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Ideggyogyaszati Szemle May 2022We review the literature on REM parasomnias, and their the underlying mechanisms. Several REM parasomnias are consistent with sleep dissociations, where certain elements... (Review)
Review
We review the literature on REM parasomnias, and their the underlying mechanisms. Several REM parasomnias are consistent with sleep dissociations, where certain elements of the REM sleep pattern emerge in an inadequate time (sleep paralysis, hypnagogic hallucinations and cataplexy) or are absent/partial in their normal REM sleep time (REM sleep without atonia, underlying REM sleep behavior disorder). The rest of REM parasomnias (sleep related painful erection, catathrenia) may have other still unclear mechanisms. REM parasomnias deserve attention, because in addition to disturbing sleep and causing injuries, they may shed light on REM sleep functions as well as the heterogeneous etiologies of parasomnias. One of them, REM sleep behavior disorder has special importance as a warning sign of evolving neurodegenerative conditions mainly synucleinopathies (some cases synucleinopathies themselves) and it is a model parasomnia revealing that parasomnias may have by autoimmune, iatrogenic and even psychosomatic etiologies.
Topics: Humans; Parasomnias; REM Sleep Behavior Disorder; Sleep Wake Disorders; Sleep, REM; Synucleinopathies
PubMed: 35819343
DOI: 10.18071/isz.75.0171 -
Journal of Anxiety Disorders Aug 2008Scrupulosity is a psychological disorder primarily characterized by pathological guilt or obsession associated with moral or religious issues that is often accompanied... (Review)
Review
Scrupulosity is a psychological disorder primarily characterized by pathological guilt or obsession associated with moral or religious issues that is often accompanied by compulsive moral or religious observance and is highly distressing and maladaptive. This paper provides a comprehensive overview of scrupulosity and an original conceptualization of the disorder based on an exhaustive literature review to increase awareness of the disorder among practicing clinicians and stimulate further research. It explores the clinical features of scrupulosity, classified as cognitive, behavioral, affective, and social features, as well as the epidemiology, etiology, and treatment of the disorder. Additionally, it is suggested that scrupulosity, despite its similarity to OCD, may merit a distinctive diagnosis, particularly considering its unique constellation and severity of symptoms and its treatment refractoriness, as supported by statistical analysis.
Topics: Behavior Therapy; Cognitive Behavioral Therapy; Compulsive Behavior; Counseling; Existentialism; Female; Guilt; Humans; Male; Mental Disorders; Models, Psychological; Morals; Obsessive-Compulsive Disorder; Religion and Psychology
PubMed: 18226490
DOI: 10.1016/j.janxdis.2007.11.004 -
Crisis May 2019It is a peculiar fact that the deadliest psychiatric disturbance - suicidality - cannot be formally diagnosed. Suicidal behavior disorder (SBD), a condition for further...
It is a peculiar fact that the deadliest psychiatric disturbance - suicidality - cannot be formally diagnosed. Suicidal behavior disorder (SBD), a condition for further study in the DSM-5, is the field's first attempt to capture suicidality in a diagnosis. To provoke discussion about the standing of suicidality as a diagnosable psychiatric condition. I present pragmatic and conceptual rationales for why a diagnosis of suicidality is clinically useful but conclude that SBD does little to aid clinicians in assessing suicidality's symptoms, planning treatment, or monitoring progress. To improve the clinical utility of SBD, I re-conceptualize it from the vantage point of descriptive psychiatry. I hypothesize that this revised SBD is an independent, episodic, and frequently co-occurring condition and propose new cognitive, affective, and behavioral criteria that more completely capture the phenomenology of suicidality. The revised SBD is a starting place for dialogue about whether a clinically significant presentation of suicidality is a mental illness and, if it is, what its defining features should be.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Humans; Mental Disorders; Suicidal Ideation; Suicide; Suicide, Attempted
PubMed: 30109964
DOI: 10.1027/0227-5910/a000543 -
Pharmacological Treatment for Pedophilic Disorder and Compulsive Sexual Behavior Disorder: A Review.Drugs Apr 2022Guidelines for the pharmacological treatment of paraphilic disorders have historically been based on data from forensic settings and on risk levels for sexual crime.... (Review)
Review
