Anxiety Disorders: University of Minnesota

White T, Nelson M, Lim KO. · Department of Psychiatry, University of Minnesota, Fairview University Medical Center, 2450 Riverside Ave., Minneapolis, MN 55454, USA. · Top Magn Reson Imaging. · Pubmed #19363432 No free full text.

Abstract: OBJECTIVES: Since the development of diffusion tensor imaging (DTI) nearly a decade ago, it has been extensively applied to a number of different psychiatric disorders. Its rapid assimilation into psychiatric research has stemmed from its unique property to measure the coherence and direction of neuronal fiber tracts. The goal of this article is to provide an overview of DTI and its application to psychiatric disorders. METHODS: We performed an extensive literature review of articles using DTI to study psychiatric disorders. To date, most DTI studies have been performed on individuals with schizophrenia. However, recent studies have emerged that evaluate white matter (WM) integrity in major depressive disorder, anxiety disorders, obsessive-compulsive disorder, attention deficit disorder, autism, and personality disorders. RESULTS: There is tremendous heterogeneity in the results of DTI studies of patients with psychiatric disorders. In schizophrenia, which currently has more than 50 studies using DTI, brain regions such as the cingulate bundle, corpus callosum, and regions within the frontal and temporal WM have a proportionally larger number of positive findings across the studies. Studies of other psychiatric disorders have findings that overlap with those seen in schizophrenia. CONCLUSIONS: There is converging evidence that a number of psychiatric disorders are associated with WM abnormalities. However, the considerable heterogeneity of results, both within and between existing studies, will require future work within and across psychiatric disorders to better delineate the neurobiological underpinnings of these white matter abnormalities.

Potegal M, Carlson GA, Margulies D, Basile J, Gutkovich ZA, Wall M. · Department of Pediatrics, University of Minnesota Medical School, MMC 486, 420 Delaware Street SE, Minneapolis, MN 55455, USA. · Curr Psychiatry Rep. · Pubmed #19302766 No free full text.

Abstract: Angry outbursts, sometimes called rages, are a major impetus for the psychiatric hospitalization of children. In hospitals, such outbursts are a management problem and a diagnostic puzzle. Among 130 4- to 12-year-olds successively admitted to a child psychiatry unit, those having in-hospital outbursts were likely to be younger, have been in special education, have had a preadmission history of outbursts, and to have a longer hospital stay. Three subsets of behaviors, coded as they occurred in 109 outbursts, expressed increasing levels of anger; two other subsets expressed increasing levels of distress. Factor structure, temporal organization, and age trends indicated that outbursts are exacerbations of ordinary childhood tantrums. Diagnostically, children with outbursts were more likely to have language difficulty and a trend toward attention-deficit/hyperactivity disorder. Outbursts of children with anxiety diagnoses showed significantly more distress relative to anger. Outbursts were not especially associated with our small sample of bipolar diagnoses.

Victor AM, Bernstein GA. · Division of Child & Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55454, USA. · Psychiatr Clin North Am. · Pubmed #19248916 No free full text.

Abstract: Anxiety disorders are one of the most common categories of psychopathology in children and adolescents. This article provides an overview of several anxiety disorders that are diagnosed often during childhood and adolescence, including separation anxiety disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Although anxiety disorders commonly show similar clinical characteristics during childhood and adulthood, this article highlights some of the differences that may present across the life span.

Gewirtz A, Forgatch M, Wieling E. · Department of Family Social Sciences & Institute of Child Development, University of Minnesota, St. Paul, MN 55108, USA. · J Marital Fam Ther. · Pubmed #18412825 No free full text.

Abstract: Trauma research has identified a link between parental adjustment and children's functioning and the sometimes ensuing intergenerational impact of traumatic events. The effects of traumatic events on children have been demonstrated to be mediated through their impact on children's parents. However, until now, little consideration has been given to the separate and more proximal mechanism of parenting practices as potential mediators between children's adjustment and traumatic events. To shed some light in this arena, we review literature on trauma, adversity, and resilience, and discuss how parenting practices may mediate trauma and adverse environmental contexts. Using a social interaction learning perspective (Forgatch & Knutson, 2002; Patterson, 2005), we propose a prevention research framework to examine the role that parenting practices may play in influencing children's adjustment in the wake of trauma exposure. The article concludes by providing a specific model and role for evidence-based parenting interventions for children exposed to mass trauma.

Gunnar MR, Quevedo KM. · Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, USA. · Prog Brain Res. · Pubmed #18037012 No free full text.

