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Grant JE, Collins M, Chamberlain SR, Chesivoir E. Disorders of impulsivity in trichotillomania and skin picking disorder. J Psychiatr Res 2024; 170:42-46. [PMID: 38101209 DOI: 10.1016/j.jpsychires.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/31/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
Trichotillomania and skin picking disorder are often classified as body-focused repetitive behaviors (BFRBs) as they are characterized by repetitive hair-pulling and skin picking, respectively. They were initially considered to be impulse control disorders despite little research scrutiny. The objective of this study was to examine the relationship of these two conditions to other disorders with impulsive features. Adults with trichotillomania (n = 104) and skin picking (n = 178) or both (n = 96) were recruited from the general community using advertisements and online support groups and completed an online survey. Participants undertook a structured clinical interview and completion of self-report instruments to characterize clinical profiles and associated characteristics. In addition, each participant completed the Minnesota Impulse Disorders Interview to screen for disorders with impulsive features. Of the 378 adults with BFRBs, 134 (35.4%) screened positive for at least one disorder with features of impulsivity with the most common being compulsive buying (18.3%) and problematic use of the internet (17.5%). Participants with a co-occurring disorder of impulsivity reported significantly worse pulling and picking symptoms (p < .001), were more likely to have co-occurring alcohol problems (p < .001) and PTSD (p < .001), and scored higher regarding dissociative symptoms (p < .001). BFRBs are associated with a range of impulsive disorders and the comorbidity may have important treatment implications.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA.
| | - Madison Collins
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, UK; Southern Health NHS Foundation Trust, Southampton, UK
| | - Eve Chesivoir
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
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Ciesinski NK, Drabick DAG, Berman ME, McCloskey MS. Personality Disorder Symptoms in Intermittent Explosive Disorder: A Latent Class Analysis. J Pers Disord 2024; 38:34-52. [PMID: 38324246 PMCID: PMC11323261 DOI: 10.1521/pedi.2024.38.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
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.
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Affiliation(s)
- Nicole K Ciesinski
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Deborah A G Drabick
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Mitchell E Berman
- Department of Psychology, Mississippi State University, Mississippi State, Mississippi
| | - Michael S McCloskey
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
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Ciesinski NK, Himelein-Wachowiak M, Krick LC, Sorgi-Wilson KM, Cheung JCY, McCloskey MS. A systematic review with meta-analysis of cognitive bias modification interventions for anger and aggression. Behav Res Ther 2023; 167:104344. [PMID: 37307657 PMCID: PMC10526745 DOI: 10.1016/j.brat.2023.104344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/05/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
Aggression and anger are associated with interpretation and attention biases. Such biases have become treatment targets for anger and aggressive behavior in cognitive bias modification (CBM) interventions. Several studies have evaluated the efficacy of CBM for the treatment of anger and aggressive behavior, with inconsistent results. The present study meta-analytically analyzed 29 randomized controlled trial studies (N = 2334) published in EBSCOhost and PubMed between March 2013 and March 2023 assessing the efficacy of CBM for anger and/or aggression. Included studies delivered CBMs that addressed either attention biases, interpretation biases, or both. Risk of publication bias and potential moderating effects of several participant-, treatment- and study-related factors were assessed. CBM significantly outperformed control conditions in the treatment of aggression (Hedge's G = -0.23, 95% CI [-0.35, -0.11], p < .001) and anger (Hedge's G = -0.18, 95% CI [-0.28, -0.07], p = .001) independent of treatment dose, participant demographic characteristics, and study quality, though overall effects were small. Follow-up analyses demonstrated that only CBMs targeting interpretation bias were efficacious for aggression outcomes, but not when baseline aggression was accounted for. Findings suggest that CBM demonstrates efficacy for the treatment aggressive behavior and to a lesser extent, anger.
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Affiliation(s)
| | | | - Lynette C Krick
- Department of Psychology and Neuroscience, Temple University, USA
| | | | - Joey C Y Cheung
- Department of Psychology and Neuroscience, Temple University, USA
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Stepanova E, Langfus JA, Youngstrom EA, Evans SC, Stoddard J, Young AS, Van Eck K, Findling RL. Finding a Needed Diagnostic Home for Children with Impulsive Aggression. Clin Child Fam Psychol Rev 2023; 26:259-271. [PMID: 36609931 DOI: 10.1007/s10567-022-00422-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/09/2023]
Abstract
Aggressive behavior is one of the most common reasons for referrals of youth to mental health treatment. While there are multiple publications describing different types of aggression in children, it remains challenging for clinicians to diagnose and treat aggressive youth, especially those with impulsively aggressive behaviors. The reason for this dilemma is that currently several psychiatric diagnoses include only some of the common symptoms of aggression in their criteria. However, no single diagnosis or diagnostic specifier adequately captures youth with impulsive aggression (IA). Here we review select current diagnostic categories, including behavior and mood disorders, and suggest that they do not provide an adequate description of youth with IA. We also specifically focus on the construct of IA as a distinct entity from other diagnoses and propose a set of initial, provisional diagnostic criteria based on the available evidence that describes youth with IA to use for future evaluation.
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Affiliation(s)
- Ekaterina Stepanova
- Virginia Commonwealth University, 1308 Sherwood Ave, Richmond, VA, 23220, USA.
| | - Joshua A Langfus
- University of North Carolina at Chapel Hill, 235 E Cameron Ave, CB# 3270, Chapel Hill, NC, 27514, USA
| | - Eric A Youngstrom
- University of North Carolina at Chapel Hill, 103 Westchester Pl, Chapel Hill, NC, 27514-5237, USA
| | - Spencer C Evans
- University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA
| | - Joel Stoddard
- University of Colorado Anschutz Medical Campus, Aurora, 13123 East 16Th Ave, Aurora, CO, 80045, USA
| | - Andrea S Young
- Johns Hopkins University, 1800 Orleans Street, Bloomberg 12N, Baltimore, MD, 21287, USA
| | - Kathryn Van Eck
- Johns Hopkins University, 1800 Orleans Street, Bloomberg 12N, Baltimore, MD, 21287, USA
| | - Robert L Findling
- Virginia Commonwealth University, 501 N 2Nd St 4Th Floor, PO Box 980308, Richmond, VA, 23298-0308, USA
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Seto MC, Healey LV, Ahmed AG. Legally Mandated, Formally Pressured, or Voluntary Anger Treatment: Associations With Treatment Recommendations, Refusal, and Completion. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20012-NP20039. [PMID: 34715763 DOI: 10.1177/08862605211050100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Legally mandated treatment is common in the criminal justice system, for example, for anger management, substance misuse, and intimate partner violence. Past studies have compared voluntary and legally mandated treatment participants but have not distinguished a third, in-between group that is formally pressured to participate in treatment, but not mandated by the criminal justice system. The current study aimed to assess differences on individual characteristics (e.g., sociodemographic and psychiatric) and baseline measures of psychopathology (e.g., anger, aggression, and depression) across three levels of voluntariness and to determine whether voluntariness was associated with treatment recommendation, refusal, and completion at an outpatient anger treatment clinic. Data were retrospectively gathered from the clinical charts of 405 participants. Referrals were classified as voluntary (e.g., self-referred, 61%), formally pressured (e.g., required by work, 14%), or legally mandated (e.g., court order, 25%). Legally mandated participants were younger, more likely to have substance use disorder, less likely to be women, to have a high school education, or to be on psychiatric medications compared to the other two groups. Voluntary participants scored higher on measures of self-reported anger, depression, and stress than the legally mandated participants. Legally mandated participants in particular presented with non-clinical levels of anger and aggression. Level of voluntariness did not affect the decision to recommend individual or group therapy after an intake assessment, but legally mandated participants were significantly more likely (OR = 2.30) than voluntary participants to refuse recommended treatment. Level of voluntariness did not have a significant association with treatment completion. Findings support our distinction between legally mandated and formally pressured participants, but do not support previous research that suggests legally mandated individuals have lower attrition rates in similar treatment programs. The study has implications for the criminal justice system and for anger treatment programs who admit participants with varying levels of voluntariness.
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Prevalence and correlates of DSM-IV and DSM-5 Intermittent Explosive Disorder amongst Myanmar refugees living in Malaysia: a population-based study. Epidemiol Psychiatr Sci 2022; 31:e57. [PMID: 35968549 PMCID: PMC9387117 DOI: 10.1017/s2045796022000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS We investigate the prevalence and risk factor profiles of Intermittent Explosive Disorder (IED) and comparison between two diagnostic measures for IED in a large population-based study of three ethnic groups of refugees (Chin, Kachin and Rohingya) from Myanmar resettled in Malaysia. METHODS Trained field personnel interviewed in total 2058 refugees, applying a clustered, probabilistic, proportional-to-size sampling framework and using the DSM-IV and DSM-5 criteria to diagnose IED. We used descriptive and bivariate analyses to explore associations of IED (using DSM IV or DMS 5) with ethnic group membership, sociodemographic characteristics and exposure to premigration traumatic events (TEs) and postmigration living difficulties (PMLDs). We also examined associations of IED with other common mental disorders (CMDs) (depression, anxiety and posttraumatic stress disorder) and with domains of functional impairment. Finally, we compared whether IED measured using DSM IV or DSM 5 generated the same or different prevalence. RESULTS For the whole sample (n = 2058), the 12-month prevalence of DSM-IV IED was 5.9% (n = 122) and for DSM-5, 3.4% (n = 71). Across the three ethnic groups, 12-month DSM-5 IED prevalence was 2.1% (Chin), 2.9% (Rohingya) and 8.0% (Kachin), whereas DSM-IV defined IED prevalence was 3.2% (Chin), 7% (Rohingya) and 9.2% (Kachin). Being single, and exposure to greater premigration TEs and PMLDs were each associated with IED. Over 80% of persons with IED recorded one or more comorbid CMDs. Persons with IED also showed greater levels of functional impairment compared with those without IED. CONCLUSIONS The pooled IED prevalence was higher than global norms but there was substantial variation in prevalence across the three study groups.
