Poor Impulse Control Research Articles

Applying the PAI Treatment Process Index to PAI-As Completed by Adolescents in a Residential Program.

The Personality Assessment Inventory (PAI) Treatment Process Index (TPI) is a measure of treatment amenability based on an index of factors related to poor treatment outcomes (e.g., hostility, lack of social support, and poor impulse control). In this study, the formula used to calculate the TPI for the adult PAI was applied to PAI-Adolescent (PAI-As) protoocols completed by 372 adolescents (mean age: 16.8 years; 80% male) during a 22-week residential program for at-risk youth. The number of disciplinary infractions received during the program was used as an indicator of the participants' response to the program. Average PAI-A scale scores and TPI scores were higher than those previously reported for community samples, but lower than those found in clinical samples. TPI scores were positively associated with disciplinary infractions, particularly nonaggressive infractions, when controlling for demographic factors and other clinically relevant variables. Results suggest that the the TPI has relevance for adolescents completing the PAI-A.

Management of a Patient with Foreign Body Ingestion at Ndola Teaching Hospital, Zambia

Foreign body (FB) ingestion refers to intentional swallowing of indigestible, non-nutritious solid substances. It is more common in children and psychiatry adult patients. Adult psychiatry patients have the highest incidence of recurrent ingestion of multiple FB that results from poor impulse control by care-givers and as a response to stress. Foreign bodies longer than 6cm, wider than 2.5cm and sharp edged are unlikely to pass without getting imparted or causing perforation. These warrant removal by endoscopy where available or laparotomy. Wereport on the management of a case of intentional swallowing of multiple FBs by a known psychiatric patient at Ndola Teaching Hospital, in Ndola, Zambia.

Management of a Patient with Foreign Body Ingestion at Ndola Teaching Hospital, Zambia

Foreign body (FB) ingestion refers to intentional swallowing of indigestible, non-nutritious solid substances. It is more common in children and psychiatry adult patients. Adult psychiatry patients have the highest incidence of recurrent ingestion of multiple FB that results from poor impulse control by care-givers and as a response to stress. Foreign bodies longer than 6cm, wider than 2.5cm and sharp edged are unlikely to pass without getting imparted or causing perforation. These warrant removal by endoscopy where available or laparotomy. We report on the management of a case of intentional swallowing of multiple FBs by a known psychiatric patient at Ndola Teaching Hospital, in Ndola, Zambia.

Study of differences between patients with schizophrenia and healthy people in semantic processing.

Semantic processing is important in language comprehension and production, and context can facilitate understanding and accelerate processing speed by pre-activating semantically related words. There are many studies suggesting that patients with schizophrenia have inferior language ability. This study was aimed to examine the differences between patients with schizophrenia and healthy people in semantic processing with Chinese classifier-noun pairs rating tasks. Participants were required to finish rating tasks to judge acceptability of classifier-noun pairs. Also, the Positive and Negative Syndrome Scale (PANSS) was conducted in the schizophrenia group. According to results of variance analysis, schizophrenic patients' accuracy of judgment on the acceptability of classifier-noun pairs differed from the control group (F=4.13, p < .05), and the contextual effect of classifier constraint could be observed in healthy people (F(1, 31)=5.38, p < .05) but not in patients with schizophrenia (F(1, 25)=3.55, p=.07), indicating that they failed to use the contextual information to facilitate language comprehension as healthy people. Stepwise linear regression analysis found that hostility, poor impulse control and suspiciousness/persecution and preoccupation in the PANSS may have contributed to the reduced sensitivity in the rating in patients (t=-2.38-3.80, p < .05).

Acquired Brain Injury-Induced Hyperphagia and Obesity, Successfully Treated With a GLP-1 Agonist

