Poor Frustration Tolerance Research Articles

Drug Abuse: Prognostic Role of Sibling Position in Bengali Culture in India: AStudy in Kolkata, India

Background: It is commonly believed that birth order is an important determinant of personality, intelligence, and economic success. A number of recently published popular books, each with its own approach to the topic tend to support the belief. In keeping with published studies, we noted strong evidence of race and ethnicity effects. In addition, we find that adolescents who lived with both of their parents are much less likely to have used tobacco, alcohol, or marijuana, whereas household income seems to have an effect on female, but not male, substance use. Growing up in an urban area is associated with an increase in the probability of having smoked marijuana and, for females only, an increase in the probability of having drunk alcohol. We find that children with older siblings are, on average, more likely to have used tobacco, alcohol, and canabis than their firstborn counterparts controlling for family size, age, and the other factors in the model. Males with older siblings are 6.2 percentage points more likely to have drunk alcohol and are 5.1 percentage points more likely to have tried marijuana than their firstborn counterparts. With this intention we observed the influence of birth order of the individual among the siblings on the course and outcome of the drug abused subject in the eastern part of India that is known at West Bengal, and its inhabitant called Bengalis. Materials and methods: The data were collected on the basis of retrospective study of the records of 225 consecutive Bengali heroin and brown sugar dependents attending at Ashadeep De-Addiction Centre in Kolkata. All the subjects were male, the age spanned 15-35 years; and hailed from low or middle socio-economic status. All the subjects were treated for detoxification and were followed up while they were undergoing the counselling sessions. The subjects were followed up for little over one year. Results: In Bengali culture the eldest, youngest and the only son, are usually considered to be of much valued position. No such extraordinarily value is attached to any other intermediate ranks. In Bengali, the eldest one usually learns to sacrifice, to tolerate and to be loyal to the hierarchical value-system, whereas the youngest one usually enjoys the indulgence, given not only by parents but also the other elder siblings, and often exhibit poor frustration tolerance and strong pleasure-seeking attitude. The first-born in having a better prognosis, and less drop-out than the lastborns, are expected to be more amenable to therapy than the latter. Conclusion: We are fully aware that the cultural influence is much more varied, extensive, intricate and complex. In such broader perspective, the present study is only a modest attempt. However, we hope that this will throw some light on such a vast subject.

Resident Mental Health: Time for Action.

Resident Mental Health: Time for Action.

ADHD and Depression: the Role of Poor Frustration Tolerance.

Unipolar depression is a common comorbidity in children with ADHD with rates ranging from 12-50%. Compared to children with ADHD alone, children with comorbid ADHD and depression require more intense interventions since they experience higher levels of stress and more psychosocial and familial problems. One mechanism hypothesized to underlie the relationship between ADHD and depression is emotion dysregulation. Cross-sectional and longitudinal research has shown that emotion dysregulation mediates the relationship between ADHD and depression. However, there are a number of limitations in the extant literature regarding emotion dysregulation as a mechanism underlying the relationship between ADHD and depression. This article aims to review those limitations and propose that by examining a specific type of emotion dysregulation, poor frustration tolerance, we may gain critical insight into the mechanisms underlying ADHD and depression. We discuss the construct of frustration, its neural basis and evidence that poor frustration tolerance is a key impairment in children with ADHD. We conclude by suggesting that poor frustration tolerance may be a key mechanism underlying the relationship between ADHD and depression, and provide recommendations for how future research can utilize affective neuroscience techniques to examine the neural, behavioral and clinical correlates of frustration tolerance in children with ADHD to more comprehensively examine this relationship.