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Salonen M, Mikkola S, Hakanen E, Sulkama S, Puurunen J, Lohi H. Personality traits associate with behavioral problems in pet dogs. Transl Psychiatry 2022; 12:78. [PMID: 35197456 PMCID: PMC8866408 DOI: 10.1038/s41398-022-01841-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/09/2022] Open
Abstract
Personality traits, especially neuroticism, strongly predict psychopathology. The domestic dog (Canis lupus familiaris Linnaeus, 1758) is used as a natural model for psychiatric disorders, but the similarity between dog and human personality and the association between dog personality and unwanted behavioral traits, such as fearfulness, aggressiveness, and impulsivity/inattention, remain unknown. This study utilized structural equation modeling (SEM) with survey data of 11,360 dogs to examine the associations and correlations between seven personality and ten unwanted behavioral traits. Personality traits included insecurity, energy, training focus, aggressiveness/dominance, human sociability, dog sociability, and perseverance. Unwanted behavioral traits included fearfulness, noise sensitivity, fear of surfaces/heights, separation anxiety, barking, stranger-directed aggression, owner-directed aggression, dog-directed aggression, hyperactivity/impulsivity, and inattention. We first fitted confirmatory factor models for the unwanted behavioral traits and the best model grouped unwanted behaviors into four latent traits: fear-related behavior, fear-aggression, aggression, and impulsivity/inattention and used this structure in the subsequent SEM model. Especially, insecurity, which resembles the human neuroticism trait, was strongly associated with unwanted behavior, paralleling the association between neuroticism and psychopathology. Similarly, training focus, resembling conscientiousness, was negatively related to impulsivity/inattention, and aggressiveness/dominance was associated with aggressive behaviors, resembling associations of conscientiousness and agreeableness with attention deficit hyperactivity disorder and aggression-related psychopathology, respectively. These results indicate that dog personality traits resemble human personality traits, suggesting that their neurological and genetic basis may also be similar and making the dog a suitable animal model for human behavior and psychiatric disorders.
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Affiliation(s)
- Milla Salonen
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland. .,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland. .,Folkhälsan Research Center, Helsinki, Finland.
| | - Salla Mikkola
- grid.7737.40000 0004 0410 2071Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Emma Hakanen
- grid.7737.40000 0004 0410 2071Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Sini Sulkama
- grid.7737.40000 0004 0410 2071Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Jenni Puurunen
- grid.7737.40000 0004 0410 2071Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Hannes Lohi
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland. .,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland. .,Folkhälsan Research Center, Helsinki, Finland.
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Ogbuagu N, Keedy S, Phan KL, Coccaro EF. Neural responses to induced emotion and response to social threat in intermittent explosive disorder. Psychiatry Res Neuroimaging 2021; 318:111388. [PMID: 34706324 DOI: 10.1016/j.pscychresns.2021.111388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Individuals with intermittent explosive disorder (IED) are reported to exhibit amygdala (AMYG) hyper-activation to anger faces during functional magnetic resonance imaging (fMRI). However, it remains unknown if emotional experience is different in study participants with IED compared with healthy controls (HC). Thus, we examined the comparative effect of pleasant and unpleasant IAPS pictures in IED and HC individuals. METHOD Eighty study participants (40 IED and 40 HC) underwent fMRI scanning while viewing blocks of angry and happy faces and while viewing blocks of pleasant and unpleasant pictures from the International Affective Picture System (IAPS). RESULTS Compared with HC participants, IED participants exhibited greater AMYG responses to angry, but not happy, faces; IED and HC participants, however, did not differ in AMYG responses to pleasant or unpleasant IAPS pictures. There were no group differences in Orbital-Frontal Cortical (OFC) responses to emotional faces or IAPS pictures other than a significantly higher OFC response pleasant, compared with unpleasant, IAPS pictures. CONCLUSION These findings suggest that, compared with healthy individuals, those with IED have a hypersensitive amygdala to social-emotional threat but that this characteristic does not extend to neural responses related to the experience of emotion in the context of the paradigms tested.
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Affiliation(s)
- Nicole Ogbuagu
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, US
| | - Sarah Keedy
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, US
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 520 King Avenue Columbus, OH, 43201, US
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 520 King Avenue Columbus, OH, 43201, US.
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Castle R, Bushell WC, Mills PJ, Williams MA, Chopra D, Rindfleisch JA. Global Correlations Between Chronic Inflammation and Violent Incidents: Potential Behavioral Consequences of Inflammatory Illnesses Across Socio-Demographic Levels. Int J Gen Med 2021; 14:6677-6691. [PMID: 34675629 PMCID: PMC8520436 DOI: 10.2147/ijgm.s324367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/01/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction This review explores the potential correlation between conditions associated with chronic inflammation and measures of violence across five socioeconomic subgroups. The hypothesis being that since chronic inflammation is associated with increased aggression, an extreme version of which is violence, there should be a correlation between incidents of violence and diseases with one or more inflammatory factors, without an equivalent correlation with the contrast group. An extension of this reasoning would predict a higher correlation among lower socio-demographic index (SDI) populations as a result of fewer resources to prevent either inflammatory disease or violent crime. Methods In order to examine this potential correlation, an analysis was made comparing rates of change in incidence between violence, inflammatory conditions, and a contrast group disease of noninflammatory nature, as determined by Pearson's correlation coefficient. Results In the low socio-demographic index, inflammatory conditions demonstrated 80% correlation with interpersonal violence, middle-low socio-demographic index inflammatory conditions demonstrated 60% correlation with interpersonal violence, middle socio-demographic index inflammatory conditions demonstrated 0% correlation with interpersonal violence, middle-high socio-demographic index inflammatory conditions demonstrated 60% correlation with interpersonal violence, and high socio-demographic index inflammatory conditions demonstrated 40% correlation with interpersonal violence. Discussion The majority of socio-demographic groups showed a significant correlation between rates of change in incidence of violence and inflammatory conditions. This correlation was not found with a similar frequency or strength in diseases not causally linked to inflammation. As predicted in the hypothesis, the highest correlations of inflammatory diseases with violence existed in the lower socio-demographic populations, supporting a link between inflammatory levels and incidences of violence.
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Affiliation(s)
- Ryan Castle
- Science Division, Whole Health Institute, Bentonville, AR, USA
| | | | - Paul J Mills
- Herbert Wertheim School of Public Health and Human Longevity Science, Center of Excellence for Research and Training in Integrative Health, University of California San Diego, La Jolla, CA, USA
| | - Michelle A Williams
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Harvard University, Boston, MA, USA
| | | | - James A Rindfleisch
- Education Department, Whole Health School of Medicine and Health Sciences, Bentonville, AR, USA
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Smith DM, Meruelo A, Campbell-Sills L, Sun X, Kessler RC, Ursano RJ, Jain S, Stein MB. Pre-enlistment Anger Attacks and Postenlistment Mental Disorders and Suicidality Among US Army Soldiers. JAMA Netw Open 2021; 4:e2126626. [PMID: 34570207 PMCID: PMC8477262 DOI: 10.1001/jamanetworkopen.2021.26626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Anger is linked to adverse outcomes in military populations; however, whether pre-enlistment anger attacks are associated with postenlistment mental disorders and suicidality is unknown. OBJECTIVE To explore the associations of pre-enlistment anger attacks with postenlistment mental health. DESIGN, SETTING, AND PARTICIPANTS In this observational cohort study, the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) New Soldier Study (NSS) surveyed soldiers entering basic training from April 2011 to November 2012, with a subsample recruited for wave 1 of the STARRS Longitudinal Study (STARRS-LS) (conducted September 2016 to April 2018). Participants were recruited from 3 US Army installations for the NSS survey. Those who were subsequently contacted for STARRS-LS completed the follow-up survey via web or telephone. Prospective analyses were based on a weighted NSS subsample included in wave 1 of STARRS-LS. Data were analyzed from May 22, 2020, to March 17, 2021. EXPOSURES History of anger attacks at baseline (NSS). Survey responses were used to classify new soldiers as having nonimpairing anger attacks (>2 attacks without interference in work or personal life), impairing anger attacks (>2 attacks with interference in work or personal life), or no significant history of anger attacks. MAIN OUTCOMES AND MEASURES Baseline analyses examined sociodemographic and clinical correlates of a history of anger attacks. Prospective logistic regression models estimated associations of baseline history of anger attacks with new onset and persistence of posttraumatic stress disorder, major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder, mania/hypomania, substance use disorder, suicidal ideation, and suicide attempt at wave 1 of STARRS-LS. RESULTS Of the 38 507 baseline participants (83.0% male and 17.0% female; mean [SD] age, 20.97 [3.57] years), 6216 were selected for and completed wave 1 of the STARRS-LS. Baseline prevalence (SE) of nonimpairing and impairing anger attacks was 8.83% (0.16%) and 5.75% (0.15%), respectively. Prospective models showed that impairing anger attacks were associated with new onset of MDD (adjusted odds ratio [AOR], 1.98; 95% CI, 1.31-2.99), GAD (AOR, 2.39; 95% CI, 1.66-3.45), panic disorder (AOR, 2.02; 95% CI, 1.34-3.05), and suicidal ideation (AOR, 2.11; 95% CI, 1.45-3.07). When baseline psychiatric comorbidity was controlled for, impairing attacks remained associated with onset of GAD (AOR, 1.75; 95% CI, 1.19-2.58) and suicidal ideation (AOR, 1.62; 95% CI, 1.09-2.42). Anger attacks were not significantly associated with persistence of pre-enlistment mental disorders. CONCLUSIONS AND RELEVANCE The findings of this study suggest that a pre-enlistment history of impairing anger attacks may be associated with elevated risk of developing GAD, MDD, and suicidality after enlistment. Detection of impairing anger attacks could aid in assessing psychiatric risk in new soldiers.
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Affiliation(s)
- Diana M. Smith
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Alejandro Meruelo
- Department of Psychiatry, University of California, San Diego, La Jolla
| | | | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, La Jolla
- Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, California
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
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Lee TJ, Zanello AF, Morrison TR, Ricci LA, Melloni RH. Valproate selectively suppresses adolescent anabolic/androgenic steroid-induced aggressive behavior: implications for a role of hypothalamic γ-aminobutyric acid neural signaling. Behav Pharmacol 2021; 32:295-307. [PMID: 33595952 DOI: 10.1097/fbp.0000000000000616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pubertal male Syrian hamsters (Mesocricetus auratus) treated with anabolic/androgenic steroids (AASs) during adolescence (P27-P56) display a highly intense aggressive phenotype that shares many behavioral similarities with pathological aggression in youth. Anticonvulsant drugs like valproate that enhance the activity of the γ-aminobutyric acid (GABA) neural system in the brain have recently gained acceptance as a primary treatment for pathological aggression. This study examined whether valproate would selectively suppress adolescent AAS-induced aggressive behavior and whether GABA neural signaling through GABAA subtype receptors in the latero-anterior hypothalamus (LAH; an area of convergence for developmental and neuroplastic changes that underlie aggression in hamsters) modulate the aggression-suppressing effect of this anticonvulsant medication. Valproate (1.0-10.0 mg/kg, intraperitoneal) selectively suppressed the aggressive phenotype in a dose-dependent fashion, with the effective anti-aggressive effects beginning at 5 mg/kg, intraperitoneally. Microinfusion of the GABAA receptor antagonist bicuculline (7.0-700 ng) into the LAH reversed valproate's suppression of AAS-induced aggression in a dose-dependent fashion. At the 70 ng dose of bicuculline, animals expressed the highly aggressive baseline phenotype normally observed in AAS-treated animals. These studies provide preclinical evidence that the anticonvulsant valproate selectively suppresses adolescent, AAS-induced aggression and that this suppression is modulated, in part, by GABA neural signaling within the LAH.
