Purpose of Review
Bipolar disorder has the highest rate of suicide of all psychiatric conditions and is approximately 20–30 times that of the general population. The purpose of this review is to ...discuss findings relevant to bipolar disorder and suicide.
Recent Findings
Risk factors include male gender, living alone, divorced, no children, Caucasian, younger age (< 35 years), elderly age (> 75 years), unemployment, and a personal history of suicide attempt and family history of suicide attempt or suicide completion, as well as predominant depressive polarity. Suicide is associated with the depressed or mixed subtypes, not mania. Although there are emerging treatments for bipolar depression, such as ketamine and TMS, lithium remains the only medication associated with lowered suicide rates in bipolar disorder.
Summary
Understanding clinical and demographic risk factors for suicide in bipolar disorder remains the best way to prevent suicidal behavior. Early intervention and treatment with anti-suicidal medications, such as lithium, along with close observation and follow-up is the best way to mitigate suicide in patients with bipolar disorder.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose of Review
Antisocial personality disorder (ASPD) is a characterized by lifelong or recurrent behavioral problems that begin in childhood or early adolescence. This communication provides an ...overview on ASPD including findings from recent reviews and new research.
Recent Findings
With regard to DSM-5’s Section III Alternative Model of Personality Disorder criteria for ASPD, advocates point to the broader symptom coverage and harmonization with ICD-11; yet critics point to the lack of evidence for improved outcomes. A new report shows that antisocial individuals age faster than non-antisocial peers. ASPD has high heritability and newer molecular studies have found intriguing linkages to genes associated with crucial brain regions. A mentalization-based therapy model has been developed and early work shows promise.
Summary
ASPD is common, widespread, and disruptive to individuals, families, and society. Chronic and lifelong, ASPD typically lessens in severity with advancing age. Assessment rests on the individual’s history because there are no diagnostic tests. ASPD likely results from an interplay of genetic and environmental factors. Brain imaging studies have linked cortical dysfunction to antisocial behavior in crucial brain regions. Medication is sometimes targeted at the individual’s aggression and irritability, but a more rational approach is to target co-occurring disorders. Cognitive-behavioral therapy and mentalization-based therapy models have been developed and are being studied.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Antisocial personality disorder (ASPD) is characterized by a pattern of socially irresponsible, exploitative, and guiltless behaviour. ASPD is associated with co-occurring mental health and addictive ...disorders and medical comorbidity. Rates of natural and unnatural death (suicide, homicide, and accidents) are excessive. ASPD is a predictor of poor treatment response. ASPD begins early in life, usually by age 8 years. Diagnosed as conduct disorder in childhood, the diagnosis converts to ASPD at age 18 if antisocial behaviours have persisted. While chronic and lifelong for most people with ASPD, the disorder tends to improve with advancing age. Earlier onset is associated with a poorer prognosis. Other moderating factors include marriage, employment, early incarceration (or adjudication during childhood), and degree of socialization.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
The author comprehensively reviews compulsive shopping (CS), a disorder characterized by excessive shopping and/or spending that leads to subjective distress and impaired functioning. CS has been ...linked to substance use disorders, mood, and anxiety disorders, and to the obsessive-compulsive spectrum. More recently, CS has been considered a behavioral addiction. Most CS experts consider CS an independent disorder. CS has an estimated prevalence of 5% in the United States general population with an onset in the late teens/early 20s. Psychiatric comorbidity is common, including mood, anxiety, substance use, and personality disorders. Little is known about its neurobiology and genetics. There are no standard treatments, but cognitive-behavioral group therapy appears promising. Future research should focus on validating the disorder and developing effective treatments.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviours regarding computer use and internet access that lead to impairment or distress. The condition ...has attracted increasing attention in the popular media and among researchers, and this attention has paralleled the growth in computer (and Internet) access. Prevalence estimates vary widely, although a recent random telephone survey of the general US population reported an estimate of 0.3-0.7%. The disorder occurs worldwide, but mainly in countries where computer access and technology are widespread. Clinical samples and a majority of relevant surveys report a male preponderance. Onset is reported to occur in the late 20s or early 30s age group, and there is often a lag of a decade or more from initial to problematic computer usage. Internet addiction has been associated with dimensionally measured depression and indicators of social isolation. Psychiatric co-morbidity is common, particularly mood, anxiety, impulse control and substance use disorders. Aetiology is unknown, but probably involves psychological, neurobiological and cultural factors. There are no evidence-based treatments for internet addiction. Cognitive behavioural approaches may be helpful. There is no proven role for psychotropic medication. Marital and family therapy may help in selected cases, and online self-help books and tapes are available. Lastly, a self-imposed ban on computer use and Internet access may be necessary in some cases.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
ABSTRACTBorderline personality disorder (BPD) and bipolar disorder (types I and II) are frequently confused because of their symptomatic overlap. Although affective instability is a prominent feature ...of each, the pattern is entirely different. BPD is characterized by transient mood shifts that occur in response to interpersonal stressors, whereas bipolar disorder is associated with sustained mood changes. These disorders can be further distinguished by comparing their phenomenology, etiology, family history, biological studies, outcome, and response to medication. Their distinction is of great clinical importance because misdiagnosis can deprive the patient of potentially effective treatment, whether it is psychotherapy for BPD or medication for bipolar disorder. On the basis of a comprehensive literature review, guidelines for differential diagnosis are suggested, and priorities for further research are recommended.
