<p>Za poremećaje iz grupe koja je u DSM-IV označena pod nazivom Deficit pažnje i poremećaji sa nasilničkim pona&scaron;anjem, a to su Deficit pažnje/Hiperaktivni poremećaj (ADHD), Poremećaj u vidu protivljenja i prkosa (ODD) i Poremećaj pona&scaron;anja (CD), može se reći da kao jedno od svojih osnovnih obeležja imaju i međusobni komorbiditet. I istraživačka praksa i iskustva kliničara ukazuju na to da je za ova tri poremećaja karakteristična tendencija da se javljaju mnogo če&scaron;će u kombinaciji, nego kao zasebni psihopatolo&scaron;ki entiteti.<br />Imajući u vidu čest komorbiditet, a uzimajući u obzir i činjenicu da među autoritetima na području bavljenja problematikom vezanom za poremećaje iz ove grupe ne postoji saglasnost po pitanju međusobnog odnosa ova tri poremećaja (ni u poslednjim izdanjima DSM i ICD klasifikacionih sistema ovi poremećaji ne tretiraju se na isti način), ovim istraživanjem nastojalo se utvrditi u kojoj meri su ADHD, ODD i CD zaista tri jedinstvena i nezavisna složaja pona&scaron;anja, ili se pre mogu tretirati kao jedan op&scaron;tiji psihopatolo&scaron;ki fenomen.<br />Na uzorku od 1471 deteta dve uzrasne kategorije, a prosečnog uzrasta od 9 godina i 4 meseca, primenjene su skale procene prisustva pona&scaron;anja karakterističnih za ADHD, Poremećaj u vidu protivljenja i prkosa i Poremećaj pona&scaron;anja. Skale su popunjavali učitelji dece. Od instrumenata je kori&scaron;ćena i skraćena forma treće revizije Konersove skale koju su popunjavali i učitelji, ali i deca iz starije grupe (sve tri skale kori&scaron;ćene u istraživanju visoke su kriterijumske validnosti). Na osnovu pravila za skorovanje, izdvojena je grupa od 373 dece koja manifestuju bihevioralne indikatore nekog od tri navedena psihopatolo&scaron;ka fenomena ili vi&scaron;e njih istovremeno. Na osnovu analize međusobnih preklapanja ispitivanih entiteta, može se zaključiti da je deficit pažnje, posmatran kao zasebna dimenzija, najmanje komorbidan od svih ispitivanih fenomena. Hiperaktivnost, posmatrana samostalno ili u kombinaciji sa deficitom pažnje, mnogo vi&scaron;e je povezana sa ostalim problemima, nego &scaron;to je to deficit pažnje. Poremećaj pona&scaron;anja i Poremećaj u vidu protivljenja i prkosa gotovo su uvek povezani, ili međusobno ili sa kombinovanim ADHD podtipom, odnosno sa izdvojenom dimenzijom hiperaktivnosti.<br />Rezultati konfirmatorne faktorske analize pokazali su da je model sa najboljim indeksima podesnosti bifaktorski model sa 4 faktora (deficit pažnje, hiperaktivnost, prkosno i suprotstavljajuće pona&scaron;anje i problemi u pona&scaron;anju), &scaron;to bi značilo da četiri izdvojena faktora predstavljaju fenomene koje karakteri&scaron;u pona&scaron;anja specifična za svaki od njih posebno, ali su ta pona&scaron;anja istovremeno i zajednički indikatori jednog generalnog faktora. Hiperaktivnost je u najvećoj meri zajednički fenomen sva tri poremećaja koja su predmet proučavanja u ovom radu, dok je nepažnja u najmanjoj meri zajednička svim poremećajima. U daljem toku statističke obrade podataka, primenjena je analiza latentnih profila. Rezultati ove analize saglasni su sa rezultatima dobijenim na osnovu analize komorbidnih stanja, kao i sa rezultatima konfirmatorne faktorske analize. Deficit pažnje, hiperaktivnost, prkosno i suprotstavljajuće pona&scaron;anje i problemi u pona&scaron;anju predstavljaju bihevioralne dimenzije koje su često povezane, pri čemu je komorbiditet svih navedenih problema zajedno posebno čest, kao i kombinacija hiperaktivnosti i deficita pažnje. Na osnovu svih sprovedenih analiza nameće se zaključak da ADHD, ODD i Poremećaj pona&scaron;anja pre predstavljaju različite dimenzije jednog generalnog psihopatolo&scaron;kog fenomena, nego &scaron;to ih možemo posmatrati kao entitete potpuno nezavisne jedan od drugog.<br />Suprotno postavljenoj hipotezi, uzrast se nije pokazao kao značajan faktor za manifestovanje pona&scaron;anja koja su tipična za Poremećaj u vidu protivljenja i prkosa i Poremećaj pona&scaron;anja. Potvrđena je pretpostavka o tome da deficit pažnje tokom vremena perzistira kod dece i ispoljava se u istoj meri, ali ne i pretpostavka o tome da dolazi do redukcije motornog nemira kako dete biva starije. Deca sa pona&scaron;anjima koja karakteri&scaron;u svaki od tri poremećaja imaju značajno slabije &scaron;kolsko postignuće u odnosu na kontrolnu grupu dece, pri čemu je saznanje o &scaron;kolskom uspehu deteta značajnije povezano sa učiteljskom procenom pona&scaron;anja dece nego sa samoprocenom samih učenika. Gradska sredina pokazala se kao značajan faktor za manifestovanje pona&scaron;anja karakterističnih samo za kombinovani ADHD podtip. Kao varijabla od značaja za ispoljavanje problematičnih pona&scaron;anja, pokazao se obrazovni nivo roditelja, i oca i majke. &Scaron;to su roditelji vi&scaron;eg obrazovnog nivoa, deca u manjoj meri manifestuju pona&scaron;anja koja su tipična za neki od tri poremećaja.