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Affiliation(s)
- Terrence J Lee
- Program in Behavioral Neuroscience, Department of Psychology, Northeastern University, Boston, Massachusetts, USA
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Prevalence and psychiatric comorbidities of intermittent explosive disorders in Metropolitan São Paulo, Brazil. Soc Psychiatry Psychiatr Epidemiol 2021; 56:687-694. [PMID: 32285139 DOI: 10.1007/s00127-020-01869-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To estimate the prevalence of intermittent explosive disorder (IED) in comorbidity with other psychiatric disorders and to describe the temporal sequencing of disorders in the São Paulo Metropolitan Area, Brazil. METHODS Data from the São Paulo Megacity Mental Health Survey, a population-based study of 5037 adult individuals, were analyzed. The World Health Organization Composite International Diagnostic Interview (CID 3.0) was used to assess lifetime DSM-IV disorders, including IED, with a response rate of 81.3%. RESULTS The majority (76.8%) of respondents with IED meet the criteria for at least one other psychiatric disorder, with a prevalence almost twice as high as that observed in individuals without IED. The prevalence of any anxiety, mood, impulse control or substance use disorders in respondents with IED was more than two times higher compared to those without IED, with prevalence ratios ranging from 2.1 (95% CI 1.74-2.48) to 2.9 (95% CI 2.12-4.06). The diagnosis of IED occurred earlier than most of the other mental disorders, except for those with usual onset in early childhood, as Specific and Social Phobias and Attention Deficit Disorder. CONCLUSION Considering that IED is a highly comorbid disorder and has an earlier onset than most other mental comorbidities in the Brazilian general population, these results may be useful in guiding governmental mental health actions.
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13
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A framework for indirect elicitation of the public health impact of gambling problems. BMC Public Health 2020; 20:1717. [PMID: 33198709 PMCID: PMC7670710 DOI: 10.1186/s12889-020-09813-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Gambling problems are increasingly understood as a health-related condition, with harms from excessive time and money expenditure contributing to significant population morbidity. In many countries, the prevalence of gambling problems is known with some precision. However, the true severity of gambling problems in terms of their impact on health and wellbeing is the subject of ongoing debate. We firstly review recent research that has attempted to estimate harm from gambling, including studies that estimate disability weights using direct elicitation. Limitations of prior approaches are discussed, most notably potential inflation due to non-independent comorbidity with other substance use and mental health conditions, and potential biases in the subjective attribution of morbidity to gambling. An alternative indirect elicitation approach is outlined, and a conceptual framework for its application to gambling is provided. Significant risk factors for propensity to develop gambling problems are enumerated, and relative risks for comorbidities are calculated from recent meta-analyses and reviews. Indirect elicitation provides a promising alternative framework for assessing the causal link between gambling problems and morbidity. This approach requires implementation of propensity score matching to estimate the counterfactual, and demands high quality information of risk factors and comorbid conditions, in order to estimate the unique contribution of gambling problems. Gambling harm is best understood as a decrement to health utility. However, achieving consensus on the severity of gambling problems requires triangulation of results from multiple methodologies. Indirect elicitation with propensity score matching and accounting for comorbidities would provide an important step towards full integration of gambling within a public health paradigm.
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14
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Johnson SL, Zisser MR, Sandel DB, Swerdlow BA, Carver CS, Sanchez AH, Fernandez E. Development of a brief online intervention to address aggression in the context of emotion-related impulsivity: Evidence from a wait-list controlled trial. Behav Res Ther 2020; 134:103708. [PMID: 32896743 DOI: 10.1016/j.brat.2020.103708] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 11/15/2022]
Abstract
Trait-like tendencies to respond impulsively to emotion, labelled emotion-related impulsivity, are robustly related to aggression. We developed and tested an online intervention to address emotion-related impulsivity and aggression. The 6-session intervention focused on behavioral techniques shown to decrease arousal and aggression, supplemented with implementation intentions and smartphone prompts to facilitate skills transfer into daily life. First, we piloted the intervention in-person with 4 people. Then, 235 participants were randomly assigned to take the online intervention immediately or after a wait-list period; those in the waitlist were then invited to take part in the intervention. Participants completed the self-rated Feelings Trigger Action Scale to assess emotion-related impulsivity, the interview-based Modified Overt Aggression Scale and the self-rated Buss Perry Aggression Questionnaire. Participants who took part in the treatment completed daily anger logs. Attrition, as with other online programs, was high; however, treatment completers reported high satisfaction, and outcomes changed more rapidly during treatment than waitlist across all key outcome indices. In analyses including all participants who took part in the treatment (immediate or delayed), we observed moderate-to-large treatment gains, which were maintained as of the 3-month follow-up assessment. This work supports the usefulness of an intervention for addressing emotion-related impulsivity and aggression.
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15
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Fahlgren MK, Kleiman EM, Puhalla AA, McCloskey MS. Age and Gender Effects in Recent Violence Perpetration. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:3513-3529. [PMID: 29294762 DOI: 10.1177/0886260517709803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although we know much about the effects of violence on victims, we know less about individuals who perpetrate violence. In the present study, we used a large, nationally representative sample of adults (National Comorbidity Study-Replication; n = 9,282) to examine demographics (i.e., age and gender) and social, occupational, and cognitive functioning among perpetrators of recent violence. We found that recent violence was more prevalent among younger individuals and males (i.e., these groups were more likely to engage in at least one act of violence). Among those who did engage in violence, there was no effect of age or gender on violence frequency (i.e., number of violent acts engaged in over the past year). Furthermore, gender moderated the effect of age on recent violence prevalence, but not violence frequency. Finally, those reporting violence over the past year showed greater impairment in all examined domains of functioning, but there was no association between impairment and frequency of violence. This study represents one of the first attempts to utilize 12-month prevalence data to explore the lifetime trajectory of violence among those who perpetrate it, which seems to peak in young adulthood and then decrease across the life span. Furthermore, although males are more likely to engage in violence than females, adults who engage in at least one act of violence demonstrate no difference in frequency of yearly violent acts, regardless of gender. Finally, it is apparent that merely engaging in any acts of violence over the past year is associated with functioning problems. Overall, most significant differences emerged between those who do and do not engage in violence, which is key for informing violence risk assessment and prevention.
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16
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de Abreu MS, C V V Giacomini A, Genario R, Fontana BD, Parker MO, Marcon L, Scolari N, Bueno B, Demin KA, Galstyan D, Kolesnikova TO, Amstislavskaya TG, Zabegalov KN, Strekalova T, Kalueff AV. Zebrafish models of impulsivity and impulse control disorders. Eur J Neurosci 2020; 52:4233-4248. [PMID: 32619029 DOI: 10.1111/ejn.14893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/25/2020] [Accepted: 06/18/2020] [Indexed: 12/22/2022]
Abstract
Impulse control disorders (ICDs) are characterized by generalized difficulty controlling emotions and behaviors. ICDs are a broad group of the central nervous system (CNS) disorders including conduct disorder, intermittent explosive, oppositional-defiant disorder, antisocial personality disorder, kleptomania, pyromania and other illnesses. Although they all share a common feature (aberrant impulsivity), their pathobiology is complex and poorly understood. There are also currently no ICD-specific therapies to treat these illnesses. Animal models are a valuable tool for studying ICD pathobiology and potential therapies. The zebrafish (Danio rerio) has become a useful model organism to study CNS disorders due to high genetic and physiological homology to mammals, and sensitivity to various pharmacological and genetic manipulations. Here, we summarize experimental models of impulsivity and ICD in zebrafish and highlight their growing translational significance. We also emphasize the need for further development of zebrafish ICD models to improve our understanding of their pathogenesis and to search for novel therapeutic treatments.
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Affiliation(s)
- Murilo S de Abreu
- Bioscience Institute, University of Passo Fundo, Passo Fundo, Brazil.,The International Zebrafish Neuroscience Research Consortium (ZNRC), Slidell, LA, USA
| | - Ana C V V Giacomini
- Bioscience Institute, University of Passo Fundo, Passo Fundo, Brazil.,Postgraduate Program in Environmental Sciences, University of Passo Fundo, Passo Fundo, Brazil
| | - Rafael Genario
- Bioscience Institute, University of Passo Fundo, Passo Fundo, Brazil
| | - Barbara D Fontana
- Brain and Behaviour Laboratory, School of Pharmacy and Biomedical Sciences, University of Portsmouth, UK
| | - Matthew O Parker
- Brain and Behaviour Laboratory, School of Pharmacy and Biomedical Sciences, University of Portsmouth, UK
| | - Leticia Marcon
- Bioscience Institute, University of Passo Fundo, Passo Fundo, Brazil
| | - Naiara Scolari
- Bioscience Institute, University of Passo Fundo, Passo Fundo, Brazil
| | - Barbara Bueno
- Bioscience Institute, University of Passo Fundo, Passo Fundo, Brazil
| | - Konstantin A Demin
- Institute of Experimental Medicine, Almazov National Medical Research Center, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia.,Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - David Galstyan
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Tatyana O Kolesnikova
- Institute of Experimental Medicine, Almazov National Medical Research Center, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | | | | | - Tatyana Strekalova
- Laboratory of Psychiatric Neurobiology, Institute of Molecular Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Division of Molecular Psychiatry, Center of Mental Health, University of Würzburg, Würzburg, Germany.,Institute of General Pathology and Pathophysiology, University of Würzburg, Moscow, Russia
| | - Allan V Kalueff
- School of Pharmacy, Southwest University, Chongqing, China.,Laboratory of Petrochemistry, Ural Federal University, Ekaterinburg, Russia
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17
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Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality. Epidemiol Psychiatr Sci 2020; 29:e138. [PMID: 32638683 PMCID: PMC7327434 DOI: 10.1017/s2045796020000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIMS Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment. METHODS IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment. RESULTS The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people ('hurt people only' and 'destroy property and hurt people'), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterised by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults. CONCLUSIONS The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterises the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.
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18
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Puhalla AA, Berman ME, Coccaro EF, Fahlgren MK, McCloskey MS. History of childhood abuse and alcohol use disorder: Relationship with intermittent explosive disorder and intoxicated aggression frequency. J Psychiatr Res 2020; 125:38-44. [PMID: 32203738 DOI: 10.1016/j.jpsychires.2020.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 01/12/2023]
Abstract
Intermittent Explosive Disorder (IED), the only psychiatric diagnosis for which affective aggression is the cardinal symptom, is uniquely associated with both a history of childhood abuse and a diagnosis of an alcohol use disorder (AUD). Moreover, both childhood abuse and AUD are associated with increased general aggression and aggression while intoxicated. Yet, no study to date has examined the relative contributions of childhood abuse and AUD to IED, nor their effects on overall and intoxicated aggression among those with and without IED. The following study aimed to fill these gaps. Participants were 493 individuals (68% female; Age M = 26.65) either with (n = 265) or without (psychiatric control group; n = 228) IED. All participants completed a clinical interview to (a) diagnose AUD, IED, and other comorbid psychiatric disorders; (b) assess childhood abuse history; and (c) determine lifetime frequency of overall and intoxicated aggression. Results indicated that a history of childhood abuse, but not AUD status, was uniquely predictive of IED status. With regard to aggression frequency, IED, AUD and childhood abuse were all independently associated with overall aggression, although only those with IED showed increased intoxicated aggression as a function of AUD severity. Overall, these results suggest that a history of childhood abuse may increase the chances of engaging in overall aggression and developing IED, which in turn may increase the association between AUD severity and intoxicated aggression.