How to Best Assess Violence Risk of Youth in Emergency Department

How to Best Assess Violence Risk of Youth in Emergency Department

Analog assessment of frustration tolerance: Association with self-reported child abuse risk and physiological reactivity

Although frustration has long been implicated in promoting aggression, the potential for poor frustration tolerance to function as a risk factor for physical child abuse risk has received minimal attention. Instead, much of the extant literature has examined the role of anger in physical abuse risk, relying on self-reports of the experience or expression of anger, despite the fact that this methodology is often acknowledged as vulnerable to bias. Therefore, the present investigation examined whether a more implicit, analog assessment of frustration tolerance specifically relevant to parenting would reveal an association with various markers of elevated physical child abuse risk in a series of samples that varied with regard to age, parenting status, and abuse risk. An analog task was designed to evoke parenting-relevant frustration: the task involved completing an unsolvable task while listening to a crying baby or a toddler's temper tantrum; time scores were generated to gauge participants’ persistence in the task when encountering such frustration. Across these studies, low frustration tolerance was associated with increased physical child abuse potential, greater use of parent–child aggression in discipline encounters, dysfunctional disciplinary style, support for physical discipline use and physical discipline escalation, and increased heart rate. Future research directions that could better inform intervention and prevention programs are discussed, including working to clarify the processes underlying frustration intolerance and potential interactive influences that may exacerbate physical child abuse.

Characteristics of young offenders depending on the type of crime

The aim of this study is to define a profile of juvenile offenders depending on the type of crime (against property or against persons), according to several socio-demographic variables, and a number of indicators of juvenile risk. Participants were 395 adolescents between the ages of 14 and 18 with a criminal record in the juvenile court over a two-year follow-up period. Results showed that in property-related offences the offender is more likely to be male, from an Eastern European country, and with inconsistent parenting. On the other hand, crimes against persons would be committed mostly by girls, Latin American or African juveniles, and with individual factors such as aggressive behaviour, outbursts of anger, poor frustration tolerance, or little concern for others. These results may be useful in designing crime prevention and offender intervention programmes.

A Naturalistic On-Off-On Trial of Dextromethorphan/Quinidine for Agitation Associated with Cerebellar Injury

Mr. A, a 47 year-old man with a complicated medical history including HIV and neurovascular syphilis, presented to an urban academic medical center with complaints of headache, vertigo, facial numbness, and intractable hiccups. He reported being awakened from sleep by a loud popping sound coming from the back of his neck with immediate onset of his presenting symptoms. Exam was remarkable for dysarthric speech and copious oral secretions that he was unable to swallow. Magnetic resonance imaging of the brain revealed areas of restricted diffusion in the left inferior cerebellar hemisphere and the left lateral aspect of the medulla consistent with an acute infarct of the left posterior inferior cerebellar artery (PICA). Subsequent CT angiography revealed an occlusion of the left vertebral artery thought to be due to dissection. Psychiatry was consulted on the 13th hospital day due to worsening episodic agitation that had begun on the 7th hospital day. He was noted to have very poor frustration tolerance, often becoming upset with his dietary restrictions and perceived delay in responses to his requests. He had pulled out his intravenous (IV) lines on several occasions and had pushed over his IV pole. Psychiatric consultation had finally been prompted by nursing becoming upset that Mr. A was watching pornography on his laptop

Surgical resection of hypothalamic hamartomas for severe behavioral symptoms

Hypothalamic hamartomas (HHs) are associated with treatment-resistant epilepsy. Many patients also experience severe and sometimes disabling psychiatric problems. The most common behavioral symptoms consist of paroxysms of uncontrolled anger related to poor frustration tolerance. These can include violence, resulting in disrupted family or school relationships, and legal consequences including incarceration. In a large cohort of patients undergoing surgical resection of HHs for refractory epilepsy, 88% of families described an improvement in overall behavioral functioning [1]. Here, we describe four patients (three males, mean age=11.9years) who underwent surgical resection of HHs largely for behavioral indications. Three patients had relatively well controlled seizures, and one had no history of epilepsy. All patients had striking improvement in their psychiatric comorbidity. HH resection can result in significant improvement in behavioral functioning, even in patients with relatively infrequent seizures. Further investigation under approved human research protocols is warranted.

Delayed sleep phase disorder and Attention deficit and hyperactivity symptoms in a teenager

JR is an 18-year-old male with five-year history of going to bed late and waking up late. He gives history of poor frustration tolerance, inattention and fidgetiness in school for which he has been unsuccessfully been treated with stimulant medications for last 3 years. There is history of similar sleep problems in his father who works nights as a mechanic. JR's sleep log shows him going to bed early morning and waking up late morning/afternoon. He shows no sleep maintenance problems and sleeps an average of 8 h per night. He shows no symptoms of depression, anxiety, inattention or hyperactivity during his hospital stay. He does not show any learning, cognitive, attention or intellectual deficits. He is currently not taking any medications. He is discharged home after 3-day hospital stay and is reportedly doing well working in a video rental store at night.

