5782 respondents participating in the Mexican National Comorbidity Survey (2001-2002) to examine the unique associations between psychiatric disorders and suicidality. RESULTS: A prior psychiatric disorder was present in 48.8% of those with a suicide ideation and in 65.2% of those with an attempt. Discrete-time survival models adjusting for comorbidity revealed that conduct disorder and alcohol abuse/dependence were the strongest predictors of a subsequent suicide attempt. Most disorders predicted suicidal ideation but few predicted the transition from ideation to a suicide plan or attempt. LIMITATIONS: M-NCS is a household survey that excluded homeless and institutionalized people, and the diagnostic instrument used did not include an assessment of all DSM-IV disorders which would increase the comorbidity discussed here. CONCLUSIONS: These results reveal a complex pattern of associations in which diverse psychiatric disorders impact different parts of the pathway to suicide attempts. These findings will help inform clinical and public health efforts aimed at suicide prevention in Mexico and other developing countries.

Gambling behaviours and motivations: a cross-cultural study of Chinese and Caucasians in Australia.

BACKGROUND: Research on gambling behaviours among the Chinese, especially compared to Caucasians, is lacking. AIMS: and METHODS: Gambling behaviours and motivations between community-based Chinese (n = 199) and Caucasians (n = 306) living in Australia were compared. RESULTS: There were significant differences between Caucasians and Australian Chinese in relation to gambling behaviours and types of motivations that could predict problem gambling between the two groups. CONCLUSIONS: The findings provide relevant information in understanding gambling behaviours and motivations among the Chinese, as well as a step towards the development of tailored preventive and treatment interventions for problem gambling in this population.

Sleep patterns and impulse control among Japanese junior high school students.

Adolescents with decreased impulse control exhibit behavioral problems. Lifestyles are related to impulse control. However, the relations of sleep patterns and impulse control among adolescents are unknown. Thus we examined how sleep patterns were associated with impulse control among Japanese junior high school students. Surveys were completed by a nationwide sample of 1934 students. A significant association between decreased impulse control and bedtimes after midnight was revealed. Specific lifestyle factors related to bedtimes after midnight were older age, greater numbers of hours spent watching television, lack of participation in an extracurricular activity, greater use of convenience stores, and increased attendance at cram schools. This study revealed that going to sleep after midnight was significantly related to decreased impulse control among adolescents. Data about specific lifestyle factors related to going to sleep after midnight should be useful in preventing those behaviors demonstrated by school children that derive from decreased impulse control.

Differences in characteristics of Asian American and white problem gamblers calling a gambling helpline.

INTRODUCTION: The characteristics of Asian American and white problem gamblers using a gambling helpline were examined to identify race-related differences. METHODS: Logistic regression analyses were conducted on data obtained from callers to a gambling helpline serving southern New England in 2000-2003, inclusive. RESULTS: Of the 144 phone calls used in the analyses, 72 were from Asian American callers and 72 were from white callers who were matched on gender, education, income, marital/cohabitation status, and age. Race-related differences were observed in forms of gambling problems, psychiatric problems secondary to gambling, substance use problems, and family history. Asian American gamblers were more likely to report suicide attempts related to gambling and problems with non-strategic gambling. White gamblers were more likely to report both casino and non-casino gambling problems and personal and familial alcohol use problems. High proportions of both groups reported problems with strategic gambling, gambling-related anxiety, family and financial problems secondary to gambling, financial debt, daily tobacco use, and a family history of problem gambling. CONCLUSION: Race-related differences should be considered in optimizing prevention and treatment strategies related to problem gambling.

Prevalence and correlates of gambling among 16 to 19-year-old adolescents in Norway.

There is evidence that young people are at high risk of developing gambling disorders. The prevalence and correlates of gambling among youth therefore merit closer study. During spring 2004, a sample of 1,351 boys and girls (aged 16-19 years) from 151 high-school classes (clusters) participated in an internet survey about gambling. The response rate was 69.8%. The instruments used in the survey were the Hospital Anxiety and Depression Scale, the Alcohol Use Disorders Identification Test and the Massachusetts Adolescent Gambling Screen, in addition to questions about demography. Controlling for the design effect, the estimated prevalence rate was 2.5% for pathological gambling and 1.9% for problem gambling. In all, 7.3% of the boys and 0.6% of the girls fulfilled the criteria for pathological or problem gambling. The results of item analysis of the DSM-IV subscale of MAGS provide support for differential item functioning between boys and girls. A multiple logistic regression analysis revealed that gender (male: OR = 9.09), depression (OR = 9.23), alcohol abuse (OR = 3.62), and dissociation (OR = 1.96) were related to problem and pathological gambling. These results support the view that gambling disorders are best understood as part of an addictive behavior spectrum (Jacobs, 2000).

Internet addiction among Greek adolescent students.

This research aimed to assess the prevalence of Internet addiction among Greek adolescent students, ages 12 to 18. The sample of 2,200 students was recruited from 120 classes among 85 schools in Thessaly, Greece. The sample included 10% of all classes in schools of Thessaly. The method of randomized stratified selection in every school was used for its constitution. Participants were asked to complete the Diagnostic Questionnaire for Internet Addiction (YDQ), based on eight criteria, as well as an inventory that included sociodemographic factors and questions about the use of Internet, their social life, and their habits. In Greece, 70.8% of adolescents had access to the Internet. The consistency of the YDQ was tested with Cronbach's alpha (0.719), with standardized item alpha (0.728). Proportions are also calculated only on the frequent Internet users, which results in 11% fulfilling five YDQ criteria. The most frequent type of Internet use is online games, representing 50.9% of Internet users, and information services, representing 46.8%. The prevalence of Internet addiction among Internet users of Central Greece is 8.2%, and it concerns mainly the male students who play online games and visit Internet cafés.

Gambling among the Chinese: a comprehensive review.

Despite being a significant issue, there has been a lack of systematic reviews on gambling and problem gambling (PG) among the Chinese. Thus, this paper attempts to fill this theoretical gap. A literature search of social sciences databases (from 1840 to now) yielded 25 articles with a total sample of 12,848 Chinese community participants and 3397 clinical participants. The major findings were: (1) Social gambling is widespread among Chinese communities as it is a preferred form of entertainment. (2) Prevalence estimates for PG have increased over the years and currently ranged from 2.5% to 4.0%. (3) Chinese problem gamblers consistently have difficulty admitting their issue and seeking professional help for fear of losing respect. (4) Theories, assessments, and interventions developed in the West are currently used to explain and treat PG among the Chinese. There is an urgent need for theory-based interventions specifically tailored for Chinese problem gamblers. (5) Cultural differences exist in patterns of gambling when compared with Western samples; however, evidence is inconsistent. Methodological considerations in this area of research are highlighted and suggestions for further investigation are also included. (6) Much of gambling research has focused on identifying risk factors and at-risk individuals. It is essential to balance this knowledge with a focus on fundamental character strengths, which act as protective factors and motivate one to refrain from gambling.

Gender differences in mental health characteristics and gambling among African-American adolescent gamblers.

This study explores gender differences in lifetime and recent substance use/internalizing behavior, childhood externalizing behavior, and gambling preferences among African-American youth gamblers. Data are from a prospective study of a community sample of 452 urban African-American youths who began at entry into first grade and were followed for ten years. Gambling was associated with high teacher ratings of childhood externalizing behaviors among males and with high parent ratings of childhood impulsivity and hyperactivity among both genders. Internalizing behavior was associated with female gambling. No male-female differences in substance use/lifetime conduct disorder among gamblers were noted. Gambling preferences/frequency differed across genders.