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Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self-control, underpinned by inferior fronto-striatal deficits. Real-time functional magnetic resonance neurofeedback (rtfMRI-NF) allows participants to gain self-control over dysregulated brain regions. Despite evidence for beneficial effects of electrophysiological-NF on ADHD symptoms, no study has applied the spatially superior rtfMRI-NF neurotherapy to ADHD. A randomized controlled trial tested the efficacy of rtfMRI-NF of right inferior prefrontal cortex (rIFG), a key region that is compromised in ADHD and upregulated with psychostimulants, on improvement of ADHD symptoms, cognition, and inhibitory fMRI activation. To control for region-specificity, an active control group received rtfMRI-NF of the left parahippocampal gyrus (lPHG). Thirty-one ADHD boys were randomly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI-NF runs over 2 weeks. Feedback was provided through a video-clip of a rocket that had to be moved up into space. A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life. Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11-month follow-up. Only the group targeting rIFG, however, showed a transfer effect, which correlated with ADHD symptom reductions, improved at trend level in sustained attention, and showed increased IFG activation during an inhibitory fMRI task. This proof-of-concept study demonstrates for the first time feasibility, safety, and shorter- and longer-term efficacy of rtfMRI-NF of rIFG in adolescents with ADHD. Hum Brain Mapp, 2017. © 2017 Wiley Periodicals, Inc.

Graphical abstract, Highlights • Test between baseline measures and generic fMRI-Neurofeedback learning in ADHD. • Left fronto-striatal fMRI activation during inhibition predicted fMRI-NF learning. • Activation in posterior regions was associated with poor fMRI-NF learning. • Clinical or cognitive measures did not predict fMRI-NF learning. • Brain function predicts NF learning in ADHD better than behavioural measures., Functional Magnetic Resonance Imaging Neurofeedback (fMRI-NF) targeting brain areas/networks shown to be dysfunctional by previous fMRI research is a promising novel neurotherapy for ADHD. Our pioneering study in 31 adolescents with ADHD showed that fMRI-NF of the right inferior frontal cortex (rIFC) and of the left parahippocampal gyrus (lPHG) was associated with clinical improvements. Previous studies using electro-encephalography-NF have shown, however, that not all ADHD patients learn to self-regulate, and the predictors of fMRI-NF self-regulation learning are not presently known. The aim of the current study was therefore to elucidate the potential predictors of fMRI-NF learning by investigating the relationship between fMRI-NF learning and baseline inhibitory brain function during an fMRI stop task, along with clinical and cognitive measures. fMRI-NF learning capacity was calculated for each participant by correlating the number of completed fMRI-NF runs with brain activation in their respective target regions from each run (rIFC or lPHG); higher correlation values were taken as a marker of better (linear) fMRI-NF learning. Linear correlations were then conducted between baseline measures and the participants’ capacity for fMRI-NF learning. Better fMRI-NF learning was related to increased activation in left inferior fronto-striatal regions during the fMRI stop task. Poorer self-regulation during fMRI-NF training was associated with enhanced activation in posterior temporo-occipital and cerebellar regions. Cognitive and clinical measures were not associated with general fMRI-NF learning across all participants. A categorical analysis showed that 48% of adolescents with ADHD successfully learned fMRI-NF and this was also not associated with any baseline clinical or cognitive measures except that faster processing speed during inhibition and attention tasks predicted learning. Taken together, the findings suggest that imaging data are more predictive of fMRI-NF self-regulation skills in ADHD than behavioural data. Stronger baseline activation in fronto-striatal cognitive control regions predicts better fMRI-NF learning in ADHD.

