Factors related to the comorbidity between oppositional defiant disorder and anxiety disorders in preschool children

Background: The aim of the study is to identify the main factors related to comorbid oppositional defiant disorder (ODD) and anxiety disorders (AD), for preschoolers, and to assess the moderating role of the children's sex. Design: The initial sample of 622 children was assessed longitudinally at the ages of 3 and 5 years by means of questionnaires and a diagnostic interview. At baseline, there were 310 boys (49.8%), most participants were of Caucasian-white ethnicity (554, 89.1%), 398 children attended to public school (64.0%) and families socioeconomic status was 64.3% medium-high, 14.1% medium and 20.5% medium-low or low levels. Methods: For the analysis, children diagnosed with ODD and/or AD were selected: n=103 at 3 years old (44 ODD, 42 AD and 17 ODD+AD) and n=106 at 5 years old (31 ODD, 60 AD and 15 ODD+AD). Results: High levels of the child's negative affectivity and the mother's aggressive behavior (versus AD), and high scores in the father's psychopathology measurements (versus ODD) are related to the presence of comorbid ODD+AD at the age of 3. High scores in the child's approach-positive anticipation, fears (only in boys, in girls the reverse effect occurred) compared to ODD and AD independently and aggressive behavior (versus AD), and low scores for smiling and laughter (versus ODD only and AD only) are predictive of comorbidity at the age of 5. Conclusions: Temperament traits may be a common factor in explaining longitudinal ODD+AD comorbidity

Comorbidity of oppositional defiant disorder and anxiety disorders in preschoolers

Background: The aim was to study the comorbidity of oppositional defiant disorder (ODD) and anxiety disorders (AD) among preschool children of the general population, and to assess the contribution of comorbidity to the child's functional impairment. Method: 622 children were assessed at the ages of 3 and 5, through a diagnostic interview. They were clustered into three diagnostic groups: only ODD, only AD and comorbid ODD+AD. Results: At age 3, ODD was associated with specific phobia, OR = 4.7, 95% CI [1.4, 14.1], and at age 5, with any anxiety disorder, OR=3.9; 95% CI [1.8, 8.4]. ODD at age 3 was predictive of separation anxiety at age 5, OR=4.1; 95% CI [1.2, 14.3]. Comorbid ODD+AD cases showed a higher risk of functional impairment at school and in behavior toward others. Sex and socioeconomic status were not related to the diagnostic group. Conclusions: ODD+AD comorbidity can be identified in preschool children. Early identification of this association is needed to adequately treat the affected childrenAntecedentes: se analiza la comorbilidad entre el trastorno negativista desafiante (TND) y los trastornos de ansiedad (TA) en preescolares de población general, y el deterioro funcional con que se asocian. Método: 622 niños fueron evaluados a los 3 y los 5 años con una entrevista diagnóstica. Se compararon 3 grupos diagnósticos: únicamente TND, únicamente TA y comorbilidad TND+TA. Resultados: a los 3 años se halló asociación entre TND y fobia específica (OR = 4.7, IC95%: 1.4÷14.1) y a los 5 años entre TND y TA, OR= 3.9; 95% IC [1.8, 8.4]. La presencia de TND a los 3 años fue predictiva de ansiedad de separación a los 5 años (OR = 4.1; IC95%: 1.2÷14.3). La comorbilidad se asoció con mayor deterioro funcional en la escuela y en el comportamiento hacia los demás. Sexo y nivel socioeconómico no se asociaron al grupo diagnóstico. Conclusiones: la comorbilidad TND+TA se puede identificar en edad preescolar. Es necesaria la detección temprana de estos trastornos para el adecuado tratamiento de los niños afectado

Comorbilidad del Trastorno Negativista Desafiante y los Trastornos de Ansiedad en preescolares

