Rates Of Antisocial Personality Disorder Research Articles

Pathways for VA and community stakeholder management of military veterans with sexual offenses: Sexual and nonsexual recidivism rates and risk factors in military veterans released from California sexually violent predator (SVP) commitment.

Military veterans with sexual offenses committed after discharge are often eligible for Veterans Affairs (VA) services including health care. There are few, if any, studies of sexual recidivism among military veterans with sexual offense histories to guide clinical management. This study examined diagnostic and postrelease sexual and nonsexual recidivism among military sexual offenders released from California sexually violent predator (SVP) commitment. The sample consisted of 363 males; 131 were identified as military veterans and 232 as civilians. The rates of recidivism were assessed for two follow-up periods: a fixed 5-year and a total 21-year follow-up. Recidivism was operationalized as any new sexual, violent, or general criminal arrest or conviction occurring after discharge to the community in California. We found a low risk for sexual reoffense for both groups. Specific to veterans, the rates for sexual and nonsexual violent recidivism were under 7% for both follow-up periods. Diagnostically, veterans had a significantly higher rate of pedophilic disorder and lower rate of antisocial personality disorder than civilians; neither were predictive of sexual recidivism or any other recidivism. On average, veterans were 61 years old at discharge; and older age at discharge was associated with a significantly lower likelihood of recidivism of any type. A relatively high proportion of veterans had a history of childhood sexual abuse and head trauma. Trauma-informed care may be a particularly valuable treatment approach for veterans with sexual offenses. These data may aid the VA and other providers in forming evidence-based decisions regarding the management of veterans with sexual offenses. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predicting Antisocial Personality Features among Justice-Involved Males and Females: The Effects of Violence Exposure in Childhood and Adolescence

The high rate of antisocial personality disorder (ASPD) among individuals involved in the justice system represents a significant public health concern, as individuals with ASPD are more likely to reoffend after incarceration and to engage in longer-term offending behavior patterns over the lifespan. Research suggests that traumatic event exposure in childhood and adolescence may be one factor that contributes to the heightened risk for ASPD in adulthood, though findings are mixed depending on the operationalization of trauma exposure and demographics of study samples. The present study examined the impact of early and varied exposure to violence on the development of ASPD features in young adulthood. In addition, given evidence for gender differences in how youth respond to trauma, as well as disparate prevalence rates of ASPD among males and females, a secondary aim was to assess the impact of gender on the relationship between early trauma and antisocial personality outcomes. The study sample consisted of 1354 adolescents (86% male) who participated in a longitudinal research study of serious juvenile offenders. A series of linear regression analyses revealed that the magnitude of violence exposure participants endorsed at baseline significantly predicted antisocial personality features at six-year follow-up. Participants’ gender was not found to moderate the relationship between violence exposure and antisocial outcomes. Results suggest that targeting maladaptive cognitions and behaviors resulting from chronic exposure to early trauma may be a crucial component of treatment for justice-involved individuals exhibiting ASPD features.

Adult outcomes of childhood disruptive disorders in offspring of depressed and healthy parents

BackgroundLongitudinal studies of children with disruptive disorders (DDs) have shown high rates of antisocial personality disorder (ASPD) and substance use in adulthood, but few have examined the contribution of parental disorders. We examine child-/adulthood outcomes of DDs in offspring, whose biological parents did not have a history of ASPD, bipolar disorder, or substance use disorders. MethodOffspring (N = 267) of parents with or without major depression (MDD), but no ASPD or bipolar disorders were followed longitudinally over 33 years, and associations between DDs and psychiatric and functional outcomes were tested. ResultsEighty-nine (33%) offspring had a DD. Those with, compared to without DDs, had higher rates of MDD (adjusted odds ratio, AOR = 3.42, p < 0.0001), bipolar disorder (AOR = 3.10, p = 0.03), and substance use disorders (AOR = 5.69, p < 0.0001) by age 18, as well as poorer school performance and global functioning. DDs continued to predict MDD and substance use outcomes in adulthood, even after accounting for presence of the corresponding disorder in childhood (MDD: hazards ratio, HR = 3.25, p < 0.0001; SUD, HR = 2.52, p < 0.0001). Associations were similar among the offspring of parents with and without major depression. DDs did not predict adulthood ASPD in either group. LimitationsAssociations are largely accounted for by conduct disorder (CD), as there were few offspring with ADHD, and oppositional defiant disorder (ODD) was not diagnosed at the time this study began. ConclusionIf there is no familial risk for ASPD, bipolar disorder or substance use, childhood DDs do not lead to ASPD in adulthood; however, the children still have poorer prognosis into midlife. Early treatment of children with DD, particularly CD, while carefully considering familial risk for these disorders, may help mitigate later adversity.

