Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.929
Filtrar
2.
Transl Psychiatry ; 14(1): 347, 2024 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-39214962

RESUMO

Neuropsychiatric symptoms (including anxiety, depression, apathy, impulse-compulsive behaviors and hallucinations) are among the most common non-motor features of Parkinson's disease. Whether these symptoms should be considered as a direct consequence of the pathophysiologic mechanisms of Parkinson's disease is controversial. Morphometric similarity network analysis and epicenter mapping approach were performed on T1-weighted images of 505 patients with Parkinson's disease and 167 age- and sex-matched healthy participants from Parkinson's Progression Markers Initiative database to reveal the commonalities and specificities of distinct neuropsychiatric symptoms. Abnormal cortical co-alteration pattern in patients with neuropsychiatric symptoms was in somatomotor, vision and frontoparietal regions, with epicenters in somatomotor regions. Apathy, impulse-compulsive behaviors and hallucinations shares structural abnormalities in somatomotor and vision regions, with epicenters in somatomotor regions. In contrast, the cortical abnormalities and epicenters of anxiety and depression were prominent in the default mode network regions. By embedding each symptom within their co-alteration space, we observed a cluster composed of apathy, impulse-compulsive behaviors and hallucinations, while anxiety and depression remained separate. Our findings indicate different structural mechanisms underlie the occurrence and progression of different neuropsychiatric symptoms. Based upon these results, we propose that apathy, impulse-compulsive behaviors and hallucinations are directly related to damage of motor circuit, while anxiety and depression may be the combination effects of primary pathophysiology of Parkinson's disease and psychosocial causes.


Assuntos
Ansiedade , Apatia , Córtex Cerebral , Alucinações , Imageamento por Ressonância Magnética , Doença de Parkinson , Humanos , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/fisiopatologia , Doença de Parkinson/complicações , Doença de Parkinson/psicologia , Doença de Parkinson/patologia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Alucinações/fisiopatologia , Alucinações/etiologia , Alucinações/diagnóstico por imagem , Alucinações/patologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/patologia , Córtex Cerebral/fisiopatologia , Apatia/fisiologia , Ansiedade/fisiopatologia , Ansiedade/diagnóstico por imagem , Depressão/diagnóstico por imagem , Depressão/fisiopatologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/fisiopatologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/diagnóstico por imagem
3.
J Affect Disord ; 363: 230-238, 2024 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-39047949

RESUMO

Intermittent Explosive Disorder (IED) is a common, chronic, and impairing psychological condition characterized by recurrent, affective aggressive behavior. IED is associated with a host of cognitive and affective symptoms not included in the diagnostic criteria which may be a valuable indicator of heterogeneity in IED-such information can be useful to enhance understanding and treatment of this disorder in mental health settings. A preliminary investigation conducted on cognitive-affective symptom heterogeneity in individuals with a history of IED demonstrated that level of emotional dysregulation primarily differentiated IED subgroups, however the sample size was limited, and almost half of the individuals did not have current IED (only lifetime IED). The present study addressed these limitations by conducting a latent class analysis of cognitive-affective symptoms among a large (n = 504) sample of individuals diagnosed with current IED. The latent IED classes were then externally validated on several adverse outcomes, historical precursors, and demographic variables. Statistical and clinical indicators supported a four-class model, with classes primarily distinguished by patients' severity of emotion dysregulation. The two moderate emotion-dysregulated classes both endorsed callous-unemotional traits and low empathy relative to other classes, a finding which differs from the initial investigation. An external validation of the four classes revealed that they significantly differed on severity outcomes (e.g., aggression, suicide attempts, antisocial behavior, global functioning, comorbidities) and historical precursors (e.g., aversive parental care, childhood maltreatment). These findings provide further insight into the heterogeneity within IED and the associations of such variability with important precursors and clinical outcomes.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Análise de Classes Latentes , Humanos , Transtornos Disruptivos, de Controle do Impulso e da Conduta/classificação , Transtornos Disruptivos, de Controle do Impulso e da Conduta/diagnóstico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/psicologia , Masculino , Feminino , Adulto , Agressão/psicologia , Agressão/classificação , Adulto Jovem , Pessoa de Meia-Idade , Sintomas Afetivos/psicologia , Adolescente , Regulação Emocional/fisiologia
4.
Ann Clin Transl Neurol ; 11(8): 2222-2229, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38952083

