1,721,346 research outputs found
Modafinil, inhibitory control, and alcoholism
No full textCommentary on L. Schmaal et al, 'Effects of Modafinil on Neural Correlates of Response Inhibition in Alcohol-Dependent Patients' Biological Psychiatry, Volume 73, Issue 3, 1 February 2013, pp 211-21
Lack of deleterious effects of buspirone on cognition in healthy male volunteers (Journal of Psychopharmacology 21, 2, DOI: 10.1177/0269881107068066)
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Endophenotypes of obsessive-compulsive disorder: Rationale, evidence and future potential
No full textObsessive-compulsive disorder (OCD) is a heritable and debilitating neuropsychiatric condition. Attempts to delineate genetic contributions have met with limited success, and there is an ongoing search for intermediate trait or vulnerability markers rooted in the neurosciences. Such markers would be valuable for detecting people at risk of developing the condition, clarifying etiological factors and targeting novel treatments. This review begins with brief coverage of the epidemiology of OCD, and presents a hierarchical model of the condition. The advantages of neuropsychological assessment and neuroimaging as objective measures of brain integrity and function are discussed. We describe the concept of endophenotypes and examples of their successful use in medicine and psychiatry. Key areas of focus in the search for OCD endophenotypes are identified, such as measures of inhibitory control and probes of the integrity of orbitofrontal and posterior parietal cortices. Finally, we discuss exciting findings in unaffected first-degree relatives of patients with OCD that have led to the identification of several candidate endophenotypes of the disorder, with important implications for neurobiological understanding and treatment of this and related conditions.</p
Phenomenology and epidemiology of trichotillomania
No full textTrichotillomania is a psychiatric disorder characterized by recurrent hair pulling, leading to hair loss and functional impairment. This chapter reviews the phenomenology and epidemiology of trichotillomania, and considers its relationship with putative obsessive-compulsive spectrum conditions and other body-focused repetitive behaviors. Salient animal models of the disorder, along with findings in human patients using neuroimaging and cognitive probes, are summarized. A brain-based model of trichotillomania is formulated, focusing on affect dysregulation, addiction, and impulse dyscontrol. Finally, the chapter flags cardinal questions for the attention of future clinical and research scrutiny.</p
Trichotillomania.
No full textTrichotillomania, characterized by the repetitive pulling out of one’s own hair leading to hair loss and functional impairment, has been documented in the medical literature since the 19th century, but has received scant research attention. Community prevalence studies suggest that trichotillomania is a common disorder with point prevalence estimate of 0.5% to 2.0%. Although recently grouped with OCD in the DSM-5, clinicians need to be aware that trichotillomania and OCD may have less in common than originally thought. In fact, approaches to treating trichotillomania, which include habit reversal therapy and medication (n-acetyl cysteine or olanzapine), are quite different from those used to treat OCD; and some first-line treatments used for OCD appear ineffective for trichotillomania. Based on our clinical experience and research findings, the article recommends several management approaches to trichotillomania
Cold pressor pain and gambling disorder: Implications for the opioid system
No full textObjective Gambling disorder (GD) is a common, disabling condition that often is exacerbated by stressful life events. Under stress, the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis are activated. The question, therefore, arises as to whether an abnormal sympathetic response can be found in individuals with GD.Method Adult individuals with GD and no current co-occurring mental disorders were enrolled. Participants completed impulsivity and gambling-related questionnaires and underwent cold pressor evaluation. GD participants were compared with controls on measures of heart rate, blood pressure, and pain.Results Fifteen people with GD and 18 controls completed the study. Kaplan-Meier analysis indicated that the GD group withdrew their hand from the painful stimulus more rapidly than controls (Wilcoxon chi-square = 3.87, p = 0.049), suggestive of lesser pain tolerance. Subjective pain ratings and cardiovascular measurements did not significantly differ between groups.Conclusions Individuals with GD manifested a relative intolerance to pain on the cold pressor paradigm, even though they physiologically did not seem to experience greater pain. Given the role of the opioid system in pain processing, it would be valuable in future work to examine whether cold pressor measures can predict response to treatments in GD, including with opioid antagonists.</p
Neurocognitive findings in young adults with binge eating disorder.
No full textObjectives: Binge-eating disorder (BED) has been associated with cognitive impairment, including on measures of impulsivity, but it is not clear in prior literature whether these deficits may have been associated with obesity, rather than BED per se. Impulsivity may play a role in predisposing people towards BED as well as in the chronicity of symptoms. The aim of this study was to examine cognitive functions between BED and healthy controls matched for age, gender, and body mass indices.Methods: Individuals with BED and healthy controls were recruited from the general community using media advertisements. After providing informed consent, study participants completed a clinical interview and computerised neuropsychological testing. Group differences were analysed.Results: Groups did not differ significantly on age, gender, education levels, or body mass indices. The BED group (N = 17) exhibited significantly impaired stop-signal response inhibition (Stop-Signal Task) and executive planning (Stockings of Cambridge Task) compared to healthy controls (N = 17). Spatial working memory and set-shifting were intact.Discussion: BED appears to be associated with motor disinhibition and impaired executive planning even controlling for obesity. Longitudinal work is needed to clarify whether motor impulsivity predisposes people to BED, and/or contributes to persistence of symptoms over time.Key pointsBinge-eating disorder is common, under-recognised, and associated with untoward physical and health sequelae.The neurobiological basis of binge-eating disorder is unclear; cognitive testing may offer insights.Many prior cognitive studies have not controlled for potential confounds, especially group differences in body mass indices (BMI). Obesity in itself has been linked with cognitive dysfunction.Here, we compared cognition between people with binge-eating disorder and controls, matched for BMI and other measures.Binge-eating disorder was associated with impaired response inhibition and executive planning.These results inform neurobiological models of binge-eating disorder and may suggest new treatment targets for this condition
Gambling and substance use: comorbidity and treatment implications
No full textGambling disorder is a common condition that was previously listed as an impulse control disorder, but is now considered a substance-related and addictive disorder. Gambling disorder has been associated with various untoward long-term outcomes including impaired quality of life, relationship break-ups, debt and mortgage foreclosure, and elevated risk of suicidality. This paper provides a concise primer on gambling disorder, with a special focus on its parallels with substance use disorders. We consider clinical presentations, comorbid expression, heritability, and treatment approaches (psychological and pharmacological). Lastly, we highlight new treatment directions suggested by the literature.</p
Symptom severity and its clinical correlates in kleptomania
No full textBackground: kleptomania (compulsive stealing) remains poorly understood, with limited data regarding its underlying pathophysiology and appropriate treatment choices. Methods: participants (N = 112) age 18 to 65 with a primary, current diagnosis of kleptomania were assessed for the severity of their stealing behavior and urges to steal, as well as related mental health symptoms. To identify clinical and demographic measures associated with variation in disease severity, we utilized the statistical technique of partial least squares. Results: greater kleptomania symptom severity was associated with having more frequent urges to steal, feeling excited by stealing, having a current eating disorder, and having a current diagnosis of obsessivecompulsive disorder (OCD). Worse symptom severity was associated with a shorter transition time (between first stealing and diagnosis of kleptomania), as well as with a higher chance of stealing from relatives and seeking treatment at some point. Conclusions: feeling a sense of reward from stealing and co-occurrence of certain disorders associated with compulsivity (eg, OCD, anorexia nervosa) were strongly associated with worse illness severity in kleptomania. Treatment approaches should incorporate these disorders as possible treatment targets. These data also may support conceptualizing kleptomania as an obsessive-compulsive-related disorder rather than being allied to substance use or impulsive disorders.</p
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