The relation of borderline personality disorder to aggression, victimization, and institutional misconduct among prisoners

ObjectiveBorderline personality disorder (BPD) is highly prevalent among incarcerated populations; however, research has yet to examine whether prisoners diagnosed with BPD experience greater interpersonal dysfunction and institutional misconduct while incarcerated. ProcedureThis study drew from a sample of 184 male and female prisoners diagnosed with major depressive disorder (MDD) in a randomized trial of depression treatment. The presence of a BPD diagnosis (n = 69) was analyzed as a predictor of disciplinary incidents/infractions (i.e., fights, arguments with staff, disciplinary infractions, isolation), time spent in isolation, and types of aggression and victimization experiences during incarceration. ResultsThere was a trend suggesting prisoners with BPD were about twice as likely as those without BPD to report disciplinary incidents/infractions (OR = 1.76 [0.93, 3.32], p = 0.075). Having a BPD diagnosis was unrelated to time in isolation and overall aggression and victimization. However, prisoners with BPD were more likely than those without BPD to perpetrate and be victimized by psychological aggression. Due to high rates of antisocial personality disorder (ASPD) in the sample as a whole (72%), additional analyses compared outcomes across prisoners with no BPD or ASPD diagnosis, BPD diagnosis only, ASPD diagnosis only, and comorbid BPD and ASPD. Prisoners with comorbid BPD and ASPD were no more likely than prisoners with ASPD only to report disciplinary incidents/infractions, but were significantly more likely than those with ASPD only to report perpetrating and being victimized by psychological aggression. ConclusionsAmong prisoners with MDD, those with a BPD diagnosis have increased risk of psychological aggression and disciplinary infractions during incarceration.

Adult Psychiatric Comorbidities of Attention-deficit Hyperactivity Disorder Diagnosed in Childhood– Systematic Review

Introduction ADHD is one of the most frequent neurodevelopment disorders with variable persistence into adulthood. Adults with ADHD have been found to have a greater risk for other comorbid psychiatric disorders. Objectives/Aims: The aim of this study was to identify psychiatric disorders with higher rates of comorbidity with ADHD than would be expected from the base rates of those disorders in the population at large. Methods: Systematic review of longitudinal prospective studies. Pubmed and PsycINFO search up to September 2014, using 'ADHD” and 'adult”, combined with 'comorbidity” or 'outcome” and 'longitudinal” or 'prospective” as search terms. Results: We found 8 studies that met our inclusion criteria. All of them have shown that ADHD persisted into adulthood in a significant percentage of children with ADHD. Elevated rates of antisocial personality disorder (ASD) have also been shown in all studies. Higher rates of major depressive disorder and substance use disorder across lifetime have been reported in four of those studies, with the others showing no differences between ADHD and control group. Three studies have shown higher rates of anxiety disorders and bipolar disorder. One study of ADHD girls has shown higher rates of eating disorders in females with childhood ADHD. Only one study evaluated other personality disorders than ASD, reporting elevated rates of passive-agressive personality disorder, histrionic personality disorder and borderline personality disorder in adults with childhood ADHD. Conclusion: Only ASD showed consistent comorbidity with ADHD in all studies. More studies are needed to extract accurate conclusions.

