Child-centered play therapy with a seven-year-old boy diagnosed with intermittent explosive disorder.

Child-centered play therapy (CCPT) has been supported as an effective method for working with children. A case study is presented that describes treatment using CCPT with a 7-year-old boy diagnosed with intermittent explosive disorder (IED). This case study delineates 16 sessions of play therapy with a registered play therapist. The behavioral problems the child exhibited at the onset of therapy were greatly improved at the conclusion of the sessions. The outcome of this case study supported the use of play therapy for children with IED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy for intermittent explosive disorder: A pilot randomized clinical trial.

No randomized clinical trials have evaluated the efficacy of psychotherapy for intermittent explosive disorder (IED). In the present study, the authors tested the efficacy of 12-week group and individual cognitive-behavioral therapies (adapted from J. L. Deffenbacher & M. McKay, 2000) by comparing them with a wait-list control in a randomized clinical trial among adults with IED (N = 45). Aggression, anger, and associated symptoms were assessed at baseline, midtreatment, posttreatment, and 3-month follow-up. Group and individual cognitive-behavioral therapy tended not to differ, with each reducing aggression, anger, hostile thinking, and depressive symptoms, while improving anger control relative to wait-list participants. Posttreatment effect sizes were large. These effects were maintained at 3-month follow-up. Findings provide initial support for the use of multicomponent cognitive-behavioral therapy in the treatment of IED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnosing DSM-IV--Part I: DSM-IV and the concept of disorder

In this first article in a two-article series, I diagnose' a problem with DSM-IV, specifically, the overinclusiveness of its diagnostic criteria. Using the harmful dysfunction analysis of the concept of disorder (Wakefield, 1992a, American Psychologist, 47, 373-388) as a framework, I argue that DSM-IV criteria for many diagnostic categories fail to satisfy the analysis' dysfunction' requirement, that is, the criteria do not distinguish harmful conditions due to internal dysfunctions from harmful conditions that are nondisordered 'problems in living'. The overinclusiveness problem, I suggest, can be partly dealt with by giving up purely symptomatic criteria and contextualizing diagnosis to take into account the relationship between triggering causes and resulting symptoms. In Part II (Wakefield, 1997, Behaviour Research and Therapy, 35, 651-665, I examine Eysenck's (1986, Contemporary directions in psychopathology: Toward the DSM-IV) proposal for a dimensional diagnostic system to supplant DSM-IV.     

Surgical treatment of juxta-renal abdominal aortic occlusion: report of 27 cases

Juxta-renal abdominal aortic occlusion is a relatively rare disease. We have treated 27 patients (25 males and 2 females) since 1984. Operations were performed on 25 patients, of whom 4 died and 84% improved. The main etiology was aorto-iliac stenosis or occlusion due to atherosclerosis and Takayasu's arteritis. Diagnostic basis included ischemia of lower limbs, pulselessness of abdominal aorta and both femoral arteries, sexual dysfunction, and positive result of angiography. Effective control of aorta below the left renal vein, aortotomy and retrograde endarterectomy were the main operative procedures. Axillo-bifemoral arterial bypass is recommended for patients associated with multiple diseases. The operative result is determined by associated diseases and the condition of run-off vessel. Associated diseases directly affect the mortality rate.     

Rorschach correlates of the DSM-IV histrionic personality disorder

Over the past decade, Americans have recognized that violence has deeply permeated the lives of the most vulnerable among us--children. There is great concern over the effect these terrible experiences will have on present and future generations. It has also awakened the collective consciousness of our society that the impact of violence extends well beyond the child who is physically victimized to other larger groups of children such as those who witness these events. This article reviews the impact violence has on children.     

Acute intermittent familial ataxia: report of a new family

INTRODUCTION. Acute intermittent familial ataxia is a rare disorder with autosomal dominant inheritance and unknown etiology which usually in childhood or adolescence. CASE 1. A 33-years-old woman who suffered from giddiness, gait ataxia, dysarthria and somnolence episodes. These episodes lasted between 4 and 72 hours. They generally occurred within a framework of emotional or physical stress. The following tests were performed: hemogram and biochemistry, blood and urine toxicology, immunological tests, cerebrospinal-fluid study, electrocardiogram, electroencephalogram, trunk and visual evocated potentials, cerebral computed tomography and cerebral magnetic resonance imaging. None of them gave significative results. CASE 2. A 12-years-old boy, son of the previous woman, who suffered from somnolence, gait ataxia and dysarthria with acute beginning. The same tests than in the above case were performed together with metabolic studies. There were no pathological findings in this case, either. The symptoms disappeared gradually in 6 days. His familial history led to a diagnosis of acute intermittent familial ataxia. A year later he suffered from a similar disorder and he was immediately treated with acetazolamide. The symptoms disappeared in 2 hours. CONCLUSIONS. Acute intermittent familial ataxia is a disorder of difficult identification. It can be easily confused with other periodical ones, because its diagnosis has to be based on the clinical findings and on the familial history. For this purpose, a therapeutic test with acetazolamide can be useful, since in most cases a spectacular clinical improvement has been observed.     