Background: Several Glucagon-like peptides 1 (GLP-1s) were approved since 2005 for the treatment of DM & obesity. Their usefulness in other conditions is not well studied. We present two cases of hyperphagia after TBI successfully treated with GLP-1 agonists. Clinical cases: Case 1: A 54-year-old female with a history of multiple traumatic brain injuries (multiple falls and a ski accident) complained of years of insatiable hunger leading to hyperphagia and over 20 pounds weight gain. With tremendous will-power, she avoided additional weight gain by adopting a strict meal-plan and increasing her water intake (10–12 liters a day) to relieve her hunger. She sipped so much water, that her sodium remained 123 - 133 mmol/L (ref: 135–146) with dilute urine. Initial tests revealed: IGF-1 315 ng/ml (52–328), FSH 77.5 mIU/ml (23–116.3), LH 24.3 mIU/ml (14.2–52.3), prolactin 17.1 ng.ml (10–54.7), estradiol 17 (<31), TSH 1.09mIU/ml (0.45–4.5), FT4 1.0 ng/dl(0.8–1.8), all within the normal limit for her age. Semaglutide 0.25mg/week was started and increased to 0.5mg/week. Within the first six months of treatment, she experienced 22 pounds of weight loss, hunger relief, less water sipping behavior, and more enjoyment of food. Her sodium rose to 137 mmol/L. Case 2: A 40-year-old female, s/p craniectomy and aneurysm clipping due to intracranial hemorrhage complicated by an ischemic stroke developed sudden, documented, 45-pound weight gain over thirteen months despite aggressive lifestyle modification attempts. Initial labs revealed: TSH 1.33 mIU/ml (0.45–4.5), FT4 1.22 ng/dl (0.8–1.8), midnight salivary cortisol 0.03 mcg/dl (<0.09), ruling out hypothyroidism and Cushing syndrome. Liraglutide 1.8mg/day was started and has resulted to date in 26 pounds (11.8% of maximum weight) by 9 months with an associated decrease in subjective hunger. Conclusion: Hyperphagia can be seen in brain injury, in response to some medications, and some genetic conditions, like Prader-Willi. The exact mechanisms are not clear am may be multifactorial. In the case of brain injury, proposed mechanisms include insatiable hunger due to ventromedial hypothalamic or brain stem dysfunction, or disinhibition and poor impulse control due to frontal lobe injury. GLP-1’s may act on the causal mechanism for increased hunger, or it may result in clinical improvement through a parallel pathway. More studies are warranted to investigate the application of GLP-1’s to hyperphagia.

Game Transfer Phenomena and Problematic Interactive Media Use: Dispositional and Media Habit Factors

The study of the effects of interactive media has mainly focused on dysregulated behaviors, the conceptualization of which is supported by the paradigms of addiction. Research into Game Transfer Phenomena (GTP) examines the interplay between video game features, events while playing, and the manipulation of hardware, which can lead to sensory-perceptual and cognitive intrusions (e.g., hallucinations and recurrent thoughts) and self-agency transient changes (e.g., automatic behaviors) related to video games. GTP can influence the interpretation of stimuli and everyday interactions and, in contrast to gaming disorder, are relatively common and not necessarily negative. However, some players have reported feeling distress due to their GTP. This study focuses on how dispositional and interactive media habit factors are related to GTP and two forms of problematic interactive media [problematic video game playing (PVG) and problematic social media use (PSMU)]. A sample of 343 university students who played video games completed an online survey (58.7% male, 19–25 years old). Not all who had experienced GTP were identified as exhibiting PVG or PSMU, but all of those in the PVG group had experienced GTP. Overall, the profiles of the groups, including GTP (91.4%), PVG (28.5%), and PSMU (24.8%), were in accordance with previous findings. Those in the GTP and the PVG groups were characterized by being male, being highly engaged in the game (either while playing or via game-related activities), and showed preferences for game-related activities. However, while those in the GTP group were significantly more likely to be fantasy-prone, those with PVG were the ones who played most per day. Those in the PSMU group were characterized by being female and/or extroverted, frequently using social/sharing platforms, and seldom playing video games. A hierarchical binary logistic regression revealed that males were more likely to experience GTP. Increases in PVG, fantasy proneness, and neuroticism increased the odds of GTP. Future work can benefit from considering the role of GTP in gaming disorder, since intrusive thoughts, cognitive biases, and poor impulse control are pivotal in the initiation and maintenance of dysfunctional playing behaviors.

