Comorbidities of mental and behavioral disorders in chemically dependent patients in different periods of abstinence

OBJECTIVE: To assess the frequency of comorbidities of mental and behavioral disorders (CMBD) in psychoactive substance (PAS)-dependent patients with different periods of abstinence cared for at Alcohol and Other Drug Psychosocial Care Centers (CAPS-ad). METHOD: All patients under treatment in the two CAPS-ad of the city of Uberlândia-MG, between April and September 2010, were consecutively assessed. The ICD-10 symptom checklist was used to diagnose CMBD; additional information was obtained from interviews and medical records. The patients were divided according to duration of abstinence: < 1 week (Group 1); 1-4 weeks (Group 2); and > 4 weeks (Group 3). RESULTS: Of all patients assessed, 62.8% were diagnosed with CMBD, which were more frequent (p < 0.05) in Group 1 (72%) than Group 3 (54.2%), and both groups were similar to Group 2 (61%). Depressive and anxiety disorders were more frequent among patients of Group 1. Mood disorders were more frequent (p < 0.05) in women [22/34 (65%) vs. 54/154 (35.1%)], whereas psychotic disorders were more frequent (p = 0.05) in men [16/154 (10.4%) vs. 0]. The presence of CMBD was associated with more severe clinical conditions. CONCLUSIONS: The higher frequency of diagnosis of CMBD in patients of Group 1 may have resulted from the difficulties in distinguishing mental disorders that are due to PAS intoxication or withdrawal from those that are not. However, to make the diagnosis of CMBD, even during detoxification, can increase the likelihood of better response to treatment.

Teachers' sick leave due to mental and behavioral disorders and return to work

This manuscript presents a review of the literature about medical leaves due to mental and behavioral disorders and return to work of teachers. There are scarce published manuscripts. Most articles relate with prevalence of mental disorders and factors associated with the work organization, and did not mention intervention proposals and or changes in the work organization and teaching work. Proposed actions are discussed.

Male/Female Manifestations of Narcissistic Personality and Behavioral Disorders.

Specifically, this paper will address the following topics : 1. The history of psychoanalytic thinking onnarcissism will be discussed, leading up to more recent ideas on the narcissistic personality disorder. 2. Drawing on historical and current ideas, an integrated definition of the narcissistic personality disorder will be presented and elaborated upon, including an examination of differing male/female narcissistic compensatory styles. 3. To foster an understanding of the development of narcissistic defenses and of differing gender styles of defense, various theories relating to gender differences in the narcissistic personality disorder will be explored: self/object relations theories, Kohut's theory on narcissism, psychosexual development theories, behavioral manifestation theories, and bodily development theories.4. The role of preoedipal development, as it relates to the formation of the male/female narcissistic personality disorder, will be examined. This section of the paper will propose that, in the narcissistic personality disorder, a pathological arrest occurred during the second or third year of life in response to trauma experienced at that time. The degree and timing of the trauma and the degree of structuralization preceding the trauma all contribute to the rigidity of the narcissistic disorder and the severity of the pathology. 5. The role of oedipal development in the male/female narcissistic personality disorder will be discussed. This discussion will address the intrapsychic configurations which arise during the oedipal period, after narcissistic defenses have solidified during the preoedipal years. While narcissism can be seen as a developmental line, with narcissistic defenses arising at any time during development, this paper will focus primarily on defenses which arise during the separation/individuation phases of development.

Long-term outcome after cognitive and behavioral regression in nonlesional epilepsy with continuous spike-waves during slow-wave sleep.

PURPOSE: To present the long-term follow-up of 10 adolescents and young adults with documented cognitive and behavioral regression as children due to nonlesional focal, mainly frontal, epilepsy with continuous spike-waves during slow wave sleep (CSWS). METHODS: Past medical and electroencephalography (EEG) data were reviewed and neuropsychological tests exploring main cognitive functions were administered. KEY FINDINGS: After a mean duration of follow-up of 15.6 years (range, 8-23 years), none of the 10 patients had recovered fully, but four regained borderline to normal intelligence and were almost independent. Patients with prolonged global intellectual regression had the worst outcome, whereas those with more specific and short-lived deficits recovered best. The marked behavioral disorders resolved in all but one patient. Executive functions were neither severely nor homogenously affected. Three patients with a frontal syndrome during the active phase (AP) disclosed only mild residual executive and social cognition deficits. The main cognitive gains occurred shortly after the AP, but qualitative improvements continued to occur. Long-term outcome correlated best with duration of CSWS. SIGNIFICANCE: Our findings emphasize that cognitive recovery after cessation of CSWS depends on the severity and duration of the initial regression. None of our patients had major executive and social cognition deficits with preserved intelligence, as reported in adults with early destructive lesions of the frontal lobes. Early recognition of epilepsy with CSWS and rapid introduction of effective therapy are crucial for a best possible outcome.