Depression in Men: Issues for Practice and Research

Researchers have long observed that men and women tend to experience mental illnesses at different rates, with women showing higher rates of mood and anxiety disorders, and men showing higher rates of antisocial personality disorder and substance abuse. Yet, there seems to be anecdotal evidence all around us that men also suffer from depression and anxiety. The American Psychiatric Association reports that depression in men is not uncommon and often goes unrecognized and untreated. Research has shown that while men develop standard symptoms of depression, they often experience it differently and may have different ways of coping. Men may be more willing to report fatigue, irritability, loss of interest in work or hobbies, and sleep disturbances, rather than feelings of sadness, worthlessness, and excessive guilt. Depression also puts men at risk for suicide. More than 90% of people who died of suicide have pre-existing depression, and men are three times more likely than women to die by suicide. Recent reports of suicide in those who are active military and veterans have prompted studies of risk factors for suicide. Factors significantly associated with an increased risk of suicide include male gender, depression, manic-depressive disorder, heavy or binge drinking, and alcohol related problems. None of the deployment related factors (combat experience, cumulative days deployed, or number of deployments) were associated with an increased suicide risk. What explanations are offered for consistent finding of gender differences in rates of depression, not only in the US worldwide? The origins of these gender differences in prevalence rates are not well understood although various ideas have been proposed to explain how they arise. These explanations include response bias, differential service utilization rates, and various biological, social, and demographic influences. Several theoretical explanations have also been proposed. This article will discuss these ideas. Language: en

O7 * FREE ORAL COMMUNICATIONS 7: COMORBIDITY AND DETOXIFICATION

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Axis II Comorbidity of Borderline Personality Disorder in Adolescents

Aims: The objective of the present study was to explore the comorbidity of borderline personality disorder (BPD) with other personality disorders in adolescents and compare these comorbidities in male and female subjects. Methods: The sample was drawn from a European research project investigating the phenomenology of BPD in adolescence (EURNET BPD). A total of 85 BPD patients (11 boys and 74 girls) with a mean age of 16.3 years were included in the study. Results: According to the results of the Structured Interview for DSM-IV Disorders of Personality, obsessive-compulsive (35.3%), antisocial (22.4%), avoidant (21.2%), dependent (11.8%) and paranoid (9.4%) personality disorders had significant co-occurrences with BPD. Although none of the gender differences was statistically significant, we observed a trend towards higher rates of antisocial personality disorders in men (45.5%) than in women (19%). Conclusion: The study results confirmed the frequency of Axis II comorbidity in adolescents with BPD and, for the first time, evidenced a differential pattern of comorbidity in males and females. This differential pattern must be taken into account when developing treatment strategies for adolescents with BPD.

Crack Users Show High Rates of Antisocial Personality Disorder, Engagement in Illegal Activities and Other Psychosocial Problems

The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse patients (crack cocaine users, cocaine snorters, and non-cocaine PAS users) in terms of psychiatric comorbidities and severity of psychosocial problems. A cross-sectional, multi-center study was conducted at five Brazilian research centers. A total of 738 current PAS abusers seeking specialized treatment (outpatient and inpatient clinics) were assessed using the sixth version of the Addiction Severity Index (ASI-6): 293 patients using crack cocaine were compared with 126 using powder cocaine and 319 using non-cocaine PAS (mostly alcohol and marijuana). Psychiatric comorbidities were assessed in a smaller sample (290 cases), originating from three of the centers, using the Mini International Neuropsychiatric Interview Plus (MINI-Plus). Crack and powder cocaine users were significantly younger than non-cocaine PAS users (31.1 ± 8.1 and 32.9 ± 8.8 vs. 42.4 ± 12, respectively; p < .001). Crack users presented a higher rate of antisocial personality disorder (25%) than powder cocaine (9%) and non-cocaine PAS users (9%), even when adjusted for confounding factors (Pr = 2.6; 95% CI 1.10-6.40). According to ASI-6 summary scores, crack users presented a significantly higher rate of occupational, family, and legal problems and reported more illegal and violent activities such as burglary and theft (23%) and threatening or assaulting (32%) than non-cocaine PAS users. Our findings, combined with the recent increase observed in the prevalence of crack use in Brazil, highlight the severity of psychiatric symptoms and psychosocial problems related to this powerful drug and corroborate the already suggested association between crack/cocaine, violence, and legal problems. Treatment programs for crack users should routinely consider the possibility of associated psychiatric comorbidities, such as antisocial personality disorder, which may affect treatment outcomes.