Pica and attention deficit hyperactivity disorder: is there a link? Comorbidity and treatment outcomes with methylphenidate

Introduction: Pica is the persistent ingestion of non-nutritive substances. It is common during childhood and may be related to nutritional deficits, intellectual disability, stress, and psychosis. However, no causative biological condition is identified in most cases and there is limited evidence to support pharmacological intervention. As several authors describe pica as an impulse control disorder and impulsive symptoms are a core aspect of the diagnostic criteria of attention deficit hyperactivity disorder (ADHD), this study reviews literature data on pica, ADHD, and treatment response during childhood and adolescence and adds two case reports to this body of evidence. Methods: Systematic literature review using the key terms “pica”, “attention deficit”, “hyperactivity”, “child”, and “adolescent”. A retrospective analysis of clinical data of two patients with pica and ADHD followed at the Child and Adolescent Psychiatry Department of Hospital Pediatrico was also conducted. Results: As far as the authors are aware, only three cases are currently reported in the literature describing comorbid pica and ADHD in children. Of these, two reported complete pica symptom remission after methylphenidate treatment. Two other cases of children with pica and ADHD observed at the Child and Adolescent Psychiatry Department of our institution were reported in this study, one of which had complete symptom remission after psychostimulant treatment optimization. Discussion: The suggested association between pica and ADHD may have underlying etiology in poor impulse control and dopaminergic system dysfunctions. Therefore, a pharmacological approach capable of improving dopaminergic functioning may be an alternative treatment for pica. Psychostimulants may improve pica by eliciting an increase in brain dopamine levels and a decrease in impulsivity.

Hebephrenic schizophrenia as a variant of frontotemporal dementia – the true dementia praecox?

IntroductionFrontotemporal Demential (FTD) is a neurodegenerative disorder evolving the frontal or temporal brain lobes. They have been described six variants. Behaviour variant (BvFTD) is the most common, and is characterized by changes in social behaviour and conduct, with loss of social awareness and poor impulse control. Hebephrenic schizophrenia (HSz), or disorganized schizophrenia, was recognized as a schizophrenia subtype, characterized by desorganized behaviour and a cognitive deteriorization. Subtypes of schizophrenia are no longer recognized as separate conditions neither in the Diagnostic and Statistical Manual of Mental Disorders, nor in the new International Statistical Classification of Diseases.ObjectivesTo review the literature about the concepts of hebephrenic schizophrenia and their similarities with the concept of frontotemporal dementiaMethodsNarrative review of the literature on PubMed/MEDLINE, using the keywords “hebephrenic szchizophrenia” AND “frontotemporal dementia”. Only articles in English were included.ResultsSome authors described dificulty in establish a diferential diagnosis between HSz and BvFTD. HSz has an earlier onset. However, BvFTD is an early age dementia. The fenomenology of both diseases is similar, and schizophrenia was historical conceptualized as praecox dementia. Frontotemporal abnormalities are common neuroimagiological findings in schizophrenia. Clinically, FTD shows a profound alteration in personality and social conduct, emotional blunting and loss of insight. Memory, intellectual functions, executive and attentional abilities may be disturbed in both.ConclusionsA diferential diagnosis between HSz and BvFTD is dificult to establish (clinically and imagiologically). The response to treatment is weak in both. It should be investigated the possibility they could be the same syndrome, onseting in diferent ages.DisclosureNo significant relationships.

Impact of Broken Family upon Adolescents’ Behavior at Secondary Schools in AL- Najaf AL-Ashraf City

Background: Broken families It is the family under divorce, separation, death of father, death of motherand death of both parents. It is the legal termination of marriage. It is also the dissolution of marriage thatis contracted between husband and wife by the judgment of a court of competent jurisdiction or by an actof the legislature. Separation and divorce have exclusion and negative effects on the behavior of children aswell as the burden of education for those in charge of it, which involves risks to the psyche and the degreeof coping with children.Objectives: To determine broken families among secondary school adolescents, assess secondary school’sadolescents’ behaviors, determine the impact of broken families on adolescents’ behaviors, and to findout the relationship between adolescent’s behaviors underbroken family and their socio-demographiccharacteristics of age, gender, parent’s education levels, family type and socio-economic status.Methodology: Anon-probability (purposive) sample of (555) students, whose age are between 12 to 18years have been selected; the sampling of study is divided into two stages which include: First stage: theschool’s selection by cluster, the AL-Najaf City divided to six districts, the schools selected randomly (36)school’s boys and girls, from (130) total schools .Second stage: students under broken family selection byusing the purposive sampling, while control group from each school students were randomly selected.Results: Indicate that there is significant relationship between the adolescent’s gender under broken familyand their behavior domain excessive suffering, poor anger control and poor social conformity. While there isa non-significant relationship between the adolescent’s gender under broken family and their other behaviordomains. The results show that there is a highly significant relationship between adolescent’s Educationallevel under broken family and their behavior domain poor impulse control and poor anger control. Whilethere is a non-significant relationship between the adolescent’s Educational level under broken family andtheir other behavior domains.Conclusion: That most of the secondary school’s adolescents under broken family have Behavior problems.Recommendation: To the Governments and Schools should create awareness on the ills of broken homeson the academic, emotional and social adjustments of students through training, workshops and seminars.Parents should be enlightened on the need to stay together as husband and wife to raise a good family

