Specific Psychiatric Conditions Research Articles

The Severity of Personality Pathology: A Risk Factor for Concurrent Substance Use Disorders in Alcohol Use Disorder

Objective: Co-occurrence of substance use disorders (CO-substance use disorders) among individuals with alcohol use disorder (AUD) is largely recognized as a critical clinical issue. However, the specific clinical variables involved are still unclear. The recent findings are controversial in pointing out the unique contribution of both impulsivity and emotion dysregulation on CO-substance use disorders. Furthermore, the co-variation between AUD and other substance use disorders includes different aspects of maladaptive personality functioning (i.e., overall severity and specific features). Therefore, this study aims at clarifying the role of impulsivity, emotional dysregulation, and severity of personality pathology on CO-substance use disorders among treatment-seeking individuals with AUD. Methods: One hundred ninety-three treatment-seeking individuals with AUD (DSM-IV-TR) were consecutively recruited. Impulsivity (Barratt Impulsiveness Scale [BIS-11]), emotional dysregulation (Difficulties in Emotion Regulation Scale [DERS]), and personality pathology (Structured Clinical Interview for DSM-IV Axis II Personality Disorder [SCID-II]) were assessed after a 2-week detoxification period. The analyses were based on several stepwise forward logistic regressions. The total score of BIS-11 and DERS together with the number of SCID-II criteria were considered, in following the order, as independent variables controlling for the comorbidity with other lifetime Axis I disorders. CO-substance use disorders was the dependent variable (i.e., any CO-substance use disorders, benzodiazepine and cannabis/cocaine use disorders). Results: The number of SCID-II criteria was the only significant predictor of overall CO-substance use disorders, odds ratio (OR) = 1.16; 95% confidence interval (CI) [1.07, 1.26], p < .01, and cannabis/cocaine use disorders, OR = 1.19; 95% CI [1.08, 1.31], p < .01. On the contrary, DERS total score was the most robust predictor of benzodiazepine use disorder, OR = 1.02; 95% CI [1.01, 1.04], p < .01, albeit the severity of maladaptive personality functioning was also significantly associated with this disorder, OR = 1.09; 95% CI [1.00, 1.18], p < .05. Conclusions: The severity of maladaptive personality pathology represents one of the main aspects involved in CO-substance use disorders among individuals with AUD. This dimension predicts the CO-substance use disorders above and beyond specific personality dimensions and other psychiatric conditions. Therefore, personality functioning should be precisely assessed and personality pathology should be addressed in the framework of AUD treatments for promoting effective long-term outcomes.

Clinical guidelines for the management of depression with specific comorbid psychiatric conditions French recommendations from experts (the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental)

BackgroundRecommendations for pharmacological treatments of major depression with specific comorbid psychiatric conditions are lacking.MethodThe French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of depression based on the RAND/UCLA Appropriatneness Method. Recommendations for lines of treatment are provided by the scientific committee after data analysis and interpretation of the results of a survey of 36 psychiatrist experts in the field of major depression and its treatments.ResultsThe expert guidelines combine scientific evidence and expert clinician’s opinion to produce recommendations for major depression with comorbid anxiety disorders, personality disorders or substance use disorders and in geriatric depression.ConclusionThese guidelines provide direction addressing common clinical dilemmas that arise in the pharmacologic treatment of major depression with comorbid psychiatric conditions.

Validation, reliability, and specificity of CliniCom™ Psychiatric Assessment Software

The purpose of this study was to determine the specificity and reproducibility of CliniCom™ Psychiatric Assessment Software to appropriately diagnose five prevalent mental health disorders. This online assessment tool incorporates proprietary algorithms for its propensity assessment. Unlike other questionnaires, which require a survey per specific mental disorder, CliniCom can simultaneously assess multiple mental disorders for an individual. CliniCom was concordant with other commonly used assessment tools in diagnosing five prevalent disorders including: Attention Deficit and Hyperactivity Disorder, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder, and Social Phobia. The online tool was overall 78% concordant in diagnosing the same disorder during a test-retest analysis. When subjects exhibited two, three, or four disorders, the tool was less consistent in diagnosing the same set of disorders during the test-retest analysis (53% concordant). However, if evaluated as individual disorders within subjects, the more persistent disorders had a higher rate of concordance: MDD (83.3%), ADHD (81.0%), and OCD (68.4%). This study proposes CliniCom as an online assessment tool that demonstrates specificity in identifying specific psychiatric conditions and shows reproducibility over multiple administrations.