Latent structure analysis of DSM-IV borderline personality disorder criteria

The aim of this study was to evaluate the structure of DSM-IV borderline personality disorder (BPD) criteria. The study group consisted of 564 consecutively admitted inpatients and outpatients. BPD criteria discriminatory power was tested by using corrected item-to-total and item-to-diagnosis correlations. Weighted least-squares (WLS) confirmatory factor analysis (CFA) was used to assess the fit of DSM-IV BPD unidimensional model. The categorical model of BPD was tested by exploratory latent class analysis (LCA). Item analysis suggested a hierarchy in BPD criteria discriminatory power, even if with different rank order with respect to the DSM-IV model. CFA showed a unifactorial structure with congeneric items as the best fitting model for DSM-IV BPD criteria (chi2 = 18.89, df= 27, P > .87). LCA showed evidence for three latent classes; heterogeneity was observed only among subjects falling below DSM-IV diagnostic threshold for BPD. These results support the categorical model of BPD, even if with several differences with respect to DSM-IV.     

Clinical relevance of adjustment disorder in DSM-III-4 and DSM-IV

This study examines the diagnosis of adjustment disorder in DSM-III-R. In view of the methodological problems associated with this, we investigated clinical characteristics of patients to whom the diagnosis had been applied. The patients in question were treated at the University Psychiatric Outpatient Clinic in Lausanne, Switzerland (N = 1,308). Four groups of comparisons are made: between adjustment disorder, other diagnoses, and no diagnosis; between adjustment disorder with depressed mood and other mood disorders; between adjustment disorder with anxious mood and anxiety disorders; and between the clinical subdivisions of adjustment disorder. This diagnosis is characterized by a high number of marital stressors, low age, predominance of women, and short period of treatment. The clinical profile is marked by a predominance of depressive and mixed types, and the relationship between these is demonstrated. Finally, the course of a certain proportion of these disorders goes beyond the 6-month period stipulated by DSM-III-R. This result justifies the modifications introduced in DSM-IV.     

Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children

OBJECTIVE: Little is known about the validity of the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children. Moreover, the results of the DSM-IV field trials raised concerns that inclusion of the new predominantly hyperactive-impulsive type of ADHD in DSM-IV might increase the likelihood of the diagnosis being given to active but unimpaired preschool and primary school children. METHOD: The validity of DSM-IV criteria for each subtype of ADHD was evaluated in 126 children, aged 4 through 6 years, and 126 matched comparison children. Probands and controls were classified by using structured diagnostic interviews of the parent and a DSM-IV checklist completed by the teacher. RESULTS: Children who met DSM-IV criteria for each subtype of ADHD according to parent and teacher reports differed consistently from controls on a wide range of measures of social and academic impairment, even when other types of psychopathology and other potential confounds were controlled. CONCLUSIONS: When diagnosed by means of a structured diagnostic protocol, all three DSM-IV subtypes of ADHD are valid for 4- through 6-year-old children in the sense of identifying children with lower mean scores on measures of adaptive functioning that are independently associated with ADHD.     

Sleep disorders related to another mental disorder (nonsubstance/primary): a DSM-IV literature review

BACKGROUND: Disturbances of the sleep/wake cycle are fundamental clinical symptoms for patients with many of the mental disorders. This review of the literature on research in sleep and mental disorders from 1966 to 1991 highlights the major developments and findings that are central to the development of a DSM-IV diagnosis of sleep disorders related to another mental disorder (nonsubstance/primary). METHOD: As a framework, the review discusses the classification criteria listed in the International Classification of Sleep Disorders (ICSD, 1990) for sleep disorders associated with mental disorders. Research relevant to the classification system is reviewed and the merits of modifying the DSM-III-R criteria based on the accumulated research are discussed. RESULTS: Overall, the review supports the notion of consistent biological alterations in the sleep/wake cycle for patients with many of the mental disorders. CONCLUSION: On the basis of this evidence, sleep disorders related to another mental disorder warrant separate diagnostic classification within a nosology for sleep disorders. The review also reveals the historical development of sleep research as a tool within the field of psychiatry for characterizing the biological bases of mental disorders.     