El trastorno negativista desafiante (TND) es una condición clínica de aparición precoz durante la primera infancia, que tiende a persistir a lo largo de la niñez y la adolescencia. Su diagnóstico se basa en la identificación clínica de un patrón recurrente de conductas de enfrentamiento, hostilidad y oposición a las normas del contexto. Es frecuente que durante el curso del TND se presenten otras comorbilidades, en especial por comportamientos disruptivos y/o de tipo disocial, y también, aunque con menos frecuencia, trastornos de ansiedad (TA). Existen sin embargo pocos trabajos empíricos que estimen la frecuencia de la presencia concurrente del TND y los TA (TND+TA) durante la etapa preescolar, de los potenciales factores de riesgo de esta comorbilidad a edades tempranas y del rol que ejercen las funciones ejecutivas. Esta tesis doctoral se presenta como un compendio de artículos que incluye tres trabajos empíricos, cuyos objetivos principales son: 1) Estimar la frecuencia de la presencia comórbida del TND+TA en niños preescolares de la población general española, de forma transversal y longitudinal entre los 3 y los 5 años, y valorar en qué grado esta condición clínica influye sobre el grado de funcionamiento cotidiano de los niños. 2) Explorar los principales factores de riesgo que conducen a presentar TND+TA de forma conjunta durante la edad preescolar en población general española. 3) Analizar la alteración en las funciones ejecutivas en preescolares con comorbilidad TND+TA. Como objetivo secundario, en esta tesis se valora el potencial rol moderador del sexo de los niños en las relaciones objeto de estudio. En los trabajos empíricos 1 a 3 se incluyen interacciones para valorar este posible efecto. Los estudios se han realizado con una amplia muestra de niños (n=622) que fueron evaluados longitudinalmente durante toda la etapa preescolar mediante cuestionario y entrevista diagnóstica estructurada. Se analizó información aportada por los principales cuidadores, los maestros y el propio sujeto. Los resultados obtenidos en los tres trabajos empíricos que se presentan en esta tesis aportan evidencia empírica sobre la relevancia de la asociación entre TND+TA en la etapa preescolar, de sus variables predictoras (factores de riesgo) y del grado en que esta comorbilidad afecta a la vida de los niños y de sus familias. Esta información resulta de notable ayuda para mejorar la detección precoz de esta condición comórbida, para el desarrollo de instrumentos de cribado y diagnóstico y para desarrollar programas de intervención preventiva y terapéutica adecuados.Oppositional defiant disorder (ODD) is a clinical condition of early onset during early childhood, which tends to persist throughout childhood and adolescence. ODD diagnosis is based on clinical identification of a recurring pattern of confrontation, hostility and opposition behavior to the contextual rules. It is common during the ODD course the presence of other comorbidities, especially disruptive disorders and/or conduct disorder, and also, though less frequently, anxiety disorders (AD). However, there are few empirical studies to estimate the frequency of ODD and AD (ODD+AD) comorbidity during the preschool stage, the potential risk factors for this comorbidity at an early age and the role of executive functions. This thesis dissertation includes three manuscripts with three empirical works, which main objectives are: 1) To estimate the frequency of the concurrent comorbidity ODD+AD in preschoolers of the Spanish general population, cross-sectional and longitudinally at ages 3 and 5 years old, and to assess how this clinical condition affects everyday life. 2) To explore the main risk factors to develop ODD+AD comorbidity during preschool age in the general Spanish population. 3) To analyze the impairment in executive functioning in preschool children diagnosed of comorbidity ODD+AD. As a secondary objective, this thesis addresses the potential moderator role of children's sex into the analyzed relationships. So the works 1 to 3 include interaction terms-parameters to assess this possible effect. The studies include a large sample of children (n=622) who were longitudinally assessed during the preschool age through questionnaire and diagnostic interview. Reports obtained from primary caretakers, teachers and the own subjects were analyzed. The results obtained in the three empirical works presented in this thesis provide empirical evidence about the relevance of the association between ODD+AD during the preschool stage, its main predictor variables (risk factors) and the extent to which this comorbidity affects life children and their families. This information is of considerable help to improve early detection of this comorbid condition, to develop screening and diagnostic instruments and to develop specific and valid preventive and therapeutic intervention programs

Subjective craving and event-related brain response to olfactory and visual chocolate cues in binge-eating and healthy individuals