Combinatorial Inputs to the Ventral Striatum from the Temporal Cortex, Frontal Cortex, and Amygdala: Implications for Segmenting the Striatum.

The canonical striatal map, based predominantly on frontal corticostriatal projections, divides the striatum into ventromedial-limbic, central-association, and dorsolateral-motor territories. While this has been a useful heuristic, recent studies indicate that the striatum has a more complex topography when considering converging frontal and nonfrontal inputs from distributed cortical networks. The ventral striatum (VS) in particular is often ascribed a “limbic” role, but it receives diverse information, including motivation and emotion from deep brain structures, cognition from frontal cortex, and polysensory and mnemonic signals from temporal cortex. Using anatomical tract-tracing in 17 male adult monkeys (Macaca nemestrina, Macaca fascicularis, Macaca mulatta), we build upon this striatal map by systematically mapping inputs from frontal cortex, amygdala, temporal pole, and medial temporal cortex. We find that the VS contains heterogeneous subregions that become apparent when considering both the identities and strengths of inputs. We parcellated the VS into a ventromedial sector receiving motivation and emotion-related information from regions including area TG, ventromedial PFC, ACC, and amygdala; and a more functionally diverse dorsolateral sector that receives this information coupled to cognitive and sensorimotor information from dorsolateral PFC, ventrolateral PFC, premotor cortex, area TAr, and area TEr. Each sector was further parcellated into smaller regions that had different proportions of these inputs. Together, the striatum contains complex, selective input combinations, providing substrates for myriad associations. This VS parcellation provides a map that can guide and interpret functional interactions in healthy individuals and those with psychiatric disorders, and may be useful in targeting treatments for specific psychiatric conditions.

Identifying Local Hot Spots of Pediatric Chronic Diseases Using Emergency Department Surveillance

ObjectiveTo use novel geographic methods and large-scale claims data to identify the local distribution of pediatric chronic diseases in New York City. MethodsUsing a 2009 all-payer emergency claims database, we identified the proportion of unique children aged 0 to 17 with diagnosis codes for specific medical and psychiatric conditions. As a proof of concept, we compared these prevalence estimates to traditional health surveys and registry data using the most geographically granular data available. In addition, we used home addresses to map local variation in pediatric disease burden. ResultsWe identified 549,547 New York City children who visited an emergency department at least once in 2009. Though our sample included more publicly insured and uninsured children, we found moderate to strong correlations of prevalence estimates when compared to health surveys and registry data at prespecified geographic levels. Strongest correlations were found for asthma and mental health conditions by county among younger children (0.88, P = .05 and 0.99, P < .01, respectively). Moderate correlations by neighborhood were identified for obesity and cancer (0.53 and 0.54, P < .01). Among adolescents, correlations by health districts were strong for obesity (0.95, P = .05), and depression estimates had a nonsignificant, but strong negative correlation with suicide attempts (−0.88, P = .12). Using SaTScan, we also identified local hot spots of pediatric chronic disease. ConclusionsFor conditions easily identified in claims data, emergency department surveillance may help estimate pediatric chronic disease prevalence with higher geographic resolution. More studies are needed to investigate limitations of these methods and assess reliability of local disease estimates.

Description of the prevalence of psychiatric disturbances in patients with refractory epilepsy

IntroductionPsychiatric morbidity in epilepsy is high, with prevalence rates of up to 50%, being higher in treatment-refractory cases. This co-morbidity worsen the quality of life. Psychiatric comorbidities are hampered by atypical presentations or disorders, which do not appear in the DSM-IV or ICD.ObjectivesTo describe the psychiatric morbidity in a group of patients with refractory-epilepsy.AimsTo provide evidence of the high morbidity and show the prevalence of the different psychiatric disorders.MethodsWe cross-sectional assessed psychiatric disturbances in resistant-epileptic patients using SCID for DSM-IV and clinical interview for epileptic specific psychiatric conditions. We grouped psychiatric disturbances into six clusters:– affective disorders;– anxiety disorders;– psychotic disorders;– eating disorders;– conduct disorder;– substance use disorder.We also considered epilepsy specific conditions as Interictal Psychotic Disorder (IPI) and Interictal Dysphoric Disorder (IDD) characterized by 3/8 symptoms: depressive mood, anergia, pain, insomnia, fear, anxiety, irritability, and euphoric mood.ResultsThe sample consist on 153 patients, with a mean age of 37. In total, 42.5% were males. One or more axis I diagnoses was seen in 38% of the patients. The most common condition was IDD (27.1%), followed by affective disorders (22%), anxiety disorders (15.3%), psychotic disorders (4%) and drug use (2%). There were no patients with eating or conduct disorders or IPI.ConclusionsPsychiatric morbidity is frequent in resistant-epilepsy. Despite 38% of patients suffered from at least one axis I diagnoses, IDD was the most prevalent condition and not included in SCID interview.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Chemistry-based molecular signature underlying the atypia of clozapine