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Affiliation(s)
| | - Mitchell E Berman
- Department of Psychology, Mississippi State University, Starkville, MI, USA
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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19
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Einberger C, Puckett A, Ricci L, Melloni R. Contemporary Pharmacotherapeutics and the Management of Aggressive Behavior in an Adolescent Animal Model of Maladaptive Aggression. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:188-202. [PMID: 32329300 PMCID: PMC7236798 DOI: 10.9758/cpn.2020.18.2.188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/02/2019] [Accepted: 09/21/2019] [Indexed: 12/28/2022]
Abstract
Objective Antipsychotic and anticonvulsant medications are increasingly being used as pharmacotherapeutic treatments for maladaptive aggression in youth, yet no information is available regarding whether these drugs exhibit aggression- specific suppression in preclinical studies employing adolescent animal models of maladaptive aggression. This study examined whether the commonly used antipsychotics medications haloperidol and risperidone and the anticonvulsant medication valproate exert selective aggression-suppressing effects using a validated adolescent animal model of maladaptive aggression. Methods Twenty-seven-day old Syrian hamsters (Mesocricetus auratus) were administered testosterone for 30 consecutive days during the first 4 weeks of adolescent development. The following day (during late adolescence), experimental animals received a single dose of haloperidol (0.00, 0.025, 0.50, 1.0 mg/kg), risperidone (0.00, 0.01, 0.03, 1.0 mg/kg), or valproate (0.00, 1.0, 5.0, 10.0 mg/kg) and tested for offensive aggression using the Resident/Intruder Paradigm. As a baseline, non-aggressive behavioral control, a separate set of pubertal hamsters was treated with sesame oil vehicle during the first 4 weeks of adolescence and then tested for aggression during late adolescence in parallel with the haloperidol, risperidone or valproate-treated experimental animals. Results Risperidone and valproate selectively reduced the highly impulsive and intense maladaptive aggressive phenotype in a dose-dependent fashion. While haloperidol marginally reduced aggressive responding, its effects were non-specific as the decrease in aggression was concurrent with reductions in a several ancillary (non-aggressive) behaviors. Conclusion These studies provide pre-clinical evidence that the contemporary pharmacotherapeutics risperidone and valproate exert specific aggression-suppressing effects in an adolescent animal model of maladaptive aggression.
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Affiliation(s)
- Clare Einberger
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Amanda Puckett
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Lesley Ricci
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Richard Melloni
- Department of Psychology, Northeastern University, Boston, MA, USA.,Program in Behavioral Neuroscience, Northeastern University, Boston, MA, USA
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20
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Radwan K, Coccaro EF. Comorbidity of disruptive behavior disorders and intermittent explosive disorder. Child Adolesc Psychiatry Ment Health 2020; 14:24. [PMID: 32514306 PMCID: PMC7257202 DOI: 10.1186/s13034-020-00330-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Aggressive behavior in children and adolescents may be accounted for by several disruptive behavioral disorders (DBD) including attention-deficit/hyperactive (ADHD), conduct (CD), and oppositional defiant (ODD), disorders and intermittent explosive disorder (IED). The comorbidity among the DBDs is well known, but not its comorbidity with IED. METHOD We reanalyzed data from the National Comorbidity Studies (adolescents and adults), and from a large clinical research adult sample, to estimate the comorbidity of IED with each of the DBDs and to explore correlates of these comorbidities. RESULTS The rate of current comorbidity between IED and the DBDs ranged from 10 to 19%, in adolescents (5-14% in adults) with odds ratios of about five. The onset of ADHD typically appeared before onset of IED while onset ODD and CD more typically appeared before that of IED in adolescents and about equally before or after IED in adults but IED persisted outside the duration window in many (ADHD) or most (ODD, CD) cases. Measures of impulsive aggression severity were highest in those with IED+DBD but relatively low in those with DBD alone while measures of DBD severity were highest in those with DBD alone and in those with IED+DBD. CONCLUSION Despite the comorbidity of IED with the DBDs, IED can be separated from the DBDs over time and in terms of severity measures of IED and of DBD. Overall, impulsive aggression varies with IED while DBD behaviors vary with DBD. Based on this, clinicians should consider IED in their differential in the workup of impulsively aggressive children and adolescents.
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Affiliation(s)
- Karam Radwan
- grid.170205.10000 0004 1936 7822Section of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, IL USA
| | - Emil F. Coccaro
- grid.412332.50000 0001 1545 0811Clinical Neuroscience and Psychotherapeutics Research Unit, Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Drive, Columbus, OH USA
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21
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Seok JW, Cheong C. Gray Matter Deficits and Dysfunction in the Insula Among Individuals With Intermittent Explosive Disorder. Front Psychiatry 2020; 11:439. [PMID: 32508687 PMCID: PMC7251158 DOI: 10.3389/fpsyt.2020.00439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
Although numerous neuroimaging studies have evaluated the characteristics of intermittent explosive disorder (IED), studies on the structural alterations and focal dysfunction in the brain in this condition are limited. This study aimed to identify gray matter deficits and functional alterations in individuals with IED using voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI) analyses. Fifteen men with IED and 15 age- and sex-matched healthy controls participated in this study. Gray matter volume and brain activation while viewing the anger-inducing films were measured using 7T MRI. VBM results indicated that individuals with IED had significantly reduced gray matter volume in the insula, amygdala, and orbitofrontal area, relative to controls. Gray matter volume in the left insula was negatively correlated with composite aggression scores. fMRI results demonstrated that relative to healthy controls, individuals with IED showed greater activation in the insula, putamen, anterior cingulate cortex, and amygdala during anger processing. Left insular activity was positively correlated with composite aggression scores. Collectively, these findings suggest that structural and functional alterations in the left insula are linked to IED; this provides insight into the neural mechanisms underlying IED.
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Affiliation(s)
- Ji-Woo Seok
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Rehabilitation Counseling Psychology, Seoul Hanyoung University, Seoul, South Korea
| | - Chaejoon Cheong
- Bioimaging Research Team, Korean Basic Science Institute, Cheongju, South Korea
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22
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Johnson SL, Sandel DB, Zisser M, Pearlstein JG, Swerdlow BA, Sanchez AH, Fernandez E, Carver CS. A brief online intervention to address aggression in the context of emotion-related impulsivity for those treated for bipolar disorder: Feasibility, acceptability and pilot outcome data. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2020; 30:65-74. [PMID: 34113851 DOI: 10.1016/j.jbct.2020.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Although aggression is related to manic symptoms among those with bipolar disorder, new work suggests that some continue to experience elevations of aggression after remission. This aggression post-remission appears related to a more general tendency to respond impulsively to states of emotion, labelled emotion-related impulsivity. We recently developed the first intervention designed to address aggression in the context of emotion-related impulsivity. Here, we describe feasibility, acceptability, and pilot data on outcomes for 21 persons who received treatment for bipolar disorder and endorsed high levels of aggression and emotion-related impulsivity. As with other interventions for aggression or bipolar disorder, attrition levels were high. Those who completed the intervention showed large changes in aggression using the interview-based Modified Overt Aggression Scale that were sustained through three months and not observed during wait list control. Although they also showed declines in the self-rated Buss-Perry Aggression Questionnaire and in self-rated emotion-related impulsivity as assessed with the Feelings Trigger Action Scale, these self-ratings also declined during the waitlist control. t Despite the limitations, the findings provide the first evidence that a brief, easily disseminated intervention could have promise for reducing aggression among those with bipolar disorder.
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Affiliation(s)
- Sheri L Johnson
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Devon B Sandel
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Mackenzie Zisser
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Jennifer G Pearlstein
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Benjamin A Swerdlow
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Amy H Sanchez
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Ephrem Fernandez
- University of Texas San Antonio, San Antonio, Texas, United States
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23
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Alia-Klein N, Gan G, Gilam G, Bezek J, Bruno A, Denson TF, Hendler T, Lowe L, Mariotti V, Muscatello MR, Palumbo S, Pellegrini S, Pietrini P, Rizzo A, Verona E. The feeling of anger: From brain networks to linguistic expressions. Neurosci Biobehav Rev 2020; 108:480-497. [DOI: 10.1016/j.neubiorev.2019.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/14/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022]
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24
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Coccaro EF. Psychiatric comorbidity in Intermittent Explosive Disorder. J Psychiatr Res 2019; 118:38-43. [PMID: 31487607 DOI: 10.1016/j.jpsychires.2019.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 01/11/2023]
Abstract
This study examined aspects of psychiatry comorbidity in Intermittent Explosive Disorder (IED) in order to explore the validity of IED in the context of other psychiatric disorders. Data from the National Comorbidity Study - Revised (NCS-R: n = 9,282 adults) and its Adolescent Supplement (NCS-AS: n = 10,148 adolescents) and a large clinical research data set (n = 1640) were analyzed in this study. Mean number of comorbid disorders among current IED participants was similar to that among other Non-IED disorders and comorbidity of IED with Non-IED disorders was similar to comorbidity among Non-IED disorders. When examined together, current IED was significantly comorbid with current bipolar, depressive, anxiety, substance use, and post-traumatic stress disorder, and age of onset of IED generally preceded that of the comorbid disorders. Finally, mean aggression scores were generally highest among those with IED and the comorbid disorder while scores among those with the comorbid disorder alone were generally less than that with IED or with IED and the comorbid disorder. Comorbidity in IED is similar to that in other, more established, Non-IED disorders. The observation that the development of IED precedes the onset of most comorbid disorders and that aggression scores in those with IED and a comorbid disorder are often higher than those with IED alone supports the rationale that a diagnosis of both IED and the comorbid disorder should be made when both are present.
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Affiliation(s)
- Emil F Coccaro
- Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA.