Highlights • ADHD patients have performance and brain activation deficits during error monitoring. • fMRI-Neurofeedback of right inferior frontal cortex improved error monitoring in ADHD. • It increased left fronto-striatal error monitoring activation in ADHD. • fMRI Neurofeedback improves performance and activation of error monitoring in ADHD., Attention Deficit/Hyperactivity Disorder (ADHD) is a self-regulation disorder, with impairments in error monitoring associated with underactivation of the related brain network(s). Psychostimulant medication improves ADHD symptoms and can upregulate brain function, but has side effects, with limited evidence for longer-term effects. Real-time functional magnetic resonance neurofeedback (fMRI-NF) has potential longer-term neuroplastic effects. We previously reported the effects of 11 runs of 8.5 min of fMRI-NF of the right inferior frontal cortex (rIFC) in adolescents with ADHD. This resulted in improvement of clinical symptom and enhanced rIFC activation post-pre treatment during response inhibition, when compared to a control group receiving fMRI-NF of the left parahippocampal gyrus (lPHG). In the current study we applied a novel analysis to the existing data by investigating the effects of fMRI-NF of rIFC in 16 adolescents with ADHD compared to fMRI-NF of lPHG in 11 adolescents with ADHD on the neurofunctional correlates of error monitoring during the same fMRI tracking stop task and potential associations with cognitive and clinical measures. We found stronger performance adjustment to errors in the rIFC-NF compared to the control lPHG-NF group. At the brain function level, fMRI-NF of rIFC compared to that of lPHG was associated with increased activation in error monitoring regions of the left IFC, premotor cortex, insula and putamen. The increased activation in left IFC-insular-striatal error monitoring regions in the rIFC-NF relative to the lPHG-NF group was furthermore trend-wise correlated with NF-induced ADHD symptom improvements. The findings of this study show, that during error monitoring, fMRI-NF training of rIFC upregulation elicited improvement in post-error behavioural adjustments and concomitant increased activation in left hemispheric fronto-insular-striatal and premotor regions mediating self-control and self-monitoring functions. This suggests that the administration of fMRI-NF of the rIFC may have had an impact on wider networks of self-regulation and self-monitoring in adolescents with ADHD.

OBJECTIVE The authors sought to assess the efficacy of functional remediation, a novel intervention program, on functional improvement in a sample of euthymic patients with bipolar disorder. METHOD In a multicenter, randomized, rater-blind clinical trial involving 239 outpatients with DSM-IV bipolar disorder, functional remediation (N=77) was compared with psychoeducation (N=82) and treatment as usual (N=80) over 21 weeks. Pharmacological treatment was kept stable in all three groups. The primary outcome measure was improvement in global psychosocial functioning, measured blindly as the mean change in score on the Functioning Assessment Short Test from baseline to endpoint. RESULTS At the end of the study, 183 patients completed the treatment phase. Repeated-measures analysis revealed significant functional improvement from baseline to endpoint over the 21 weeks of treatment (last observation carried forward), suggesting an interaction between treatment assignment and time. Tukey's post hoc tests revealed that functional remediation differed significantly from treatment as usual, but not from psychoeducation. CONCLUSIONS Functional remediation, a novel group intervention, showed efficacy in improving the functional outcome of a sample of euthymic bipolar patients as compared with treatment as usual.