Earliest symptoms discriminating juvenile‐onset bipolar illness from ADHD

Controversy surrounds the diagnosis and earliest symptoms of childhood-onset bipolar illness, emphasizing the importance of prospective longitudinal studies. To acquire a preliminary, more immediate view of symptom evolution, we examined the course of individual symptoms over the first 10 years of life in juvenile-onset bipolar illness (JO-BP) compared with attention-deficit hyperactivity disorder (ADHD). Parents of formally diagnosed children retrospectively rated 37 symptoms in each year of the child's life based on the degree of dysfunction in their child's usual family, social, or educational roles. A subset of children with onset of bipolar disorder prior to age 9 (JO-BP) compared with those with ADHD was the focus of this analysis. Brief and extended periods of mood elevation and decreased sleep were strong early differentiators of JO-BP and ADHD children. Depressive and somatic symptoms were later differentiators. Irritability and poor frustration tolerance differentiated the two groups only in their greater incidence and severity in JO-BP compared with a moderate occurrence in ADHD. In contrast, hyperactivity, impulsivity, and decreased attention showed highly similar trajectories in the two groups. Elevated mood and decreased sleep discriminated JO-BP and ADHD as early as age 3, while classic ADHD symptoms were parallel in the groups. These retrospective results provide preliminary insights into symptom differences and their temporal evolution between bipolar disorder and ADHD in the first 10 years of life.

Tyrosine Supplements for ADHD Symptoms With Comorbid Phenylketonuria

Back to table of contents Previous article Next article LETTERFull AccessTyrosine Supplements for ADHD Symptoms With Comorbid PhenylketonuriaJonathan Posner M.D.,Daniel Gorman M.D.,Bonnie J. Nagel Ph.D.,Jonathan Posner M.D.Search for more papers by this author,Daniel Gorman M.D.Search for more papers by this author,Bonnie J. Nagel Ph.D.Search for more papers by this author,Published Online:1 Apr 2009AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Phenylketonuria is the most common genetic disorder of amino acid metabolism with an incidence of 1 per 15,000 births. It is caused by a mutation in the gene coding for phenylalanine hydroxylase resulting in an inability to metabolize phenylalanine to tyrosine—a precursor of dopamine and norepinephrine. Treatment for phenylketonuria involves restricting protein intake. If a low protein diet is commenced at birth and maintained throughout development, many patients achieve normal cognitive functioning. Failure to maintain the diet, however, leads to elevated serum phenylalanine with subsequent cognitive decline and potential mental retardation. 1 As individuals with phenylketonuria are unable to metabolize phenylalanine to tyrosine, and tyrosine is an essential precursor to dopamine, some authors have suggested that tyrosine-enriched foods be included as part of the diet for patients with phenylketonuria. Several studies have investigated the use of tyrosine supplements to reverse the cognitive effects associated with hyperphenylalaninemia, but the results have been mixed. 2 To our knowledge, however, no studies have investigated the use of tyrosine supplements for psychiatric conditions comorbid with phenylketonuria. We present the case of a young boy with phenylketonuria and comorbid attention-deficit/hyperactivity disorder (ADHD) who was treated with tyrosine supplementation. Given that tyrosine is an essential precursor to dopamine, we hypothesized that the patient’s ADHD symptoms may have been exacerbated by hypotyrosinemia. By supplementing his diet with tyrosine, we were able to achieve a reduction in his ADHD symptoms, and we suspect that the mechanism of action was an augmentation of dopaminergic activity.Case ReportAA, a 4-year-old boy with phenylketonuria, was started at birth on a protein-restricted diet and was followed in a metabolic disease clinic. He was developing normally until age 3, when his parents noted behavioral problems characterized by impulsivity and poor frustration tolerance. At age 4, he was enrolled in an early intervention program and received psychosocial treatments to address worsening symptoms of inattention, hyperactivity, and aggression. After 4 months of treatment, AA showed little improvement. He underwent a comprehensive psychiatric evaluation, and a diagnosis of ADHD, Combined Type, was made. AA was started on a tyrosine supplement at a dose of 100 mg/kg/day. The treatment was well tolerated and after 4 weeks of treatment, he showed a dramatic improvement in his ADHD symptoms. Standardized ratings are shown in Table 1 . TABLE 1. Neuropsychological Assessment of ADHD SymptomsTABLE 1. Neuropsychological Assessment of ADHD SymptomsEnlarge tableComment Attention-deficit/hyperactivity disorder is a heterogeneous condition characterized by inattention, hyperactivity, and impulsivity. Although its precise pathophysiology is unknown, neuropsychological studies have found deficits in executive functions, including inhibitory control and set shifting. 3 Moreover, consistent with longstanding data that psychostimulants reduce the symptoms of ADHD, functional imaging studies have implicated abnormalities in the dopaminergic pathways of the anterior attentional system. 4Our findings suggest that our patient’s symptoms of ADHD may have been exacerbated by a deficiency in tyrosine and suggest a potential approach for treating patients with comorbid phenylketonuria and ADHD. Moreover, our findings suggest that inquiring into dietary habits may be important when evaluating children with ADHD.Oregon Health & Science UniversityUniversity of TorontoOregon Health & Science University