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25
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Manchia M, Comai S, Pinna M, Pinna F, Fanos V, Denovan-Wright E, Carpiniello B. Biomarkers in aggression. Adv Clin Chem 2019; 93:169-237. [PMID: 31655730 DOI: 10.1016/bs.acc.2019.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aggressive behavior exerts an enormous impact on society remaining among the main causes of worldwide premature death. Effective primary interventions, relying on predictive models of aggression that show adequate sensitivity and specificity are currently lacking. One strategy to increase the accuracy and precision of prediction would be to include biological data in the predictive models. Clearly, to be included in such models, biological markers should be reliably associated with the specific trait under study (i.e., diagnostic biomarkers). Aggression, however, is phenotypically highly heterogeneous, an element that has hindered the identification of reliable biomarkers. However, current research is trying to overcome these challenges by focusing on more homogenous aggression subtypes and/or by studying large sample size of aggressive individuals. Further advance is coming by bioinformatics approaches that are allowing the integration of inter-species biological data as well as the development of predictive algorithms able to discriminate subjects on the basis of the propensity toward aggressive behavior. In this review we first present a brief summary of the available evidence on neuroimaging of aggression. We will then treat extensively the data on genetic determinants, including those from hypothesis-free genome-wide association studies (GWAS) and candidate gene studies. Transcriptomic and neurochemical biomarkers will then be reviewed, and we will dedicate a section on the role of metabolomics in aggression. Finally, we will discuss how biomarkers can inform the development of new pharmacological tools as well as increase the efficacy of preventive strategies.
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Affiliation(s)
- Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.
| | - Stefano Comai
- San Raffaele Scientific Institute and Vita Salute University, Milano, Italy; Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Martina Pinna
- Forensic Psychiatry Unit, Sardinia Health Agency, Cagliari, Italy
| | - Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy; Puericulture Institute and Neonatal Section, University Hospital Agency of Cagliari, Cagliari, Italy
| | | | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Medeiros GC, Seger-Jacob L, Garreto AK, Kim HS, Coccaro EF, Tavares H. Aggression directed towards others vs. aggression directed towards the self: clinical differences between intermittent explosive disorder and nonsuicidal self-injury. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2019; 41:303-309. [PMID: 30843959 PMCID: PMC6804311 DOI: 10.1590/1516-4446-2018-0149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/11/2018] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Gustavo C. Medeiros
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Liliana Seger-Jacob
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Anna K. Garreto
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Hyoun S. Kim
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Emil F. Coccaro
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Hermano Tavares
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Fanning JR, Coleman M, Lee R, Coccaro EF. Subtypes of aggression in intermittent explosive disorder. J Psychiatr Res 2019; 109:164-172. [PMID: 30551023 PMCID: PMC6699742 DOI: 10.1016/j.jpsychires.2018.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/05/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
Research in aggression has distinguished two major subtypes of aggressive behavior: hostile and instrumental. Previous research has examined these subtypes in healthy individuals and forensic samples but not in intermittent explosive disorder (IED), a disorder characterized by recurrent and severe aggressive behavior. We examined aggression subtypes in individuals with IED, healthy subjects, and psychiatric control subjects. We also considered the relationship between aggression subtypes and measures of trait anger and impulsivity to evaluate whether the hostile/instrumental dichotomy adequately captures the heterogeneity of aggressive behavior in this sample. Finally, we consider the implications of these results for research on aggression, including neuroscience research on aggression.
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Affiliation(s)
| | | | - Royce Lee
- McLean Hospital, Harvard Medical School, United States
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Anger, social support, and suicide risk in U.S. military veterans. J Psychiatr Res 2019; 109:139-144. [PMID: 30537566 DOI: 10.1016/j.jpsychires.2018.11.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/23/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
There have been considerable efforts to understand, predict, and reduce suicide among U.S. military veterans. Studies have shown that posttraumatic stress disorder (PTSD), major depression (MDD), and traumatic brain injury (TBI) increase risk of suicidal behavior in veterans. Limited research has examined anger and social support as factors linked to suicidal ideation, which if demonstrated could lead to new, effective strategies for suicide risk assessment and prevention. Iraq/Afghanistan era veterans (N = 2467) were evaluated in the ongoing Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) multi-site Study of Post-Deployment Mental Health on demographic and psychological variables. Analyses revealed that suicidal ideation in veterans was positively associated with anger and negatively associated with social support. These results remained significant in multivariate logistic regression models controlling for relevant variables including PTSD, MDD, and TBI. Examining interrelationships among these variables, the analyses revealed that the association between PTSD and suicidal ideation was no longer statistically significant once anger was entered in the regression models. Further, it was found that TBI was associated with suicidal ideation in veterans with MDD but not in veterans without MDD. These findings provide preliminary evidence that suicide risk assessment in military veterans should include clinical consideration of the roles of anger and social support in addition to PTSD, MDD, and TBI. Further, the results suggest that suicide prevention may benefit from anger management interventions as well as interventions aimed at bolstering social and family support as treatment adjuncts to lower suicide risk in veterans.
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Shao Y, Qiao Y, Xie B, Zhou M. Intermittent Explosive Disorder in Male Juvenile Delinquents in China. Front Psychiatry 2019; 10:485. [PMID: 31404282 PMCID: PMC6675866 DOI: 10.3389/fpsyt.2019.00485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/20/2019] [Indexed: 12/11/2022] Open
Abstract
Objective: Although several previous studies have focused on the mental health problems in detained juvenile offenders in China and found high levels of major psychiatric morbidity, the prevalence of intermittent explosive disorder (IED) in this group remains unknown. The purpose of this study is to discover the prevalence of IED among juvenile offenders in China as well as the difference in demographic characteristics and personality traits between IED offenders and the general population. Method: A total of 280 delinquent boys (Mean age 16.10 years) were interviewed by trained psychiatrists. The interview procedure included the recording of sociodemographic characteristics, criminal records, Composite International Diagnostic Interviews (CIDI), State-Trait Anger and Expression of Anger Inventory-2 (STAXI-2) and Modified Overt Aggression Scales (MOAS). Results: Of the 280 delinquent boys, 32 (11.4%) were diagnosed with IED, 129 (46.1%) were non-IED psychopathology controls (PC), and 119 (42.5%) were healthy controls (HC). Except for substance use disorder (SUD), no differences in psychiatric comorbidity were found between youths with IED and those with another psychiatric disorder. Compared with the PC and HC groups, those in the IED group were more likely to commit a violent crime such as rape, assault, or an affray but it is less likely that their motive can be explained by money or property. The IED group also had a higher rate of recidivism history than the HC group. The IED group displayed higher levels of state and trait anger and anger expression than the HC group and lower levels of anger control than both the PC and HC groups. MOAS also showed that those in the IED group were more aggressive than those in the PC and HC groups. Conclusion: The relationships between IED, anger and aggression reflect the need to develop and implement specific and individually tailored intervention approaches to correct IED juvenile offenders' behavior in order to prevent new crime.
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Affiliation(s)
- Yang Shao
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Qiao
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Xie
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhou
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Forster N, Lund DW. Identifying and dealing with functional psychopathic behavior in higher education. ACTA ACUST UNITED AC 2018. [DOI: 10.1002/joe.21897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Steakley-Freeman DM, Lee RJ, McCloskey MS, Coccaro EF. Social desirability, deceptive reporting, and awareness of problematic aggression in intermittent explosive disorder compared with non-aggressive healthy and psychiatric controls. Psychiatry Res 2018; 270:20-25. [PMID: 30243128 DOI: 10.1016/j.psychres.2018.08.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 08/06/2018] [Accepted: 08/16/2018] [Indexed: 12/24/2022]
Abstract
Individuals with DSM-5 Intermittent Explosive Disorder (IED) are often suspected of minimizing the nature of their recurrent, problematic, impulsive aggressive behavior due to the social undesirability of these behaviors. Our first study involved 400 study participants categorized as Healthy Controls (HC), Psychiatric Controls (PC) and as having IED and included the Crowne-Marlowe Social Desirability Scale (SDS), the Lie Scale from the Eysenck Personality Questionnaire-Revised (EPQ-R Lie), and the Readiness to Change (Anger) Questionnaire (RTC). IED study participants had lower SDS and lower EPQ-R Lie scores, while having higher RTC scores, compared with both HC and PC study participants. Thus, when studied in a clinical research setting, IED study participants do not provide socially desirable answers to questions and do not engaging in deceptive reporting; likely because they have recognized their need/interest in reducing their own impulsive aggressive behavior. The second study, part of a family study of 70 probands and their first-degree relatives revealed a very high positive (96.3%), but substantially lower negative (55.8%), predictive power for IED based on informant report. This suggests that, while interview of close informants can confirm the diagnosis of IED, informant interviews cannot rule out IED when such informants provide a negative report.
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Affiliation(s)
- Diana M Steakley-Freeman
- Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Royce J Lee
- Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Michael S McCloskey
- Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Emil F Coccaro
- Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA.
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Zhang H, Pu C, Wang Q, Tan X, Gou J, He H, Zhang Y, Yin T, Wang Y, Tang X. Physicochemical Characterization and Pharmacokinetics of Agomelatine-Loaded PLGA Microspheres for Intramuscular Injection. Pharm Res 2018; 36:9. [PMID: 30411255 DOI: 10.1007/s11095-018-2538-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to design agomelatine loaded long acting injectable microspheres, with an eventual goal of reducing the frequency of administration and improving patient compliance in treatment of depression. METHODS AGM-loaded microspheres were prepared by an O/W emulsion solvent evaporation method. The physicochemical properties and in vitro performance of the microspheres were characterized. The pharmacokinetics of different formulations with various particle sizes and drug loadings were evaluated. RESULTS AGM-loaded microspheres with drug loading of 23.7% and particle size of 60.2 μm were obtained. The in vitro release profiles showed a small initial burst release (7.36%) followed by a fast release, a period of lag time and a second accelerated release. Pore formation and pore closure were observed in vitro, indicating that the release of drug from microspheres is dominated by water-filled pores. Pharmacokinetic studies showed that AGM microspheres could release up to 30 days in vivo at a steady plasma concentration. As well, particle size and drug loading could significantly influence the in vivo release of AGM microspheres. CONCLUSIONS AGM-loaded microspheres are a promising carrier for the treatment of major depressant disorder.
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Affiliation(s)
- Hongjuan Zhang
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Chenguang Pu
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Qiao Wang
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Xinyi Tan
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Jingxin Gou
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Haibing He
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Yu Zhang
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Tian Yin
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
| | - Yanjiao Wang
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China.
| | - Xing Tang
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, 110016, China
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Galbraith T, Carliner H, Keyes KM, McLaughlin KA, McCloskey MS, Heimberg RG. The co-occurrence and correlates of anxiety disorders among adolescents with intermittent explosive disorder. Aggress Behav 2018; 44:581-590. [PMID: 30040122 PMCID: PMC6249027 DOI: 10.1002/ab.21783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 11/06/2022]
Abstract
We examined the lifetime prevalence of anxiety disorders (ADs) among adolescents with lifetime intermittent explosive disorder (IED), as well as the impact of co-occurring ADs on anger attack frequency and persistence, additional comorbidity, impairment, and treatment utilization among adolescents with IED. IED was defined by the occurrence of at least three anger attacks that were disproportionate to the provocation within a single year. Data were drawn from the National Comorbidity Survey-Adolescent Supplement (N = 6,140), and diagnoses were based on structured lay-administered interviews. Over half (51.89%) of adolescents with IED had an AD, compared to only 22.88% of adolescents without IED. Compared to adolescents with IED alone, adolescents with IED and comorbid ADs: (a) were more likely to be female; (b) reported greater impairment in work/school, social, and overall functioning; (c) were more likely to receive an additional psychiatric diagnosis, a depressive or drug abuse diagnosis, or diagnoses of three or more additional disorders; and (d) had higher odds of receiving any mental/behavioral health treatment as well as treatment specifically focused on aggression. Adolescents with IED alone and those with comorbid ADs did not differ in the number of years experiencing anger attacks or the highest number of anger attacks in a given year. ADs frequently co-occur with IED and are associated with elevated comorbidity and greater impairment compared to IED alone. Gaining a better understanding of this comorbidity is essential for developing specialized and effective methods to screen and treat comorbid anxiety in adolescents with aggressive behavior problems.