Antisocial personality disorder (ASPD) is characterized by disregard for, and violation of the rights of others that begins in childhood and continues into adulthood (American Psychiatric Association, 2000). ASPD has been associated with childhood abuse and neglect (Luntz & Widom, 1994), victimization and increased vulnerability for additional psychiatric and personality disorders (Compton, Conway, Stinson, Colliver, & Grant, 2005;Robins, Tipp, & Przybeck, 1991). One of the strongest findings in ASPD research is its male preponderance, with a 3:1 ratio of men to women (Compton et al., 2005). Research on sex differences in early risk factors of antisocial behavior showed similar rates of neurocognitive deficits and family adversity in antisocial males and females (Moffitt, Caspi, Rutter, & Silva, 2001). However, much less is known about sex differences in childhood maltreatment among individuals with ASPD. Although higher rates of childhood maltreatment have been reported in women versus men in the general population (Keyes et al., 2012), it is unclear whether this is true in a general population sample of individuals with ASPD. In data from the early 1980s (Robins et al., 1991) men with DSM–III ASPD were more likely to have a history of multiple traffic offenses and arrests, whereas females with ASPD were more likely to have had multiple sexual partners. Among more recent clinical (Goldstein et al., 1996) and community (Mikulich-Gilbertson, Salomonsen-Sautel, Sakai, & Booth, 2007) samples of individuals with ASPD and comorbid substance use disorders, data suggest that women are more likely to have run away from home, to be impulsive, and to lack remorse, whereas men are more likely to report aggressive behaviors such as initiating fights, using weapons, being cruel to animals, setting fires, and meeting the criterion of reckless disregard for safety of others. Since previous research has relied on localized and small samples of drug users limiting the generalization of its findings, examination of sex differences in antisocial behavior and ASPD criteria in a general population sample of ASPD individuals is warranted. Goldstein et al. (1996) also found that women presented with greater psychiatric comorbidity than their male counterparts in the clinical sample of individuals with SUD and comorbid ASPD. In addition, two recent studies using a general population sample examined clinical characteristics of antisocial syndromes and reported sex by antisocial syndrome interactions for comorbid psychiatric disorders and family history of psychopathology among subsamples limited to those with drug use disorders (DUD; Goldstein, Compton et al., 2007) or alcohol use disorders (AUD; Goldstein, Dawson et al., 2007). Among those with DUD and comorbid ASPD, more women than men reported family history of DUD and higher prevalence of lifetime mood, anxiety, and additional personality disorders, but almost identical patterns of ASPD criteria (Goldstein, Compton et al., 2007). Among those with AUD and comorbid ASPD, no sex differences in ASPD symptomatology or psychiatric comorbidity patterns were observed (Goldstein, Dawson et al., 2007). Overall, existing information on sex differences on psychiatric comorbidity is limited by use of treatment-seeking samples (Goldstein et al., 1996) or subsamples of individuals with alcohol or drug use disorders (Goldstein, Compton et al., 2007; Goldstein, Dawson et al., 2007; Mikulich-Gilbertson et al., 2007). Finally, previous studies have failed to examine important clinical correlates such as disability, stress levels, and social support in men and women with ASPD. Information regarding differential levels of impairment and need are relevant to the development and implementation of strategies in the management of ASPD in men and women. The present study aims to fill these gaps in our knowledge, and to respond to the American Psychiatric Association, which has called attention to the critical importance of sex in the presentation of psychiatric disorders (Narrow, First, Sirovatka, & Regier, 2007). We therefore present a comprehensive picture of sex differences in childhood adverse events (CAE) and adult adverse events (AAE), lifetime psychiatric comorbidity, clinical presentation, and other clinical correlates of DSM–IV ASPD. We investigated these sex differences in ASPD using data from a large, nationally representative sample of the U.S. adult population. Specifically, the goals of this study were: (1) to compare men and women in the general population with ASPD on the prevalence of childhood individual and parent-related adverse events and adulthood adverse events; (2) to compare lifetime comorbidity patterns in men and women with ASPD; (3) to identify sex differences in reported antisocial behaviors and DSM–IV ASPD criteria met among individuals diagnosed with ASPD; and (4) to investigate social support, disability, and stress levels in men and women with ASPD.

Objective: Functional magnetic resonance imaging (fMRI)studies in conduct disorder and in oppositional defiant disorderhave shown inconsistencies. The aim of this metaanalysisof fMRI studies in disruptive behavior disorders wasto establish the most consistent brain dysfunctions and toaddress task- and subtype-related heterogeneity.Method: Web-based publication databases were searchedto conduct a meta-analysis of all whole-brain fMRI studiesof youths with disruptive behavior disorder or conduct problemsup to August 2015. Sub-meta-analyses were conductedin functional subdomains of emotion processing; in cool andhot executive functions, which refer to goal-directed highercognitive functions with and without motivational andaffective significance; and in a subgroup of youths with additionalpsychopathic traits. The authors performed a metaanalysisof voxel-based group differences in functionalactivation using the anisotropic effect-size version of seedbasedd mapping.Results: Across 24 studies, 338 youths with disruptive behaviordisorder or conduct problems relative to 298 typicallydevelopingyouthshadconsistentunderactivationintherostraland dorsal anterior cingulate and in the medial prefrontalcortex andventral caudate. Sub-meta-analysesof fMRI studiesshowed that medial fronto-cingulate dysfunction was drivenby hot executive function. The sub-meta-analysis of emotionprocessing fMRI studies showed the most consistent underactivationin the dorsolateral prefrontal cortex and temporalpole, while cool executive functions were associated withtemporal abnormalities. Youths with disruptive behavior disorderwith psychopathic traits showed reduced ventromedialprefrontal-hypothalamic-limbic activation, but they alsoshowed hyperactivation in cognitive control mediating dorsolateralprefrontal-dorsal and striatal regions.Conclusions: The findings show that the most consistentdysfunction in youths with disruptive behavior disorder isin the rostro-dorsomedial, fronto-cingulate, and ventralstriatalregions that mediate reward-based decision making,which is typically compromised in the disorder. Youthswith psychopathic traits, on the other hand, have dysfunctionsassociated with the ventromedial prefrontal cortex andlimbic system, together with dorsal and fronto-striatal hyperfunctioning,which may reflect poor affect reactivity andempathy in the presence of hyperactive executive control.These findings provide potential targets for neurotherapeuticand pharmacological interventions.