Guidelines for the pharmacological treatment of paraphilic disorders have historically been based on data from forensic settings and on risk levels for sexual crime. However, emerging treatment options are being evaluated for individuals experiencing distress because of their sexual urges and preferences, targeting both paraphilic disorders such as pedophilic disorder (PeD) and the new diagnosis of compulsive sexual behavior disorder (CSBD) included in the International Classification of Diseases, 11th Revision (ICD-11). As in other mental disorders, this may enable individualized pharmacological treatment plans, taking into account components of sexuality (e.g. high libido, compulsivity, anxiety-driven/sex as coping), medical and psychiatric comorbidity, adverse effects and patient preferences. In order to expand on previous reviews, we conducted a literature search focusing on randomized controlled trials of pharmacological treatment for persons likely to have PeD or CSBD. Our search was not restricted to studies involving forensic or criminal samples. Twelve studies conducted between 1974 and 2021 were identified regardless of setting (outpatient or inpatient), with only one study conducted during the last decade. Of a total of 213 participants included in these studies, 122 (57%) were likely to have PeD, 34 (16%) were likely to have a CSBD, and the remainder had unspecified paraphilias (40, 21%) or sexual offense (17, 8%) as the treatment indication. The diagnostic procedure for PeD and/or CSBD, as well as comorbid psychiatric symptoms, has been described in seven studies. The studies provide some empirical evidence that testosterone-lowering drugs reduce sexual activity for patients with PeD or CSBD, but the body of evidence is meager. There is a need for studies using larger samples, specific criteria for inclusion, longer follow-up periods, and standardized outcome measures with adherence to international reporting guidelines.
Topics: Compulsive Behavior; Humans; International Classification of Diseases; Paraphilic Disorders; Sexual Behavior; Sexual Dysfunctions, Psychological
PubMed: 35414050
DOI: 10.1007/s40265-022-01696-1 -
Continuum (Minneapolis, Minn.) Apr 2016This article provides an overview of the clinical features, neuropathologic findings, diagnostic criteria, and management of dementia with Lewy bodies (DLB) and... (Review)
Review
PURPOSE OF REVIEW
This article provides an overview of the clinical features, neuropathologic findings, diagnostic criteria, and management of dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD), together known as the Lewy body dementias.
RECENT FINDINGS
DLB and PDD are common, clinically similar syndromes that share characteristic neuropathologic changes, including deposition of α-synuclein in Lewy bodies and neurites and loss of tegmental dopamine cell populations and basal forebrain cholinergic populations, often with a variable degree of coexisting Alzheimer pathology. The clinical constellations of DLB and PDD include progressive cognitive impairment associated with parkinsonism, visual hallucinations, and fluctuations of attention and wakefulness. Current clinical diagnostic criteria emphasize these features and also weigh evidence for dopamine cell loss measured with single-photon emission computed tomography (SPECT) imaging and for rapid eye movement (REM) sleep behavior disorder, a risk factor for the synucleinopathies. The timing of dementia relative to parkinsonism is the major clinical distinction between DLB and PDD, with dementia arising in the setting of well-established idiopathic Parkinson disease (after at least 1 year of motor symptoms) denoting PDD, while earlier cognitive impairment relative to parkinsonism denotes DLB. The distinction between these syndromes continues to be an active research question. Treatment for these illnesses remains symptomatic and relies on both pharmacologic and nonpharmacologic strategies.
SUMMARY
DLB and PDD are important and common dementia syndromes that overlap in their clinical features, neuropathology, and management. They are believed to exist on a spectrum of Lewy body disease, and some controversy persists in their differentiation. Given the need to optimize cognition, extrapyramidal function, and psychiatric health, management can be complex and should be systematic.
Topics: Autonomic Nervous System Diseases; Cognition Disorders; Disease Management; Humans; Lewy Body Disease; Mental Disorders; Parkinson Disease; REM Sleep Behavior Disorder
PubMed: 27042903
DOI: 10.1212/CON.0000000000000309 -
Journal of Behavioral Addictions Jun 2019Compulsive sexual behavior disorder (CSBD) will be included in ICD-11 as an impulse-control disorder. CSBD also shares clinical features with obsessive-compulsive...
BACKGROUND AND AIMS
Compulsive sexual behavior disorder (CSBD) will be included in ICD-11 as an impulse-control disorder. CSBD also shares clinical features with obsessive-compulsive spectrum disorders (OCSDs) and behavioral addictions. There has been relatively little systematic investigation of CSBD in obsessive-compulsive disorder (OCD), the paradigmatic compulsive disorder. We aimed to determine prevalence of CSBD in OCD, and its associated sociodemographic and clinical features, including associated comorbidity, to learn more about the nature of CSBD.