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Affiliation(s)
- Todd Galbraith
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | | | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
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Coccaro EF, Shima CK, Lee RJ. Comorbidity of personality disorder with intermittent explosive disorder. J Psychiatr Res 2018; 106:15-21. [PMID: 30240963 DOI: 10.1016/j.jpsychires.2018.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 11/16/2022]
Abstract
There is ambiguity in how recurrent anger and aggression are accounted for by psychiatric nosology. One area of uncertainty is the extent to which Intermittent Explosive Disorder (IED) overlaps with and is distinct from Personality Disorder (PD). Accordingly, we conducted a study of individuals with IED and PD in order to understand the nature of comorbidity relationships seen across these two areas of psychopathology. One-thousand-five-hundred-twenty-one adults were studied (441 Healthy Controls (HC), 430 Psychiatric Controls (PC), and 650 IED subjects) and assessed for DSM-5 psychiatric disorders, life history of aggressive behavior, trait aggression, state and trait anger reactivity, and impulsivity. While nearly half of IED study participants had a comorbid PD diagnosis, nearly half with a Cluster B PD, almost as many had other personality disorders. IED predicted anger symptoms and history of aggressive behavior above and beyond a PD diagnosis. Comorbidity between IED and either Antisocial (AsPD) or Borderline (BPD) PD was associated with the highest levels of aggressive behavior. However, having IED comorbid with either AsPD and/or BPD PD was not associated with higher levels of impulsivity. Underlying personality traits related to anger, affect, and social behavior, but not identity disturbance, contribute to the shared symptom profile of IED and PD. IED is usually comorbid with PD, but does not have a unique relationship with any single PD. When comorbid with PD, a diagnosis of IED predicts more severe anger and aggression, but not necessarily increased impulsivity. These results suggest that IED and PD diagnoses retain clinical utility when made in cases meeting criteria for both.
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Affiliation(s)
- Emil F Coccaro
- Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
| | - Carolyn K Shima
- Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Royce J Lee
- Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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Gan G, Zilverstand A, Parvaz MA, Preston-Campbell RN, d'Oleire Uquillas F, Moeller SJ, Tomasi D, Goldstein RZ, Alia-Klein N. Habenula-prefrontal resting-state connectivity in reactive aggressive men - A pilot study. Neuropharmacology 2018; 156:107396. [PMID: 30366001 DOI: 10.1016/j.neuropharm.2018.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/25/2018] [Accepted: 10/17/2018] [Indexed: 01/21/2023]
Abstract
Disproportionate anger and reactive aggression in response to provocation are core symptoms of intermittent-explosive disorder (IED). Previous research shows a link between the propensity for aggression in healthy individuals and altered functioning of prefrontal-limbic and default-mode networks (DMN) at rest when no provocation is present. In a pilot study, we used resting-state functional magnetic resonance imaging to investigate the effects of pronounced reactive aggression in men, exemplified by IED, on the functional organization of resting-state brain networks including subcortical nodes such as the habenula previously implicated in aggression in preclinical models. Graph theory was applied to resting-state networks to determine alterations in global efficiency and clustering in high reactive aggressive men compared to low reactive aggressive men (controls). Further, we computed within-group correlations between trait aggression and graph measures, as well as within-group whole-brain seed-to-voxel regression analyses between trait aggression and habenula resting-state functional connectivity (rsFC). Reactive aggressive men compared to controls showed higher global efficiency in the left habenula, the left pulvinar in the thalamus, the left dorso-lateral prefrontal cortex, and the right temporal pole, as well as a trend for decreased clustering in DMN nodes. In the reactive aggressive group, high levels of trait aggression were linked to lower global efficiency of the left habenula, and to lower rsFC between the left habenula and the left ventro-lateral prefrontal cortex, a core region involved in inhibitory control. Together with preclinical evidence, our findings in men underline the relevance of aberrant habenula-prefrontal connectivity for the severity of aggressive behavior. This article is part of the Special Issue entitled 'Current status of the neurobiology of aggression and impulsivity'.
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Affiliation(s)
- G Gan
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, NY, USA; Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - A Zilverstand
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, NY, USA
| | - M A Parvaz
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, NY, USA
| | - R N Preston-Campbell
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | - F d'Oleire Uquillas
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, NY, USA
| | - S J Moeller
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, NY, USA; Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - D Tomasi
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - R Z Goldstein
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, NY, USA
| | - N Alia-Klein
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, NY, USA.
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Affleck W, Carmichael V, Whitley R. Men's Mental Health: Social Determinants and Implications for Services. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:581-589. [PMID: 29673270 PMCID: PMC6109884 DOI: 10.1177/0706743718762388] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Numerous scholars have stated that there is a silent crisis in men's mental health. In this article, we aim to provide an overview of core issues in the field of men's mental health, including a discussion of key social determinants as well as implications for mental health services. Firstly, we review the basic epidemiology of mental disorders with a high incidence and prevalence in men, including suicide and substance use disorder. Secondly, we examine controversies around the low reported rates of depression in men, discussing possible measurement and reporting biases. Thirdly, we explore common risk factors and social determinants that may explain higher rates of certain mental health outcomes in men. This includes a discussion of 1) occupational and employment issues; 2) family issues and divorce; 3) adverse childhood experience; and 4) other life transitions, notably parenthood. Fourthly, we document and analyze low rates of mental health service utilization in men. This includes a consideration of the role of dominant notions of masculinity (such as stubbornness and self-reliance) in deterring service utilization. Fifthly, we note that some discourse on the role of masculinity contains much "victim blaming," often adopting a reproachful deficit-based model. We argue that this can deflect attention away from social determinants as well as issues within the mental health system, such as claims that it is "feminized" and unresponsive to men's needs. We conclude by calling for a multipronged public health-inspired approach to improve men's mental health, involving concerted action at the individual, health services, and societal levels.
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Affiliation(s)
- William Affleck
- 1 Department of Psychiatry, McGill University, Montreal, Quebec
| | | | - Rob Whitley
- 1 Department of Psychiatry, McGill University, Montreal, Quebec.,2 Douglas Mental Health University Institute, Montreal, Quebec
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Costa AM, Medeiros GC, Redden S, Grant JE, Tavares H, Seger L. Cognitive-behavioral group therapy for intermittent explosive disorder: description and preliminary analysis. BRAZILIAN JOURNAL OF PSYCHIATRY 2018; 40:316-319. [PMID: 29590263 PMCID: PMC6899396 DOI: 10.1590/1516-4446-2017-2262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/17/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a group therapy based on cognitive-behavioral techniques customized for intermittent explosive disorder (IED). The current report presents the preliminary results of a clinical trial comparing pre- and post-intervention scores in different anger dimensions. METHODS The studied sample consisted of 84 treatment-seeking subjects. The mean (standard deviation) age was 43.0 (11.9) years, and 78% were male. The therapeutic group program consisted of 15 weekly sessions plus three maintenance sessions. The sessions lasted approximately 90 minutes each. RESULTS No differences were found in demographic profile and pre-treatment status between subjects who completed treatment (n=59) and dropouts (n=25). Comparison of State-Trait Anger Expression Scale (STAXI) scores pre- and post-treatment showed statistically significant changes in all anger scales and subscales of the questionnaire. CONCLUSION This preliminary report is a significant addition to currently scarce clinical data. Our findings provide further evidence that structured cognitive-behavioral group therapy, with a focus on anger management and cognitive coping, may be a promising approach to the treatment of IED.
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Affiliation(s)
- Ana M Costa
- Departamento de Psiquiatria, Instituto de Psiquiatria, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Gustavo C Medeiros
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah Redden
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Hermano Tavares
- Departamento de Psiquiatria, Instituto de Psiquiatria, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Liliana Seger
- Departamento de Psiquiatria, Instituto de Psiquiatria, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Rynar L, Coccaro EF. Psychosocial impairment in DSM-5 intermittent explosive disorder. Psychiatry Res 2018; 264:91-95. [PMID: 29627702 PMCID: PMC5983894 DOI: 10.1016/j.psychres.2018.03.077] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
The purpose of this study was to document the functional severity of DSM-5 IED in a clinical research sample. IED and control groups were compared on psychosocial functioning, life satisfaction, and on a variety of cognitive and behavioral issues. IED study participants reported significantly worse psychosocial function, quality of life, and higher job dysfunction than both psychiatric and healthy control study participants. The presence of DSM-5 IED is associated with significant psychosocial and functional impairment. Early intervention may aid in minimizing the consequences of impulsive aggressive behavior, and improving psychosocial functioning and quality of life.
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Affiliation(s)
- Lauren Rynar
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | - Emil F. Coccaro
- Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago
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Gelegen V, Tamam L. Prevalence and clinical correlates of intermittent explosive disorder in Turkish psychiatric outpatients. Compr Psychiatry 2018; 83:64-70. [PMID: 29604524 DOI: 10.1016/j.comppsych.2018.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 01/25/2018] [Accepted: 03/07/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Intermittent explosive disorder (IED) is defined as the failure to resist aggressive impulses resulting in repeated acts of verbal and/or physical aggression. Although it is frequently encountered in clinical psychiatric practice, there is a paucity of data concerning IED in the scientific literature both internationally and in Turkey. The aim of this study was to evaluate the prevalence of IED and associated sociodemographic and clinical features in a clinical setting. METHODS A total of 406 patients who were referred to our psychiatry outpatient clinic for the first time in a six-month period were included in the study. The diagnosis of IED was made using both Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) and DSM-5 criteria. Axis I disorder and personality disorder diagnoses were made according to DSM-5 criteria. Diagnoses were based on information from the Structured Clinical Interview for DSM-IV (SCID I) and the Structured Clinical Interview for DSM-IV personality disorders (SCID II), Symptom Checklist-90 (SCL-90), Wender Utah Rating Scale, Adult Attention Deficit Hyperactivity Disorder (ADHD) DSM-IV Based Diagnostic Screening and Rating Scale, a clinical interview conducted by the researcher, and a sociodemographic data form. In addition, participants were administered the Buss-Perry Aggression Scale and Barratt Impulsiveness Scale Version 11 (BIS-11) to assess aggression and impulsivity. RESULTS Lifetime and 12-month prevalence of IED according to DSM-5 were 16.7% and 11.3%, respectively. Mean age at onset was 16.4 years. The prevalence of lifetime IED was 3.8 times higher in males than females (95% CI = 1.9-7.5); twice as high in individuals living in rural areas compared to those living in urban centers (95% CI = 1.1-3.7); 2.7 times higher among those with lifetime suicide attempt versus those without (95% CI = 1.3-5.6); 4.5 times higher in those with lifetime self-injurious behavior compared to those without (95% CI = 2.3-8.7); and 3 times higher in individuals reporting aggression/anger problems in the family compared to those without (95% CI = 1.5-5.9). The prevalences of childhood ADHD, conduct disorder, and oppositional defiant disorder were significantly higher in the IED group. CONCLUSION The result of the current study has revealed that approximately one-sixth of respondents experienced lifetime IED according to DSM-5 diagnostic criteria. Statistically significant sociodemographic correlates of IED include gender, urbanicity, history of suicide attempt, history of self-injurious behavior, and family history of aggression/anger problems.