RESUMO

Impulse control disorders and their consequences display variability among individuals, indicating potential involvement of environmental and genetic factors. In this retrospective study, we analyzed a cohort of Parkinson's disease patients treated with dopamine agonists and investigated the influence of the dopamine D4 receptor gene polymorphism, DRD4 7R+, which is linked to psychiatric disorders, impulsive traits, and addictive behaviors. We found that DRD4 7R+ is a significant genetic risk factor associated with the severity of ICD.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Agonistas de Dopamina , Doença de Parkinson , Receptores de Dopamina D4 , Humanos , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/genética , Receptores de Dopamina D4/genética , Transtornos Disruptivos, de Controle do Impulso e da Conduta/genética , Transtornos Disruptivos, de Controle do Impulso e da Conduta/induzido quimicamente , Masculino , Agonistas de Dopamina/efeitos adversos , Agonistas de Dopamina/farmacologia , Agonistas de Dopamina/administração & dosagem , Pessoa de Meia-Idade , Feminino , Idoso , Estudos Retrospectivos , Polimorfismo Genético
5.
Ann Afr Med ; 23(3): 400-405, 2024 Jul 01.
Artigo em Francês, Inglês | MEDLINE | ID: mdl-39034565

RESUMO

INTRODUCTION: Parkinson's disease (PD) is a prevalent neurodegenerative disorder with significant nonmotor symptom (NMS) burden, including impulse control disorders. This study aimed to comprehensively evaluate NMS and impulse control disorders in PD patients under primary care. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted on 32 PD patients and evaluated using standardized assessment tools. Demographics, comorbidities, and symptom burdens were recorded. Evaluation tools included the Hoehn and Yahr Scale, REM Sleep Behavior Disorder assessment, Geriatric Depression Scale, Montreal Cognitive Assessment scale for cognitive impairment, NMS scale, and identification of impulse control disorders. RESULTS: In PD, comorbidities were prevalent (84%), and most were at Hoehn and Yahr Stages 2 and 3. REM Sleep Behavior Disorder was present in 28.12%, with 5 receiving clonazepam treatment. Depression affected 28.12%, with 5 receiving pharmacological treatment. Cognitive impairment was notable in 9 patients. NMS burden was high, with varying severity. Impulse control disorders were limited, whereas one case of dopamine dysregulation syndrome was identified. DISCUSSION: This primary care-based study in India assessed NMS and impulse control disorders in PD patients, highlighting comorbidities and management opportunities. The study's strength lies in evaluating an unselected primary care population, whereas limitations include small sample size. CONCLUSION: This study emphasizes the importance of primary care physicians in monitoring and managing NMS in PD patients. Impulse control disorders and cognitive impairment are critical aspects that need attention. The findings support an integrated approach involving health-care professionals across various disciplines to provide holistic care for PD patients.


Résumé Introduction:La maladie de Parkinson (PD) est un trouble neurodégénératif prévalent avec un fardeau significatif de symptômes non moteurs (NMS), y compris les troubles du contrôle des impulsions. Cette étude visait à évaluer de manière exhaustive les NMS et les troubles du contrôle des impulsions chez les patients atteints de la maladie de Parkinson pris en charge en soins primaires.Matériaux et méthodes:Une étude transversale descriptive a été menée sur 32 patients atteints de la maladie de Parkinson et évaluée à l'aide d'outils d'évaluation standardisés. Les données démographiques, les comorbidités et le fardeau des symptômes ont été enregistrés. Les outils d'évaluation comprenaient l'échelle de Hoehn et Yahr, l'évaluation du trouble du comportement en sommeil paradoxal (RBD), l'échelle de dépression gériatrique, l'échelle d'évaluation cognitive de Montréal pour les troubles cognitifs, l'échelle NMS et l'identification des troubles du contrôle des impulsions.Résultats:Chez les patients atteints de la maladie de Parkinson, les comorbidités étaient prévalentes (84 %), et la plupart étaient aux stades 2 et 3 de l'échelle de Hoehn et Yahr. Le trouble du comportement en sommeil paradoxal était présent chez 28,12 % des patients, dont 5 recevaient un traitement au clonazépam. La dépression affectait 28,12 % des patients, dont 5 recevaient un traitement pharmacologique. Une altération cognitive était notable chez 9 patients. Le fardeau des NMS était élevé, avec une gravité variable. Les troubles du contrôle des impulsions étaient limités, tandis qu'un cas de syndrome de dysrégulation dopaminergique a été identifié.Discussion:Cette étude menée en soins primaires en Inde a évalué les NMS et les troubles du contrôle des impulsions chez les patients atteints de la maladie de Parkinson, mettant en évidence les comorbidités et les opportunités de prise en charge. La force de l'étude réside dans l'évaluation d'une population de soins primaires non sélectionnée, tandis que les limites comprennent une petite taille d'échantillon.Conclusion:Cette étude souligne l'importance des médecins de soins primaires dans la surveillance et la prise en charge des NMS chez les patients atteints de la maladie de Parkinson. Les troubles du contrôle des impulsions et l'altération cognitive sont des aspects critiques qui nécessitent une attention particulière. Les résultats soutiennent une approche intégrée impliquant des professionnels de la santé de différentes disciplines pour fournir des soins holistiques aux patients atteints de la maladie de Parkinson.