High-sugar/high-fat foods are related to binge-eating behaviour and especially people with low inhibitory control may encounter elevated difficulties to resist their intake. Incentive sensitization to food-related cues might lead to increased motivated attention towards these stimuli and to cue-induced craving. To investigate the combined influence of olfactory and visual stimuli on craving, inhibitory control and motivated attention, 20 healthy controls and 19 individuals with binge-eating viewed chocolate and neutral pictures, primed by chocolate or neutral odours. Subjective craving and electroencephalogram activity were recorded during the task. N2 and Late Positive Potential (LPP) amplitudes were analysed. Patients reported higher craving than controls. Subjective craving, N2 and LPP amplitudes were higher for chocolate versus neutral pictures. Patients showed a higher relative increase in N2 amplitudes to chocolate versus neutral pictures than controls. Chocolate images induced significant increases in craving, motivated attention and measures of cognitive control. Chocolate odour might potentiate the craving response to visual stimuli, especially in patients with binge-eating

Attention to emotion through a go/no-go task in children with oppositionality and callous-unemotional traits

Background: There is debate about whether the difficulties that children with different degrees of oppositionality (ODD) and callous-unemotional traits (CU) have in processing emotions are global or specific. The aim of this study is to identify difficulties in recognizing emotion (happiness, anger, sadness and fear) through a go/no-go task in children with different levels of ODD and CU traits. Method: A total of 320 8-year-old children were assessed through questionnaires filled out by teachers about oppositional defiant symptoms and CU traits and were then distributed into four groups: LowCU-HighODD, HighCU-LowODD, HighCU-HighODD and a comparison group (LowCU-LowODD). Results: The analyses of variance comparing the 4 groups showed that the two groups with high ODD were less accurate than the control group in recognizing the emotion when the stimuli expressed happiness, fear or neutral emotion. The HighCU-HighODD group differed in the quality of the response (correct/wrong responses) but not in the reaction time in relation to the comparison group. The LowCU-HighODD group was faster to respond to emotions than the comparison group. Implications: The results show that the deficit in emotion processing is not restricted to specific distressing emotions such as fear or sadness, but they point to a global impairment in emotion processing in children scoring high in the constructs studied. The results also suggest that the difficulties that children with combined CU traits and oppositional conduct problems have in processing emotions are more of an emotional rather than an attentional natur

The relevance of personality traits in impulsivity-related disorders: from substance use disorders and gambling disorder to bulimia nervosa

Background and aims: the main aim of this study was to analyze and describe the clinical characteristics and shared personality traits in different impulsivity-compulsivity spectrum disorders: substance use disorders (SUD), gambling disorder (GD), and bulimia nervosa (BN). The specific aims were to compare personality differences among individuals with pure SUD, BN with and without SUD, and GD with and without SUD. In addition, we assessed the differential predictive capacity of clinical and personality variables in relation to diagnostic subtype. Methods: the sample comprised 998 subjects diagnosed according to DSM-IV-TR criteria: 101 patients were diagnosed with SUD, 482 with GD, 359 with BN, 11 with GD + SUD, and 45 patients with BN + SUD. Various assessment instruments were administered, as well as other clinical measures, to evaluate their predictive capacity. Results: marked differences in personality traits were observed between groups. Novelty seeking, harm avoidance, self-directedness, cooperation, and self-transcendence best differentiated the groups. Notably, novelty seeking was significantly higher in the two dual pathology subgroups. Patients with dual pathology showed the most dysfunctional personality profiles. Discussion and conclusion: our results indicate the existence of shared dysfunctional personality traits among the groups studied, especially in novelty seeking and self-directedness

How do online sports gambling disorder patients compare with land-based patients?

Background and aims: recent technological developments have brought about notable changes in the way people gamble. The widespread use of mobile Internet devices and gambling websites has led to a significant leap in the number of people who recreationally gamble. However, for some, gambling can turn into a psychiatric disorder resembling substance addiction. At present, there is a shortage of studies examining differences between adults with gambling disorder (GD) who exclusively make sports bets online, GD patients that are non-sports Internet gamblers, and offline gamblers. Therefore, this study was undertaken to determine the differences between these three groups, considering sociodemographic, personality, and clinical characteristics. Methods: the sample consisted of 2,743 treatment-seeking male patients from the Pathological Gambling Unit at a university hospital. All patients met DSM-5 criteria for GD. Results: we found that gamblers who exclusively engaged in non-sports Internet gambling activities were younger than offline gamblers and online sports gamblers. Non-sports Internet gamblers were also more likely to have greater levels of debt compared with offline gamblers. In terms of personality characteristics, our sample displayed low levels of self-directedness and cooperativeness and high levels of novelty seeking. In addition, online sports gamblers obtained higher scores in persistence than non-sports Internet gamblers and offline gamblers. Discussion and conclusion: although differences if terms of gambling severity were not identified between groups, GD patients who exclusively bet online appear to possess distinct personality characteristics and higher debt levels compared with offline gamblers