BACKGROUND: Prior studies on the association between sleep disturbances and suicidal behavior did not explore whether or not short sleep is a marker of suicide intent, lethality or risk. METHODS: Design: Cross-sectional. Participants: Suicide attempters (SAs) (n=434). Controls included 83 psychiatric inpatients who have never been SAs, and 509 healthy controls. Measurements: Short sleep was defined by self-assessment as ≤5h per day. The MINI and the DSM-IV version of the International Personality Disorder Examination Screening Questionnaire were used to diagnose Axis I and Axis II diagnoses, respectively. Suicide intent and lethality were evaluated through the Beck's Suicidal Intent Scale (SIS) and the Risk-Rescue Rating Scale (RRRS), respectively. Beck's Medical Lethality Scale (BMLS) was administered to assess the degree of medical injury, and the SAD PERSONS mnemonic scale was used to evaluate suicide risk. Statistical analyses: Chi-square tests and logistic regression analyses explored frequencies of short sleep in 3 samples. Chi-square tests explored whether or not suicide intent, lethality and risk were greater in SAs with short-sleep versus those without short-sleep. RESULTS: Short sleep was more prevalent in SAs than in psychiatric controls only in males. In female SAs, short sleep was significantly associated with several SIS items and high scores in the SAD PERSONS. LIMITATIONS: Sleep duration was assessed only by self-report. CONCLUSIONS: The association between short sleep and suicidal behavior may be partly explained by confounders. Short sleep may be a marker of severity of suicidal behavior among female SAs. Language: en

Background: Burden related to major depressive disorder (MDD) derives mostly from long-term occurrence of symptoms. This study aims to examine the prevalence, sociodemographic correlates, patterns of 12-month and lifetime psychiatric comorbidity, lifetime risk factors, psychosocial functioning, and mental health service utilization of chronic major depressive disorder (CMDD) compared to nonchronic major depressive disorder. Methods: Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). Results: The 12-month and lifetime prevalence of CMDD within the population meeting criteria for MDD was 26.5% and 24.0%, respectively. Individuals reporting a chronic course of MDD were socioeconomically and educationally disadvantaged, tended to be older, report loss of spouse or history of divorce, live in rural areas, have public assistance, low self-esteem, worse overall health and more likely to report comorbidities, most importantly dysthymia, generalized anxiety disorder, avoidant, and dependant personality disorder. Individuals with chronic MDD were more likely to report familial but not childhood onset risk factors for MDD. Those suffering CMDD were more likely to seek and receive mental health care than other forms of MDD, even though it took longer to start treatment. Conclusion: Chronic course of MDD is related to still worse socioeconomic conditions, educational achievement, more comorbidities, and family risk factors, although other courses of MDD carried greater risk of unmet treatment. Depression and Anxiety, 2011. © 2011 Wiley-Liss, Inc. Language: en

Objective—Prior research has consistently documented a strong association between generalized anxiety disorder (GAD) and substance use disorder (SUD). GAD and SUD comorbidity (GAD-SUD) represents clinical challenges as the patients’ symptoms are often more severe and are frequently prolonged making their management more complex when compared with individuals with GAD only. The purpose of this study was to examine whether individuals with GAD-SUD differ meaningfully from individuals with GAD and no SUD comorbidity (GAD-NSUD) in terms of demographic characteristics, risk factors, psychiatric comorbidity and clinical correlates. Methods—Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (N=43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. Results—We found that the lifetime prevalence rate of GAD-SUD is about 2.04% while that of GAD-NSUD is of 2.10%. Individuals with GAD-SUD showed higher psychiatric comorbidity rates than those with GAD-NSUD. Treatment seeking rates for GAD are equally low in GAD-SUD and GAD-NSUD. Both groups were as likely to receive pharmacological treatment for anxiety. Conclusion—The findings of our study indicate that individuals of GAD-SUD constitutes half of the lifetime prevalence of GAD and that GAD-SUD is associated with high overall vulnerability for additional psychopathology, particularly in the externalizing spectrum, higher disability and higher use of alcohol and drugs to relieve anxiety symptoms.