The central nervous system is functionally organized as a dynamic network of interacting neural circuits that underlies observable behaviors. At higher resolution, these behaviors, or phenotypes, are defined by the activity of a specific set of biomolecules within those circuits. Identification of molecules that govern psychiatric phenotypes is a major challenge. The only organic molecular entities objectively associated with psychiatric phenotypes in humans are drugs that induce psychiatric phenotypes and drugs used for treatment of specific psychiatric conditions. Here, we identified candidate biomolecules contributing to the organic basis for psychosis by deriving an in vivo biomolecule-tissue signature for the atypical pharmacologic action of the antipsychotic drug clozapine. Our novel in silico approach identifies the ensemble of potential drug targets based on the drug’s chemical structure and the region-specific gene expression profile of each target in the central nervous system. We subtracted the signature of the action of clozapine from that of a typical antipsychotic, chlorpromazine. Our results implicate dopamine D4 receptors in the pineal gland and muscarinic acetylcholine M1 (CHRM1) and M3 (CHRM3) receptors in the prefrontal cortex (PFC) as significant and unique to clozapine, whereas serotonin receptors 5-HT2A in the PFC and 5-HT2C in the caudate nucleus were common significant sites of action for both drugs. Our results suggest that D4 and CHRM1 receptor activity in specific tissues may represent underappreciated drug targets to advance the pharmacologic treatment of schizophrenia. These findings may enhance our understanding of the organic basis of psychiatric disorders and help developing effective therapies.

Indian nursing students' attitudes toward mental illness and persons with mental illness.

Background:Nursing fraternity play a pivotal role in psychiatric services. Negative attitudes toward mental illness have been consistently reported in nursing students. Psychiatric conditions and persons suffering from them may elicit different kinds of attitudinal responses.Objective:The current study aimed at assessing the attitude toward mental illness and also at comparative evaluation of the attitude toward persons with different psychiatric, physical, and social conditions.Materials and Methods:The present study was carried out among conveniently selected nursing students (n = 100) using Attitude Scale for Mental Illness (ASMI) and Attitude to Mental Illness Questionnaire (AMIQ) on their 1st day of psychiatric posting.Results:Higher stereotype (3.1 ± 0.8), benevolence (3.7 ± 0.6), and pessimistic prediction (3.4 ± 0.9) were reported toward mental illness. Negative attitude was noted toward persons with criminal background (4.8 ± 3.7), heroin abuse (3.2 ± 3.6), suicidal depression (1.36 ± 3.6), alcohol use (0.59 ± 4.38), and schizophrenia (0.03 ± 3.2) in the same order, with positive attitude toward diabetic (−4.4 ± 3.9) and religious persons (−5.13 ± 3.6). Significant correlation of ASMI scores was noted mainly with schizophrenia of AMIQ but not with other psychiatric conditions.Conclusion:High negative attitudes in nursing students underline the need for stronger antistigma measures. Differences in attitude toward mental illness in general and specific psychiatric conditions need further systematic evaluation.