Myofunctional Therapy Using Twin Block Appliance in a Class II Malocclusion Patient with ADHD Author(s)Yufita Fitriani, Mega Moeharyono Puteri, Sindy Cornelia Nelwan, Nur Masyitah Iskandar Putri

A 9-year-old male ADHD patient with class II dentoskeletal malocclusion came to the Pediatric Department of Universitas Airlangga, Surabaya, with a chief complaint of a protrusive look. The patient had a behavior disorder of ADHD (Attention Deficit Hyperactivity Disorder), in which its symptoms may be challenging in dental treatment since it heavily depends on the patient’s obedience and case selection. References and similar studies of myofunctional therapy in Class II Malocclusion Patients with ADHD are still scarce. Most patients with class II malocclusion present with hyperactive perioral muscle and altered tongue position. Hence, myofunctional appliance is a reliable treatment choice. A special rule where the patient was asked to focus on the operator’s instruction for 10 minutes and then a 5-minute break, was applied to this patient to overcome ADHD symptoms as a behavior management strategy. This is in line with a theory stating that children with ADHD are prone to distraction, causing them to have a shorter duration of focus, limited sustained attention span, poor impulse control, and motor overactivity compared to normal children. This strategy gave a positive result in maintaining the cooperation of the patient using the twin block for 6 months which is lead to positive progress in malocclusion correction.

Inhibitory control and impulsive responses in neurodevelopmental disorders.

The impairment of inhibitory control is often assumed to be the core deficit of several neurodevelopmental disorders characterized by poor impulse control. However, could the same deficit explain different clinical phenotypes? Evidence from behavioural studies is very mixed. This is partly because inhibition is a highly complex executive function. Thus, the different types of tasks that generically tap into inhibitory control are likely to provide different outcomes. Additionally, sample inhomogeneity in terms of age, comorbidity, and medical treatment are confounding factors. Therefore, to make a reliable assessment of the deficit of inhibitory control in a given disorder, the same task and samples with similar characteristics must be employed. This article reviews and discusses studies on five neurodevelopmental disorders with impaired impulse control where these criteria have been used: Tourette syndrome; obsessive-compulsive disorder; attention-deficit/hyperactivity disorder; primary motor stereotypies; and autism spectrum disorder. Overall, they suggest that the mechanisms underlying the inability to control urges are extremely heterogeneous and cannot be ascribed to a general impairment of inhibition. These findings do not support the hypothesis that inhibitory deficits represent a transdiagnostic feature of neurodevelopmental disorders with poor impulse control. WHAT THIS PAPER ADDS: The mechanisms underlying the inability to control urges in neurodevelopmental disorders are heterogeneous. Inhibition impairments cannot generally explain all neurodevelopmental disorders characterized by poor urge control.

Comparative Analysis of Indicators of the Early Stages of Sensory and Sensorimotor Information Processing in Aggressive and Nonaggressive Schizophrenia Patients

Objective. To study the characteristics of the early stages of sensory (inhibition of the P50 event-related potential) and sensorimotor (prestimulus modification of the acoustic startle reaction (ASR)) information processing in patients with schizophrenia taking account of their behavioral characteristics. Materials and methods. Two groups of patients were investigated using oculography and electroencephalography: aggressive patients (group A, 44 subjects) and nonaggressive patients (group NA, 27 subjects); a control group of 48 healthy subjects were also studied. Patients’ mental status was assessed on the PANSS. Results and conclusions. These studies identified features characteristic of schizophrenia patients, particularly increases in the latent period of ASR, deficiency of prestimulus inhibition (PSI) (with delay intervals of 60 msec), and inhibition of P50 relative to normal. The aggressivity factor influenced the lateralized features of these deviations in ASR only in group A. Group NA showed an increase in baseline ASR amplitude and a decrease in prestimulus ASR amplitude. Analysis of P50 showed a significant increase in amplitude and a decrease in latency in responses to the second stimulus in group NA. A significant increase on the G14 scale (Poor impulse control) and the nature of its correlation with ASR and P50 measures in group A suggested that increased impulsivity was an important factor in aggressive behavior in the cohort of patients studied here. The characteristics of ASR and P50 typical of group NA provided evidence of increased sensitivity to external stimuli, which may be associated with personality features inhibiting aggression. These results led to the conclusion that measures of the early stages of information processing can be regarded as potential predictors of aggressive behavior in schizophrenia patients.