Abstract: Post-traumatic stress disorder (PTSD) is associated with functional abnormalities of the hypothalamic-pituitary-adrenocortical (HPA) axis. Emerging evidence suggests that failures in social regulation of the HPA axis in young children manifested as neglectful or abusive care may play a role in shaping cortico-limbic circuits involved in processing experiences threatening experiences encountered later in life. Low cortisol levels, particularly near the peak of the diurnal rhythm, have been reported in abused, neglected and deprived children. Thus early imprinting effects of parenting quality on the HPA system regulation may be one of the mechanisms causing heightened risk of PTSD in responses to later trauma. However there is also evidence that the altered patterns of cortisol production seen in the context of early adverse care are not permanent, and remit once the care children receive improves. What awaits study is whether periods of atypical cortisol levels and altered HPA function early in life, even if transient, impact brain development in ways that heighten vulnerability to PTSD in response to traumas experienced later.

Winbush NY, Gross CR, Kreitzer MJ. · Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA. · Explore (NY). · Pubmed #18005910 No free full text.

Abstract: INTRODUCTION: Sleep disturbance is common and associated with compromised health status. Cognitive processes characterized by stress and worry can cause, or contribute to, sleep complaints. This study systematically evaluated the evidence that sleep can be improved by mindfulness-based stress reduction (MBSR), a formalized psychoeducational intervention that helps individuals self-manage and reframe worrisome and intrusive thoughts. METHODS: Articles were identified from searches of Medline, Allied and Complementary Medicine Database, CINAHL, PsycINFO, Digital Dissertations, and the Cochrane Central Register of Controlled Trials. Eligible for inclusion were English language clinical trials of MBSR that reported preintervention and postintervention measures of sleep quality or duration. Studies employing multicomponent interventions were excluded. Studies were reviewed independently by the first and second authors. RESULTS: Thirty-eight articles were identified for review. Seven met inclusion criteria. Lack of standardized outcome measures precluded pooling of results for quantitative data analysis. Sleep report measures varied (standardized scales, single item, sleep diaries). Four studies (all uncontrolled) found that MBSR significantly improved measures of sleep quality or duration. The remaining studies found no statistically significant difference between treatment and control conditions. CONCLUSIONS: To date, controlled studies have not clearly demonstrated the positive effects of MBSR on sleep quality and duration. However, there is some evidence to suggest that increased practice of mindfulness techniques is associated with improved sleep and that MBSR participants experience a decrease in sleep-interfering cognitive processes (eg, worry). More research is needed using standardized sleep scales and methods, with particular attention to the importance of MBSR home practice.

Fu SS, McFall M, Saxon AJ, Beckham JC, Carmody TP, Baker DG, Joseph AM. · Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, and Department of Medicine, University of Minnesota, Minneapolis, MN, USA. · Nicotine Tob Res. · Pubmed #17978982 No free full text.

Abstract: We conducted a systematic review of what is known about the relationship between post-traumatic stress disorder (PTSD) and smoking to guide research on underlying mechanisms and to facilitate the development of evidence-based tobacco treatments for this population of smokers. We searched Medline, PsychINFO, and the Cochrane Central Register of Controlled Trials and identified 45 studies for review that presented primary data on PTSD and smoking. Smoking rates were high among clinical samples with PTSD (40%-86%) as well as nonclinical populations with PTSD (34%-61%). Most studies showed a positive relationship between PTSD and smoking and nicotine dependence, with odds ratios ranging between 2.04 and 4.52. Findings also suggest that PTSD, rather than trauma exposure itself, is more influential for increasing risk of smoking. A small but growing literature has examined psychological factors related to smoking initiation and maintenance and the overlapping neurobiology of PTSD and nicotine dependence. Observational studies indicate that smokers with PTSD have lower quit rates than do smokers without PTSD. Yet a few tobacco cessation treatment trials in smokers with PTSD have achieved quit rates comparable with controlled trials of smokers without mental disorders. In conclusion, the evidence points to a causal relationship between PTSD and smoking that may be bidirectional. Specific PTSD symptoms may contribute to smoking and disrupt cessation attempts. Intervention studies that test behavioral and pharmacological interventions designed specifically for use in patients with PTSD are needed to reduce morbidity and mortality in this population.

Kroll JL. · Department of Psychiatry, University of Minnesota Medical School and the Community-University Health Care Clinic, Minneapolis, MN 55404, USA. · Curr Opin Psychiatry. · Pubmed #17921757 No free full text.