P-81 - Early maladaptive schemas in addicts and their association with personality disorders

Introduction Substance dependence and personality disorders often co-occur and personality disorders are highly prevalent comorbid conditions among addicted individuals. Early maladaptive schemas contribute to development of personality disorders as well as addictive behaviors. Objectives Examining early maladaptive schemas among addict persons with and without personality disorders. Aims To determine whether there are particular schemas that are associated with specific personality disorders. Methods In this cross-sectional study the participants were 100 persons with substance dependence including 84 opioid addicts, 5 cannabis dependents and 11 subjects with methamphetamine dependence. Participants were given the Young Schema Questionnaire-Long Form in order to identify Early Maladaptive Schemas. Furthermore, structured Clinical Interview for DSM-IV (SCID-II) was performed by a trained interviewer to identify personality disorders. Results Fifty three percent of participants had borderline personality disorder and the rate of antisocial personality disorder was 14%. Borderline personality disorder was associated with abandonment and Mistrust/Abuse schemas. There was found no significance difference between persons with borderline personality disorder and subjects with antisocial personality disorder in terms of Early maladaptive schemas. Compared to subjects without personality disorder, participants with personality disorder had higher scores of “persormance” and “impaired limits” domains.There was a significant association between educational level and early maladaptive schemas. Conclusion People with schema domains of impaired performance and impaired limits may be more likely to develop cluster B personality disorders and this finding is in accordance with the previous study of the authors which showed that these domains of schemas were more prevalent among addict people.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterJifeng Cai Ph.D.Yan Gu Ph.D.Shuqiao Yao M.D., Ph.D.Jifeng Cai Ph.D.Search for more papers by this authorYan Gu Ph.D.Search for more papers by this authorShuqiao Yao M.D., Ph.D.Search for more papers by this authorPublished Online:1 Sep 2010https://doi.org/10.1176/ps.2010.61.9.947AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Screening for Personality Disorders Among Chinese Prison InmatesTo the Editor: Although only about one-third of the world's inmates live in Western countries, 99% of available data from prison surveys are derived from Western populations ( 1 ). Such disparity underscores the need for greater forensic psychiatric research in non-Western populations. We surveyed 2,961 inmates of five prisons in South China. Seventy-four percent (N=2,189) were men, and the mean±SD age was 30.0±9.9. We used the Personality Diagnostic Questionnaire–4+ (PDQ), the reliability and validity of which have been thoroughly confirmed in Chinese populations ( 1 ). Written informed consent was obtained. Data analyses were conducted with SPSS, version 13.0. Group differences were examined with t tests or Mann-Whitney U tests, depending on the nature of the data. Using a cutoff score of 4 or 5, depending on the personality disorder, we found rates of personality disorders ranging from 8% (N=240) to 67% (N=1,981). Borderline personality disorder and antisocial personality disorder were most common—52% (N=1,552) and 67% (N=1,981), respectively. Fazel and Danesh ( 2 ) systematically reviewed 62 studies on the prevalence of major psychiatric disorders among delinquents and found that approximately 65% (N=1,925) had a personality disorder, of which antisocial personality disorder was most common (47%, N=1,392) ( 1 ). One possible explanation for the higher prevalence of antisocial personality disorder in our study (67%) may be the poor economic status and low level of education of Chinese inmates. These factors have been linked to personality formation. Another explanation may be related to the large proportion of male inmates in our study. Rates of antisocial personality disorder were higher among male inmates than among female inmates in our sample (72% compared with 53%). The larger proportion of males resulted in a higher rate of antisocial personality disorder and higher average scores for the PDQ antisocial subtype. Among the 2,961 inmates, 42% (N=1,235) were violent offenders. We found that inmates with a history of violent behavior scored higher than nonviolent inmates on PDQ scales for antisocial, borderline, schizotypal, and depressive personality disorder. [A table comparing scores of inmate subgroups is available as an online supplement to this letter at ps.psychiatryonline.org .] These findings are consistent with those of a previous study, which found that antisocial and borderline personality disorders among men were correlated with violent conduct ( 3 ). Furthermore, the presence of antisocial personality traits among inmates with a history of violence has been consistently associated with an increased likelihood of violent reoffending ( 4 ). In a study of female offenders by Putkonen and colleagues ( 5 ), 81% of those who committed repeat offenses had a personality disorder diagnosis. In our sample, repeat offenders had significantly higher scores than first offenders on antisocial, depressive, and paranoid personality disorder scales (see online table). Thus personality disorder may have considerable predictive validity. A prison sentence should offer inmates an opportunity to receive psychiatric assessment and treatment that they may not have had access to outside prison. Furthermore, assessment and treatment may help prevent repeat offenses. Sadly, because of a lack of resources, this opportunity is often unavailable, and providing it remains a challenge for the Chinese government.Acknowledgments and disclosuresThis study was funded by grant 20060400892 from the Postdoctoral Science Foundation of China and grant 2007RS4032 from the Science Foundation of Hunan Province.The authors report no competing interests.Dr. Cai and Dr. Gu are affiliated with the Department of Forensic Science, School of Basic Medical Sciences, and Dr. Yao is with the Medical Psychological Research Center, all at Central South University, Changsha, Hunan, China.