Assuntos
Disfunção Cognitiva , Comorbidade , Depressão , Transtornos Disruptivos, de Controle do Impulso e da Conduta , Doença de Parkinson , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/epidemiologia , Doença de Parkinson/psicologia , Estudos Transversais , Masculino , Feminino , Índia/epidemiologia , Pessoa de Meia-Idade , Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Idoso , Prevalência , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/diagnóstico , Depressão/epidemiologia , Transtorno do Comportamento do Sono REM/epidemiologia , Transtorno do Comportamento do Sono REM/diagnóstico , Índice de Gravidade de Doença , Atenção Primária à Saúde
6.
Aggress Behav ; 50(4): e22167, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39073143

RESUMO

Aggression refers to a wide range of behaviors with lasting individual and societal consequences. Recurrent, unplanned aggressive behavior is the core diagnostic criterion for intermittent explosive disorder (IED). In this study, we compared two behavioral measures of aggression in the laboratory: the Taylor Aggression Paradigm (TAP) and the Point-Subtraction Aggression Paradigm (PSAP). This sample (n = 528) included community participants who met DSM-5 criteria for IED (n = 156), met DSM-5 criteria for a nonaggressive psychiatric disorder (n = 205), or did not meet DSM-5 criteria for any psychiatric disorder (n = 167). All participants completed the TAP, a single-session PSAP, and relevant self-report measures. MANOVA analyses demonstrated differences between IED participants and nonaggressive participants; however, these group differences were no longer significant for the PSAP after including demographic variables. Correlation analyses found that the TAP and PSAP were positively related to one another and the composite variables associated with aggressive behavior (i.e., history of aggression, impulsivity, and propensity to experience anger) and; dependent correlations revealed that past aggression and trait anger were more strongly related to the TAP. Differences in TAP and PSAP outcomes may be partially attributed to operationalizations of aggression and methods of aggression and provocation. Further, as aggressive and nonaggressive participants differed on the PSAP somewhat mirroring the TAP, our results add to growing evidence of the validity of a single-session PSAP; further research is needed to fully establish single-session PSAP as a laboratory aggression task compared to the multi-session PSAP.


Assuntos
Agressão , Transtornos Disruptivos, de Controle do Impulso e da Conduta , Humanos , Agressão/psicologia , Agressão/fisiologia , Masculino , Feminino , Adulto , Transtornos Disruptivos, de Controle do Impulso e da Conduta/psicologia , Adulto Jovem , Comportamento Impulsivo/fisiologia , Pessoa de Meia-Idade , Adolescente , Ira/fisiologia
7.
Neurobiol Dis ; 198: 106560, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38852751