Abstract: PURPOSE OF REVIEW: Recent studies raise controversies about the nature of psychotic illnesses, and the role of life experiences and drug abuse as causative agents in the onset of psychoses. RECENT FINDINGS: Evidence from studies across many geographic locales and cultures finds increased risk of psychoses in first- and second-generation immigrant populations. Trauma incurred in war and civil unrest, trauma of child abuse, and the experience of being bullied in childhood are correlated with increased rates of psychoses in the populations at risk. The risk of onset of psychoses is increased by maternal and infant starvation, and by substance misuse (marijuana, khat) in late childhood and adolescence. These studies question the validity of a categorical distinction between the schizophrenic and affective illnesses. SUMMARY: A variety of extrinsic factors, such as in-utero and infant malnutrition, substance abuse, and traumatic experiences, appear to be significant risk factors for the development of schizophrenia-like and psychotic affective disorders. These findings raise the issue of whether the present classification of the psychoses is in urgent need of reconceptualization.

Spillers CS. · Dept. of Communication Science and Disorders, 221 Bohannon Hall, 1207 Ordean Court, University of Minnesota Duluth, Duluth, MN 55812, USA. · Am J Speech Lang Pathol. · Pubmed #17666545 No free full text.

Abstract: PURPOSE: To offer an existential framework for understanding some of the emotional and grieving issues that can accompany communication disorders. METHOD: A narrative review of selected existential psychology literature is provided. I. Yalom's (1980, 1986) model is used as a foundation to explore the 4 existential issues of death, freedom/responsibility, loneliness, and meaninglessness. This model is then applied to communication disorders based on the work of D. Luterman (1984, 2001). These 4 existential issues are juxtaposed with K. Moses' (1989) model of the grief response, which includes denial, anxiety, fear, depression, anger, and guilt. Suggestions for responding within one's scope of practice are provided. CONCLUSION: Combined, existential and grieving models can offer clinicians new insight into clients' loss resolution work. This inner work constitutes a spiritual journey that may parallel the journey through therapy and rehabilitation. The case is made that attending to these issues can enhance long-term outcomes of treatment.

Grant JE, Odlaug BL, Potenza MN. · Psychiatry Department, University of Minnesota Medical School, Minneapolis, MN 55454, USA. · Harv Rev Psychiatry. · Pubmed #17454177 No free full text.

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Talge NM, Neal C, Glover V, Anonymous00261. · Institute of Child Development, University of Minnesota, USA. · J Child Psychol Psychiatry. · Pubmed #17355398 No free full text.

Abstract: We review a significant body of evidence from independent prospective studies that if a mother is stressed while pregnant, her child is substantially more likely to have emotional or cognitive problems, including an increased risk of attentional deficit/hyperactivity, anxiety, and language delay. These findings are independent of effects due to maternal postnatal depression and anxiety. We still do not know what forms of anxiety or stress are most detrimental, but research suggests that the relationship with the partner can be important in this respect. The magnitude of these effects is clinically significant, as the attributable load of emotional/behavioral problems due to antenatal stress and/or anxiety is approximately 15%. Animal models suggest that activity of the stress-responsive hypothalamic-pituitary-adrenal (HPA) axis and its hormonal end-product cortisol are involved in these effects in both mother and offspring. The fetal environment can be altered if stress in the mother changes her hormonal profile, and in humans, there is a strong correlation between maternal and fetal cortisol levels. However, many problems remain in understanding the mechanisms involved in this interaction. For example, maternal cortisol responses to stress decline over the course of pregnancy, and earlier in pregnancy, the link between maternal and fetal cortisol is less robust. It is possible that the effects of maternal anxiety and stress on the developing fetus and child are moderated by other factors such as a maternal diet (e.g., protein load). It is suggested that extra vigilance or anxiety, readily distracted attention, or a hyper-responsive HPA axis may have been adaptive in a stressful environment during evolution, but exists today at the cost of vulnerability to neurodevelopmental disorders.