P02-27 The neglected relationship between compulsiveness and impulsiveness - implications in psychiatric diagnosis

The goal of the authors is to stimulate reflection on the distribution in continuum of compulsive and impulsive behaviours and highlight how important it is to constantly question psychiatric diagnoses, to avoid running the risk of dangerous categorisations.They describe the case of a 31 year-old patient who attended the Emergency department of Coimbra University Hospitals complaining of depression and obsessive-compulsive symptoms that interfered with his daily life and with his sleep. He said that he used to attend psychiatry appointments and that he was “antisocial”, but added: “I'm as impulsive as much as I'm emotional”.The patient's records show that he was always diagnosed with antisocial personality disorder, established by the first consultant he saw,specifically mentioning: “problems obeying rules”, “impulsiveness”, “getting into fights and brawls entailing legal action” with the obsessive-compulsive symptoms being secondary. However, the follow-up of the patient conduced by me revealed obsessive-compulsive symptoms in special compulsive checking rituals (which began in childhood), excessive concern with the size of his nose (and other parts of the body) that started in adolescence, as well as a personality marked by impulsiveness and a poor frustration tolerance, leading to highly aggressive episodes triggered by events/circumstances that he himself did not regard as particularly relevant. The results of the studies on the relationship between impulsiveness and compulsiveness could have a strong impact on reformulating the psychiatric nosology. Whenever we come across a new patient, as complete a clinical history as possible should be taken and easy diagnoses should be avoided.

Comorbidity of adult attention deficit hyperactivity disorder and its relation to executive functions in patients with antisocial personality disorder

Background: Main features of antisocial personality disorder (APD) are aggression, tendency to violence, poor frustration tolerance, impulsivity, difficulties in learning from experiences. Attention deficit hyperactivity disorder (ADHD) is characterized with difficulty to sustain attention, hyperactivity and impulsivity. Association between ADHD and violent behavior is well known. Childhood onset ADHD carries a high risk of persisting into adulthood as antisocial behaviors. Aim: In the present study, comorbidity of adult ADHD was screened in a group of patients with APD. Executive functions and attention were assessed by using neuropsychological test instruments. In addition, their relation to ADHD subtypes was investigated. Methods: A total of 90 male subjects with APD were included. Also, 90 ageand sex-matched healthy control subjects were involved into the study. The patients and control subjects were assessed by a semi-structured socio-demographic form, SCID-II, Turgay’s Adult ADHD Rating Scale, Wender Utah Rating Scale, Wisconsin Card Sorting Test, Stroop Test, Continuous Performance Test, and Trail-Making Test. Results: Comorbidity rate of adult ADHD was 83.3% in APD group while 6.7% of control subjects had a diagnosis of adult ADHD. The most frequently diagnosed ADHD subgroup was combined type in both APD and control group. In APD group, executive functions were significantly more deficient as compared to the control group. Among all ADHD subgroups, inattention subtype had the worst performance in neuropsychological assessments. Conclusion: Comorbidity of adult ADHD was quite common in APD subjects. Executive functions were generally deficient in APD patients with a co-diagnosis of adult ADHD.

