Examining relations between psychopathology and psychopathy dimensions among adolescent female and male offenders

Aim: This study was performed to investigate relations between psychopathology and psychopathy in adolescent female and male detainees. Method: We examined 91 male and 123 female adolescent detainees (aged 14–19) for psychopathology -using the Youth Self Report, the Overt Aggression Scale-Modified and a Conduct Disorder Self Report Scale- and for psychopathic dimensions using the psychopathy checklist youth version (PCL:YV). Based on a linear regression analysis we compared the specific associations between psychopathology and psychopathy in both male and female delinquent juveniles. Results: Our results revealed higher scores for externalizing behavior and psychopathic dimensions in delinquent males, and higher internalizing problem scores in delinquent females. Furthermore, we found a positive relationship between suicidal behavior and the psychopathy total score as well as the affective, the lifestyle and the antisocial dimension only in girls. No association was found for suicidal behavior in boys. Regarding anxious-depressive behavior, we found a negative relation to the psychopathy total score and to the affective psychopathy factor for the boys. Conclusion: Expectedly, the population of incarcerated adolescents exhibited a high prevalence of psychopathology. At the same time our results referred to meaningful gender-related differences with respect to associations with psychopathy. The gender-related differences in psychopathological symptoms could indicate varied subtypes of psychopathy in boys and girls

Atomoxetine treatment and ADHD-related difficulties as assessed by adolescent patients, their parents and physicians

<p>Abstract</p> <p>Background</p> <p>The degree of ADHD-related difficulties – reflecting overall impairment, social functioning, and quality of life – may be perceived differently by adolescent patients, parents and physicians. The primary aim of this study was to investigate ADHD-related difficulties during atomoxetine treatment, as perceived by the three different raters. Secondary objectives focused on effectiveness and tolerability of atomoxetine treatment in a population of adolescent patients with ADHD.</p> <p>Methods</p> <p>Adolescents with ADHD, aged 12–17 years, received open-label atomoxetine (0.5–1.2 mg/kg/day) up to 24 weeks. ADHD-related difficulties at various times of the day were rated using the Global Impression of Perceived Difficulties (GIPD) instrument. Inter-rater agreement was analyzed using Cohen's Kappa with 95% confidence intervals (95% CI). ADHD-Rating Scale (ADHD-RS) and Clinical Global Impression Severity (GGI-S) scores were assessed by the investigator; and spontaneous adverse events, vital signs and laboratory parameters were collected for tolerability assessments.</p> <p>Results</p> <p>159 patients received atomoxetine. Patients' baseline mean GIPD total ratings were significantly lower than parents' and physicians' scores (12.5 [95%CI 11.6;13.5] vs. 17.2 [16.2;18.2] and 18.8 [17.8;19.8]). For all raters, GIPD scores significantly improved over time. Changes were greatest within the first two weeks. Kappa coefficients varied between 0.186 [0.112;0.259] and 0.662 [0.529;0.795], with strongest agreements between parent and physician assessments, and significant improvements of patient/physician agreements over time (based on 95% CIs). ADHD-RS and CGI-S scores significantly improved over the course of the study (based on 95% CIs). Tolerability results were consistent with earlier reports.</p> <p>Conclusion</p> <p>ADHD-related difficulties were perceived differently by the raters in this open-label trial, but consistently improved during atomoxetine treatment. The GIPD instrument appeared sensitive to treatment-related change. These primarily quantitative findings may guide future studies to more systematically investigate the clinical and practical relevance of the differences observed. Additionally, in order to further validate these results, placebo- and comparator-controlled trials are recommended as well as inclusion of healthy controls and other patient populations.</p> <p>Trial Registration</p> <p><b>Clinical Trial Registry</b>: ClinicalTrials.gov: NCT00191737</p

Emotional dysregulation and trauma predicting psychopathy dimensions in female and male juvenile offenders

Background: Psychopathy is a specific syndrome that predicts future violent and aggressive behavior in adults. Studies in youth and adults have demonstrated a strong association between early traumatic incidents and later dissocial behavior. Moreover, the impact of personality pathology and emotional dysregulation on aggressive and violent behavior is well established. However, few studies have addressed the relationship between early traumatization and psychopathic traits in adolescents. Method: The present study examined associations between both general dimensions of personality pathology and early traumatic experiences and the dimensions of psychopathy in 170 male and 171 female adolescent detainees. Results: Analyses revealed associations between physical abuse, emotional dysregulation and psychopathic traits in delinquent boys but not in delinquent girls. Conclusion: Hypothesized relationships between trauma, personality pathology could only be confirmed in the lifestyle and antisocial, but not in the core affective and interpersonal facets of psychopathy

Treatment of psychiatric comorbidities and interaction patterns in Coffin‐Siris syndrome: A case report of a 4‐year‐old girl

Key Clinical Message Coffin‐Siris syndrome (CSS) is a rare genetic disorder and often co‐occurs with attention‐deficit hyperactivity disorder (ADHD) and autism spectrum (ASD). The present case study illustrates possible therapeutic interventions of these common psychiatric comorbidities taking into account the family interaction patterns. This can contribute to improve holistic management and overall level of functionality

Pathological Internet Use—An Important Comorbidity in Child and Adolescent Psychiatry: Prevalence and Correlation Patterns in a Naturalistic Sample of Adolescent Inpatients