The Impact of Expressive Emotion Brief Psychotherapy on Psychological Health of Kidney Transplant Recipients

Background: The effect of kidney transplantation on improvement of survival rate and post-transplant-medical health is dramatic. Transplantation is associated with various emotions such as loss, grief and bereavement. Therefore, any psychiatric intervention that can improve the psychological aspects of these patients is valuable. Objectives: Due to the specific medical and psychiatric conditions of Kidney transplant recipients, researchers have designed expressive emotion psychotherapy as a simple, feasible and time limited brief psychotherapy for these patients. The aim was the assessment of this psychotherapy on quality of life and general health of kidney transplant recipients. Methods: This 12-week randomized double-blind clinical trial took place at the Kidney transplant department of Imam Khomeini hospital, an academic and governmental hospital affiliated with Tehran University of Medical Sciences (TUMS) from November 2015 to February 2016 (Iran). From a total of 82 patients screened for this study, 64 patients (34 in the intervention group and 30 in the control group) completed the trial. Participants were divided to two groups: the first received expressive emotion intervention and the second received fact recording education as the control group. Outcomes were assessed by the kidney transplant questionnaire (KTQ) and general health questionnaire (GHQ-28) at baseline and at weeks four and twelve. Results: Baseline demographic characters of patients in both groups were similar. The mean age of patients that participated in the study were respectively 39.26 ± 12.98 and 40.83 ± 14.37 for intervention and control groups. The results of this study indicated that patients in the “intervention” group had a statistically significant enhancement in total KTQ score (P = 0.001) and total GHQ score (P = 0.001). Regarding every domain of GHQ, this group had a better condition than the “control” group (P = 0.000). The intervention had a significant effect on certain domains of KTQ such as “uncertainty/fear” and “emotion”. Conclusions: Expressive emotion brief psychotherapy that focuses on the instructions of expression about one’s living and dealing with a diagnosis of chronic medical condition is recommended for kidney transplant recipients.

Update on Obstructive Sleep Apnea: Implications for Neuropsychiatry.

Update on Obstructive Sleep Apnea: Implications for Neuropsychiatry.

Electroconvulsive therapy: Promoting awareness among primary care physicians.

This article aims to promote awareness among primary care providers and support electroconvulsive therapy as a generally well-tolerated, effective therapeutic modality to treat specific psychiatric conditions in appropriately selected patients. There seem to be several potential barriers to treatment with electroconvulsive therapy including stigma, lack of providers who preform it, and lack of awareness among providers referring patients who may be appropriate candidates. The article provides a brief overview of electroconvulsive therapy principles and topics and includes a case report to illustrate clinical utility. The article proposes the concept that a potential way to overcome barriers to treatment with electroconvulsive therapy may be to promote education and awareness of it as a viable treatment modality among primary care providers.

Transcranial Direct Current Stimulation in Child and Adolescent Psychiatry.

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that consists of applying a weak electric current over the scalp to modulate cortical excitability. tDCS has been extensively investigated in adults with psychiatric disorders. The aim of this study was to review the current literature regarding the use of tDCS in children and adolescents with psychiatric disorders. We searched MEDLINE and EMBASE databases for studies evaluating the safety and efficacy of tDCS in children and adolescents from age 0 to 18 years with psychiatric disorders. We found six studies that evaluated patients with different psychiatric disorders, with diverse study designs and stimulation parameters, including three small randomized clinical trials (RCTs), one evaluating childhood-onset schizophrenia, one RCT with patients with autism spectrum disorders (ASD), and one study in attention-deficit/hyperactivity disorder (ADHD); three open-label studies, two evaluating patients with ASD, and one study of feasibility of the technique in children and adolescents with language disorders and diverse psychiatric disorders, including ASD, intellectual disability, and ADHD. We also found three studies of dosage considerations in the general pediatric population. The technique was well tolerated, with no reports of serious side effects. Preliminary research suggests that tDCS may be well tolerated and safe for children and adolescents with psychiatric and neurodevelopmental disorders. Nevertheless, because the literature regarding tDCS in child and adolescent psychiatry is scarce and there exist limited numbers of randomized controlled trials, it is not possible to draw definite conclusions. Future studies should investigate the technique with regard to specific psychiatric conditions in comparison with standard treatments. In addition, long-term efficacy and safety should be monitored.

Efficacy of experiential dynamic therapy for psychiatric conditions: A meta-analysis of randomized controlled trials.