Finding a place for healing: Women survivors of childhood sexual abuse and their experience of accessing services

Women survivors of child sexual abuse often suffer a range of difficulties including a chronic and painful sense of insecurity, a lack of self-esteem, difficulty with interpersonal relationships, poor frustration tolerance, overwhelming emotions, depression, sensitivity to criticism and rejection, distrust, suspiciousness and a fragile sense of self. They may also experience a range of serious psychological consequences, their life trajectory often marked by chaos and complexity. In Australia, services have been developed in government, non-government and private sectors to meet the needs of these women; however, anecdotal evidence suggests that services may be patchy in both availability and standards. The aim of the Reframing Responses study (O'Brien, Henderson & Bateman, 2006) was to explore the provision of services in the non-government sector. This paper presents findings related to the experiences of women survivors of child sexual abuse in accessing and utilising services. A qualitative study design was used. Fourteen women participated in focus groups and interviews to provide rich descriptions of their experiences of disclosure, accessing services, what was helpful, and what was unhelpful. The women provided descriptions of their experience of services across all sectors. They confirmed a lack of availability particularly in terms of longer-term counselling, a lack of consistency in terms of models and standards, and provided clear indications of what was helpful and what was not. The findings of this study have implications for the development of services for consistency in standards of services, models, and needs for training and education.

Dementia With Mood Symptoms in a Fragile X Premutation Carrier With the Fragile X-Associated Tremor/Ataxia Syndrome: Clinical Intervention With Donepezil and Venlafaxine

Dementia With Mood Symptoms in a Fragile X Premutation Carrier With the Fragile X-Associated Tremor/Ataxia Syndrome: Clinical Intervention With Donepezil and Venlafaxine

Language, School Functioning, and Behavior Among African American Urban Kindergartners

Significant relations among language impairments, academic difficulties, and behavioral problems have been well established in previous research, primarily with impaired children or non-minority samples. However, how and why these three developmental domains tend to co-vary has received only limited attention. Preliminary research suggests that academic deficiencies mediate the relation between language impairments and problem behavior. This study assessed 97 urban African American kindergarten children (mean age = 5.98, SD = .33) on measures of language impairment, school functioning, and behavior problems to examine potential processes linking these areas of functioning. Similar to previous research, all three factors correlated significantly with one another. Children with language problems were more likely to have problems with school functioning, and school functioning mediated the relation between language and behavior problems. Additionally, poor frustration tolerance moderated the relation between language impairment and behavior problems. Implications and limitations are discussed.

A Review of Rating Scales for Measuring Behavior Change Due to Frontal Systems Damage

To perform a critical review of scales designed to measure frontal behavior change. Changes in cognition due to frontal disease or damage have been well described, but noncognitive changes in behavior are often more deleterious functionally for frontal patients. The review concentrates on five behavior rating scales: the Behavior Rating Inventory of Executive Functions (BRIEF), the Dysexecutive Questionnaire (DEX), the Frontal Behavior Inventory (FBI), the Frontal Systems Behavior Scale (FrSBe), the Iowa Rating Scales of Personality Change (IRSPC), and the Neuropsychiatric Inventory (NPI). Other scales purporting to measure specific aspects of frontal functioning, but having less research support, are described briefly. The BRIEF and FrSBe have good reliability and large-scale norms. No norms are available for the other scales. The FrSBe and IRSPC have been shown to be valid in discriminating frontal from nonfrontal lesioned patients, but this has not been shown in the other scales. The FBI and NPI require trained raters, whereas the FrSBe, IRSPC, and BRIEF are administered to patients and/or family informants directly. The NPI and FBI are sensitive to certain changes in behavior attributed to frontal systems disruption but have been used primarily in dementia.