Grant JE. · Department of Psychiatry, University of Minnesota School of Medicine, 2450 Riverside Avenue, Minneapolis, MN 55454, USA. · Isr J Psychiatry Relat Sci. · Pubmed #16910369 links to  free full text

Abstract: Kleptomania, characterized by repetitive, uncontrollable stealing of items not needed for personal use, is a disabling disorder that often goes unrecognized in clinical practice. Although originally conceptualized as an obsessive compulsive spectrum disorder, emerging evidence (clinical characteristics, familial transmission, and treatment response) suggests that kleptomania may have important similarities to both addictive and mood disorders. In particular, kleptomania frequently co-occurs with substance use disorders, and it is common for individuals with kleptomania to have first-degree relatives who suffer from a substance use disorder. Additionally, there is some suggestion that selective serotonin reuptake inhibitors, the treatment of choice for obsessive compulsive disorder, may lack efficacy for kleptomania. Instead, other medications (lithium, anti-epileptics, and opioid antagonists) have shown early promise in treating kleptomania. Evidence suggests that there may be subtypes of kleptomania that are more like OCD, whereas others have more similarities to addictive and mood disorders. Subtyping of individuals with kleptomania may be a useful way to better understand this behavior and decide on effective treatment interventions.

Grant JE, Phillips KA. · Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, USA. · Ann Clin Psychiatry. · Pubmed #16402752 links to  free full text

Abstract: BACKGROUND: Body dysmorphic disorder (BDD) is a relatively common and often-disabling obsessive compulsive spectrum disorder that often goes unrecognized in clinical practice. METHODS: The present review examines the clinical features of BDD, its relationship to other disorders, and what is known about effective treatment. RESULTS: BDD consists of a distressing and impairing preoccupation with imagined or slight defects in appearance that can focus on any body area. Insight is usually poor or absent; nearly half of patients are delusional. Typical associated behaviors include skin picking, mirror checking, excessive grooming, and camouflaging. It appears that higher doses of serotonin reuptake inhibitors and longer treatment trials than those used for many other psychiatric disorders, including depression, are often needed to effectively treat BDD. Cognitive-behavioral therapy also appears efficacious and is currently considered the psychotherapy of choice for BDD. Core techniques are cognitive restructuring, behavioral experiments, response (ritual) prevention, and exposure. CONCLUSIONS: Further research is needed to minimize the underrecognition of BDD and to improve proper treatment. Because of the high rates of comorbidity in patients with BDD, treatment studies need to include subjects with co-occurring disorders and thereby attempt to understand how these other disorders affect treatment response. Finally, more research needs to address the pathophysiology of BDD (for example, by incorporating imaging and genetics).

Rivard AL, Hellmich C, Sampson B, Bianco RW, Crow SJ, Miller LW. · University of Minnesota, Minneapolis, MN, USA. · Prog Transplant. · Pubmed #16252635 No free full text.

Abstract: The psychiatric and psychosocial evaluation of the heart transplant candidate can identify particular predictors for postoperative problems. These factors, as identified during the comprehensive evaluation phase, provide an assessment of the candidate in context of the proposed transplantation protocol. Previous issues with compliance, substance abuse, and psychosis are clear indictors of postoperative problems. The prolonged waiting list time provides an additional period to evaluate and provide support to patients having a terminal disease who need a heart transplant, and are undergoing prolonged hospitalization. Following transplantation, the patient is faced with additional challenges of a new self-image, multiple concerns, anxiety, and depression. Ultimately, the success of the heart transplantation remains dependent upon the recipient's ability to cope psychologically and comply with the medication regimen. The limited resource of donor hearts and the high emotional and financial cost of heart transplantation lead to an exhaustive effort to select those patients who will benefit from the improved physical health the heart transplant confers.

Mahowald MW, Schenck CH. · Minnesota Regional Sleep Disorders Center, Minneapolis, MN 55415, USA. · Neurol Clin. · Pubmed #16243617 No free full text.

Abstract: Parasomnias are unpleasant or undesirable behavioral or experiential phenomena that occur during sleep. Once believed unitary phenomena related to psychiatric disorders, it is now clear that parasomnias result from several different phenomena and usually are not related to psychiatric conditions. Parasomnias are categorized as primary (disorders of the sleep states) and secondary (disorders of other organ systems that manifest themselves during sleep). Primary sleep parasomnias can be classified according to the sleep state of origin: rapid eye movement sleep, non-rapid eye movement sleep, and miscellaneous (those not respecting sleep state). Secondary sleep parasomnias are classified by the organ system involved.

Weinert C. · Division of Pulmonary, Allergy and Critical Care Medicine and Clinical Outcomes Research Center, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA. · Curr Opin Crit Care. · Pubmed #16015119 No free full text.