METHODS
Adult outpatients with current OCD ( = 539) participated in this study. The Structured Clinical Interview for OCSDs was used to diagnose OCSDs (Tourette's syndrome, compulsive shopping, pathological gambling, kleptomania, pyromania, intermittent explosive disorder, self-injurious behavior, and CSBD). Prevalence rates of OCSDs in male versus female patients as well as comorbid disorders in OCD patients with and without CSBD were compared.
RESULTS
Lifetime prevalence of CSBD was 5.6% in patients with current OCD and significantly higher in men than women. OCD patients with and without CSBD were similar in terms of age, age of onset of OCD, present OCD illness severity, as well as educational background. Lifetime prevalence rates of several mood, obsessive-compulsive, and impulse-control disorders were considerably elevated in patients with lifetime CSBD.
DISCUSSION AND CONCLUSIONS
A substantive number of OCD patients suffered from CSBD. CSBD in OCD was more likely comorbid with other mood, obsessive-compulsive, and impulse-control disorders, but not with disorders due to substance use or addictive behaviors. This finding supports conceptualization of CSBD as a compulsive-impulsive disorder.
Topics: Adolescent; Adult; Aged; Comorbidity; Compulsive Behavior; Educational Status; Female; Humans; Interviews as Topic; Male; Middle Aged; Obsessive-Compulsive Disorder; Prevalence; Severity of Illness Index; Sex Distribution; Sexual Dysfunctions, Psychological; Young Adult
PubMed: 31079471
DOI: 10.1556/2006.8.2019.23 -
Mayo Clinic Proceedings Oct 2016Sleep disorders and neurodegenerative diseases are commonly encountered in primary care. A common, but underdiagnosed sleep disorder, rapid eye movement sleep behavior... (Review)
Review
Sleep disorders and neurodegenerative diseases are commonly encountered in primary care. A common, but underdiagnosed sleep disorder, rapid eye movement sleep behavior disorder (RBD), is highly associated with Parkinson disease and related disorders. Rapid eye movement sleep behavior disorder is common. It is estimated to affect 0.5% of the general population and more than 7% of individuals older than 60 years; however, most cases go unrecognized. Rapid eye movement sleep behavior disorder presents as dream enactment, often with patients thrashing, punching, and kicking while they are sleeping. Physicians can quickly assess for the presence of RBD with high sensitivity and specificity by asking patients the question "Have you ever been told that you act out your dreams, for example by punching or flailing your arms in the air or screaming and shouting in your sleep?" Patients with RBD exhibit subtle signs of neurodegenerative disease, such as mild motor slowing, constipation, or changes in sense of smell. These signs and symptoms may predict development of a neurodegenerative disease within 3 years. Ultimately, most patients with RBD develop a neurodegenerative disease, highlighting the importance of serial neurological examinations to assess for the presence of parkinsonism and/or cognitive impairment and prognostic counseling for these patients. Rapid eye movement sleep behavior disorder is treatable with melatonin (3-6 mg before bed) or clonazepam (0.5-1 mg before bed) and may be the most common, reversible cause of sleep-related injury. Thus, it is important to identify patients at risk of RBD in a primary care setting so that bedroom safety can be addressed and treatment may be initiated.
Topics: Central Nervous System Depressants; Clonazepam; Diagnosis, Differential; GABA Modulators; Humans; Melatonin; Mental Disorders; Neurodegenerative Diseases; Primary Health Care; REM Sleep Behavior Disorder; Referral and Consultation
PubMed: 27712640
DOI: 10.1016/j.mayocp.2016.07.019 -
Neuroscience Bulletin Jun 2018The neurocircuitries that constitute the cortico-striato-thalamo-cortical (CSTC) circuit provide a framework for bridging gaps between neuroscience and executive... (Review)
Review
The Mechanism of Cortico-Striato-Thalamo-Cortical Neurocircuitry in Response Inhibition and Emotional Responding in Attention Deficit Hyperactivity Disorder with Comorbid Disruptive Behavior Disorder.