RESUMO

BACKGROUND: Impulse control disorders (ICD) in Parkinson's disease (PD) is highly multifactorial in etiology and has intricate neural mechanisms. Our multimodal neuroimaging study aimed to investigate the specific patterns of structure-function-neurotransmitter interactions underlying ICD. METHODS: Thirty PD patients with ICD (PD-ICD), 30 without ICD (PD-NICD) and 32 healthy controls (HCs) were recruited. Gyrification and perivascular spaces (PVS) were computed to capture the alternations of cortical surface morphology and glymphatic function. Seed-based functional connectivity (FC) were performed to identify the corresponding functional changes. Further, JuSpace toolbox were employed for cross-modal correlations to evaluate whether the spatial patterns of functional alterations in ICD patients were associated with specific neurotransmitter system. RESULTS: Compared to PD-NICD, PD-ICD patients showed hypogyrification and enlarged PVS volume fraction in the left orbitofrontal gyrus (OFG), as well as decreased FC between interhemispheric OFG. The interhemispheric OFG connectivity reduction was associated with spatial distribution of µ-opioid pathway (r = -0.186, p = 0.029, false discovery rate corrected). ICD severity was positively associated with the PVS volume fraction of left OFG (r = 0.422, p = 0.032). Furthermore, gyrification index (LGI) and percent PVS (pPVS) in OFG and their combined indicator showed good performance in differentiating PD-ICD from PD-NICD. CONCLUSIONS: Our findings indicated that the co-altered structure-function-neurotransmitter interactions of OFG might be involved in the pathogenesis of ICD.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Imageamento por Ressonância Magnética , Imagem Multimodal , Doença de Parkinson , Humanos , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/patologia , Doença de Parkinson/fisiopatologia , Masculino , Pessoa de Meia-Idade , Feminino , Transtornos Disruptivos, de Controle do Impulso e da Conduta/diagnóstico por imagem , Transtornos Disruptivos, de Controle do Impulso e da Conduta/patologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/etiologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/fisiopatologia , Idoso , Imageamento por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Neuroimagem/métodos , Neurotransmissores/metabolismo , Encéfalo/diagnóstico por imagem , Encéfalo/patologia
10.
J Behav Ther Exp Psychiatry ; 85: 101973, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38776752

RESUMO

BACKGROUND AND OBJECTIVES: Intermittent Explosive Disorder (IED) is an impulsive aggression disorder with self-control problems. However, the mechanisms underpinning the self-control problems in IED have not been clearly investigated. Therefore, this study examined the nature of self-control problems and their types, including cognitive inhibition, behavioral inhibition, and emotional interference in IED. METHODS: Participants included three groups: IED (n = 54), psychiatric control (n = 59), and healthy control (n = 62). They were first screened with SCL-90-R, and then they were clinically interviewed. They all did computerized neurocognitive tasks, including Color-Word Stroop Task, Emotional Stroop Task, Go-NoGo Task, and Stop-Signal Task. RESULTS: MANOVA analyses showed that the IED group had poorer performance in cognitive inhibition, response inhibition, and increased emotional interference than the two psychiatric and healthy control groups. They performed much worse than the other two groups, particularly in action cancellation (Stop-Signal Task), and showed increasingly emotional interference. LIMITATIONS: The brain reaction of individuals while doing the tasks was not examined, and some variables were not measured. Also, it is unclear how the emotional eruption interferes with cognitive content and behavioral inhibition. CONCLUSIONS: These findings indicate that self-control problems in IED can be due to deficient cognitive, emotional, and behavioral inhibitions, each appearing sequentially during a step-by-step process and facilitating the onset of IED signs and symptoms. Such a distinguished understanding of the role of neurocognitive mechanisms can lead to the development of accurate explanatory approaches and increase the effectiveness of treatment.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Inibição Psicológica , Autocontrole , Humanos , Transtornos Disruptivos, de Controle do Impulso e da Conduta/fisiopatologia , Masculino , Adulto , Adulto Jovem , Feminino , Testes Neuropsicológicos , Função Executiva/fisiologia , Adolescente , Teste de Stroop
11.
J Bodyw Mov Ther ; 38: 583-592, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38763612