Abstract: PURPOSE: As a greater number of patients survive critical illness, there is increasing interest in accelerating patients' recovery after intensive care unit discharge. There is compelling evidence that psychiatric illnesses such as depression impair functional status in patients with chronic medical illnesses. Therefore, psychiatric conditions that develop after critical illness are a logical target for treatment or prevention strategies to improve recovery after critical illness. RECENT FINDINGS: This is a new area of investigation for intensive care unit researchers. To date, most studies have focused on descriptive epidemiology of psychiatric conditions at varying times after intensive care unit discharge. Small randomized trials have shown that depression and posttraumatic stress symptoms can be reduced by interventions during or after mechanical ventilation, although the causal mechanisms leading to these improved outcomes are obscure. Promising results must be confirmed in additional trials. After acute myocardial infarction, large trials have found that psychosocial interventions started after hospital discharge are ineffective at preventing psychosocial impairment. SUMMARY: Psychiatric symptoms and disorders affect 15%-35% of patients months after intensive care unit discharge. There is no consistent evidence that antidepressant medications are safe or effective in critically ill patients. Understanding the causal pathways that lead from acute medical stress to neuronal alterations and subsequent psychiatric symptoms will allow more precise targeting of preventive interventions.

Overmier JB, Murison R. · Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA. · Psychoneuroendocrinology. · Pubmed #15963654 No free full text.

Abstract: Traumas have both immediate consequences and proactive consequences. Examples include learned helplessness, HPA-axis responsivity, gastrointestinal vulnerability to ulcer, and other correlates of anxiety disorders. Both immediate and proactive consequences may be modulated by behavioral and cognitive evolutionary evolved adaption processes, among which are forms of learning that enable 'coping'. Examples of associative and non-associative forms of coping and effects on learned helplessness, HPA-axis responsivity, and gastrointestinal vulnerability are presented. The importance of attention to behavioral contingencies in situations in which potentially traumatic events occur is emphasized as critical to understanding that it is not the physical event(s) per se that determine the immediate and long term consequences.

Shepard M. · University of Minnesota, Duluth, USA. · J Interpers Violence. · Pubmed #15722498 No free full text.

Abstract: The past 20 years have seen great strides in addressing violence against women by their male partners. Although the author cannot point to one single intervention or set of interventions as being the most effective, institutional reforms that have included coordinated community responses have had a positive impact. During the next 10 years, researchers must learn how to address the obstacles that prevent institutional responses from being more effective in addressing the needs of victims.

Leon GR. · Department of Psychology, University of Minnesota, Minneapolis, Minnesota 55455, USA. · Prehosp Disaster Med. · Pubmed #15453154 No free full text.

Abstract: The psychosocial sequelae can be intense and of long duration in the aftermath of natural and technological disasters, as well as terrorist attacks. Post-traumatic stress symptoms and full syndrome disorder, depression, anxiety, somatic complaints, and excessive alcohol use have been demonstrated consistently, particularly following large-scale disasters. This paper examines the psychological research conducted at various intervals after extensive natural disasters, the Three Mile Island and Chernobyl technological accidents, and recent terrorist events in the United States. Factors predictive of the emergence of emotional distress and psychological and physical problems following a disaster also are discussed.

Kim SW, Grant JE, Kim SI, Swanson TA, Bernstein GA, Jaszcz WB, Williams KA, Schlievert PM. · Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA. · J Neuropsychiatry Clin Neurosci. · Pubmed #15377732 links to  free full text

Abstract: Rheumatic fever is an immunologically mediated disease that follows infection by group A beta-hemolytic Streptococcus (GABHS). In rheumatic fever, antibodies generated against GABHS cross-react with the heart, joints, skin, and other sites, inducing an inflammatory, multisystem disease. Brain tissue-specific antibodies have been demonstrated in a subset of children with Sydenham chorea (a component of the Jones criteria for the diagnosis of rheumatic fever), and most Sydenham chorea patients manifest obsessive-compulsive symptoms very similar to those in traditional obsessive-compulsive disorder. The parallels drawn from the paradigm of Sydenham's chorea to Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is an area of active controversy. Newly emerging information on the role of GABHS superantigens in the pathogenesis of rheumatic fever is of particular interest. In this article, we review the microbial characteristics of GABHS and the subsequent immune responses to GABHS as a possible etiology of PANDAS.

Krueger RF, Tackett JL, Markon KE. · Department of Psychology, University of Minnesota--Twin Cities, Minneapolis, Minn. 55455, USA. · Adv Psychosom Med. · Pubmed #15248367 No free full text.