Background. Few studies have examined the prevalence of problematic internet use (PIU) in young people undergoing inpatient treatment in child and adolescent psychiatry centers. The aims of our study were thus (a) to assess the frequency of comorbid PIU in a sample of adolescent psychiatric inpatients and compare it with a control group of nonreferred adolescents and (b) to gain insights into correlations between PIU and psychiatric comorbidities. Methods. 111 child and adolescent psychiatry inpatients (CAP-IP, mean age 15.1±1.4 years; female : male 72.4% : 27.6%) undergoing routine psychodiagnostics were screened for the presence of PIU. The widely used Compulsive Internet Use Scale (CIUS) was chosen for this purpose. Prevalence rates of PIU were then compared to matched nonreferred control subjects from a school sample. Additionally, comorbidities of inpatients with PIU were compared to inpatients without PIU. Results. Our inpatient sample showed a much higher prevalence of PIU than that found in previous populational samples of young people. Compared with a matched school sample, addictive internet use was 7.8 times higher and problematic internet use 3.3 times higher among our adolescent sample. PIU was significantly associated with characteristic patterns of psychopathology, that is, suicidality, difficulties in establishing stable and consolidated identity, and peer victimization. Conclusion. PIU among adolescents undergoing inpatient psychiatric treatment is much more frequent than among their peers in the general population and is associated with specific patterns of psychopathology

NICHT-SUIZIDALE SELBSTVERLETZUNGEN BEI STATIONÄREN PATIENTEN DER KINDER- UND JUGENDPSYCHIATRIE: PRÄVALENZ, GESCHLECHTERVERTEILUNG UND KOMORBIDE PSYCHOPATHOLOGIE IN EINER NATURALISTISCHEN KLINISCHEN STICHPROBE

Background: A growing body of research points toward nonsuicidal self-injury (NSSI) in adolescents as an important and frequent health-related risk factor. In 2013, NSSI was proposed in section 3 of the DSM-5 as a new diagnostic entity warranting further study. In line with that goal, the present study was conducted in order to evaluate prevalence, gender distribution and comorbidities of NSSI in a sample of adolescent psychiatric inpatients. Subjects and methods: The study included 130 adolescents (mean age 15.09 years, SD ± 1.47; 71.5% female) undergoing inpatient psychiatric treatment at a specialized facility. The factors assessed were sociodemographic data, the presence of NSSI according to the proposed DSM-5 criteria, clinical psychiatric diagnosis, the presence of suicidality and the presence of personality disorder. Results: A large percentage, 38.5%, of the sample fulfilled DSM-5 criteria for NSSI, and more than half (50.8%) of the adolescents indicated having injured themselves at least once in the past. Patients with NSSI were predominantly young women and clustered in a spectrum of diagnostic entities including not only borderline personality disorders but also substance use disorders and affective disorders. A strong association was found between suicidality (suicidal ideation, history of suicide attempt) and NSSI. Conclusions: In line with previous findings, NSSI among adolescent psychiatric inpatients was found to be a frequent phenomenon associated with a broad spectrum of comorbidities. Moreover, while NSSI is conceptualized as an act without suicidal intent, it commonly occurs in patient groups with suicidal ideation or with a history of suicide attempts.Hintergrund: Eine steigende Zahl von Forschungsarbeiten belegt die Bedeutung von nicht-suizidalen Selbstverletzungen (NSSV) als häufigen und wichtigen gesundheitsbezogenen Risikofaktor bei Jugendlichen. 2013 wurden NSSV im DSM-5 in den Abschnitt 3 der weiter zu beforschenden Entitäten aufgenommen. Das Ziel dieser Studie war dementsprechend, Prävalenz, Geschlechterverteilung und komorbide Psychopathologie in einer Stichprobe von jugendlichen stationären Patienten zu untersuchen. Sample und Methoden: In die Studie wurden 130 Jugendliche (mittleres Alter 15,09 Jahre, SD ± 1,47; 71,5% weiblich) eingeschlossen, die als stationäre Patienten an einer kinderund jugendpsychiatrischen Klinik aufgenommen waren. Neben soziodemographischen Daten waren die erhobenen klinischen Variablen die Prävalenz von NSSV nach den DSM-5 – Kriterien, die klinisch-psychiatrische Diagnose, das Vorliegen einer Persönlichkeitsstörung sowie das Vorliegen von Suizidalität. Resultate: Ein hoher Prozentsatz von 38,5% der stationären Patienten erfüllten die DSM-5-Kriterien für NSSV, mehr als die Hälfte der Jugendlichen (50,8%) gaben an, sich in der Vergangenheit schon einmal selbst verletzt zu haben. NSSV kamen häufiger bei weiblichen Patientinnen vor, und zeigten eine signifikante Häufung in einem Spektrum von klinischen Diagnosen, welches nicht nur Borderline-Persönlichkeitsstörungen sondern auch Suchterkrankungen und affektive Störungen beinhaltete. NSSV waren hochsignifikant mit Suizidalität (Suizidgedanken, Suizidversuch in Anamnese) assoziiert. Schlussfolgerungen: Im Einklang mit bisheriger Literatur zeigten sich NSSV in unserer Studie als ein häufiges Phänomen, welches mit einem breiten Spektrum von komorbiden Störungen assoziiert war. Obwohl NSSV per definitionem ohne suizidale Absicht ausgeführt werden, besteht eine enge Verbindung zu Suizidgedanken sowie Suizidversuchen in der Anamnese