Long-term outcome after cognitive and behavioral regression in non-lesional epilepsy with CSWS

Purpose: To present the long-term outcome (LTO) of 10 adolescents and young adults with documented cognitive and behavioral regression as children due to non-lesional focal, mainly frontal epilepsy with continuous spike-waves during slow wave sleep (CSWS). Method: Past medical and EEG data of all patients were reviewed and neuropsychological tests exploring main cognitive functions were administered. Result: After a mean duration of follow-up of 15.6 years (range 8-23 years), none of the 10 patients had recovered fully, but four regained borderline to normal intelligence and were almost independent. Patients with prolonged global intellectual regression had the worst outcome, whereas those with more specific and short-lived deficits recovered best. The marked behavioral disorders that were so disturbing during the active period (AP) resolved in all but one patient. Executive functions were neither severely nor homogenously affected. Three patients with a frontal syndrome during the AP disclosed only mild residual executive and social cognition deficits. The main cognitive gains occurred shortly after the AP, but qualitative improvements continued to occur. LTO correlated best with duration of CSWS. Conclusion: Our findings emphasize that cognitive recovery after cessation of CSWS depends on the severity and duration of the initial regression. None of our patients had major executive and social cognition deficits with preserved intelligence as reported in adults with destructive lesions of the frontal lobes during childhood. Early recognition of epilepsy with CSWS and rapid introduction of effective therapy are crucial for a best possible outcome.

Troubles du contrôte des impulsions et maladie de Parkinson [Impulse control disorders and Parkinson's disease].

A variety of behavioral disorders occurring abruptly in patients with Parkinson's disease (PD) has been recently published and attracted considerable attention in the press. Taking the form of pathological gambling, compulsive shopping, addiction to Internet and to other recreational activities, hypersexuality or bulimia, impulse control disorders (ICD) related to PD are probably more frequent than previously appreciated and may have consequences as spectacular as disastrous for the involved patients. ICD are currently viewed as particular adverse reactions to antiparkinsonian medications, notably to dopamine agonists, and, accordingly, tend to improve or disappear when PD therapy is appropriately adjusted.

Behavioral and neuroendocrine effects of the exposure to chronic restraint or variable stress in early adolescent rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Non-Substance-Related Disorders: Gambling disorder and internet addiction

Behavioral addictions are highly prevalent and have a major individual and societal impact. Moreover, given the availability and increase of potentially addictive activities in our societal development (e.g. internet, gaming, online pornography) an increase in these types of behavioral disorders is very likely. Gambling Disorders are best studied among the non-chemical addictions. However, effective treatment interventions need to be further developed, in particular for Internet Addiction. Most of the available evidence supports behavioral interventions as first line treatment. Specifically for Gambling Disorder, pharmacotherapy can be an useful augmentation.. Psychiatric comorbidities are frequent in patients with behavioral addictions and negatively affect the course of non-substance-related disorders. Concurrent treatment of these comorbid disorders is advised, although there is a clear need of conducting studies evaluating the effectiveness of integrated treatment approaches.

Class placement and academic and behavioral variables as predictors of graduation for students with disabilities