RESUMO

BACKGROUND: The purpose of this study was to review the evidence for the potential of Tai Chi Chuan (TCC) as a model of meditative movement in benefiting people with impulsivity related disorders and provide guidance for future research. METHODS: A scoping review of the literature was conducted in five databases. Eligibility criteria were original articles reporting TCC based interventions or included TCC techniques and provided any assessment on impulsivity or related measures, impulse control disorders, or other psychiatric disorders related to impulsivity (e.g., addictive disorders, ADHD, and other conduct disorders). Twenty-eight out of 304 studies initially retrieved were reviewed. The reports concentrated mostly on neurodegenerative conditions, cognitive decline, and substance use disorders (SUD). RESULTS: TCC had several positive effects in cognitive domains resulting in improvements in memory, executive functions, inhibitory control, attention, and verbal fluency. These improvements in memory, executive function, including inhibitory control and attention, and verbal fluency were associated with changes in the brain plasticity, resting activity, and other neurobiological markers. CONCLUSION: Albeit no study was found on the use of TCC in impulse control disorders or impulse related conditions, other than SUD, the findings suggest that considering the behavioral impact of TCC, especially the improvement of executive functions, it could be a valuable therapeutic tool for approaching impulse control related disorders.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Função Executiva , Comportamento Impulsivo , Tai Chi Chuan , Humanos , Tai Chi Chuan/métodos , Transtornos Disruptivos, de Controle do Impulso e da Conduta/terapia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/fisiopatologia , Comportamento Impulsivo/fisiologia , Função Executiva/fisiologia , Atenção/fisiologia , Memória/fisiologia , Cognição/fisiologia
12.
CNS Drugs ; 38(6): 443-457, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38613665

RESUMO

Impulse control disorders in Parkinson's disease are relatively common drug-induced addictive behaviours that are usually triggered by the dopamine agonists pramipexole, ropinirole and rotigotine. This narrative review aimed to provide a comprehensive overview of the current knowledge of impulse control disorders in Parkinson's disease. We summarised the prevalence, clinical features, risk factors and potential underlying mechanisms of impulse control disorders in Parkinson's disease. Moreover, recent advances in behavioural and imaging characteristics and management strategies are discussed. Early detection as well as a tailored multidisciplinary approach, which typically includes careful adjustment of the dopaminergic therapy and the treatment of associated neuropsychiatric symptoms, are necessary. In some cases, a continuous delivery of levodopa via a pump or the dopamine D1 receptor agonist, apomorphine, can be considered. In selected patients without cognitive or speech impairment, deep brain stimulation of the subthalamic nucleus can also improve addictions. Finding the right balance of tapering dopaminergic dose (usually dopamine agonists) without worsening motor symptoms is essential for a beneficial long-term outcome.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Agonistas de Dopamina , Doença de Parkinson , Humanos , Doença de Parkinson/tratamento farmacológico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/induzido quimicamente , Transtornos Disruptivos, de Controle do Impulso e da Conduta/tratamento farmacológico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/etiologia , Fatores de Risco , Agonistas de Dopamina/efeitos adversos , Agonistas de Dopamina/administração & dosagem , Agonistas de Dopamina/farmacologia , Antiparkinsonianos/administração & dosagem , Antiparkinsonianos/efeitos adversos , Estimulação Encefálica Profunda
13.
Sci Rep ; 14(1): 4627, 2024 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-38438386

RESUMO

Impulse Control Disorder (ICD) in Parkinson's disease is a behavioral addiction induced by dopaminergic therapies, but otherwise unclear etiology. The current study investigates the interaction of reward processing variables, dopaminergic therapy, and risky decision-making and subjective feelings in patients with versus without ICD. Patients with (n = 18) and without (n = 12) ICD performed a risky decision-making task both 'on' and 'off' standard-of-care dopaminergic therapies (the task was performed on 2 different days with the order of on and off visits randomized for each patient). During each trial of the task, participants choose between two options, a gamble or a certain reward, and reported how they felt about decision outcomes. Subjective feelings of 'pleasure' are differentially driven by expectations of possible outcomes in patients with, versus without ICD. While off medication, the influence of expectations about risky-decisions on subjective feelings is reduced in patients with ICD versus without ICD. While on medication, the influence of expected outcomes in patients with ICD versus without ICD becomes similar. Computational modeling of behavior supports the idea that latent decision-making factors drive subjective feelings in patients with Parkinson's disease and that ICD status is associated with a change in the relationship between factors associated with risky behavior and subjective feelings about the experienced outcomes. Our results also suggest that dopaminergic medications modulate the impact expectations have on the participants' subjective reports. Altogether our results suggest that expectations about risky decisions may be decoupled from subjective feelings in patients with ICD, and that dopaminergic medications may reengage these circuits and increase emotional reactivity in patients with ICD.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Doença de Parkinson , Humanos , Motivação , Doença de Parkinson/tratamento farmacológico , Emoções , Dopamina , Recompensa
14.
Sci Rep ; 14(1): 6557, 2024 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-38503756