Introduction This study evaluates the physical health of patients with schizophrenia and analyzes the change in the percentage of patients with evaluations in the known diabetes and cardiovascular risk predictors before and 6 months after the dissemination of the “Consensus on Physical Health in Schizophrenia Patients”. Material and methods This is an epidemiological non-interventional and transversal study, in which 229 psychiatrists evaluated 1,193 clinical records of patients with a diagnose of schizophrenia according to ICD-10, attended in the psychiatry consultations planned in January and September of 2007. Study results were analyzed using descriptive statistics. Results 1,193 evaluable patients were included, with a mean age of 39.7 ± 11.6 years, diagnosed of schizophrenia 15.0 ± 10.3 years ago, and a 65.90% were men. The presence of concomitant diseases was 39.98%, being hypercholesterolemia (46.33%), hypertriglyceridaemia (33.54%) and arterial hypertension (26.00%) the most frequent. After the dissemination of the Consensus, the percentage of patients who had all the physical measurements taken increased by 13.75%. Forty eight per cent of the psychiatrists were considered as being aware of the Consensus. The percentage of measurements taken was higher within the psychiatrists who were aware of the Consensus (17.32%) than within those who were not aware of it (10.33%). Conclusions The results of this study show an increase of the physical health control from patients with schizophrenia after the dissemination of the Consensus, which should improve an integral approach of these patients to ensure a similar life expectancy, quality of life and function to the general population.

Introduction: Prior research suggests that racial minority groups in the United States are more vulnerable to develop a gambling disorder than whites. However, no national survey on gambling disorders exists that has focused on ethnic differences.Methods: Analyses of this study were based on the National Epidemiologic Survey on Alcohol and Related Conditions, a large (N=43,093) nationally representative survey of the adult (≥18 years of age) population residing in house-holds during 2001–2002 period. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision diagnoses of pathological gambling, mood, anxiety, drug use, and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IVVersion.Results: Prevalence rates of disordered gambling among blacks (2.2%) and Native/Asian Americans (2.3%) were higher than that of whites (1.2%). Demographic characteristics and psychiatric comorbidity differed among Hispanic, black, and white disordered gamblers. However, all racial and ethnic groups evidenced similarities with respect to symptom patterns, time course, and treatment seeking for pathological gambling.Conclusion: The prevalence of disordered gambling, but not its onset or course of symptoms, varies by racial and ethnic group. These varying prevalence rates may reflect, at least in part, cultural differences in gambling and its acceptability and accessibility. These data may inform the need for targeted prevention strategies for high-risk racial and ethnic groups.

BackgroundPsychostimulant medication, most commonly the catecholamine agonist methylphenidate, is the most effective treatment for attention-deficit/hyperactivity disorder (ADHD). However, relatively little is known on the mechanisms of action. Acute effects on brain function can elucidate underlying neurocognitive effects. We tested methylphenidate effects relative to placebo in functional magnetic resonance imaging (fMRI) during three disorder-relevant tasks in medication-naïve ADHD adolescents. In addition, we conducted a systematic review and meta-analysis of the fMRI findings of acute stimulant effects on ADHD brain function.MethodsThe fMRI study compared 20 adolescents with ADHD under either placebo or methylphenidate in a randomized controlled trial while performing stop, working memory, and time discrimination tasks. The meta-analysis was conducted searching PubMed, ScienceDirect, Web of Knowledge, Google Scholar, and Scopus databases. Peak coordinates of clusters of significant effects of stimulant medication relative to placebo or off medication were extracted for each study.ResultsThe fMRI analysis showed that methylphenidate significantly enhanced activation in bilateral inferior frontal cortex (IFC)/insula during inhibition and time discrimination but had no effect on working memory networks. The meta-analysis, including 14 fMRI datasets and 212 children with ADHD, showed that stimulants most consistently enhanced right IFC/insula activation, which also remained for a subgroup analysis of methylphenidate effects alone. A more lenient threshold also revealed increased putamen activation.ConclusionsPsychostimulants most consistently increase right IFC/insula activation, which are key areas of cognitive control and also the most replicated neurocognitive dysfunction in ADHD. These neurocognitive effects may underlie their positive clinical effects.