Eating disorder in a transgendered patient: a case report

Avascular necrosis (AVN) is a devastating adverse effect of corticosteroid therapy rarely reported in the setting of inflammatory bowel disease. We describe a 48-year-old woman with 6 weeks of progressive bilateral knee pain resulting in the inability to ambulate. Her symptoms developed suddenly, 9 months after treatment with hydrocortisone enemas for ulcerative proctitis. On physical examination, the patient had knee tenderness, decreased range of motion, and flexion contractures. Magnetic resonance imaging showed multiple bony infarcts in bilateral distal femora and proximal tibias, consistent with advanced AVN. Initial therapy included pain management, serial casting, gentle flexibility and strengthening, and limited mobility training. The rehabilitation efforts led to functional improvement. Ultimately, bilateral total knee arthroplasties were recommended to treat her advanced AVN. This is the first reported case of AVN secondary to hydrocortisone enemas. We review the literature and discuss the pathophysiology and management of corticosteroid-induced AVN.     

Definitions of panic attacks and panic disorder in the DSM-IV: Implications for research.

The authors review various definitions of panic and recent conceptual and empirical evidence that led to the revised definitions of panic in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994). The DSM-IV definitions of panic are more precise and more empirically based than those contained in the DSM-III—R, but are designed primarily for clinicians rather than researchers. Thus, it is possible that definitions of panic used in research under the DSM-IV system will encompass a heterogeneous mix of emotional phenomena. Recommendations on essential components of a conservative definition of panic are proposed for research purposes. Implications of this definition for limited symptom attacks and "nonfearful" panic are elaborated and related to final definitions of panic attacks and panic disorder in the DSM-IV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Joubert syndrome: a report of 5 cases

OBJECTIVE: To review clinical features, radiological findings and prognosis in Joubert syndrome. MATERIAL AND METHODS: We report 5 children (3 male and 2 female) with the diagnosis of Joubert syndrome by clinical and radiological findings. They were diagnosed in the first year of life, in the Hospital Infantil La Paz (Madrid, Spain), from 1971 to 1996. Three patients have already been published, and here, we report two new cases. RESULTS: Partial absence of the cerebellar vermis, hypotonia and developmental delay were seen in all patients. Other cardinal findings were episodic hyperpnoea (5/5) with periods of apnoea (2/5), abnormal eye movements (2/5) and strabismus (3/5), tongue protrusion (2/5), seizures (1/5), hemifacial spasms (1/5) and occipital meningocele (2/5). Clinical manifestations were first noticed soon after birth. Two patients died in the first 5 years of life, and the rest of the cases actually show severe mental retardation. CONCLUSIONS: Joubert syndrome is a rare and probably underdiagnosed syndrome with bad prognosis. This inherited condition is characterized by agenesis of the cerebellar vermis, mental retardation, hypotonia, episodic hyperpnoea and abnormal eye movements. Additional manifestations have been reported since the original cases were described.     

Bullous sarcoidosis: a report of three cases

Three cases of pulmonary sarcoidosis presented as bullous emphysema with severe airflow obstruction, and the diagnosis of sarcoidosis was unsuspected for at least 2 years. Potential mechanisms of bullous emphysema from sarcoidosis are discussed. The physician should suspect sarcoidosis as the cause of bullous emphysema when young patients who have smoked relatively few pack-years present with emphysema or severe airflow obstruction. Additional clues are the presence of mediastinal adenopathy on a chest radiograph or a CT scan and a history consistent with extrapulmonary sarcoidosis.     

Empirical evaluation of DSM-IV generalized anxiety disorder criteria in children and adolescents

Evaluated the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) generalized anxiety disorder (GAD) criteria in children and adolescents. Clinic-referred children meeting criteria for DSM-IV GAD, those meeting criteria for another DSM-IV anxiety disorder, and normal children participated in a structured interview and completed self-report questionnaires. Groups were compared in terms of interview and self-report measures to examine convergent and discriminant validity. In addition, developmental differences, cross-informant symptom and syndrome agreement, and validity of parent and child report were determined. Finally, the symptoms comprising the GAD associated symptom criterion (Criterion C) were examined in terms of rate of endorsement and predictive power. Results showed that parameters of worry differentiated children with GAD from those with other anxiety disorders and controls. Developmental differences in the sample did not appear to necessitate a separate criteria set for the classification of generalized anxiety in children of this age. Symptoms from GAD Criterion C evidenced moderately high rates of endorsement and acceptable predictive power. Overall, the DSM-IV GAD criteria for children and adolescents are supported, but further evaluation is necessary before firm conclusions can be drawn.     

Unhealthy aggression: Intermittent explosive disorder and adverse physical health outcomes.