The relevance of personality traits in impulsivity-related disorders: From substance use disorders and gambling disorder to bulimia nervosa

Background and aims The main aim of this study was to analyze and describe the clinical characteristics and shared personality traits in different impulsivity–compulsivity spectrum disorders: substance use disorders (SUD), gambling disorder (GD), and bulimia nervosa (BN). The specific aims were to compare personality differences among individuals with pure SUD, BN with and without SUD, and GD with and without SUD. In addition, we assessed the differential predictive capacity of clinical and personality variables in relation to diagnostic subtype. Methods The sample comprised 998 subjects diagnosed according to DSM-IV-TR criteria: 101 patients were diagnosed with SUD, 482 with GD, 359 with BN, 11 with GD + SUD, and 45 patients with BN + SUD. Various assessment instruments were administered, as well as other clinical measures, to evaluate their predictive capacity. Results Marked differences in personality traits were observed between groups. Novelty seeking, harm avoidance, self-directedness, cooperation, and self-transcendence best differentiated the groups. Notably, novelty seeking was significantly higher in the two dual pathology subgroups. Patients with dual pathology showed the most dysfunctional personality profiles. Discussion and conclusion Our results indicate the existence of shared dysfunctional personality traits among the groups studied, especially in novelty seeking and self-directedness

Phenotypes in gambling disorder using sociodemographic and clinical clustering analysis: an unidentified new subtype?

Background: gambling disorder (GD) is a heterogeneous disorder which has clinical manifestations that vary according to variables in each individual. Considering the importance of the application of specific therapeutic interventions, it is essential to obtain clinical classifications based on differentiated phenotypes for patients diagnosed with GD. Objectives: to identify gambling profiles in a large clinical sample of n = 2,570 patients seeking treatment for GD. Methods: an agglomerative hierarchical clustering method defining a combination of the Schwarz Bayesian Information Criterion and log-likelihood was used, considering a large set of variables including sociodemographic, gambling, psychopathological, and personality measures as indicators. Results: three-mutually-exclusive groups were obtained. Cluster 1 (n = 908 participants, 35.5%), labeled as "high emotional distress," included the oldest patients with the longest illness duration, the highest GD severity, and the most severe levels of psychopathology. Cluster 2 (n = 1,555, 60.5%), labeled as "mild emotional distress," included patients with the lowest levels of GD severity and the lowest levels of psychopathology. Cluster 3 (n = 107, 4.2%), labeled as "moderate emotional distress," included the youngest patients with the shortest illness duration, the highest level of education and moderate levels of psychopathology. Conclusion: in this study, the general psychopathological state obtained the highest importance for clustering

Response trajectories of gambling severity after cognitive behavioral therapy in young-adult pathological gamblers

Background and aims: the significant increase in the prevalence of gambling disorder (GD) among young adults in recent years has attracted interest in determining therapeutic efficiency in this sector of the population. The aim of this work was to estimate the response trajectories of gambling severity during the six-month follow-up after a cognitive behavioral therapy (CBT) program in young adult patients and to identify the main variables associated with each trajectory. Methods: the sample included n = 192 patients, aged 19-35 years old, seeking treatment for GD. Response trajectories were identified through latent class growth analysis. Results: three trajectories emerged: T1 (n = 118, 61.5%), composed of patients with severe GD at pre-treatment and good evolution to recovery; T2 (n = 62, 32.3%), with patients with moderate-high GD affectation at baseline and good evolution to recovery; and T3 (n = 12, 6.3%), with participants with severe baseline GD severity and poor evolution after CBT (Abbott, 2019). The highest risk of poor therapeutic outcomes was related to lower social index positions, high emotional distress, high scores in harm avoidance and low scores in self-directedness. Discussion and conclusions: differences in the response trajectories at short-term follow-up after CBT reveal heterogeneity in the samples including young and young-adult GD patients. Patients' phenotype at baseline should be considered when developing efficient, person-centered intervention programs, which should comprise strategies aimed at increasing emotional regulation capacities, self-esteem and self-efficacy, with the aim of avoiding relapses in the medium-long term after therapy