<br />Rezultati dobijeni ovim istraživanjem jasno ukazuju na neophodnost posmatranja tri poremećaja iz grupe Deficit pažnje i poremećaji sa nasilničkim pona&scaron;anjem kroz drugačiju prizmu, a ne samo uzimajući u obzir kategorijalni pristup. U daljim istraživanjima problematike deficita pažnje i poremećaja sa nasilničkim pona&scaron;anjem u na&scaron;oj sredini, bilo bi poželjno uzorkom obuhvatiti decu iz vi&scaron;e od dve uzrasne kategorije, kao i decu iz velikih gradova, a svakako da bi uključivanje kliničkog uzorka dece u značajnoj meri doprinelo daljem rasvetljavanju međusobnog odnosa ADHD-a, Poremećaja u vidu protivljenja i prkosa i Poremećaja pona&scaron;anja.</p> / <p>One of the main features for the DSM-IV Attention Deficit and Disruptive Behavior Disorders (Attention Deficit/Hyperactivity Disorder, Conduct Disorder and Oppositional Defiant Disorder) is their mutual comorbidity. Both research and clinical practice showed that ADHD, ODD and CD typically occur in combination and that noncomorbid ODD, ADHD or CD are fairly rare. The overlap between those diagnosis is very well established. Regarding the frequent comorbidity, together with the fact that there is no consensus among authorities in the field (the specific criteria for diagnosing ADHD, ODD or CD vary between the guidelines adopted in the United States &ndash; DSM, and those used in Europe and in other international communities - ICD), one of the aims of this study was to determine whether ADHD, ODD and CD are really three unique and independent behavioral psychopathological entities, or those three can be treated as one more general psychopathological phenomenon.<br />The research was conducted on a convenience sample of N=1471 children (N=760 boys), with an average age of 9 years and 4 months. The presence of characteristics of ADHD, Oppositional Defiant Disorder and Conduct Disorder was measured with three scales &ndash; IVJER, CDRS-IV and ODDRS. These scales have been administrated to teachers. Third revision of the Conners Rating Scale (CRS) was also used in this study &ndash; both teacher report short form and self-report short form. Based on the rules for scoring the rating scales used in this research, a group of 373 children, who exhibit behavioral indicators of one of the three psychopathological phenomena listed above or several of them simultaneously are identified. On the basis of an analysis of the mutual overlapping of the examined entities, it can be concluded that the attention deficit, observed as a separate dimension, is the least comorbid of all the investigated phenomena. Hyperactivity, observed alone or in combination with attention deficit, is much more associate with other problems than attention deficit alone. Conduct Disorder and Oppositional Defiant Disorder are almost always in correlation, either with each other or with a combined ADHD subtype, or with a separate dimension of hyperactivity.<br />The results of the Confirmatory Factor Analysis (CFA) showed that the model with the best goodness-of-fit indices is the bifactor model with 4 factors (attention deficit, hyperactivity, defiant and oppositional behaviors and behavioral problems), which means that four separate factors represent phenomena which are characterized by behaviors specific to each of the factors, but, at the same time, these behaviors are the common indicators of the general factor. Hyperactivity is largely a common characteristic of all three disorders from the group, while attention deficit is at least common to all disorders. The results of the Latent Class Analysis (LCA) are consistent with the results obtained from the analysis of the mutual overlapping of the examined entities, as well as with the CFA results. Attention deficit, hyperactivity, defiant and oppositional behaviors and severe conduct problems are behavioral dimensions which are often in correlation, with the comorbidity of all these problems together being particularly common, along with the combination of hyperactivity and attention deficit. The research findings showed that ADHD, ODD and Conduct Disorder are more likeley to represent the different dimensions of a general psychopathological phenomenon, than being the entities completely independent of each other.<br />In contrast to the hypothesis, age did not prove to be a significant factor in the manifestation of behavior that is typical of Oppositional Defiant Disorder and Conduct Disorder. It is confirmed that attention deficit persists over time in children and is demonstrated to the same extent, but it is not confirmed that there is a reduction in hyperactivity as the child gets older. Children with behaviors that characterize each of the three disorders have significantly lower school achievement than the control group of children, whereby the knowledge about the child&rsquo;s school achievement is significantly more associate with the teacher&#39;s assessment of the child&rsquo;s behavior rather than with the self-evaluation of the students themselves. The urban environment proved to be a significant factor in the manifestation of behavior typical only of the combined ADHD subtype. As a variable of significance for the manifestation of problematic behaviors, the educational level of parents has been demonstrated. It is less likely for children to manifest behaviors that are typical of one of the three disorders, if the parents&rsquo; educational level is higher.<br />The research findings clearly point to the necessity of observing three disorders from the group Attention Deficit and Disruptive Behavior Disorders through a different prism, not just taking into account the categorical approach. The further research in the field of problem behaviors in our community, should include children from more than two age categories, as well as children from large cities. Clinical samples of children will significantly contribute to further clarification of the relation between ADHD, ODD and Conduct Disorder.</p>

No description available.

Both spinal pain and temporomandibular disorders (TMD) commonly occur in the general population. Previous studies demonstrate neurophysiologic and biomechanical couplings between the trigeminal and cervical regions. This investigation tested the null hypothesis of no relationship between spinal pain (neck, shoulder and/or low back) and TMD, by using questionnaires and clinical examinations of the jaw function. In an age- and sex-matched case-control study, the specific aim was to compare the prevalence of signs and symptoms of TMD among cases with long-term spinal pain and controls without spinal pain. The results showed that subjects with spinal pain had signs and symptoms of TMD significantly more often than did controls. The associations remained after excluding all participants with jaw pain. Furthermore, the comorbidity pattern was similar, regardless of location of spinal pain. In a cross-sectional study, the specific aim was to test whether there is a reciprocal cross-sectional dose-response-like relationship between spinal pain and TMD. Two different designs were used, one with frequency/severity of spinal pain as independent variable, and the other, with frequency/severity of TMD symptoms as independent variable. The analysis showed increasing odds for presence of TMD symptoms with increasing frequency/severity of spinal pain, and increasing odds for presence of spinal pain with increasing frequency/severity of TMD symptoms. In a case-control study within a 2-year prospective cohort, the specific aim was to test whether there is a reciprocal temporal relationship between signs and symptoms in trigeminally, and symptoms in spinally, innervated areas. Incidence of symptoms in these areas was analyzed in relation to presence of spinal pain, headaches, and signs and symptoms of TMD at baseline. The main findings were that presence of signs of TMD at baseline increased the onset of spinal pain and symptoms in the trigeminal area, and that spinal pain increased the onset of symptoms in the trigeminal area. An augmentation effect between the significant baseline variables was observed for the incidence of headaches and jaw pain. In conclusion, the investigation demonstrated a cross-sectional and temporal relationship between spinal pain and TMD; thus, the null hypothesis was rejected. The results indicate common pathophysiological mechanisms in the development of spinal pain and TMD. The comorbidity and reciprocal influence that were found call for an integrated and multidimensional approach in the management of individuals with long-term spinal pain and TMD.

Background: Subtle and inconsistent differences in hypothalamic-pituitary-adrenal (HPA) axis activity have been reported for patients with panic disorder. While these patients show little or no alterations in basal ACTH and cortisol levels, it has been hypothesized that HPA hyperresponsivity was a trait in panic patients when exposed to novel and uncontrollable stimulation. Methods: Thirty-four patients (23 females, mean age 35 yrs) diagnosed with panic disorder were compared to 34 healthy controls matched for age, gender, smoking status, and use of oral contraceptives. Both groups were exposed twice to a potent laboratory stress protocol, the Trier Social Stress Test (TSST) on consecutive days. Free salivary cortisol levels and heart rate responses were repeatedly measured before and following the TSST. In addition, the cortisol awakening response (CAR) was assessed to further investigate HPA reactivity in PD patients. Results: While the TSST induced similar heart rate stress responses in both groups, cortisol responses were clearly absent in the panic patients with normal responses in the controls (F(1.96, 66) = 20.16; p < 0.001). No differences in basal cortisol levels were observed in the extended baseline period. The same cortisol stress non-response patterns were observed when patients with/without comorbid depression, or with/without psychotropic medication were compared. In contrast to their non-response to the psychosocial stressor, panic patients showed a significant CAR. Conclusion: These findings provide strong evidence to suggest that PD patients present with a striking lack of cortisol responsivity to acute uncontrollable psychosocial stress under laboratory conditions. This unresponsiveness of the HPA axis appears to be rather specific, since a normal CAR in the morning could be documented in these patients. Thus, the present results do not support the hypothesis that PD patients show a trait HPA hyperresponsiveness to novel and uncontrollable stimulation. In contrast, the data provide support for a hyporesponsive HPA axis under emotional stress in PD patients.

Social anxiety disorder, also known as social phobia, is one of the most prevalent anxiety disorders, affecting 7-13% of subjects in the community at some time in their lives. Despite being eminently treatable, it remains largely under-recognised and, therefore, undertreated. The disorder is characterized by a fear of scrutiny by others, with sufferers experiencing excessive anxiety in social and performance situations. This excessive anxiety usually leads to avoidance behaviour that can severely affect normal daily living. With onset commonly occurring during childhood or adolescence, social anxiety disorder may disrupt normal patterns of development of social and personal relationships, often having a long-term impact on emotional stability in social or working life. If left untreated, the course of social anxiety disorder is frequently complicated with comorbid conditions, particularly major depression or substance abuse. This review assesses the size of the clinical problem by evaluating current and lifetime prevalence estimates, age of onset, risk factors and evolution of the clinical course; thereby providing the rationale for early recognition and prompt treatment.

Background: Despite an abundance of questionnaire data, the prevalence of clinically significant and medically unexplained pain syndromes in the general population has rarely been examined with a rigid personal-interview methodology. Objective To examine the prevalence of pain syndromes and DSM-IV pain disorder in the general population and the association with other mental disorders, as well as effects on disability and health-care utilization. Methods: Analyses were based on a community sample of 4.181 participants 18–65 years old; diagnostic variables were assessed with a standardized diagnostic interview (M-CIDI). Results: The 12-month prevalence for DSM-IV pain disorder in the general population was 8.1%; more than 53% showed concurrent anxiety and mood disorders. Subjects with pain disorder revealed significantly poorer quality of life, greater disability, and higher health-care utilization rates compared to cases with pain below the diagnostic threshold. The majority had more than one type of pain, with excessive headache being the most frequent type. Conclusions: Even when stringent diagnostic criteria are used, pain disorder ranks among the most prevalent conditions in the community. The joint effects of high prevalence in all age groups, substantial disability, and increased health services utilization result in a substantial total burden, exceeding that of depression and anxiety.

Background: A recent epidemiological analysis on premenstrual dysphoric disorder (PMDD) in the community revealed increased rates of DSM-IV posttraumatic stress disorder (PTSD) among women suffering from PMDD. Aims: To explore whether this association is artifactual or might have important pathogenic implications. Methods: Data come from a prospective, longitudinal community survey of an original sample of N¼1488 women aged 14–24, who were followed-up over a period of 40 to 52 months. Diagnostic assessments are based on the Composite International Diagnostic Interview (CIDI) using the 12-month PMDD diagnostic module. Data were analyzed using logistic regressions (odds ratios) and a case-by-case review. Results: The age adjusted odds ratio between PTSD and threshold PMDD was 11.7 (3.0–46.2) at baseline. 10 women with full PTSD and at least subthreshold PMDD were identified at follow-up. Most reported an experience of abuse in childhood before the onset of PMDD. Some had experienced a life-threatening experience caused by physical attacks, or had witnessed traumatic events experienced by others. 3 women reported more than one traumatic event. Conclusions: A case-by-case review and logistic regression analyses suggest that women with traumatic events and PTSD have an increased risk for secondary PMDD. These observations call for more in-depth analyses in future research.

According to previous research, internalizing and externalizing problems tend to be comorbid or co-occur at different ages in development (Angold, Costello, & Erkanli, 1999). The question that this dissertation addresses is how and why internalizing and externalizing problems, two disorders that represent separate forms of psychopathology, co-occur in children. This is an important question for the developmental psychopathology perspective because an appreciation of the concept of co-occurrence is essential for explaining the development and taxonomy of internalizing and externalizing psychopathology, and for understanding the etiology and course of these symptoms (Achenbach, 1990). Attempts to explain co-occurrence have proposed that co-occurring psychopathology might represent distinct, meaningful syndromes (Angold & Costello, 1992; O’Connor et al., 1998), and in support of this idea, evidence of the existence of pure and co-occurring internalizing and externalizing problems has been found (Keiley et al., 2003). However, no previous study has identified heterogeneous developmental patterns of pure or combined internalizing and externalizing problems within a dynamic framework by taking trajectories of change into account. This dissertation uses data from the NICHD study of Early Child Care to explore the co-occurrence between internalizing and externalizing problems from age 2 to 12 with the use of Latent Class Growth Analysis. The sample included 1232 children (52% male). Different groups of children exhibiting low/normative, pure internalizing, pure externalizing, and co-occurring internalizing and externalizing problems across the 10 year period were identified. The higher risk groups deviated from the low/normative group in terms of antecedents, SES risk, medical risk, difficult temperament, and home environment. Moreover, children who exhibited pure moderate externalizing problems, and children who exhibited chronic externalizing problems, with and without co-occurring internalizing problems, engaged in more risky behaviors and were more likely to have friends who also engaged in risky behaviors. Furthermore, the pure chronic externalizing group and the groups scoring high on internalizing problems, with and without co-occurring externalizing problems, were more asocial with peers. Finally, children exhibiting chronic co-occurring externalizing and internalizing problems were more excluded by peers in comparison to the rest of the sample’s population.

Uppsatsens övergripande syfte var att undersöka profiler av samsjuklighet mellan depressiva symtom och olika undergrupper av social ångest hos unga vuxna (20-24 år) samt dess samband med livstillfredsställelse och upplevd social funktionsnedsättning inom yrkesliv/studier respektive sociala aktiviteter. Data har inhämtats via självskattningsformulär. Resultaten analyserades genom en klusteranalys. Två profiler med samsjuklighet mellan undergrupper av social ångest och depressiva symtom framkom. Denna samsjuklighet verkar vara relaterad till både en lägre grad av upplevd livstillfredsställelse samt till funktionsnedsättning inom två domäner, yrkesliv/studier och sociala aktiviteter. / The main purpose of this thesis was to investigate profiles of comorbidity between depressive symptoms and different subgroups of social anxiety in young adults (20-24 years) and its relationship to life satisfaction and social dysfunction within the domains occupation/education and social activities. The data used was gathered through questionnaires. The results were analyzed with cluster analysis.  Two profiles with comorbidity between subgroups of social anxiety and depressive symptoms were found. This comorbidity seems to be related to a lower level of experienced life satisfaction and to dysfunction within two domains, occupation/education and social activities.

Hintergrund: Ein signifikanter Anteil der Patienten mit einer chronischen körperlichen Erkrankung weist eine komorbide psychische Störung auf. Ob und in welchem Ausmaß sich die Prävalenzraten psychischer Störungen bei Patienten mit einer chronischen Erkrankung von denen der Allgemeinbevölkerung unterscheiden, ist bislang noch kaum untersucht. Fragestellung: Die vorliegende epidemiologische Studie untersucht geschlechts- und altersadjustierte 4-Wochen, 12-Monats- und Lebenszeitprävalenzen psychischer Störungen bei Rehabilitationspatienten mit muskuloskelettalen und kardiovaskulären Erkrankungen im Vergleich zu Prävalenzraten der Allgemeinbevölkerung. Methode: Die Daten der drei Stichproben (N = 4192) basieren jeweils auf einem zweistufigen, epidemiologischen Untersuchungsansatz mit einer schriftlichen Befragung der Patienten bzw. Probanden zu ihrem psychischen Befinden (GHQ-12; M-CIDI-S) und einem anschließenden Interview (M-CIDI) bei einem randomisiert ausgewählten Teil der Gesamtstichprobe. Ergebnisse: Mit adjustierten Lebenszeitprävalenzen von 59.3 % (OR: 1.6) und 56.2 % (OR: 1.4) weisen die Patienten mit einer muskuloskelettalen und kardiovaskulären Erkrankung im Vergleich zur Allgemeinbevölkerung (47.9 %) eine deutlich erhöhte Prävalenz psychischer Störungen auf. Am häufigsten sind affektive Störungen (22.5 % bis 34.9%) und Angststörungen (18.4 % bis 33.8 %). Schlussfolgerung: Der im Vergleich zur Allgemeinbevölkerung deutliche Zusammenhang zwischen chronischen körperlichen Erkrankungen und psychischen Störungen verdeutlicht die Bedeutsamkeit einer verstärkten Diagnostik und Behandlung komorbider psychischer Störungen bei chronisch erkrankten Patienten. / Background: A significant part of patients with chronic diseases have comorbid mental disorders. However, by now it is nearly unexplored if and to what extend the prevalence rates of mental disorders in patients with chronic diseases differ from the rates of the general population. Objective: The present epidemiologic study investigates sex- and age-adjusted 4-week, 12-months, and lifetime prevalence rates of mental disorders in inpatients with musculoskeletal and cardiovascular diseases compared to prevalence rates of the general population. Methods: In each sample (N = 4192), the data based on a two-stage epidemiologic design. The first stage entailed the use of a screening questionnaire for mental disorders (GHQ-12; M-CIDI-S). The second stage consisted of an interview (M-CIDI) of a randomised part of the sample. Results: The adjusted lifetime prevalence in both clinical samples (musculoskeletal: 59.3 %, OR 1.6; cardiovaskular: 56.2 %, OR 1.4) is high compared to the rate of the general population (47.9 %). Affective disorders (22.5 % to 34.9 %) and anxiety disorders (18.4% to 33.8 %) are the most common disorders. Conclusions: Compared to the general population there is a clear correlation between chronic diseases and mental disorders, that shows the importance of an improved diagnostic and treatment of patients suffering from comorbid mental disorders.