Prospective Follow‐Up of Empirically Derived Alcohol Dependence Subtypes in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC): Recovery Status, Alcohol Use Disorders and Diagnostic Criteria, Alcohol Consumption Behavior, Health Status, and Treatment Seeking

We have previously reported on an empirical classification of Alcohol Dependence (AD) individuals into subtypes using nationally representative general population data from the 2001 to 2002 Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and latent class analysis. Our results suggested a typology of 5 separate clusters based upon age of onset of AD, multigenerational familial AD, rates of antisocial personality disorder (ASPD), endorsement of specific AD and Alcohol Abuse (AA) criteria, and the presence of comorbid mood, anxiety, and substance use disorders (SUD). In this report, we focus on the clinical follow-up of these cluster members in Wave 2 of the NESARC (2004 to 2005). The mean interval between NESARC Wave 1 and NESARC Wave 2 interviews was 36.6 (SD = 2.6) months. For these analyses, we utilized a Wave 2 NESARC sample that was comprised of a total of 1,172 individuals who were initially ascertained as having past-year AD at NESARC Wave 1 and initially subtyped into one of 5 groupings using latent class analysis. We identified these subtypes as: (i) Young Adult, characterized by very early age of onset, minimal family history, and low rates of psychiatric and SUD comorbidity; (ii) Functional, characterized by older age of onset, higher psychosocial functioning, minimal family history, and low rates of psychiatric and SUD comorbidity; (iii) Intermediate Familial, characterized by older age of onset, significant familial AD, and elevated comorbid rates of mood disorders SUD; (iv) Young Antisocial, characterized by early age of onset and elevated rates of ASPD, significant familial AD, and elevated rates of comorbid mood disorders and SUD; (v) Chronic Severe, characterized by later onset, elevated rates of ASPD, significant familial AD, and elevated rates of comorbid mood disorders and SUD. In this report, we examine Wave 2 recovery status, health status, alcohol consumption behavior, and treatment episodes based upon these subtypes. Significantly fewer of the Young Adult and Functional subtypes continued to meet full DSM-IV AD criteria in Wave 2 than did the Intermediate Familial, the Young Antisocial, and the Chronic Severe subtypes. However, we did not find that treatment seeking for alcohol problems increased over Wave 1 reports. In Wave 2, Young Antisocial and Chronic Severe subtypes had highest rates of past-year treatment seeking. In terms of health status, the Intermediate Familial, the Young Antisocial, and the Chronic Severe subtypes had significantly worse mental health scores than the Young Adult and Functional subtypes. For physical health status, the Functional, Intermediate Familial, Young Antisocial, and the Chronic Severe subtypes had significantly worse scores than the Young Adult subtype. In terms of alcohol consumption behavior, the Young Adult, Functional, and Young Antisocial subtypes significantly reduced their risk drinking days between Wave 1 and Wave 2, whereas the Intermediate Familial and the Chronic Severe subtypes did not. The results suggest that the empirical AD typology predicts differential clinical outcomes 3 years later. Persistence of full AD, treatment seeking, and worse mental health status were associated most strongly with those subtypes manifesting the greatest degree of psychiatric comorbidity. Reductions in alcohol consumption behavior and good physical health status were seen among the 2 younger subtypes. Overall, the least prevalent subtype, the Chronic Severe, showed the greatest stability in the manifestations of AD, despite having the highest rate of treatment seeking.