RESUMO

The relationship between Gaming Disorder (GD) and the experience of functional impairments has received considerable theoretical attention in the recent past and current diagnostic approaches underscore the centrality of functional impairments as a requirement for GD diagnosis. However, there is limited empirical evidence illuminating the interplay between GD and functional impairments, particularly among specific vulnerable groups. The present study seeks to bridge this gap by investigating an English-speaking sample (N = 5198) comprising an age- and gender-matched group of Professional Gamers (PG, n = 2599) and Non-Professional Gamers (NPG, n = 2599) sub-sampled from a larger sample of 192,260 individuals. The results revealed that PG were at a greater risk for GD compared to NPG as the prevalence rate of GD among PG (3.31%) was significantly higher and almost doubled that of NPG (1.73%), with PG further exhibiting higher overall GD symptom-load and weekly time spent gaming compared to NPG. Furthermore, PG reported experiencing significantly higher frequency of gaming-related functional impairments compared to NPG, with the in particular affected areas for both PG and NPG being 'school and/or work', 'physical health', and 'family', with other key differences emerging in relation to other outcomes. Overall, the present findings show that not only GD symptom-load but also some functional impairment is higher in PG compared to NPG which highlights the need to develop and support prevention and intervention strategies for this at-risk population.


Assuntos
Comportamento Aditivo , Transtornos Disruptivos, de Controle do Impulso e da Conduta , Jogos de Vídeo , Humanos , Instituições Acadêmicas , Comportamento Aditivo/epidemiologia
15.
Am J Geriatr Psychiatry ; 32(7): 879-894, 2024 07.
Artigo em Inglês | MEDLINE | ID: mdl-38538517

RESUMO

Excoriation disorder (ED) is defined as compulsive skin picking that results in skin damage and emotional distress. Optimal management of ED includes individualized treatment plans consisting of psychotherapies, behavioral and pharmacologic interventions. Compared with younger populations, older adults are at increased risk for poor outcomes, such as infection and hospitalization, and require unique management considerations. Risk factors that contribute to disease burden include age-related changes to the skin and underlying medical and psychiatric comorbidities. A literature review was conducted on ED yielding limited evidence exclusive to older adults. The authors suggest a therapeutic approach to ED in older adults based on available evidence and experience from inpatient and outpatient psychiatric settings. Finally, opportunities for future research are highlighted.


Assuntos
Comportamento Autodestrutivo , Humanos , Idoso , Comportamento Autodestrutivo/terapia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/terapia , Pele , Fatores de Risco , Transtorno de Escoriação
16.
Pituitary ; 27(2): 197-203, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38345719

RESUMO

BACKGROUND: Impulse control disorders (ICDs) have been described as underrecognized side effects of dopamine agonists (DAs) in neurological disorders but are not sufficiently understood in endocrine conditions. OBJECTIVE: To identify the prevalence of DAs induced ICDs and determine potential risk factors related to these disorders in patients with prolactinoma and non-function pituitary adenomas (NFPAs). METHODS: This is a cross-sectional multicenter study involving 200 patients with prolactinoma and NFPAs, who received follow-ups in tertiary referral centers. DA-induced ICDs were assessed using ICD questionnaires modified from prior studies. RESULT: At least one ICD was reported by 52% of participants, among whom 28.5% mentioned compulsive shopping, 24.5% punding, and 24.5% hypersexuality. Furthermore, 33% of the patients reported the presence of one type of ICD behavior, while 12% specified two and 7% had three types of such behavior. The multivariable logistic regression showed that the significant risk factors of ICD were younger age (adjusted odds ratio [AOR]: 0.92, 95% confidence interval [CI]: 0.88-0.97, p 0.001), being single (AOR: 0.15, 95%CI: 0.03-0.84, p 0.03), and a positive history of psychiatric illness (AOR: 7.67, 95% CI: 1.37-42.97, p 0.021). CONCLUSION: ICDs with a broad range of psychiatric symptoms are common in individuals with DA-treated prolactinoma and NFPAs. Endocrinologists should be aware of this potential side effect, particularly in patients with a personal history of psychiatric disorder.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Neoplasias Hipofisárias , Prolactinoma , Humanos , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Agonistas de Dopamina/efeitos adversos , Estudos Transversais , Transtornos Disruptivos, de Controle do Impulso e da Conduta/induzido quimicamente , Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/tratamento farmacológico
17.
J Neurol ; 271(5): 2798-2809, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38416170