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Affiliation(s)
- Volkan Gelegen
- Osmaniye Government Hospital, Department of Psychiatry, Osmaniye, Turkey.
| | - Lut Tamam
- Cukurova University, Department of Psychiatry, Adana, Turkey
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Puiu AA, Wudarczyk O, Goerlich KS, Votinov M, Herpertz-Dahlmann B, Turetsky B, Konrad K. Impulsive aggression and response inhibition in attention-deficit/hyperactivity disorder and disruptive behavioral disorders: Findings from a systematic review. Neurosci Biobehav Rev 2018; 90:231-246. [PMID: 29689282 DOI: 10.1016/j.neubiorev.2018.04.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/13/2018] [Accepted: 04/17/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although impulsive aggression (IA) and dysfunctional response inhibition (RI) are hallmarks of attention-deficit/hyperactivity disorder (ADHD) and disrupted behavioral disorders (DBDs), little is known about their shared and distinct deviant neural mechanisms. AIMS AND METHODS Here, we selectively reviewed s/fMRI ADHD and DBD studies to identify disorder-specific and shared IA and RI aberrant neural mechanisms. RESULTS In ADHD, deviant prefrontal and cingulate functional activity was associated with increased IA. Structural alterations were most pronounced in the cingulate cortex. Subjects with DBDs showed marked cortico-subcortical dysfunctions. ADHD and DBDs share similar cortico-limbic structural and functional alterations. RI deficits in ADHD highlighted hypoactivity in the dorso/ventro-lateral PFC, insula, and striatum, while the paralimbic system was primarily dysfunctional in DBDs. Across disorders, extensively altered cortico-limbic dysfunctions underlie IA, while RI was mostly associated with aberrant prefrontal activity. CONCLUSION Control network deficits were evidenced across clinical phenotypes in IA and RI. Dysfunctions at any level within these cortico-subcortical projections lead to deficient cognitive-affective control by ascribing emotional salience to otherwise irrelevant stimuli. The clinical implications of these findings are discussed.
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Affiliation(s)
- Andrei A Puiu
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Olga Wudarczyk
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Katharina S Goerlich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany; Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Mikhail Votinov
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany; JARA-Institute Brain Structure-Function Relationship, Research Center Jülich and RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine 10, Research Center Jülich, Aachen, Germany.
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Bruce Turetsky
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.
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41
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Trait anger modulates neural activity in the fronto-parietal attention network. PLoS One 2018; 13:e0194444. [PMID: 29672547 PMCID: PMC5908080 DOI: 10.1371/journal.pone.0194444] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/02/2018] [Indexed: 11/19/2022] Open
Abstract
Anger is considered a unique high-arousal and approach-related negative emotion. The influence of individual differences in trait anger on the processing of visual stimuli is relevant to questions about emotional processing and remains to be explored. Using functional magnetic resonance imaging (fMRI), we explored the neural responses to standardized images, selected based on valence and arousal ratings in a group of men with high trait anger compared to those with normative to low anger scores (controls). Results show increased activation in the left-lateralized ventral fronto-parietal attention network to unpleasant images by individuals with high trait anger. There was also a group by arousal interaction in the left thalamus/pulvinar such that individuals with high trait anger had increased pulvinar activation to the high-arousal (versus low arousal) unpleasant images as compared to controls. Thus, individual differences in trait anger in men are associated with brain regions subserving executive attentional and sensory integration during the processing of unpleasant emotional stimuli, particularly to high arousal images.
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Harford TC, Chen CM, Kerridge BT, Grant BF. Self- and other-directed forms of violence and their relationship with lifetime DSM-5 psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III). Psychiatry Res 2018; 262:384-392. [PMID: 28939392 PMCID: PMC5849477 DOI: 10.1016/j.psychres.2017.09.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 11/26/2022]
Abstract
A combined history of violence toward self and others has been reported in clinical and incarcerated populations. Psychiatric disorders have been implicated as risk factors. This study examines the lifetime prevalence of this combined violence in the general population and its associations with DSM-5 psychiatric disorders in comparison with other- and self-directed violence. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) were analyzed, including 36,309 U.S. adults ages 18 and older. Violent behavior was defined by suicide attempts; recurrent suicidal behavior; gestures, threats, or self-mutilating behavior (self-directed); and multiple items of violence toward others (other-directed) in four categories: none, self-directed only, other-directed only, and combined self-/other-directed. Multinomial logistic regression examined these violence categories in association with sociodemographics and lifetime DSM-5 psychiatric disorders. Results show that approximately 18.1% of adults reported violent behavior, including self-directed only (4.4%), other-directed only (10.9%), and combined self- and other-directed violence (2.8%). DSM-5 psychiatric disorders significantly associated with the violence typology include alcohol, tobacco, cannabis, and other drug use disorders; mood disorders; posttraumatic stress disorder; and schizotypal, antisocial, and borderline personality disorders. Findings extend the clinical literature regarding the co-occurrence of self- and other-directed violent behaviors to the general population.
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Affiliation(s)
- Thomas C. Harford
- CSR, Incorporated, 4250 N. Fairfax Dr., Suite 500, Arlington, VA,
22203, United States
| | - Chiung M. Chen
- CSR, Incorporated, 4250 N. Fairfax Dr., Suite 500, Arlington, VA,
22203, United States,Corresponding author: CSR, Incorporated, 4250 N. Fairfax Dr.,
Suite 500, Arlington, VA 22203. Tel.: + 1 703 741 7125; fax: + 1 703 312
5230
| | - Bradley T. Kerridge
- Department of Psychiatry, Columbia University, New York State
Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY, 10032,United
States
| | - Bridget F. Grant
- Epidemiology and Biometry Branch, Division of Epidemiology and
Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National
Institutes of Health, Room 3077, 5635 Fishers Lane, M.S. 9304, Bethesda, MD,
20892-9304, United States
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43
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Medeiros GC, Seger L, Grant JE, Tavares H. Major depressive disorder and depressive symptoms in intermittent explosive disorder. Psychiatry Res 2018; 262:209-212. [PMID: 29455060 DOI: 10.1016/j.psychres.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/28/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
It is estimated that between 1.7 and 2.6 million people have had intermittent explosive disorder (IED) during their life in the United States alone. Co-occurring psychiatric disorders are very common in IED, being major depressive disorder arguably the most common. The objective of this study was to examine the clinical correlates of IED and depressive manifestations in 74 treatment-seeking subjects. After controlling for confounders, there were associations between major depressive disorder and severity of depressive symptoms, and (a) higher assault scores, (b) more severe hostile behavior and (c) worse social adjustment. Management of depressive symptoms may be an important for IED treatment.
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Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9070, United States.
| | - Liliana Seger
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo, São Paulo, SP, Brazil
| | - Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
| | - Hermano Tavares
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo, São Paulo, SP, Brazil
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45
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Mikics É, Guirado R, Umemori J, Tóth M, Biró L, Miskolczi C, Balázsfi D, Zelena D, Castrén E, Haller J, Karpova NN. Social Learning Requires Plasticity Enhanced by Fluoxetine Through Prefrontal Bdnf-TrkB Signaling to Limit Aggression Induced by Post-Weaning Social Isolation. Neuropsychopharmacology 2018; 43:235-245. [PMID: 28685757 PMCID: PMC5635971 DOI: 10.1038/npp.2017.142] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 01/09/2023]
Abstract
Escalated or abnormal aggression induced by early adverse experiences is a growing issue of social concern and urges the development of effective treatment strategies. Here we report that synergistic interactions between psychosocial and biological factors specifically ameliorate escalated aggression induced by early adverse experiences. Rats reared in isolation from weaning until early adulthood showed abnormal forms of aggression and social deficits that were temporarily ameliorated by re-socialization, but aggression again escalated in a novel environment. We demonstrate that when re-socialization was combined with the antidepressant fluoxetine, which has been shown to reactivate juvenile-like state of plasticity, escalated aggression was greatly attenuated, while neither treatment alone was effective. Early isolation induced a permanent, re-socialization-resistant reduction in Bdnf expression in the amygdala and the infralimbic cortex. Only the combined treatment of fluoxetine and re-socialization was able to recover Bdnf expression via epigenetic regulation. Moreover, the behavior improvement after the combined treatment was dependent on TrkB activity. Combined treatment specifically strengthened the input from the ventral hippocampus to the mPFC, suggesting that this pathway is an important mediator of the beneficial behavioral effects of the combined psychosocial and pharmacological treatment of abnormal aggression. Our findings suggest that synergy between pharmacological induction of plasticity and psychosocial rehabilitation could enhance the efficacy of therapies for pathological aggression.