Multifinality in the development of personality disorders: A Biology × Sex × Environment interaction model of antisocial and borderline traits

Although antisocial personality disorder (ASPD) is more common among males and borderline PD (BPD) is more common among females, some authors have suggested that the two disorders reflect multifinal outcomes of a single etiology. This assertion is based on several overlapping symptoms and features, including trait impulsivity, emotional lability, high rates of depression and suicide, and a high likelihood of childhood abuse and/or neglect. Furthermore, rates of ASPD are elevated in the first degree relatives of those with BPD, and concurrent comorbidity rates for the two disorders are high. In this article, we present a common model of antisocial and borderline personality development. We begin by reviewing issues and problems with diagnosing and studying PDs in children and adolescents. Next, we discuss dopaminergic and serotonergic mechanisms of trait impulsivity as predisposing vulnerabilities to ASPD and BPD. Finally, we extend shared risk models for ASPD and BPD by specifying genetic loci that may confer differential vulnerability to impulsive aggression and mood dysregulation among males and impulsive self-injury and mood dysregulation among females. Although the precise mechanisms of these sex-moderated genetic vulnerabilities remain poorly understood, they appear to interact with environmental risk factors including adverse rearing environments to potentiate the development of ASPD and BPD.

Antisocial personality disorder and psychopathy in women: A literature review on the reliability and validity of assessment instruments

Crime rates are low in women compared to men. The two disorders most commonly associated with offending behaviour, antisocial personality disorder (ASPD) and psychopathy, are also less prevalent in female samples. However, developments in forensic psychiatry have often ignored gender, and the utility of constructs such as psychopathy and their assessment instruments in female samples remains unclear. This article presents a review of studies looking at rates of ASPD and psychopathy and on the reliability and validity of assessment instruments of these disorders in women. Gender differences in symptom patterns will be considered. The literature seems to suggest that DSM-IV criteria for ASPD may lead to an underestimation of the prevalence of the disorder in women due to the requirement of childhood conduct disorder symptoms. The Psychopathy Checklist-Revised (PCL-R) is a valid and reliable instrument to identify psychopathy in women but there are gender differences in the factor structure and item loadings on this measure. Research to date seems to suggest a three-factor model may be most strongly supported in females. Preliminary evidence suggests the PCL-R may have some value in predicting future offending while the PCL:SV may be useful in predicting institutional violence. Clinical implications are discussed.

A Developing World Perspective on Homicide and Mental Disorder: An Eighteen-Year Retrospective Study (1980–1998) at Jos, Nigeria

We examined the association between mental disorder and homicide in a developing country. Specifically, we studied culpable homicide offenders referred for psychiatric evaluation in Northern Nigeria, including their psychiatric diagnoses and their relationship with victims. A semi-structured questionnaire was used to collect forensic, demographic, and clinical information from 12,500 patients who underwent court-ordered psychiatric evaluations at the Jos University Teaching Hospital. Of all patients evaluated at the hospital, 1.3% had committed a homicide. Schizophrenia was the most common diagnosis among homicide offenders; there were relatively low rates of antisocial personality disorder and substance dependence. Most offenders knew their victims. The mean duration of time between arrest and psychiatric assessment was 24 months, with a range between 6 to 192 months. We discuss the implications of these findings with respect to motivations for homicide, the evaluation of offenders, and the need for treatment and follow-up of patients.

Personality Disorders Over Time: Precursors, Course, and Outcome

Personality Disorders Over Time: Precursors, Course, and Outcome

Antisocial personality disorder and TC treatment outcomes

There is a belief that persons diagnosed with antisocial personality disorder (APD) do not respond well to treatment, but the existing research has not supported this hypothesis. This study examined the relationship of APD to therapeutic community (TC) treatment outcomes. A total of 275 men and women were randomly assigned to two TCs. It was hypothesized that clients diagnosed with APD via the Millon Clinical Multiaxial Inventory (MCMI-II) would have poorer treatment outcomes than those with no APD. The MCMI-II was used to diagnose APD because of its focus in underlying pathological personality traits, as opposed to strict behavioral criteria as used in the Diagnostic and Statistical Manual of Mental Disorders classifications for APD; this hypothesis was not supported. Logistic regression analyses indicated that an MCMI-II diagnosis of APD was unrelated to treatment outcomes. Treatment completion was the most important factor in reducing recent drug use and post-discharge arrests. The results indicate that persons diagnosed with APD, with histories of substantial drug abuse and criminality, can benefit from TC treatment with aftercare in the community or at the very least, do as well as those with no APD. In light of the high prevalence rates of APD in substance-abusing populations, future research should continue to explore the many issues surrounding the diagnosis of APD, as well as its relationship to treatment outcomes.