Risk and Protective Factors for Gun Violence in Male Juvenile Offenders

ABSTRACT Objective To examine several risk and protective factors as predictors of future gun violence among male juvenile offenders. Method Data came from a longitudinal cohort of 1,170 male juvenile offenders (42.1% Black; 34.0% Latino; 19.2% White) ages 14–19 who were adjudicated for a serious offense. Interviews were conducted with participants every 6 months for 3 years and then annually for 4 years. The outcome was self-reported gun violence assessed at each follow-up. The time-lagged predictors included several self-reported risk factors (i.e., gun carrying, non-gun violence, drug dealing, heavy drinking, poor impulse control, rewards for crime, peer gun carrying, peer non-gun delinquency, gang membership) and protective factors (i.e., concern for others, expectations, and aspirations for work/family, religious beliefs, adult social supports). The data were analyzed using generalized estimating equation models. Results There were 266 participants who reported engaging in gun violence at one or more assessments. Gun carrying was a significant predictor of future gun violence; however, nearly half (49%) of the juveniles who reported gun carrying across the repeated assessments did not report engaging in gun violence. Besides gun carrying, several risk (i.e., drug dealing, heavy drinking, rewards for crime, gang membership, peer gun carrying) and protective (i.e., concern for others, aspirations for work/family, religious beliefs, adult social supports) factors significantly predicted gun violence, after controlling for their co-occurrence (Risk factor odds ratios = 1.18–1.50; Protective factor odds ratios =.44-.87; ps<.05). Conclusions Interventions designed to prevent gun violence among juvenile offenders should reduce targeted risk factors, while strengthening protective factors that may offset these risks.

The Relationship Between Response-Inhibitory Event-Related Potentials and Symptoms of Attention-Deficit/Hyperactivity Disorder in Adult Patients with Major Depressive Disorder.

ObjectiveAttention-deficit and poor impulse control have frequently been observed in major depressive disorder (MDD) and attention-deficit and hyperactivity disorder (ADHD). Altered event-related potential (ERP) performance, such as GoNogo tasks, has been regarded as a neurocognitive process associated with attention and behavioral inhibition. The aim of this study was to investigate the association between Nogo ERP and adult ADHD in MDD. MethodsA total of 64 participants with MDD (32 comorbid with ADHD) and 32 healthy controls aged 19–45 years were recruited; they performed GoNogo paradigms during electroencephalogram measurement. Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and the Adult ADHD Self-Report Scale (ASRS) were evaluated. Clinical measures and GoNogo ERP were compared between three groups: depression with ADHD, depression without ADHD, and healthy controls. ResultsMDD subjects with ADHD showed significantly decreased Nogo P3 amplitude at frontal electrode, compared with those without ADHD and healthy controls. MDD subjects with ADHD showed significantly longer Nogo N2 latency at frontal and frontocentral electrodes, compared with those without ADHD and healthy controls. In MDD subjects with ADHD, the Nogo P3 amplitude at the frontal electrode was negatively correlated with the ASRS score and inattention. The Nogo N2 latency at the frontal electrode was positively correlated with false alarm rate. Conclusion The decreased Nogo P3 amplitude in the frontal area might be a potential biological marker for inattention in depressed patients with ADHD.