A plethora of magnetic resonance imaging studies have shown that ADHD is characterized by multiple functional and structural neural network abnormalities beyond the classical fronto-striatal model, including fronto-parieto-temporal, fronto-cerebellar and even fronto-limbic networks. There is evidence for a maturational delay in brain structure development which likely extends to brain function and structural and functional connectivity, but this needs corroboration by longitudinal imaging studies. Dysfunction of the ventrolateral prefrontal cortex seems to be more pronounced relative to other pediatric disorders and is also the most consistent target of acute psychostimulant medication. Future studies are likely to focus on using neuroimaging for clinical translation such as for individual diagnostic and prognostic classification and as a neurotherapy to reverse brain function abnormalities.

The aim of this study was to examine the demographic, clinical, and treatment correlates of bipolar disorder (BD) in outpatients 65 years or older and to compare patients with BD subtype I (BD-I) versus BD subtype II (BD-II) and patients with early onset (EO; 50 years old) of the illness. Sixty-nine consecutive outpatients with BD were included. Diagnosis was delayed for a mean of 14.1 years, significantly longer in patients with EO (18.6 years) than with LO (3.3 years). Mild to moderate depressive symptoms were detected in 29% of the patients. The patients were receiving a mean of 3 different psychotropic medications. Antidepressants were more frequently prescribed to patients with BD-II than to patients with BD-I (75.80% vs. 48.60%) and to patients with EO (71.7%) than to LO (35.3%). Geriatric BD has similar clinical characteristics with those of younger ages, and these do not seem to greatly differ with subtype or age of onset.

Objectives. To examine whether age of First diagnosis, gender, psychiatric comorbidity, and treatment modalities (pharmacotherapy or psychotherapy) at Child and Adolescent Mental Health Services (CAMHS) moderate the risk of Adult Mental Health Services (AMHS) utilization in patients diagnosed with hyperkinetic disorder at CAMHS. Methods. Data were derived from the Madrid Psychiatric Cumulative Register Study. The target population comprised 32,183 patients who had 3 or more visits at CAMHS. Kaplan-Meier curves were used to assess survival data. A series of logistic regression analyses were performed to study the role of age of diagnosis, gender, psychiatric comorbidity, and treatment modalities. Results. 7.1% of patients presented with hyperkinetic disorder at CAMHS. Compared to preschool children, children and adolescents first diagnosed with hyperkinetic disorder at CAMHS were more likely to use AMHS. Female gender and comorbidity with affective disorders, schizophrenia, schizotypal and delusional disorders increased the risk of use of AMHS. Pharmacological or combined treatment of hyperkinetic disorder diagnosed at CAMHS was associated with increased risk of use at AMHS. Conclusions. Older age of first diagnosis, female gender, psychiatric comorbidity, and pharmacological treatment at CAMHS are markers of risk for the transition from CAMHS to AMHS in patients with hyperkinetic disorder diagnosed at CAMHS, This paper was supported by the National Alliance for Research on Schizophrenia and Affective Disorders (NARSAD), Fondo de Investigacion Sanitaria (FIS) PI060092 and RD06/0011/0016, ETES (PI07/90207), the Conchita Rabago Foundation, the Harriet and Esteban Vicente Foundation, the Spanish Ministry of Health (SAF2010-21849), and Instituto de Salud Carlos III, CIBERSAM (Intramural Project, P91B; Rio Hortega SCO/3410/2004). Dr. Blasco- Fontecilla acknowledges the SpanishMinistry of Health (Rio Hortega CM08/00170), Alicia Koplowitz Foundation, and Conchita Rabago Foundation for funding his postdoctoral stage at CHRU, Montpellier, France