Experiential dynamic therapy (EDT) is a subgroup of short-term psychodynamic psychotherapy (STPP) that emphasizes patients' in-session affective processing. To evaluate the efficacy of EDT for psychiatric conditions, we conducted a meta-analysis of randomized controlled trials. Twenty-eight studies published between 1978 and 2014 were included, encompassing 1,782 adult patients with mood, anxiety, personality, or mixed disorders. Across targeted outcome domains, medium-size between-groups effects (Cohen's ds ranging from 0.39 to 0.65) favored EDT over inactive controls at posttreatment and in symptom measures at follow-up. We found no differences between EDT and active treatments (e.g., medication, cognitive-behavioral therapy, manualized supportive therapy) at posttreatment, but EDT outperformed supportive therapy at follow-up (d = 0.75). In terms of within-group effect sizes, EDT was associated with large improvements in general psychiatric symptoms (d = 1.11), depression (d = 1.33), and anxiety (d = 1.09) and with small to moderate gains in the areas of interpersonal problems (d = 0.55) and global functioning (d = 0.86). Small but significant effects suggested continued improvement between posttreatment and follow-up. Heterogeneity in pre-post effects was explored in subgroup analyses, which indicated that EDT might be most effective in depressive disorders and that individual EDT had larger effects compared with group treatment. In addition, EDT performed better in higher quality studies. We conclude that EDT is a promising treatment for psychiatric conditions in adults. Further high-quality studies evaluating contemporary versions of EDT in specific psychiatric conditions are warranted.

Support the Research in the Field of Obesity, Eating Disorders and Weight Management

According to World Health Organization, in 2014, more than 1.9 billion adults (18 years and older) were overweight, and of these over 600 million were obese. Additionally, about 13% of the world’s adult population (11% of men and 15% of women) were obese and 39% of adults aged 18 years and over (38% of men and 40% of women) were overweight. In developing countries with emerging economies the rate of increase of childhood overweight and obesity has been more than 30% higher than that of developed countries. Furthermore, obesity is associated with cardiovascular diseases, bone metabolic diseases, endocrinological illnesses, metabolic syndrome, sleepbreathing abnormalities, and several disorders affecting multiple organs and systems, and is relate with specific psychiatric and reproductive conditions.

Journal Digest

Journal Digest

Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: a longitudinal study.

The relationship of specific psychiatric conditions to adherence has not been examined in longitudinal studies of youth with perinatal HIV infection (PHIV). We examined associations between psychiatric conditions and antiretroviral nonadherence over 2 years. Longitudinal study in 294 PHIV youth, 6-17 years old, in the United States and Puerto Rico. We annually assessed three nonadherence outcomes: missed above 5% of doses in the past 3 days, missed a dose within the past month, and unsuppressed viral load (>400 copies/ml). We fit multivariable logistic models for nonadherence using Generalized Estimating Equations, and evaluated associations of psychiatric conditions (attention deficit hyperactivity disorder, disruptive behavior, depression, anxiety) at entry with incident nonadherence using multivariable logistic regression. Nonadherence prevalence at study entry was 14% (3-day recall), 32% (past month nonadherence), and 38% (unsuppressed viral load), remaining similar over time. At entry, 38% met symptom cut-off criteria for at least one psychiatric condition. Greater odds of 3-day recall nonadherence were observed at week 96 for those with depression [adjusted odds ratio (aOR) 4.14, 95% confidence interval (CI) 1.11-15.42] or disruptive behavior (aOR 3.36, 95% CI 1.02-11.10], but not at entry. Those with vs. without attention deficit hyperactivity disorder had elevated odds of unsuppressed viral load at weeks 48 (aOR 2.46, 95% CI 1.27-4.78) and 96 (aOR 2.35, 95% CI 1.01-5.45), but not at entry. Among 232 youth adherent at entry, 16% reported incident 3-day recall nonadherence. Disruptive behavior conditions at entry were associated with incident 3-day recall nonadherence (aOR 3.01, 95% CI 1.24-7.31). In PHIV youth, comprehensive adherence interventions that address psychiatric conditions throughout the transition to adult care are needed.

Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled trial

A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7–10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental cost-effectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities. Trial RegistrationClinicaltrials.gov: NCT01390168.