Hostility and aggressive behaviour in first episode psychosis: Results from the OPTiMiSE trial

AimThe aim of this paper is to determine clinical factors related to hostility and disturbing and aggressive behaviour and to examine the effect of medication on these behaviours in FEP. MethodsData from phase I and II of the OPTiMiSE trial are used. Outcome measures are the hostility item of the Positive and Negative Syndrome Scale (PANSS P7) and the disturbing and aggressive behaviour domain of the Personal and Social Performance scale (PSP-D). ResultsModerate, severe or extreme hostility (PANSS P7 > 3) was present in 42 patients (9.4%). The PANSS P7 and PSP-D were low to moderate but significantly associated with the selected PANSS items: delusions, hallucinatory behaviour, excitement, tension, uncooperativeness, unusual thought content, impulsivity, and lack of judgement and insight. In a subsample of 185 patients (41.5%) with baseline PANSS P7 > 1, the PANSS P7 and PSP-D scores improved in the first 4 weeks of amisulpride treatment. This effect remained significant after controlling for baseline positive symptoms (PANSS P1-P6). No significant differences were found between olanzapine and amisulpride in the second phase of the trial. ConclusionClinical risk factors such as poor impulse control, uncooperativeness and excitement could help clinicians in detecting and treating hostile and aggressive behaviour in FEP. Amisulpride could be an effective antipsychotic choice in the treatment of FEP patients who express hostile or aggressive behaviour. Future research is needed to compare the effects of amisulpride and olanzapine on hostility in FEP during the first weeks of treatment.

Application of Region Efficiency Index in Functional Connectivity Analysis of Schizophrenia.

Functional connections (FCs) methodology based on functional MRI data is an effective lever to investigate macroscopic neural activity patterns underlying critical aspects of cognition and behavior in schizophrenia (SZs). Dysconnectivity hypothesis are important features of SZs. However, region properties of brain network have been less investigated by special markers of graph indexes in general mental disorders. Region efficiency index are introduced to explore the information integration capacity among different regions and subsystems. The important process is to uncover noticeable edge weight and region efficiency of FCs in 67 healthy controls and 53 chronic schizophrenia (SZs) patients. Forty-five abnormal edges with significant P-values of FCs weight scores are discovered. There is abnormal thalamic-cortical FCs in SZs. Importantly, hippocampus L, hippocampus R, and parahippocampal gyrus L are endowed with significantly different node efficiency scores in SZs patients. The scores of hippocampus L is consistent with motor retardation, lack of judgment and insight, and poor impulse control. Though strict contrastive study, it can be infer that the brain information integration is dysfunction in schizophrenia. Meanwhile, it is worth stressing that efficiency is a meaningful biological marker to excavating schizophrenic psychopathology.

Short-Term Fasting Selectively Influences Impulsivity in Healthy Individuals.

Previous research has shown that short-term fasting in healthy individuals is associated with changes in risky decision-making. The current experiment was designed to examine the influence of short-term fasting in healthy individuals on four types of impulsivity: reflection impulsivity, risky decision-making, delay aversion, and action inhibition. Participants were tested twice, once when fasted for 20 h, and once when satiated. Participants demonstrated impaired action inhibition when fasted; committing significantly more errors of commission during a food-related Affective Shifting Task. Participants also displayed decreased reflection impulsivity when fasted, opening significantly more boxes during the Information Sampling Task (IST). There were no significant differences in performance between fasted and satiated sessions for risky decision-making or delay aversion. These findings may have implications for understanding eating disorders such as Bulimia Nervosa (BN). Although BN has been characterized as a disorder of poor impulse control, inconsistent findings when comparing individuals with BN and healthy individuals on behavioral measures of impulsivity question this characterization. Since individuals with BN undergo periods of short-term fasting, the inconsistent findings could be due to differences in the levels of satiation of participants. The current results indicate that fasting can selectively influence performance on the IST, a measure of impulsivity previously studied in BN. However, the results from the IST were contrary to the original hypothesis and should be replicated before specific conclusions can be made.

Aggressiveness is associated with excitement on the five-factor model of the positive and negative syndrome scale and prefrontal function in patients with stable schizophrenia

Aggressiveness is a clinical concern in the stable phase of schizophrenia, as well as in the acute phase. The factors that affect aggressiveness during the stable phase remain unclear. This study investigated factors associated with aggressiveness in patients with stable schizophrenia. Sixty-six patients with schizophrenia who were in the stable phase without acute exacerbation were assessed for aggressiveness using the Buss–Perry Aggression Questionnaire; impulsivity using the Barratt Impulsiveness Scale Version 11, psychotic symptoms using the five-factor model of the Positive and Negative Syndrome Scale (PANSS) including positive symptoms, negative symptoms, disorganization, excitement, and emotional distress; and prefrontal hemodynamic responses using near-infrared spectroscopy. Multivariate regression analyses showed that the excitement factor of the PANSS five-factor model, which comprised four PANSS items (poor impulse control, hyperactivity, hostility, and uncooperativeness), and delayed prefrontal hemodynamic responses were associated with elevated aggressiveness. These findings suggest that in patients with stable schizophrenia, excitement symptoms and prefrontal dysfunction are associated with elevated aggressiveness. Furthermore, the impact of impulsive traits on aggressiveness is less relevant. Our results shed light on a specific aspect of aggressiveness in patients with stable schizophrenia and may indicate factors to consider in the clinical setting.