The early-onset fearful panic attack as a predictor of severe psychopathology

The objective of this study was to replicate previous findings indicating that early-onset panic attack (≦20 years) with fear represents a possible prodrome of early-onset severe psychopathology. Data were drawn from the Epidemiologic Catchment Area Survey (ECA) ( n=20 291), a household sample of adults aged 18 and older drawn from five cities in the United States. Multivariate logistic regression analyses were used to differentiate those with early-onset panic attacks with fear from those with other panic attacks (early-onset without fear, late-onset without fear, late-onset with fear) with regard to psychiatric comorbidity, age at onset of comorbid mental disorders, and suicidal ideation and suicide attempts. Results of statistical analyses revealed that early-onset fearful panic attack ( n=368) was associated with increased likelihood of major affective and substance use disorders, significantly earlier onset of comorbid mental disorders, higher rates of suicidal ideation and suicide attempt, and higher rates of antisocial personality disorder compared with those with other subtypes of panic attacks. Multiple logistic regression analyses showed that early-onset fearful panic was independently associated with increased odds of major depression [OR=3.0 (2.6, 3.5)], bipolar disorder [OR=7.9 (5.7, 10.8)], antisocial personality disorder [OR=1.5 (1.3, 1.7)], agoraphobia [OR=1.2 (1.1, 1.4)], simple phobia [OR=1.6 (1.4, 1.8)], and alcohol dependence [OR=1.3 (1.2, 1.5)], compared with those with all other panic attacks. These findings are consistent with previous epidemiologic data and provide new evidence to suggest that early-onset fearful panic attack may be a marker of increased vulnerability to severe and persistent psychopathology and associated with high rates of suicidality.

Fourteen-Year Follow-up of Speech/Language-Impaired and Control Children: Psychiatric Outcome

To examine the association between early childhood speech and language disorders and young adult psychiatric disorders. In a longitudinal community study conducted in the Ottawa-Carleton region of Ontario, Canada, interviewers administered structured psychiatric interviews to age 19 participants who were originally identified as speech-impaired only, language-impaired, or nonimpaired at age 5. The first stage of the study took place in 1982 when participants were 5 years old, and the latest stage of the study took place between 1995 and 1997 when participants had a mean age of 19 years. This report examines the association between early childhood speech/language status and young adult psychiatric outcome. Children with early language impairment had significantly higher rates of anxiety disorder in young adulthood compared with nonimpaired children. The majority of participants with anxiety disorders had a diagnosis of social phobia. Trends were found toward associations between language impairment and overall and antisocial personality disorder rates. Males from the language-impaired group had significantly higher rates of antisocial personality disorder compared with males from the control group. Age of onset and comorbidity did not differ by speech/language status. The majority of participants with a disorder had more than one. Results support the association between early childhood speech and language functioning and young adult psychiatric disorder over a 14-year period. This association underscores the importance of effective and early interventions.

Validation of a system of classifying female substance abusers on the basis of personality and motivational risk factors for substance abuse.

This study explored the validity of classifying a community-recruited sample of substance-abusing women (N = 293) according to 4 personality risk factors for substance abuse (anxiety sensitivity, introversion-hopelessness, sensation seeking, and impulsivity). Cluster analyses reliably identified 5 subtypes of women who demonstrated differential lifetime risk for various addictive and nonaddictive disorders. An anxiety-sensitive subtype demonstrated greater lifetime risk for anxiolytic dependence, somatization disorder, and simple phobia, whereas an introverted-hopeless subtype evidenced a greater lifetime risk for opioid dependence, social phobia, and panic and depressive disorders. Sensation seeking was associated with exclusive alcohol dependence, and impulsivity was associated with higher rates of antisocial personality disorder and cocaine and alcohol dependence. Finally, a low personality risk subtype demonstrated lower lifetime rates of substance dependence and psychopathology.