Dropout rates impacting students with high-incidence disabilities in American schools remain staggering (Bost, 2006; Hehir, 2005). Of this group, students with Emotional Behavioral Disorders (EBD) are at greatest risk. Despite the mandated national propagation of inclusion, students with EBD remain the least included and the least successful when included (Bost). Accordingly, this study investigated the potential significance of inclusive settings and other school-related variables within the context of promoting the graduation potential of students with Specific Learning Disabilities (SLD) or EBD. This mixed-methods study investigated specified school-related variables as likely dropout predictors, as well as the existence of first-order interactions among some of the variables. In addition, it portrayed the perspectives of students with SLD or EBD on the school-related variables that promote graduation. Accordingly, the sample was limited to students with SLD or EBD who had graduated or were close to graduation. For the quantitative component the numerical data were analyzed using linear and logistic regressions. For the qualitative component guided student interviews were conducted. Both strands were subsequently analyzed using Ridenour and Newman’s (2008) model where the quantitative hypotheses are tested and are later built-upon by the related qualitative meta-themes. Results indicated that a successful academic history, or obtaining passing grades was the only significant predictor of graduation potential when statistically controlling all the other variables. While at a marginal significance, results also yielded that students with SLD or EBD in inclusive settings experienced better academic results and behavioral outcomes than those in self-contained settings. Specifically, students with SLD or EBD in inclusive settings were found to be more likely to obtain passing grades and less likely to be suspended from school. Generally, the meta-themes yielded during the student interviews corroborated these findings as well as provided extensive insights on how students with disabilities view school within the context of promoting graduation. Based on the results yielded, provided the necessary academic accommodations and adaptations are in place, along with an effective behavioral program, inclusive settings can be utilized as drop-out prevention tools in special education.

Comparison of repeated and two non-repeated readings conditions on reading abilities of students with emotional and/or behavioral disabilities

Students with emotional and/or behavioral disorders (EBD)present considerable academic challenges along with emotional and/or behavioral problems. In terms of reading, these students typically perform one-to-two years below grade level (Kauffman, 2001). Given the strong correlation between reading failure and school failure and overall success (Scott & Shearer-Lingo, 2002), finding effective approaches to reading instruction is imperative for these students (Staubitz, Cartledge, Yurick, & Lo, 2005). This study used an alternating treatments design to comparethe effects of three conditions on the reading fluency, errors, and comprehension of four, sixth-grade students with EBD who were struggling readers. Specifically, the following were compared: (a) Repeated readings in which participants repeatedly read a passage of about 100-150 words, three times, (b) Non-repeated readings in which participants sequentially read an original passage of about 100-150 words once, and (c) Equivalent non-repeated readings in which participants sequentially read a passage of about 300-450 words, equivalent to the number of words in the repeated readings condition. Also examined were the effects of the three repeated readings practice trials per sessions on reading fluency and errors. The reading passage difficulty and length established prior to commencing were used for all participants throughout the standard phase. During the enhanced phase, the reading levels were increased 6 months for all participants, and for two (the advanced readers), the length of the reading passages was increased by 50%, allowing for comparisons under more rigorous conditions. The results indicate that overall repeated readings had the best outcome across the standard and enhanced phases for increasing readers’ fluency, reducing their errors per minute, and supporting fluency answers to literal comprehension questions correctly as compared to non-repeated and equivalent non-repeated conditions. When comparing nonrepeated and equivalent non-repeated readings,there were mixed results. Under the enhanced phases, the positive effects of repeated readings were more demonstrative. Additional research is needed to compare the effects of repeated and equivalent non-repeated readings across other populations of students with disabilities or varying learning styles. This research should include collecting repeated readings practice trial data for fluency and errors to further analyze the immediate effects of repeatedly reading a passage.

Class Placement and Academic and Behavioral Variables as Predictors of Graduation for Students with Disabilities

Dropout rates impacting students with high-incidence disabilities in American schools remain staggering (Bost, 2006; Hehir, 2005). Of this group, students with Emotional Behavioral Disorders (EBD) are at greatest risk. Despite the mandated national propagation of inclusion, students with EBD remain the least included and the least successful when included (Bost). Accordingly, this study investigated the potential significance of inclusive settings and other school-related variables within the context of promoting the graduation potential of students with Specific Learning Disabilities (SLD) or EBD. This mixed-methods study investigated specified school-related variables as likely dropout predictors, as well as the existence of first-order interactions among some of the variables. In addition, it portrayed the perspectives of students with SLD or EBD on the school-related variables that promote graduation. Accordingly, the sample was limited to students with SLD or EBD who had graduated or were close to graduation. For the quantitative component the numerical data were analyzed using linear and logistic regressions. For the qualitative component guided student interviews were conducted. Both strands were subsequently analyzed using Ridenour and Newman’s (2008) model where the quantitative hypotheses are tested and are later built-upon by the related qualitative meta-themes. Results indicated that a successful academic history, or obtaining passing grades was the only significant predictor of graduation potential when statistically controlling all the other variables. While at a marginal significance, results also yielded that students with SLD or EBD in inclusive settings experienced better academic results and behavioral outcomes than those in self-contained settings. Specifically, students with SLD or EBD in inclusive settings were found to be more likely to obtain passing grades and less likely to be suspended from school. Generally, the meta-themes yielded during the student interviews corroborated these findings as well as provided extensive insights on how students with disabilities view school within the context of promoting graduation. Based on the results yielded, provided the necessary academic accommodations and adaptations are in place, along with an effective behavioral program, inclusive settings can be utilized as drop-out prevention tools in special education.