Objectives. To define different subgroups of suicide attempters according to age at onset of suicide attempts. Methods. Participants were 229 suicide attempters (147 females; 82 males) admitted to a general hospital in Madrid, Spain. We used admixture analysis to determine the best-fitting model for the age at onset of suicide attempts separated by sex. Results. The best fitted model for the age at onset of suicide attempts was a mixture of two gaussian distributions. Females showed an earlier age at onset of suicide attempts in both Gaussian distributions (mean ± S.D.) (26.98 ± 5.69 and 47.98 ± 14.13) than males (32.77 ± 8.11 and 61.31 ± 14.61). Early-onset female attempters were more likely to show borderline personality disorder than late-onset female attempters (OR = 11.11; 95% CI = 2.43–50.0). Conclusions. Age at onset of suicide attempts characterizes different subpopulations of suicide attempters, This paper was supported by the National Alliance for Research on Schizophrenia and Affective Disorders (NARSAD), Fondo de Investigación Sanitaria (FIS) PI060092, Fondo de Investigacion Sanitaria FIS RD06/0011/0016, ETES (PI07/90207), the Conchita Rábago Foundation, the Spanish Ministry of Health, Instituto de Salud Carlos III, and CIBERSAM (Intramural Project, P91B). Dr. Blasco-Fontecilla acknowledges the Spanish Ministry of Health (Rio Hortega CM08/00170), Alicia Koplowitz Foundation, and Conchita Rabago Foundation for funding his postdoctoral stage at CHRU, Montpellier, France

Introduction: Studies on adult bipolar patients have demonstrated a disability associated with the bipolar disorder, even in euthymic patients, but there is a lack of data in the elderly population. Material and method: A cross-sectional, multicentre study on a consecutive sample of ambulatory bipolar patients (DSM-IV-TR criteria), aged 65 years or over. Retrospective and cross-sectional sociodemographic and clinical data were collected, as well as the Clinical Global Impression for Bipolar Modified scale (CGI-BP-M) and the level of disability using the World Health Organisation Disability Assessment Schedule (WHO/DAS). The disability was assessed globally and by areas. The presence of a moderate to maximum disability compared to a mild to no disability was considered a dependent variable. Results: A moderate to maximum global disability was present in 43.6% of the sample. By areas, occupational functioning was the area most frequently affected, and personal care the least affected. The only variables which were associated with disability were the presence of medical comorbidity (P = .01), increased age (P = .005) global clinical severity (P = .0001) and in the depressive pole (P = .03). There was no relationship between clinical subtype, duration of the disease, number of previous episodes, number of hospitalisations, or other clinical variables and the degree of disability. Conclusions: These data underline the need to establish specific therapeutic strategies in the approach to depressive symptoms and medical comorbidity, with the aim of minimising the disability in elderly bipolar patients. Given the lack of current data, new studies are needed with larger samples and control groups. (C) 2010 SEP y SEPB. Published by Elsevier Espana, S.L. All rights reserved.

OBJECTIVE: To investigate the association between substance use disorders (SUDs) and the clinical presentation, risk factors, and correlates of major depressive disorder (MDD) by examining differences among 3 groups: (1) individuals with lifetime MDD and no comorbid SUD (MDD-NSUD); (2) individuals with comorbid MDD and SUD (MDD-SUD); and (3) individuals with substance-induced depressive disorder (SIDD). METHOD: Data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS: The lifetime prevalence of MDD-NSUD was 7.41%, whereas those of MDD-SUD and SIDD were 5.82% and 0.26%, respectively. Overall, risk factors for MDD were more common among individuals with MDD-SUD and SIDD than among those with MDD-NSUD. Individuals with MDD-SUD and SIDD had similar rates of comorbidity with any psychiatric disorder, but both groups had higher rates than individuals with MDD-NSUD (odds ratio [OR] = 2.3; 95% CI, 1.9-2.7 and OR = 2.5; 95% CI, 1.4-4.4, respectively). Individuals with SIDD were significantly less likely to receive medication than those with MDD-SUD or MDD-NSUD (OR = 0.5; 95% CI, 0.3-0.9 for both groups). CONCLUSIONS: MDD-SUD is associated with high overall vulnerability to additional psychopathology, a higher number of and more severe depressive episodes, and higher rates of suicide attempts in comparison to individuals with MDD-NSUD. SIDD has low prevalence in the general population but is associated with increased clinical severity and low rates of medication treatment. Similar patterns of comorbidity and risk factors in individuals with SIDD and those with MDD-SUD suggest that the 2 conditions may share underlying etiologic factors. Language: en