Objective: To examine the relationship between Intermittent Explosive Disorder (IED; a psychiatric diagnosis characterized by episodes of affective aggression) and adverse physical health outcomes. Design: A large epidemiological sample drawn from the Collaborative Psychiatric Epidemiological Surveys (N = 10,366), was used to compare participants with a lifetime diagnosis of IED (n = 929) to those without any history of IED (n = 9,437) on demographic variables (age, education, gender, race) common risk factors (smoking status, body mass index, substance use disorders, past accident or injury requiring treatment, major depression) and the presence of 12 adverse health outcomes. Main Outcome Measures: History of heart attacks, coronary heart disease, hypertension, stroke, lung disease, diabetes, cancer, arthritis, back/neck pain, ulcer, headaches, and other chronic pain. Results: Logistic regression analysis controlling for demographic and other risk factors indicated that IED was associated with 9 of the 12 adverse physical health outcomes (coronary heart disease, hypertension, stroke, diabetes, arthritis, back/neck pain, ulcer, headaches, and other chronic pain). Only cancer, heart attacks, and lung disease were not significantly related to IED. Conclusion: IED may be a risk factor for several significant adverse physical health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reverse dorsal digital and metacarpal flaps: a review of 27 cases

It was reported previously that normal soft tissues accumulate 67Ga by a transferrin-dependent route, but uptake by tumors can be transferrin independent. It was also reported that, although overexpression of the transferrin receptor can promote Ga avidity, the transferrin-independent uptake of 67Ga is significant and can be augmented to exceed transferrin-mediated levels by increasing extracellular calcium. In assessing the effect of calcium channel blockers on uptake of 67Ga, it was observed that, after exposure to light (either visible or ultraviolet [UV]), nifedipine strongly potentiates the cellular uptake of 67Ga by a transferrin-independent process. METHODS: The effect of nifedipine on 67Ga uptake as a function of time, concentration, duration and type of preexposure to light was determined in two cultured Chinese hamster ovary cell lines. One cell line lacks the transferrin receptor. In the other, the human transferrin receptor has been restored by transfection and is overexpressed constitutively. RESULTS: Although there are some differences in pattern of stimulation of uptake, nifedipine subjected to either UV or fluorescent light strongly promotes the uptake of 67Ga in the cultured cells in a time-dependent and concentration-dependent manner. Maximal uptake of 67Ga occurs when the cells are incubated for 30 min with 25 micromol/L nifedipine preexposed to either 4h of fluorescent or 1h of UV light. Under these conditions, uptake of 67Ga is 1000-fold greater than basal levels and 50-fold greater than can be achieved by the transferrin-dependent route. Light-shielded nifedipine has no effect on 67Ga uptake. CONCLUSION: The effect of photodegraded nifedipine on the uptake of 67Ga is independent of expression of the transferrin receptor. The potential for photodegraded nifedipine to improve oncologic imaging with 67Ga warrants further investigation.     

Signature murders: a report of several related cases

Three female patrons of singles bars were murdered in separate events in Bellevue, Washington in 1990 within sixty-seven days of each other. An evaluation of those murders revealed that all the murders were linked by a distinct personal "signature" or "calling card" left by the killer. As reported in the literature, the modus operandi of a killer frequently changes from one murder to the next and is different from the killer's signature, which is a permanent psychological imprint at each scene. The murder cases reported here demonstrate an elaborate signature of one killer who engaged in a rare personalization of his necrophilic fantasies by posing, openly displaying, and sexually inserting foreign objects into each one of three victims' bodies.     

Metastasizing pleomorphic adenoma: a report of three cases

BACKGROUND: This study evaluates the diagnosis and treatment of women with pathologic nipple discharge caused by ductal carcinoma in situ (DCIS). METHODS: Women with unilateral spontaneous bloody, serous, or brown nipple discharge who presented between January 1, 1988 and August 1, 1996 were identified by retrospective chart review. Women with nonspontaneous, physiologic discharge were excluded. RESULTS: Two hundred seventy-seven women with a mean age of 59.5 years (range, 24 to 88 years) underwent duct exploration and biopsy for pathologic discharge, with 43 (15.5%) found to have DCIS. The discharge was bloody in 29, clear in eight, and brown in six women. Seven of 12 (58%) women with an associated breast mass were found to have a microinvasive component with the DCIS. Discharge cytology showed malignant cells in only two of 12 (16%) women examined. A ductogram was performed on 20 women, with filling defects seen in 10, ectasia in 3, narrowing in 4, and normal ducts in 3. The DCIS included 17 (40%) specimens with cribriform pattern, 17 (40%) micropapillary, 8 (18%) comedo, and 2 (2%) solid. Twelve microinvasive cancers were found in combination with DCIS. After duct exploration, 37 (86%) patients were found to have extensive or multifocal DCIS to the margin, or both, with 32 (74%) patients requiring mastectomy to achieve free surgical margins. There was residual disease in 27 of 32 (84%) mastectomy specimens after initial biopsy. Breast conservation was possible in only 11 (26%) women. Forty of 43 (93%) are disease-free with a median follow-up of 37 months. CONCLUSION: Women presenting with pathologic nipple discharge require duct exploration regardless of cytologic or radiologic findings. When discharge is the result of DCIS, extensiveness of disease in relation to central location and intraductal spread may preclude breast conservation in as many as 27 of 43 (63%) cases.