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Objective: To review the literature about the use of atypical antipsychotics in the treatment of pathological aggression in children and adolescents. Method: The databases MEDLINE, SciELO, and LILACS were searched for publications in Portuguese or English from 1992 to August 2011 using the following keywords: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behavior, aggression, and violent behavior. Results: Sixty-seven studies of good methodological quality and clinical interest and relevance were identified. Studies including children and adolescents were relatively limited, because few atypical antipsychotics have been approved by the Food and Drug Administration (FDA). All the medications included in this review (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole and clozapine) have some effectiveness in treating aggression in children and adolescents, and choices should be based on clinical indications and side effects. Conclusions: There are few studies about the effectiveness and safety of atypical antipsychotics for the pediatric population, and further randomized controlled studies with larger groups of patients and more diagnostic categories, such as severe conduct disorder and oppositional defiant disorder, should be conducted to confirm the results reported up to date and to evaluate the impact of long-term use.

Competing notions of social justice and contradictions in special education reform

In the past three decades, special education has been subjected to extensive critique and reform of practices. These critiques have been based on notions of social justice and equity. However, the field has suffered from inadequate attention to assumptions about social justice. Social justice is essentially a contested concept. Rather than representing a unitary and universally shared concept, social justice has variable meanings. Differing views of social justice can be seen to underlie apparent contradictions in continuing practice in response to pressures for reform. Reforms predicated on individual rights have been undermined by deep commitments to meritocratic practices in U.S. schools. Reforms based on more communitarian principles, however, ignore the need for structure and the tendency for communal values to marginalize people with disabilities. Special education reform today requires a different basis in a relational definition of the self, structures to support the qualities of relationships, and a belief in the mutability of social justice.

Sexual satisfaction among patients with erectile dysfunction treated with counseling, sildenafil, or both

Introduction. Sexual satisfaction is linked to life satisfaction, and erectile dysfunction (ED) may lead to an impaired quality of life (QOL). Aim. Our goal was to evaluate the QOL among Brazilian patients with ED, before and after three kinds of treatment. Methods. Men aged 25-55 years, with a diagnosis of psychogenic or mixed ED, according to the Classification of Mental and Behavioral Disorders of the International Classification of Diseases, 10th edition, and the Standard Practice in Sexual Medicine, were randomly assigned to three treatment groups: counseling, sildenafil, and sildenafil plus counseling. At baseline each group had 40 patients. Sildenafil was provided in 50 mg that could be adjusted to 100 mg. The patients could initially take one to two tablets per week and the entire treatment lasted for 3 months. Counseling was provided in group sessions that took place once a week. They were evaluated at baseline and after 3 months of treatment with the Male Sexual Quotient (MSQ) and the Sexual Health Inventory for Men (SHIM). Main Outcome Measures. The correlation between the patients` MSQ score and scores on the SHIM. Results. One hundred seventeen patients were enrolled. The three groups were similar according to age, marital status, mean time of ED, and ED severity and etiology. At baseline, MSQ and SHIM total scores were not different among the three groups. MSQ scores increased from 41.2 +/- 15.3, 38.7 +/- 18.0, and 46.8 +/- 17.0 to 48.5 +/- 15.3, 63.8 +/- 21.6, and 70.0 +/- 17.3 after counseling, sildenafil, and sildenafil plus counseling, respectively (P < 0.05). SHIM scores also increased significantly (9.6 +/- 4.1, 9.7 +/- 4.1, and 10.2 +/- 3.9 to 12.1 +/- 3.9, 16.7 +/- 5.6, and 17.7 +/- 4.5 after counseling, sildenafil, and sildenafil plus counseling, respectively) (P < 0.05). There were no serious adverse events related to sildenafil, and no patient was withdrawn from the study because of an adverse event. Conclusions. The three treatments were significantly efficient, and the best treatment was sildenafil associated with counseling.