PurposeTo evaluate the impact of the “Spanish Consensus on Physical Health in Patients with Schizophrenia” on psychiatrists’ evaluations of the physical health of patients with schizophrenia.MethodEpidemiological, non-interventional, national, multicentre study, with two retrospective, cross-sectional data collection stages in which 229 psychiatrists evaluated 1193 clinical records of patients with schizophrenia (ICD-10) seen in January and September of 2007.ResultsMean age of the patients was 39.7 ± 11.6 years, 65.5% were men, diagnosed for schizophrenia 14.0 ± 10.3 years ago. Forty percent of the patients suffer from a concomitant disease, the most prevalent being hypercholesterolemia (46.3%), hypertriglyceridaemia (33.5%) and arterial hypertension (26.0%). The difference in the number of patients who had all the physical measurements taken between the two cross-sectional evaluations was 13.8% (CI: 11.8%, 15.7%). The differences for each parameter were: weight 13.7% (CI: 11.7%, 15.6%), BMI 13.58% (CI: 11.6%, 15.5%), waist circumference 14.0% (CI: 12.0%, 15.39%), lipid profile 2.9% (CI: 1.9%, 3.9%) and glycaemia 2.6% (CI: 1.7%, 3.5%).ConclusionsThese results imply that the dissemination of the “Consensus on Physical Health in Schizophrenia Patients”, and possibly other actions, has made psychiatrists more aware of an integral approach to patients with schizophrenia, promoting increased monitoring of the physical health of these patients.

OBJECTIVE: To estimate the prevalence, sociodemographic correlates, comorbidity, and rates of mental health service utilization of fire-setters in the general population. METHOD: A face-to-face survey of more than 43,000 adults aged 18 years and older residing in households was conducted during the 2001-2002 period. Diagnoses of mood, anxiety, substance use disorders, and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). RESULTS: The prevalence of lifetime fire-setting in the US population was 1.13 (95% CI, 1.0-1.3). Being male, never married, and US-born and having a yearly income over $70,000 were risk factors for lifetime fire-setting, while being Asian or Hispanic and older than 30 years were protective factors for lifetime fire-setting. The strongest associations with fire-setting were with disorders often associated with deficits in impulse control, such as antisocial personality disorder (ASPD) (odds ratio [OR] = 21.8; CI, 6.6-28.5), drug dependence (OR = 7.6; 95% CI, 5.2-10.9), bipolar disorder (OR = 5.6; 95% CI, 4.0-7.9), and pathological gambling (OR = 4.8; 95% CI, 2.4-9.5). Associations between fire-setting and all antisocial behaviors were positive and significant. A lifetime history of fire-setting, even in the absence of an ASPD diagnosis, was strongly associated with substantial rates of Axis I comorbidity, a history of antisocial behavior, a family history of other antisocial behaviors, decreased functioning, and higher treatment-seeking rates. CONCLUSIONS: Our findings suggest that fire-setting may be better understood as a behavioral manifestation of a broader impaired control syndrome and part of the externalizing spectrum. Fire-setting and other antisocial behaviors tend to be strongly associated with each other and increase the risk of lifetime and current psychiatric disorders, even in the absence of a DSM-IV diagnosis of ASPD. Language: en

Objective: This study presented nationally representative data on the lifetime prevalence, correlates, and comorbidity of shoplifting among adults in the United States. Method: Data were derived from a large national sample of the United States population. Face-to-face surveys of more than 43,000 adults ages 18 years and older residing in households were conducted during the 2001–2002 period. Diagnoses of mood, anxiety, and drug disorders as well as personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM-IV Version. Results: The prevalence of lifetime shoplifting in the U.S. population was 11.3%. Associations between shoplifting and all antisocial behaviors were positive and significant. Besides stealing, the behaviors more strongly associated with shoplifting were making money illegally and scamming someone for money. Strong associations between shoplifting and all 12month and lifetime comorbid psychiatric disorders were also found. The strongest associations with shoplifting were with disorders often associated with deficits in impulse control, such as antisocial personality disorder, substance use disorders, pathological gambling, and bipolar disorder. High rates of mental health service use were also identified in this population. Conclusions: Shoplifting is a relatively common behavior. A history of shoplifting is associated with substantial rates of comorbid disorders, psychosocial impairment, and mental health service use. Future research should identify the biological and environmental underpinnings of shoplifting and develop effective screening tools and interventions for individuals with shoplifting problems.