To evaluate the occurrence of axis I and II psychiatric disorders among patients with traumatic brain injury (TBI).
Prospective observational study. Forty-five adult patients, who had attended an emergency unit because of TBI, were recruited. At 12 months, 38 patients were interviewed.
Psychiatric disorders were evaluated using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II).
Before TBI, the 12-month rate of axis I psychiatric disorders was relatively high (39.5%) and the rate of alcohol dependence was especially elevated (18.4%). During the 12 months after TBI, axis I disorders were found in 47.4% of subjects. Six patients (15.8%) were found to have a disorder with an onset after TBI. Of these, five patients had depressive disorders (13.2%). Almost one third of the subjects (29.0%) had personality disorders. Antisocial and obsessive-compulsive personality disorders were the most frequent (10.5%).
Both axis I and II psychiatric disorders are common among patients with TBI. Alcohol dependence and personality disorders are prevalent in individuals prone to TBI, whereas depressive disorders typically develop after injury. Psychiatric disorders should be addressed in rehabilitation, as otherwise they will hinder the recovery after TBI.
Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9304, USA. email@example.com
BACKGROUND: Very little information is available on the co-occurrence of different personality disorders (PDs) and alcohol and drug use disorders in the US population. OBJECTIVE: To present national data on sex differences in the co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol and drug use disorders and 7 of the 10 DSM-IV PDs. DESIGN: Face-to-face interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43 093). SETTING: The United States and the District of Columbia, including Alaska and Hawaii. PARTICIPANTS: Household and group-quarters residents, aged 18 years and older. RESULTS: Among individuals with a current alcohol use disorder, 28.6% (95% confidence interval [CI], 26.7-30.6) had at least 1 PD, whereas 47.7% (95% CI, 43.9-51.6) of those with a current drug use disorder had at least 1 PD. Further, 16.4% (95% CI, 15.1-17.6) of individuals with at least 1 PD had a current alcohol use disorder and 6.5% (95% CI, 5.7-7.3) had a current drug use disorder. Associations between PDs and alcohol and drug use disorders were overwhelmingly positive and significant (P
Comment In: Evid Based Ment Health. 2004 Nov;7(4):12415504812
Previous studies have demonstrated individual associations between borderline personality disorder (BPD), panic attacks (PAs), and panic disorder (PD) in relation to suicide attempts (SAs). This study examined the comorbid effects of these variables. Data from wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (N = 34,653) were used to examine using logistic regression the relationship between individuals with BPD (n = 562), PA (n = 253), PD (n = 255), comorbid BPD and PD (n = 146), and co-occurring BPD and PA (n = 119) who had attempted suicide. It was found that BPD, PD, and PA are associated with SAs. Comorbid PD and BPD, or PA and BPD, only slightly increased the association of BPD alone with SA. Associations were greatly decreased after controlling for affective dysregulation. These findings emphasize the importance of affective dysregulation in individuals with BPD in relation to suicide attempts.
Authors observed 96 patients (81 males and 15 females) with overvalued depressions within the pubertal decompensation of personality disorders. Past medical history and prospective observation showed that those conditions develop over the long period of distimia and pose a high risk of suicide. Such conditions differ mildly in content - metaphysical, dysmorphophobical or hypohondriacal, but far more significantly in a parity of structural components of overvalued symptoms, which consist of an ideational cultivation, an affective filling and a component of inclination. According to prevalence of one of the components three main types of such depressions were described: classical, obsessive and type of overvalued inclination. There was established a correlation between type of depression and patient's personality structure and it influenced on the clinical course of depression, the choice of therapy and on prognosis on personality disorders compensation probability in adulthood.
To identify specific risk factors for filicide, parental killing of one's own children.
A nationwide matched cohort study of filicides, including filicide-suicide, was conducted in Sweden 1973-2008 (N = 151). We linked longitudinal national registry data on offender psychiatric and neurologic morbidity (ICD codes), suicide attempts, traumatic injury, and previous criminality. We compared filicide offenders and their children to age- and sex-matched general population controls and their children. To compare homicide perpetrator subtypes, parallel analyses were made with nonfilicide homicide offenders (N = 3,979) and matched controls.
History of major psychiatric disorder, defined as psychotic, affective, or personality disorder, was more common among filicide perpetrators even after adjusting for socioeconomic factors and other potential perpetrator and child confounders (adjusted odds ratio [AOR] = 8.6; 95% CI, 3.7-20.0). Substance misuse was not an independent risk factor, whereas prior suicide attempt conferred a marked increase of filicide risk (AOR = 11.6; 95% CI, 4.0-33.3). Multiple birth was the only child risk factor for filicide that was significant (AOR = 4.8; 95% CI, 1.3-17.6) in multivariate analyses. Overall, nonfilicide homicide offenders exhibited similar risk factors as filicide perpetrators; additionally, substance misuse and violent crime were significantly more frequent and suicide attempt less common (nonoverlapping 95% CIs) than in filicide offenders.
Major psychiatric disorder and previous suicide attempt were strong independent risk factors of filicide; however, substance misuse and prior violent crime were less common than among nonfilicide homicide offenders. Filicide prevention attempts should focus major psychiatric disorder and suicidal behavior in particularly strained parents, instead of more general risk factors for interpersonal violence such as substance misuse.
This study investigates prospectively the development of single and repeated unintentional injuries from birth to 42 months in a random population sample of new-born children in Quebec (Canada) (N?=?1,770). The outcome measures are single unintentional injuries (SUI) and repeated unintentional injuries (RUI). Results showed that the risk factors for SUI differed from the risk factors for RUI. SUI was predicted by mother's antisocial behavior during high school (OR?=?1.72) and mother's age at first birth (OR?=?1.82) with children from older mothers at higher likelihood of SUI. Also, boys (OR?=?1.36) and hyperactive children (OR?=?1.06) were at increased risk of SUI. RUI was predicted by maternal smoking during pregnancy (OR?=?1.68), medication on prescription (OR?=?1.53) and medication without prescription (OR?=?1.54). Boys (OR?=?2.01), children with a difficult temperament (OR?=?1.13) and those with single mothers had higher rates of RUI (OR?=?2.05). Maternal perception of impact (OR?=?1.15) and maternal feelings of self-efficacy (OR?=?0.87; marginally significant) were also associated with RUI. These results show that maternal and child risk factors identified during pregnancy and just after birth can predict SUI as well as RUI in early childhood. However, the only common risk factor for SUI and RUI is the child's sex, with boys being at higher risk than girls. Implications of these findings and suggestions for prevention are discussed.
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