RESUMO

BACKGROUND: Although apathy and impulse control disorders (ICDs) are considered to represent opposite extremes of a continuum of motivated behavior (i.e., hypo- and hyperdopaminergic behaviors), they may also co-occur in Parkinson's disease (PD). OBJECTIVES: We aimed to explore the co-occurrence of ICDs and apathy and its neural correlates analyzing gray matter (GM) changes in early untreated PD patients. Moreover, we aimed to investigate the possible longitudinal relationship between ICDs and apathy and their putative impact on cognition during the first five years of PD. METHODS: We used the Parkinson's Progression Markers Initiative (PPMI) database to identify the co-occurrence of apathy and ICDs in 423 early drug-naïve PD patients at baseline and at 5-year follow-up. Baseline MRI volumes and gray matter changes were analyzed between groups using voxel-based morphometry. Multi-level models assessed the longitudinal relationship (across five years) between apathy and ICDs and cognitive functioning. RESULTS: At baseline, co-occurrence of apathy and ICDs was observed in 23 patients (5.4%). This finding was related to anatomical GM reduction along the cortical regions involved in the limbic circuit and cognitive control systems. Longitudinal analyses indicated that apathy and ICDs were related to each other as well as to the combined use of levodopa and dopamine agonists. Worse apathetic and ICDs states were associated with poorer executive functions. CONCLUSIONS: Apathy and ICDs are joint non-exclusive neuropsychiatric disorders also in the early stages of PD and their co-occurrence was associated with GM decrease in several cortical regions of the limbic circuit and cognitive control systems.


Assuntos
Apatia , Transtornos Disruptivos, de Controle do Impulso e da Conduta , Substância Cinzenta , Imageamento por Ressonância Magnética , Doença de Parkinson , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/patologia , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/fisiopatologia , Apatia/fisiologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/etiologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/fisiopatologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/diagnóstico por imagem , Transtornos Disruptivos, de Controle do Impulso e da Conduta/patologia , Estudos Longitudinais , Comportamento Impulsivo/fisiologia
18.
J Pers Disord ; 38(1): 34-52, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38324246

RESUMO

Intermittent explosive disorder (IED) is characterized by recurrent reactive aggression. IED is associated with significant personality pathology that is suggestive of higher levels of general personality disorder (PD). However, little is known about how personality factors impact the severity and presentation of IED. The present study employed a latent class analysis to assess for distinct PD symptom classes within IED and to evaluate whether these classes differed in terms of severity and behavioral presentation. Statistical and clinical indicators revealed a four-class model, with latent classes distinguished primarily on general levels of PD symptoms (low, moderate, high). However, the two moderate PD symptom classes were distinguished from other classes on avoidant PD. In addition, classes differed in terms of severity and presentation, suggesting important implications for both general PD and avoidant PD comorbidity within IED. Results provide further insight into the heterogeneity within IED and suggest a more nuanced approach in treating this serious condition.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Transtornos da Personalidade , Humanos , Análise de Classes Latentes , Personalidade , Agressão
20.
Parkinsonism Relat Disord ; 121: 106017, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38401377

RESUMO

Dopamine agonist withdrawal syndrome (DAWS) results from the reduction or suspension of dopamine agonist medications; it encompasses mainly psychiatric symptoms, including suicidal behaviors. In patients with Parkinson's disease (PD), the impact of DAWS can be significant in terms of distress and disability; however, we must take this syndrome into account as a threatening condition because suicidal behaviors could be developing in the context of DAWS. Here we present a brief case of DAWS affecting a young man with PD, whom abruptly discontinued DA treatment and developed psychiatric symptoms within two weeks which led to a suicidal attempt.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Doença de Parkinson , Síndrome de Abstinência a Substâncias , Humanos , Masculino , Transtornos Disruptivos, de Controle do Impulso e da Conduta/complicações , Dopaminérgicos , Agonistas de Dopamina/efeitos adversos , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Síndrome de Abstinência a Substâncias/etiologia , Síndrome de Abstinência a Substâncias/diagnóstico , Tentativa de Suicídio
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA