The aim of this study was to investigate white matter (WM) abnormalities in obsessive-compulsive disorder (OCD) and its relationship to severity of obsessive-compulsive symptoms.

Conventional and diffusion tensor imaging were acquired in nine patients with OCD and nine gender- and age-matched healthy volunteers. Changes in fractional anisotropy (FA) and mean diffusivity (MD) were investigated using selected regions of interest (ROIs) analyses and whole brain tract-based spatial statistic analyses. A priori ROIs were placed bilaterally in internal capsule (IC), superior longitudinal fascicule (SLF), cingulate bundle (CB), and corpus calosum (CC).

ROIs analyses showed that, as compared to healthy volunteers, patients with OCD exhibited reduced FA values bilaterally in regions of the posterior limb of the IC and in the SLF and increased MD values bilaterally in the posterior limb of the IC, in the left CB, and in the splenium of CC. Voxelwise analysis showed that, as compared to controls, patients with OCD exhibited reduced FA and increased MD in regions of the cortical spinal tract (genu and posterior limb of internal capsule and corona radiata) and the SLF. Severity of OCD correlated with WM alterations in different brain regions, ie, the left (rho=0.70 [MD]) and right (rho=0.70 [MD]) anterior limb of the IC, the left (rho=0.97 [MD]) and right SLF (rho=0.81 [MD]), and the genu of CC (rho=0.66 [MD]; rho=-0.69 [FA]).

Our findings support the involvement of different WM tracts in OCD and suggest that greater impairment in WM integrity is associated with increased severity of OCD symptoms.

The dimensional approach of the obsessive-compulsive symptoms may help to find more homogeneous groups of patients. The brain derived neurotrophic factor (BDNF) may help to identify neurobiological differences between obsessive-compulsive symptom dimensions.

We compared serum BDNF (pg/μg) levels of 25 unmedicated patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for obsessivecompulsive disorder (OCD) and 25 controls, using the Dimensional Yale‐Brown Obsessive‐Compulsive Scale, the Yale‐Brown Obsessive‐Compulsive Scale and the Beck's Anxiety and Depression Inventories.

There were no sociodemographic differences between the groups. The standard error of mean serum BDNF levels were reduced in unmedicated OCD patients (0.47+0.038) when compared to healthy controls (0.75+0.060) (P<.001). The patients with the presence of sex/religion obsessive-compulsive symptoms (OCS) dimension (P=.002), with chronic course of OCS (P=.022) and the presence of lifetime major depression (P=.016) and social anxiety (P=.030) presented higher levels of BDNF than OCD patients without those features. The severity of aggression (P=.039) and sex/religion (P<.001) OCS dimension presented direct (moderate and strong, respectively) correlation with serum BDNF levels in this sample. Serum BDNF levels were decreased in OCD patients when compared to healthy controls.

Sexual and religious content of symptoms and aggression and sex/religion dimensions severity should be better explored, since these specific OCS dimensions could be based on neurocircuits diverse from those of the other OCS dimensions.

We sought to determine attitudes toward patients with borderline personality disorder (BPD) among mental health clinicians at nine academic centers in the United States.

A self-report questionnaire was distributed to 706 mental health clinicians, including psychiatrists, psychiatry residents, social workers, nurses, and psychologists.

The study showed that most clinicians consider BPD a valid diagnosis, although nearly half reported that they preferred to avoid these patients. The clinician's occupational subgroup was significantly related to attitude. Staff nurses had the lowest self-ratings on overall caring attitudes, while social workers had the highest. Social workers and psychiatrists had the highest ratings on treatment optimism. Social workers and psychologists were most optimistic about psychotherapy effectiveness, while psychiatrists were most optimistic about medication effectiveness. Staff nurses had the lowest self-ratings on empathy toward patients with BPD and treatment optimism.

Negative attitudes persist among clinicians toward BPD, but differ among occupational subgroups. Overall, caring attitudes, empathy, and treatment optimism were all higher among care providers who had cared for a greater number of BPD patients in the past 12 months.

These findings hold important implications for clinician education and coordination of care for patients with BPD.

The aim of the present study was to explore the relationship between subthreshold mood symptoms and suicidality in patients with complicated grief (CG).

Fifty patients with CG were included in the study and evaluated by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis-I disorders, the Inventory of Complicated Grief, and the Mood Spectrum Self Report (MOODS-SR) lifetime version, to evaluate the subthreshold mood symptoms.

Twenty-eight patients (56%) reported lifetime suicidal ideation and 11 patients (22%) reported suicide attempts. Subthreshold depressive and rhythmicity/vegetative functions items of the MOODS-SR were significantly associated with increased suicidal ideation and attempts, while subthreshold manic items were associated with suicidal ideation only. Relationships were confirmed after controlling for Axis-I disorders comorbidity.

The results of the present study suggest the usefulness of exploring lifetime subthreshold mood symptoms in CG patients, in order to promptly identify those who may be more prone to suicidality.

Psychiatric conditions affect multiple areas of psychosocial functioning, including functioning in the workplace. The purpose of this study was to establish norms for absenteeism (work days missed due to mental or physical illness) and work performance (quality of work performed when at work) for healthy individuals.

We selected 300 individuals without psychiatric or medical conditions from the National Comorbidity Survey Replication study (NCS-R). Absenteeism and work performance were assessed using the NCS-R version of the Health and Work Performance Questionnaire (HPQ).

Employees missed an average of 5.1 days of work in the past year. Absenteeism varied across occupations, with performers of routine tasks, office clerks, and professionals exhibiting the greatest variance in days missed. Work performance ratings were skewed toward high performance ratings and did not differ across occupations. Gender, age, race/ethnicity, and education level did not substantially moderate absenteeism and work performance norms.

Skewed ratings for work performance are consistent with previous findings using the HPQ. This may reflect a general tendency that individuals rate themselves favorably when they compare themselves to others.

This study provides normative tables for absenteeism and work performance in individuals without psychiatric or medical conditions, against which individuals with such conditions may be compared.

To determine the influence of ethnicity on the age at onset (AAO) and further understand the significance of AAO as a clinical marker of bipolar and schizoaffective disorders.

Admixture analysis was used to identify sub-groups characterized by differences in AAO. Differences in clinical features were analyzed for these sub-groups using multivariate logistic regression. Comparisons were made with previous studies using the 2-Sample Kolmogorov-Smirnov Test.

Admixture analysis yielded a combination of 2 normal theoretical distributions with means (SD) of 16.9 (3.6) for the early-onset sub-group and 24.4 (9.2) years for the late-onset sub-group. The sub-groups were divided by a cut-off of 22 years. There were significant differences between the early and late onset bipolar patient populations regarding substance abuse comorbidity (P=.044) and psychotic features (P=.015). Ethnicity did not have a significant influence on the AAO.

The associations between early-onset and higher incidence of psychosis and substance abuse in our sample are consistent with other studies exploring the AAO in bipolar disorder.

Our findings support the notion of AAO as a clinical marker for the underlying heterogeneity of bipolar spectrum disorders. In particular, we found a strong overlap of early AAO with clinical features associated with greater severity and poor outcome.

An in-office linguistic study was conducted to help improve understanding of how to better evaluate and treat attention-deficit/hyperactivity disorder (ADHD).

Naturally occurring interactions were recorded among 7 psychiatrists and 23 patients and 8 pediatricians along with 22 patients and their parents. Participants were interviewed separately post-visit. Transcripts of interactions and interviews were analyzed using sociolinguistic techniques.

Visits were variable in length and lacked concrete treatment plans. In the pediatric setting, children were typically excluded from dialogues, accounting for only 8% of words spoken. School was the primary metric used to evaluate symptoms. Pediatricians allayed parents' concerns about stimulant therapy by promising to prescribe the lowest possible dose, rather than discussing titrating to an optimal dose. Adults were evaluated idiosyncratically without the use of scales or tools. Stimulants were positioned as short-term “trials” without strong physician recommendations.

Conversations about stimulant therapy lacked goal- and expectation-setting. Also missing from conversations was a definitive treatment plan based on the core symptoms of ADHD. Incorporating open-ended questions and tools or rating scales may result in a more effective and efficient in-office dialogue.

Further research is warranted to assess the efficacy of communication strategies to enhance in-office discussions of ADHD and stimulant therapy.

Self-harm is a direct, socially unacceptable,repetitive behavior that causes minor to moderate physical injury without suicidal intent. It is also a significant and growing concern among prison inmates, although it has been rarely studied. In the present study, we aimed to investigate demographic, psychosocial, and clinical variables associated to this critical bahaviour in a high risk sample of 1,555 male prisoners.

Prisoners were interviewed about their history of self-mutilation, psychiatric history,and forensic history. The prisoners completed the Barratt Impulsivity Scale, Buss-Durkee Hostility Inventory, Eysenck Personality Questionnaire, and Childhood Trauma Questionnaire.

Eighteen percent of prisoners had a history of self-harm. They more frequently reported childhood traumas, were more likely to be unmarried, previously imprisoned, tested positive for substance abuse, had a history of suicide attempt, and more likely showed violent tendencies.

Self-harm among prisoners is common, being found in almost 20% of the subjects in our sample. Self-mutilation among prisoners appears to be multi-factorial with developmental, socio-demographic, psychiatric, and personality determinants.

Self-harm is associated with critical behaviors such as violence, substance abuse and suicide attempts, which represent major critical problems in contention environments.

The aim of this study is to explore the applicability of brain rate (fb) for the diagnosis of attention-deficit/hyperactivity disorder (ADHD), analyzing the spatial distribution of fb through analysis of its values in sagittal and lateral electrodes' positions, recorded in four conditions (eyes closed, eyes opened, visual continuous performance task and emotional continuous performance task).

Sixty-seven adults diagnosed with ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and 50 age-matched control subjects participated in the study. The brain activity of the subjects was recorded by 19 channel quantitative electroencephalography (QEEG) system and fb was calculated with the fb software.

Maximum values of fb for sagittal topography are obtained in central region and the minimum in frontal region, while lateral topography maximum values are found in the left and right sides and the minimum in midline region. A positive correlation between the fb values and the QEEG spectra subtypes was obtained, with lower values for normals, first and second subtype, and higher values for the third and fourth subtype. On the other hand, there was no correlation between behavioral symptoms and fb values.

The applicability of an fb indicator in the diagnosis of ADHD is especially pronounced for the higher subtypes (ADHD III and IV), corresponding to heterogeneous and multifactorial character of this disorder.