M47. AKATHISIA AND ATYPICAL ANTIPSYCHOTICS: EXPLORING ASSOCIATIONS TO SUICIDALITY AND AGITATION

BackgroundAntipsychotic associated akathisia is a highly relevant clinical phenomenon. The common side effect can be stigmatizing, cause subjective distress and depression, lead to medication noncompliance and be potentially disabling for patients with psychosis. Associations between akathisia and both suicide, depression and agitation has been suggested in research literature, but inconsistently. This study investigates the level of akathisia at hospital discharge/first follow-up for consecutively admitted patients with acute phase psychosis, comparing four atypical antipsychotics (AAPs) regarding the presence of akathisia, and explores possible associations between akathisia and both suicidality, depression and agitation.MethodsThis study is a sub-study of the Bergen Psychosis Project (BPP), a pragmatic, rater-blind, randomized trial comparing head-to-head ziprasidone, olanzapine, risperidone and quetiapine. The present study reports cross-sectional data at discharge/first follow-up after acute admission to hospital for patients with psychosis. Patients were assessed with The Positive And Negative Syndrome Scale (PANSS). We applied the validated PANSS Excited Component (PANSS-EC) factor to assess agitation. The PANSS-EC consists of the five PANSS items: P4 Excitement, P7 Hostility, G4 Tension, G8 Uncooperativeness and G14 Poor impulse control. To assess depression in general and suicidality specifically we used the validated Calgary Depression Scale for Schizophrenia (CDSS).Furthermore the Clinical Global Impression – Severity Scale (CGI-S), and the patient-administered version of the UKU Side Effect Self-Rating Scale (UKU SERS Pat).ResultsA total of 109 patients were included of which 35 (32.1 %) were females, mean age was 34.0 (12.4). The mean total PANSS score was 54.9 (14.4), the mean CGI-S was 3.7 (1.1) and the mean total CDSS score was 3.9 (4.0). Our preliminary results show that a total of 58 (53.3%) patients had used antipsychotics before entering the study. Some level of akathisia was reported by ¼ of the patients, meaning a score of 1 or more on the UKU SERS Pat. There was a statistically significant difference between ziprasidone and olanzapine, with higher akathisia level in the ziprasidone group. Furthermore, there were statistically significant correlations between akathisia and suicidality and between akathisia and depression. We found no significant correlation between akathisia and the PANSS-EC factor or between akathisia and the PANSS general item G14 Poor impulse control. Statistical details will be presented on the poster.DiscussionOur study shows that akathisia is a prevalent side effect in a clinically relevant sample of patients with acute phase psychosis treated with atypical antipsychotics. The prevalence of antipsychotic associated akathisia ranges widely across studies due to, among others, methodological heterogeneities and varieties in measurement tools. In our study, akathisia was significantly associated with both depression and suicidality. The finding of a significant correlation between akathisia and suicidality supports a previous finding that even a mild to moderate experience of akathisia in first episode patients had an increase in the likelihood to be suicidal. We found no relationship with agitation in our study. As akathisia may go unrecognized in clinical practice and may contribute to medication noncompliance, systematic assessment for symptoms of akathisia is warranted.ConclusionAkathisia is still a prevalent phenomenon in a substantial proportion of patients treated with atypical antipsychotics. Special attention is called for regarding the association towards suicidality.

Understanding Adolescent Vulnerability to Methamphetamine Use Disorder: The Role of Early Life Adversity, Impulse Control and Cognition

Among illicit substances, methamphetamine represents one of the greatest global health threats. More alarming, people aged as young as 15 have reported using meth in the past year. This is a major concern because adolescence is a period of heightened vulnerability to addiction. Evidence suggests that childhood adversity, poor impulse control and cognitive deficits may be contributing factors.