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Affiliation(s)
- Éva Mikics
- Department of Behavioral Neurobiology, Institute of Experimental Medicine, Budapest, Hungary
| | - Ramon Guirado
- Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Juzoh Umemori
- Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Máté Tóth
- Department of Behavioral Neurobiology, Institute of Experimental Medicine, Budapest, Hungary
| | - László Biró
- Department of Behavioral Neurobiology, Institute of Experimental Medicine, Budapest, Hungary
| | - Christina Miskolczi
- Department of Behavioral Neurobiology, Institute of Experimental Medicine, Budapest, Hungary
| | - Diána Balázsfi
- Department of Behavioral Neurobiology, Institute of Experimental Medicine, Budapest, Hungary
| | - Dóra Zelena
- Department of Behavioral Neurobiology, Institute of Experimental Medicine, Budapest, Hungary
| | - Eero Castrén
- Neuroscience Center, University of Helsinki, Helsinki, Finland,Neuroscience Center, University of Helsinki, PO Box 56, Helsinki 00014, Finland, Tel: +358 50520 7974, Fax: +358 919 157 620, E-mail:
| | - József Haller
- Department of Behavioral Neurobiology, Institute of Experimental Medicine, Budapest, Hungary
| | - Nina N Karpova
- Neuroscience Center, University of Helsinki, Helsinki, Finland,School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida do Café sn, Ribeirão Preto, Brazil
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46
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Harford TC, Yi HY, Chen CM, Grant BF. Substance use disorders and self- and other-directed violence among adults: Results from the National Survey on Drug Use And Health. J Affect Disord 2018; 225:365-373. [PMID: 28846958 PMCID: PMC5626648 DOI: 10.1016/j.jad.2017.08.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 05/30/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Previous studies have identified a violence typology of self- and other-directed violence. This study examines the extent to which substance use disorders (SUDs) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), independent of serious psychological distress, major depressive episodes, assault arrest, and criminal justice involvement, are associated with these violence categories. METHOD Data were obtained from the National Survey on Drug Use and Health (NSDUH) pooled across survey years 2008-2015, with a combined sample of 314,881 adult respondents. According to self-report data on suicide attempt (self-directed) and attacking someone with the intent for serious injury (other-directed), violence was categorized in four categories: none, self-directed only, other-directed only, and combined self-/other-directed. Multinomial logistic regression was used to estimate the adjusted odds ratios associated with the risk factors for different forms of violence. RESULTS Nicotine dependence and the number of DSM-IV SUDs criteria (except the criterion of legal problems) for alcohol, marijuana, and pain reliever use disorders are significantly associated with the self-/other-directed violence categories. LIMITATIONS Cross-sectional data do not allow assessment of directionality of important factors. CONCLUSIONS The identification of the combined self- and other-directed violence among adults in the general population extends studies in the adolescent population, and significant correlation between self- and other-directed violence provides additional support for clinical studies that established this association. Findings expand the associated risk factors identified in previous studies for the adult population. Prevention and treatment programs need to address both forms of violence and suicidality.
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Affiliation(s)
| | | | - Chiung M. Chen
- Corresponding author: CSR, Incorporated, 4250 N. Fairfax Dr., Suite 500, Arlington, VA 22203, , Telephone: (703) 741-7125, Fax: (703) 312-5230
| | - Bridget F Grant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Bethesda, MD 20892, United States
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Nam JH, Lim MS, Choi HK, Kim JY, Kim SK, Oh SS, Koh SB, Kang HT. Factors increasing the risk for psychosocial stress among Korean adults living in rural areas: using generalized estimating equations and mixed models. Ann Occup Environ Med 2017; 29:53. [PMID: 29118991 PMCID: PMC5664797 DOI: 10.1186/s40557-017-0209-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/23/2017] [Indexed: 12/29/2022] Open
Abstract
Background This study was conducted to analyze the distribution of the psychosocial well-being index among adults living in two rural communities in Korea and to examine its correlation with lifestyle variables such as sleep duration, regular exercise, and sedentary time. Methods Using the cohort data of the Atherosclerosis Risk of a Rural Area Korean General Population, this study examined 3631 participants living in Wonju and Pyeongchang in Gangwon Province; their preliminary data were established from 2005 to 2007 while their follow-up data were collected 3 years later. This study investigated demographic characteristics, lifestyle habits, disease history, Psychosocial Well-being Index-Short Form (PWI-SF) scores, sleep duration, regular exercise, and sedentary time during work. Using repeated measures ANOVA, this study examined how the variables and PWI-SF scores changed over the course of 3 years and identified the correlation between them based on mixed model analysis. Afterwards, using the generalized estimation equation, this study identified each variable's risk towards the PWI-SF high-risk group and performed a stratified analysis by occupation after dividing the participants into farmers and non-farmers. Results The PWI-SF high-risk group was found to be 18.9% of the participants from preliminary data and 15.5% from follow-up data. The odds ratio towards the PWI-SF high-risk group was 1.503 (95% CI 1.241-1.821) in the short sleep duration group and 1.327 (95% CI 1.136-1.550) in the non-regular exercise group. A stratified analysis by occupation showed that middle and long sedentary time in the white-collar group increased the risk toward the PWI-SF high-risk group. Conclusions Short sleep duration, no regular exercise, and long sedentary time in the white-collar group were identified as risk factors toward the PWI-SF high-risk group in the rural communities, and policy interventions are needed to address this issue.
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Affiliation(s)
- Ju-Hyun Nam
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Myeong-Seob Lim
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hyun-Kyeong Choi
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jae-Yeop Kim
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sung-Kyeong Kim
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sung-Soo Oh
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sang-Baek Koh
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hee-Tae Kang
- Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Korea
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Silove D, Mohsin M, Tay AK, Steel Z, Tam N, Savio E, Da Costa ZM, Rees S. Six-year longitudinal study of pathways leading to explosive anger involving the traumas of recurrent conflict and the cumulative sense of injustice in Timor-Leste. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1281-1294. [PMID: 28825139 DOI: 10.1007/s00127-017-1428-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 08/06/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Cumulative evidence suggests that explosive anger may be a common reaction among survivors of mass conflict. However, little is known about the course of explosive anger in the years following mass conflict, or the psychosocial factors that influence the trajectory of that reaction pattern. We examined these issues in a 6-year longitudinal study (2004-2010) conducted among adult residents of a rural and an urban village in Timor-Leste (n = 1022). METHODS We derived a brief, context-specific index of explosive anger using qualitative methods. Widely used measures of post-traumatic stress disorder (PTSD) and severe psychological distress were calibrated to the Timor context. We developed an index of the cumulative sense of injustice related to consecutive historical periods associated with conflict in Timor-Leste. We applied partial structural equation modeling (SEM) to examine pathways from baseline explosive anger, socio-demographic factors, recurrent trauma, mental health indices (PTSD, severe psychological distress) and the sense of injustice, to explosive anger. RESULTS Half of the sample with explosive anger at baseline continued to report that reaction pattern after 6 years; and a third of those who did not report explosive anger at baseline developed the response by follow-up. A symmetrical pattern of younger age, female gender and the trauma count for the preceding historical period predicted explosive anger at each assessment point. The sense of injustice was related to explosive anger at follow-up. Explosive anger was associated with impairment in functioning and conflict with the intimate partner and wider family. CONCLUSIONS Sampling constraints caution against generalizing our findings to other populations. Nevertheless, our data suggest that explosive anger may persist for a prolonged period of time following mass conflict and that the response pattern is initiated and maintained by recurrent trauma exposure associated with a sense of injustice. Averting recurrence of mass violence and addressing persisting feelings of injustice may assist in reducing anger in conflict-affected societies. Whether explosive anger at the individual level increases risk of collective violence under conditions of social and political instability requires further inquiry.
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Affiliation(s)
- Derrick Silove
- Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, Australia. .,Academic Mental Health Unit, Level 2 Mental Health Centre, The Liverpool Hospital, Sydney, Australia.
| | - Mohammed Mohsin
- Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, Australia.,Academic Mental Health Unit, Level 2 Mental Health Centre, The Liverpool Hospital, Sydney, Australia
| | - Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, Australia.,Academic Mental Health Unit, Level 2 Mental Health Centre, The Liverpool Hospital, Sydney, Australia
| | - Zachary Steel
- School of Psychiatry, St Johns of God, Richmond Hospital, The Black Dog Institute, University of New South Wales, St. John of God, Australia
| | | | | | | | - Susan Rees
- Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, Australia.,Academic Mental Health Unit, Level 2 Mental Health Centre, The Liverpool Hospital, Sydney, Australia
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49
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Cougle JR, Summers BJ, Allan NP, Dillon KH, Smith HL, Okey SA, Harvey AM. Hostile interpretation training for individuals with alcohol use disorder and elevated trait anger: A controlled trial of a web-based intervention. Behav Res Ther 2017; 99:57-66. [PMID: 28941810 DOI: 10.1016/j.brat.2017.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/09/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
High trait anger is associated with more severe alcohol use problems, and alcohol has been found to facilitate aggressive behavior among individuals with high trait anger. Treatments focused on a sample with alcohol use disorder with elevated anger could reduce alcohol use problems, as well as violence and aggression. We sought to examine the efficacy of interpretation bias modification for hostility (IBM-H) in a sample with high trait anger and alcohol use disorder (AUD). Fifty-eight individuals with AUD and elevated trait anger were randomly assigned to eight web-based sessions (two per week) of IBM-H or a healthy video control condition (HVC). Measures of interpretation bias, anger, and alcohol use were administered at pre- and post-treatment and at one-month follow-up. IBM-H led to greater improvements in interpretation bias compared to HVC at post and follow-up. IBM-H also led to greater reductions in trait anger than HVC, though this was an indirect effect mediated by changes in interpretation bias. Further, IBM-H led to lower anger expression than HVC; this was a direct (non-mediated) effect. Lastly, both conditions reported decreases in alcohol use and consequences following treatment, though there were no significant differences between them. These findings provide initial support for the utility of IBM-H as a brief non-confrontational intervention for AUD with elevated trait anger. Limitations and future research directions are discussed.
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Affiliation(s)
- Jesse R Cougle
- Department of Psychology, Florida State University, United States.
| | - Berta J Summers
- Department of Psychology, Florida State University, United States
| | | | - Kirsten H Dillon
- Department of Psychiatry and Behavioral Sciences, Duke University, United States
| | - Hillary L Smith
- Department of Psychology, Florida State University, United States
| | - Sarah A Okey
- Department of Psychology, Florida State University, United States
| | - Ashleigh M Harvey
- Department of Psychology, University of Wisconsin-Milwaukee, United States
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50
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Fanning JR, Keedy S, Berman ME, Lee R, Coccaro EF. Neural Correlates of Aggressive Behavior in Real Time: a Review of fMRI Studies of Laboratory Reactive Aggression. Curr Behav Neurosci Rep 2017; 4:138-150. [PMID: 29607288 PMCID: PMC5875983 DOI: 10.1007/s40473-017-0115-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Aggressive behavior has adaptive value in many natural environments; however, it places substantial burden and costs on human society. For this reason, there has long been interest in understanding the neurobiological basis of aggression. This interest, and the flourishing of neuroimaging research in general, has spurred the development of a large and growing scientific literature on the topic. As a result, a neural circuit model of aggressive behavior has emerged that implicates interconnected brain regions that are involved in emotional reactivity, emotion regulation, and cognitive control. RECENT FINDINGS Recently, behavioral paradigms that simulate provocative interactions have been adapted to neuroimaging protocols, providing an opportunity to directly probe the involvement of neural circuits in an aggressive interaction. Here we review neuroimaging studies of simulated aggressive interactions in research volunteers. We focus on studies that use a well-validated laboratory paradigm for reactive physical aggression and examine the neural correlates of provocation, retaliation, and evaluating punishment of an opponent. SUMMARY Overall, the studies reviewed support the involvement of neural circuits that support emotional reactivity, emotion regulation, and cognitive control in aggressive behavior. Based on a synthesis of this literature, future research directions are discussed.
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Affiliation(s)
- Jennifer R Fanning
- Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Sarah Keedy
- Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Mitchell E Berman
- Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS 39762, USA
| | - Royce Lee
- Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Emil F Coccaro
- Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
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