Latent class analysis (LCA) was used to test the validity of the Pathways Model in 285 subjects with DSM-IV pathological gambling (PG). In addition to identifying three subtypes that roughly ...correspond with those described in the model (Behaviorally Conditioned, or BC, Emotionally Vulnerable, or EV, Antisocial-Impulsivist, or AI), LCA identified a fourth class, termed the Antisocial Drinker, or AD, characterized by high rates of antisociality, conduct disorder, and alcohol use disorder. BC gamblers comprised 45% of the sample, followed by EV (24%), AD (22%), and AI (9%) gamblers. Women were more likely to be EV gamblers (OR = 1.89) and less likely to be AD gamblers (OR = 0.46). Those who had attempted suicide were more likely to be EV (OR = 3.06) or AI (OR = 3.05) gamblers and less likely to be BC (OR = 0.37) or AD gamblers (OR = 0.50). Greater childhood maltreatment was associated with AD (standardized OR = 1.81) and AI (standardized OR = 1.43) gamblers. Individuals with later PG onset were less likely to be AI gamblers (standardized OR = 0.48). Individuals who preferred slots were more likely to be EV gamblers (OR = 1.83) and less likely to be AD gamblers (OR = 0.33). The BC subtype was associated with better health outcomes, better social functioning, less childhood maltreatment, and less severe PG. The AI subtype was associated with worse health outcomes, worse social functioning, and higher PG severity. The findings provide a better understanding PG heterogeneity that could be relevant to clinical management.
Compulsive buying disorder (CBD) is characterized by excessive shopping cognitions and buying behavior that leads to distress or impairment. Found worldwide, the disorder has a lifetime prevalence of ...5.8% in the US general population. Most subjects studied clinically are women (~80%), though this gender difference may be artifactual. Subjects with CBD report a preoccupation with shopping, prepurchase tension or anxiety, and a sense of relief following the purchase. CBD is associated with significant psychiatric comorbidity, particularly mood and anxiety disorders, substance use disorders, eating disorders, and other disorders of impulse control. The majority of persons with CBD appear to meet criteria for an Axis II disorder, although there is no special "shopping" personality. Compulsive shopping tends to run in families, and these families are filled with mood and substance use disorders. There are no standard treatments. Psychopharmacologic treatment studies are being actively pursued, and group cognitive-behavioral models have been developed and are promising. Debtors Anonymous, simplicity circles, bibliotherapy, financial counseling, and marital therapy may also play a role in the management of CBD.
The most current, comprehensive work available to date, the Textbook of Antisocial Personality Disorder is the definitive source of information on this difficult and often poorly understood and ...underdiagnosed disorder. A group of distinguished international experts, researchers, and clinicians provide their unique perspectives on what has been learned so far about antisocial personality disorder (ASPD) and other forms of antisocial behavior, including childhood conduct disorder, adult antisocial behavior, and psychopathy. Highly useful for both clinicians tasked with caring for these patients and researchers involved in probing its causes and treatments, the book looks at the phenomenology and natural course of ASPD, as well as its neuropathology, neurophysiology, genetic risk factors, epigenetics, and social determinants. The authors also explore some promising directions regarding prevention and treatment. Throughout the book, illustrative case vignettes provide a real-world view of people diagnosed with ASPD, including symptoms, course, and severity. In addition, tables, graphs, and illustrations further define the important points. Urgently needed and written with authority by those at the forefront of this vexing disorder, the Textbook of Antisocial Personality Disorder provides useful information on topics such as The history and definition of ASPD Clinical concepts such as epidemiology, comorbidity, symptoms, and course Suspected causes of the disorder Neurophysiology, neurotransmitters, and neuroimaging of the disease The relationship of ASPD to psychopathy Current treatment recommendations Special coverage is included on antisocial women, antisocial children, antisocial sexual offenders, forensic aspects of ASPD, and preventive strategies.
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