Is there progression from irritability/dyscontrol to major depressive and manic symptoms? A retrospective community survey of parents of bipolar children

Background: Although previous studies have discussed age-related changes in the presentation of early onset bipolar illness, the developmental progression of early symptoms remains unclear. The current study sought to trace parents’ retrospective report of yearly occurrence of symptoms in a sample of children with and without a diagnosis of bipolar disorder in the community. Methods: Parents retrospectively rated the occurrence of 37 activated and withdrawn symptoms causing dysfunction for each year of their child’s life (mean age 12.6±6.9). Children were divided into three groups based on parent report of diagnosis by a community clinician: bipolar ( n=78); non-bipolar diagnosis ( n=38); and well (no psychiatric diagnosis) ( n=82). Principal components analysis was performed to understand the relationship among the symptom variables and their potential differences among the three groups as a function of age. Results: Four symptom components were derived and these began to distinguish children with bipolar disorder from the other groups at different ages. Component II (irritability/dyscontrol), which included temper tantrums, poor frustration tolerance, impulsivity, increased aggression, decreased attention span, hyperactivity and irritability, began to distinguish bipolar children from the others the earliest (i.e., from ages 1 to 6). The other components (I, III, and IV) which included symptoms more typical of adult depression (I), mania (III), and psychosis (IV), distinguished the children with a bipolar diagnosis from the others much later (between ages 7 and 12). Limitations: The data were derived from retrospective reports by parents of their children’s symptoms on a yearly symptom check list instrument which has not been previously utilized. Parents’ ratings were not validated by an outside rater. Moreover, the children were diagnosed in the community and a formal diagnostic interview was not given. Conclusions: By parental report, the cluster of symptoms in the irritability/dyscontrol component may characterize the earliest precursors to an illness eventually associated with more classic manic and depressive components that are diagnosed and treated as bipolar disorder in the community. These retrospective survey data suggesting a longitudinal evolution of symptom clusters in childhood bipolar-like illness identify a number of areas for prospective research and validation.

Personality traits predicting long-term adjustment after surgery for ulcerative colitis.

Very few studies have examined the relationship between personality traits and long-term postoperative psychosocial adjustment. In a sample of 46 patients, we examined the relation between personality traits before pelvic pouch surgery for ulcerative colitis and psychosocial adjustment seven years postoperatively, controlling for the effects of surgical functional outcome. The Karolinska Psychodynamic Profile (KAPP) was used for personality assessment. Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale were also used. As assessed by the KAPP, poor frustration tolerance, long-standing preoperative problems in sexual functioning, perfectionistic body ideals, and lack of alexithymia predicted poorer postoperative long-term psychosocial adjustment in the areas of health concerns, sexuality, family relations, and psychological distress. Surgical functional outcome itself was a poor predictor of long-term adjustment. The results indicate that it may be beneficial to take personality factors into account in preoperative assessment.

Acquired Personality Disturbances Associated With Bilateral Damage to the Ventromedial Prefrontal Region

Personality changes in 7 participants with bilateral ventromedial prefrontal lesions (PF-BVM), 14 participants with prefrontal lesions but not bilateral ventromedial involvement (PF-NBVM), and 36 with nonprefrontal lesions (NPF) were investigated with the Iowa Rating Scales of Personality Change. Informants rated 30 specific characteristics for degree of disturbance and change from premorbid personality. PF-BVM participants showed a higher rate of acquired disturbances than NPF participants in blunted emotional experience, apathy, low emotional expressiveness, inappropriate affect, poor frustration tolerance, irritability, lability, indecisiveness, poor judgment, social inappropriateness, lack of planning, lack of initiation and persistence, and lack of insight. Differences between the PF-BVM and PF-NBVM groups were significant for several of these characteristics. All 7 PF-BVM participants developed a syndrome, including general dampening of emotional experience; poorly modulated emotional reactions; defective decision making, especially in the social realm; impaired goal-directed behavior; and striking lack of insight. Similarities between this syndrome of "acquired sociopathy" and developmental psychopathy in characteristic personality disturbances and psychophysiological abnormalities suggest that diminished emotionality, impaired decision making, and psychosocial dysfunction may be related to ventromedial prefrontal dysfunction in both groups.