Abstract: Patterns of comorbidity among common mental disorders can be understood from the perspective of a model that regards mood, anxiety and somatization disorders as elements within an internalizing spectrum of disorder, and substance use and antisocial behavior disorders as elements within a separate externalizing spectrum of disorder. In this chapter, we evaluate the possibility of linking this model to literature on chronic pain. Evidence from psychosocial and biological perspectives points towards mechanisms that link chronic pain to internalizing disorders. Such evidence indicates that the internalizing-externalizing model may provide a useful framework for suggesting new directions for research on connections between chronic pain and mood, anxiety, and related disorders and traits.

Little JW. · University of Minnesota, Minneapolis, USA. · Gen Dent. · Pubmed #15055656 No free full text.

Abstract: Anxiety disorders are the most frequently found psychiatric problem in the general population. The most common anxiety disorders are phobias, panic attack, generalized anxiety disorder, post-traumatic stress disorder and acute stress disorder. Recent terrorist attacks in the U.S. have had a marked impact on the mental health status of individuals directly affected by the attacks as well as those who were far from the scenes of destruction. To provide effective dental care, the dentist must be able to identify anxious patients and deal with their anxiety. This process may involve referring the patient for medical evaluation and treatment of very severe cases of anxiety. In most cases, the dentist can manage the patient by using behavioral and/or pharmacologic means.

Yates TM. · Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN 55455, USA. · Clin Psychol Rev. · Pubmed #14992806 No free full text.

Abstract: This article utilizes a developmental psychopathology framework to explicate one pathway, originating in childhood traumatic experience, toward the development of self-injurious behavior (SIB). The descriptive psychopathology of SIB is summarized first, followed by an overview of theoretical interpretations of SIB within psychoanalytic, neo-analytic, behavioral, and biological paradigms. Building on these empirical and theoretical foundations, a developmental psychopathology framework is used to model the development of SIB in the aftermath of childhood traumatic experience, particularly maltreatment. In this model, maltreatment undermines positive adaptation at motivational, attitudinal, instrumental, emotional, and/or relational levels of competence. In turn, vulnerabilities in the child's adaptive resources necessitate the application of alternative regulatory and relational strategies, such as self-injury, to the negotiation of contemporaneous and prospective developmental issues. The article concludes with a discussion of the empirical and clinical implications of a developmental understanding of SIB as a compensatory regulatory strategy in posttraumatic adaptation.

Reiff MI, Stein MT. · Division of Pediatric Clinical Neuroscience, University of Minnesota, Mayo Mail Code 486, 420 Deleware Street S.E., Minneapolis, MN 55455, USA. · Pediatr Clin North Am. · Pubmed #14558680 No free full text.

Abstract: Attention-deficit/hyperactivity disorder is the most common neurobehavioral disorder of childhood, with most children maintaining symptoms of ADHD as adolescents and as adults. It is among the most common chronic conditions that primary care pediatricians see. Progress in brain imaging, genetics, neuropsychology, and molecular biology of ADHD reveals complex interactions between neurologic mechanisms, genetics, and environmental influences. Core behaviors seen in children with ADHD include hyperactivity, impulsivity, and inattention. The DSM-IV standard for diagnosis emphasized the importance of documenting that these behaviors occur at school and in the home, the chronicity of symptoms, and the connection between the behaviors and impairments in educational achievement or social development. The complex nature of this disorder is indicated by the observation that children and adolescents with ADHD have associated conditions, such as learning disorders, anxiety, oppositional behaviors, and depression. The AAP practice guideline on the evaluation and diagnosis of school-aged children with ADHD provides primary care pediatricians with a scientific foundation for assessing children with behavior and learning problems. Attention to accurate documentation of behaviors, coexisting learning disorders and mental health conditions, and the development of office practices that support the diagnostic process will ensure that children receive an appropriate and comprehensive assessment.

Coleman E, Raymond N, McBean A. · Department of Family Practice and Community Health, University of Minnesota Medical School, USA. · Minn Med. · Pubmed #12921375 No free full text.

Abstract: The hallmarks of compulsive sexual behavior (CSB) are recurrent and intense sexually arousing fantasies, sexual urges, and behaviors that cause individuals distress in daily functioning. Clinical signs of CSB can include anxiety, depression, somatic complaints, alcohol or drug use or dependency, relationship problems, or signs of abuse. This article describes the symptoms of paraphilic and nonparaphilic CSB and discusses their epidemiology, etiology, as well as comorbid psychiatric conditions. It also presents screening questions that clinicians can use with patients suspected of having CSB and outlines medical and psychiatric treatment for the condition. When CSB is suspected, referral to a clinician experienced in treating sexual disorders is recommended.