Gender-related differences in the associations between sexual impulsivity and psychiatric disorders

ObjectiveSexual impulsivity (SI) has been associated with conditions that have substantial public health costs, such as sexually transmitted infections and unintended pregnancies. However, SI has not been examined systematically with respect to its relationships to psychopathology. We aimed to investigate associations between SI and psychopathology, including gender-related differences. MethodWe performed a secondary data analysis of Wave-2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national sample of 34,653 adults in the United States. DSM-IV-based diagnoses of mood, anxiety, drug and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Scheduled DSM-IV Version. ResultsThe prevalence of SI was considerable (14.7%), with greater acknowledgment by men than women (18.9% versus 10.9%; p < 0.0001). For both women and men, SI was positively associated with most Axis-I and Axis-II psychiatric disorders (OR range: Women, Axis-I:1.89–6.14, Axis-II:2.10–10.02; Men, Axis-I:1.92–6.21, Axis-II:1.63–6.05). Significant gender-related differences were observed. Among women as compared to men, SI was more strongly associated with social phobia, alcohol abuse/dependence, and paranoid, schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive personality disorders. ConclusionThe robust associations between SI and psychopathology across genders suggest the need for screening and interventions related to SI for individuals with psychiatric concerns. The stronger associations between SI and psychopathology among women as compared to men emphasize the importance of a gender-oriented perspective in targeting SI. Longitudinal studies are needed to determine the extent to SI predates, postdates or co-occurs with specific psychiatric conditions.

Diagnoses Associated With Use of Atypical Antipsychotics in a Commercial Health Plan: A Claims Database Analysis

BackgroundAtypical antipsychotics are indicated for specific psychiatric conditions; however, they are frequently used for US Food and Drug Administration–nonapproved indications. ObjectiveThis study assessed the types of medical diagnoses associated with atypical antipsychotic prescriptions in commercial health care plans. MethodsThis retrospective cohort study used the OptumInsight commercial data set from January 2008 to June 2011. The index date was defined as the earliest date of prescription for the atypical antipsychotics aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone, from January 1, 2009, through June 30, 2010. Medical claims during a 2-year period (12 months before and 12 months after the index date) were used to identify relevant diagnostic codes from the International Classification of Diseases, Ninth Edition, Clinical Modification associated with the antipsychotic prescription. A logistic regression analysis was conducted to examine the predictors of use of atypical antipsychotics without a relevant diagnosis, that is, schizophrenia, bipolar, or major depressive disorder (MDD). ResultsOf 18,352 patients included in the analysis, 3593 (19.5%) who filled a prescription for atypical antipsychotics did not have an approved diagnosis. Off-label utilization varied, with approximately a quarter of patients with prescriptions for quetiapine (24.1%), risperidone (23.1%), or olanzapine (21.8%) being without a relevant diagnostic code, whereas proportions were lower for patients prescribed aripiprazole (14.0%) or ziprasidone (13.1%). Of those with a psychiatric disorder other than schizophrenia, bipolar disorder, or MDD, approximately a third of prescriptions were for anxiety disorders, with similar proportions across all atypical antipsychotics. Patients were often prescribed quetiapine for substance abuse (22.7%), whereas patients with “other psychiatric conditions” were prescribed risperidone (26.3%) or ziprasidone (25.0%). The logistic regression analysis indicated that patients prescribed olanzapine, quetiapine, or risperidone were significantly more likely to have no diagnostic code for schizophrenia, bipolar disorder, or MDD compared with patients prescribed aripiprazole. ConclusionNearly a fifth of commercially insured patients were prescribed atypical antipsychotics, in particular, olanzapine, quetiapine, or risperidone, for diagnoses that were not aligned with US Food and Drug Administration–approved indications.

Axis I Psychopathology and the Perpetration of Intimate Partner Violence

Initial evidence suggests that individuals with specific psychiatric conditions may perpetrate intimate partner violence (IPV) at greater frequency than nondiagnosed comparison samples. The present investigation examined the relationship between IPV and specific clinical diagnoses. The current investigation utilized data provided by 190 (34% female) adult offenders during court-mandated substance use evaluations to investigate the incidence of past-year IPV among samples of dually diagnosed (bipolar, posttraumatic stress disorder [PTSD], and attention deficit-hyperactivity disorder [ADHD]) clients relative to 3 comparison samples matched on substance use and sociodemographic variables. Bipolar and PTSD diagnosed participants were more likely to perpetrate IPV than matched comparison and ADHD participants. Bipolar and PTSD diagnosed participants were equally likely to perpetrate IPV, as were ADHD and matched comparison samples. The frequency of IPV perpetration among bipolar and PTSD diagnosed clients may complicate interpersonal and relationship functioning. The development of integrated treatments for IPV and underlying psychopathology is recommended.