The neurocircuitries that constitute the cortico-striato-thalamo-cortical (CSTC) circuit provide a framework for bridging gaps between neuroscience and executive function in attention deficit hyperactivity disorder (ADHD), but it has been difficult to identify the mechanisms for regulating emotional problems from the understanding of ADHD comorbidity with disruptive behavior disorders (DBD). Research based on "cool" and "hot" executive functional theory and the dual pathway models, which are thought of as applied response inhibition and delay aversion, respectively, within the neuropsychological view of ADHD, has shed light on emotional responding before and after decontextualized stimuli, while CSTC circuit-related domains have been suggested to explain the different emotional symptoms of ADHD with or without comorbid DBD. This review discusses the role of abnormal connections in each CSTC circuit, especially in the emotion circuit, which may be responsible for targeted executive dysfunction at the neuroscience level. Thus, the two major domains - abstract thinking (cool) and emotional trait (hot) - trigger the mechanism of onset of ADHD.
Topics: Animals; Attention Deficit Disorder with Hyperactivity; Attention Deficit and Disruptive Behavior Disorders; Brain; Cerebral Cortex; Corpus Striatum; Emotions; Humans; Inhibition, Psychological; Neuropsychological Tests; Thalamus
PubMed: 29508250
DOI: 10.1007/s12264-018-0214-x -
Addictive Behaviors Aug 2020Compulsive Sexual Behavior Disorder (CSBD) is characterized by a persistent failure to control intense and recurrent sexual impulses, urges, and/or thoughts, resulting...
Compulsive Sexual Behavior Disorder (CSBD) is characterized by a persistent failure to control intense and recurrent sexual impulses, urges, and/or thoughts, resulting in repetitive sexual behavior that causes a marked impairment in important areas of functioning. Data collected from clinical populations suggest that CSBD frequently co-occurs with other Axis I and II psychiatric disorders; however, studies conducted so far suffer from methodological shortcomings that prevent the determination of accurate psychiatric comorbidity rates (e.g., small sample sizes, reliance on non-reliable assessment methods in the estimation of comorbidity or the non-inclusion of healthy individuals to compare prevalence rates). The purpose of this study was to explore psychiatric comorbidity in a sample of individuals with and without CSBD. The study sample comprised 383 participants distributed into two groups through a cluster analyses: 315 participants without CSBD (non-CSBD) and 68 qualifying as sexually compulsives (CSBD). Participants were assessed for co-occurring Axis I and II clinical conditions using structured clinical interviews for the DSM-IV (SCID-I and II). The majority of CSBD participants (91.2%) met the criteria for at least one Axis I disorder, compared to 66% in non-CSBD participants. CSBD participants were more likely to report an increased prevalence of alcohol dependence (16.2%), alcohol abuse (44%), major depressive disorder (39.7%), bulimia nervosa (5.9%), adjustment disorders (20.6%), and other substances -mainly cannabis and cocaine- abuse or dependence (22.1%). Concerning Axis II, prevalence of borderline personality disorder was significantly higher in CSBD participants (5.9%). As expected, prevalence of different psychiatric conditions was significantly increased among sexually compulsive participants, revealing comorbidity patterns with important implications in the conceptualization, assessment, and treatment of patients with CSBD.
Topics: Comorbidity; Compulsive Behavior; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Humans; Mental Disorders; Prevalence; Psychiatric Status Rating Scales; Sexual Dysfunctions, Psychological
PubMed: 32244085
DOI: 10.1016/j.addbeh.2020.106384 -
Behaviour Research and Therapy Apr 2010Betrayal is the sense of being harmed by the intentional actions or omissions of a trusted person. The most common forms of betrayal are harmful disclosures of...
Betrayal is the sense of being harmed by the intentional actions or omissions of a trusted person. The most common forms of betrayal are harmful disclosures of confidential information, disloyalty, infidelity, dishonesty. They can be traumatic and cause considerable distress. The effects of betrayal include shock, loss and grief, morbid pre-occupation, damaged self-esteem, self-doubting, anger. Not infrequently they produce life-altering changes. The effects of a catastrophic betrayal are most relevant for anxiety disorders, and OC D and PTSD in particular. Betrayal can cause mental contamination, and the betrayer commonly becomes a source of contamination. In a series of experiments it was demonstrated that feelings of mental contamination can be aroused by imagining unacceptable non-consensual acts. The magnitude of the mental contamination was boosted by the introduction of betrayal themes. Feelings of mental contamination can also be aroused in some 'perpetrators' of non-consensual acts involving betrayal. The psychological significance of acts of betrayal is discussed.
Topics: Adult; Cognitive Behavioral Therapy; Emotions; Fear; Female; Humans; Interpersonal Relations; Male; Mental Disorders; Middle Aged; Models, Psychological; Obsessive-Compulsive Disorder; Social Behavior; Trust
PubMed: 20035927
DOI: 10.1016/j.brat.2009.12.002