Disinhibitory psychopathology and delay discounting in alcohol dependence: Personality and cognitive correlates.

Increased discounting of delayed rewards may reflect a decision bias that contributes to excessive use of alcohol and more generally, to an impulsive, disinhibitory predisposition that is characterized by a preference for immediate over long-term rewards. The current study examined the association between delay discounting of rewards and the covariation among several types of disinhibitory problems that are often comorbid with alcohol dependence (AD). Lifetime problems with alcohol, marijuana, other drugs, childhood conduct disorder, and adult antisocial behavior were assessed in a sample of 426 young adults, 257 of whom had a lifetime diagnosis of AD. Higher delay discounting rates were associated with the covariation among all domains of disinhibitory problems and were not uniquely associated with any one domain. Higher delay discounting rates also were associated with lower intelligence, lower working memory capacity, and higher trait impulsivity. The results suggest that increased delay discounting of rewards may reflect aspects of a general vulnerability to externalizing, disinhibitory disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Refinements in the hierarchical structure of externalizing psychiatric disorders: Patterns of lifetime liability from mid-adolescence through early adulthood.

Research on hierarchical modeling of psychopathology has frequently identified 2 higher order latent factors, internalizing and externalizing. When based on the comorbidity of psychiatric diagnoses, the externalizing domain has usually been modeled as a single latent factor. Multivariate studies of externalizing symptom features, however, suggest multidimensionality. To address this apparent contradiction, confirmatory factor analytic methods and information-theoretic criteria were used to evaluate 4 theoretically plausible measurement models based on lifetime comorbidity patterns of 7 putative externalizing disorders. Diagnostic information was collected at 4 assessment waves from an age-based cohort of 816 persons between the ages of 14 and 33. A 2-factor model that distinguished oppositional behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder) from social norm violation disorders (conduct disorder, adult antisocial behavior, alcohol use disorder, cannabis use disorder, hard drug use disorder) demonstrated consistently good fit and superior approximating abilities. Analyses of psychosocial outcomes measured at the last assessment wave supported the validity of this 2-factor model. Implications of this research for the theoretical understanding of domain-related disorders and the organization of classification systems are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in the genetic and environmental influences on childhood conduct disorder and adult antisocial behavior.

Sex differences in the genetic and environmental influences on childhood conduct disorder and adult antisocial behavior were examined in a large community sample of 6,383 adult male, female, and opposite-sex twins. Retrospective reports of childhood conduct disorder (prior to 18 years of age) were obtained when participants were approximately 30 years old, and lifetime reports of adult antisocial behavior (antisocial behavior after 17 years of age) were obtained 8 years later. Results revealed that either the genetic or the shared environmental factors influencing childhood conduct disorder differed for males and females (i.e., a qualitative sex difference), but by adulthood, these sex-specific influences on antisocial behavior were no longer apparent. Further, genetic and environmental influences accounted for proportionally the same amount of variance in antisocial behavior for males and females in childhood and adulthood (i.e., there were no quantitative sex differences). Additionally, the stability of antisocial behavior from childhood to adulthood was slightly greater for males than females. Though familial factors accounted for more of the stability of antisocial behavior for males than females, genetic factors accounted for the majority of the covariation between childhood conduct disorder and adult antisocial behavior for both sexes. The genetic influences on adult antisocial behavior overlapped completely with the genetic influences on childhood conduct disorder for both males and females. Implications for future twin and molecular genetic studies are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A prospective study of hyperactive boys with conduct problems and normal boys: adolescent and adult criminality

OBJECTIVE: To examine the relationship between attention deficit disorder with hyperactivity in childhood and criminality in adolescence and adulthood in 89 hyperactive and 87 normal control subjects. METHOD: In this prospective study, adolescent follow-up intervals ranged from 13 to 21 years and adult follow-up ranged from 18 to 23 years. The official arrest records for all subjects were obtained. RESULTS: Hyperactive subjects had significantly higher juvenile (46% versus 11%) and adult (21% versus 1%) arrest rates. Juvenile and adult incarceration rates were also significantly higher. Childhood conduct problems predicted later criminality, and serious antisocial behavior in adolescence predicted adult criminality. CONCLUSIONS: Hyperactive children are at risk for both juvenile and adult criminality. The risk for becoming an adult offender is associated with conduct problems in childhood and serious antisocial behavior (repeat offending) in adolescence. Hyperactive children who do not have conduct problems are not at increased risk for later criminality.     

Latent structure and factorial invariance of a neuropsychological test battery for the study of preclinical Alzheimer's disease.

Objective: To examine the latent structure of a test battery currently being used in a longitudinal study of asymptomatic middle-aged adults with a parental history of Alzheimer's disease (AD) and test the invariance of the factor solution across subgroups defined by selected demographic variables and known genetic risk factors for AD. Method: An exploratory factor analysis (EFA) and a sequence of confirmatory factor analyses (CFA) were conducted on 24 neuropsychological measures selected to provide a comprehensive estimate of cognitive abilities most likely to be affected in preclinical AD. Once the underlying latent model was defined and the structural validity established through model comparisons, a multigroup confirmatory factor analysis model was used to test for factorial invariance across groups. Results: The EFA solution revealed a factor structure consisting of five constructs: verbal ability, visuospatial ability, speed & executive function, working memory, and verbal learning & memory. The CFA models provided support for the hypothesized 5-factor structure. Results indicated factorial invariance of the model across all groups examined. Conclusions: Collectively, the results suggested a relatively strong psychometric basis for using the factor structure in clinical samples that match the characteristics of this cohort. This confirmed an invariant factor structure should prove useful in research aimed to detect the earliest cognitive signature of preclinical AD in similar middle aged cohorts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Study of the biosynthesis of fumonisins B1, B2 and B3 by different strains of Fusarium moniliforme

The relation between childhood behavior disorders (CBD), attentional difficulties (ADD), and antisocial personality disorder (ASP) was examined in a clinical population of alcoholics and polysubstance abusers. Polysubstance abusers reported increased CBD symptomatology, increased attentional problems, a higher rate of ASP, and a greater number of both current and lifetime ASP symptoms relative to alcoholics without polysubstance abuse. An examination of gender effects revealed significant differences on self-reported adult attentional problems, with females endorsing a greater number of items. As a group, females exhibited the highest rate of ASP. Males showed a significant correlation between current ASP symptoms and both attention and conduct problems in early childhood.     

Do executive and reactive disinhibition mediate the effects of familial substance use disorders on adolescent externalizing outcomes?

The present study examined the potential mediating roles of executive and reactive disinhibition in predicting conduct problems, attention-deficit/hyperactivity disorder (ADHD) symptoms, and substance use among adolescents with and without a family history of substance use disorders. Using data from 247 high-risk adolescents, parents, and grandparents, structural equation modeling indicated that reactive disinhibition, as measured by sensation seeking, mediated the effect of familial drug use disorders on all facets of the adolescent externalizing spectrum. Executive disinhibition, as measured by response disinhibition, spatial short term memory, and “trait” impulsivity, was associated with ADHD symptoms. Moreover, although executive functioning weakness were unrelated to familial substance use disorders, adolescents with familial alcohol use disorders were at risk for “trait” impulsivity marked by a lack of planning. These results illustrate the importance of “unpacking” the broad temperament style of disinhibition and of studying the processes that underlie the commonality among facets of the externalizing spectrum and processes that predict specific externalizing outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mentoring and self-efficacy for advanced nursing practice: a philosophical approach for nurse practitioner preceptors

The purpose of this study was to compare persons with antisocial personality disorder (ASP) with those who meet the adult criteria for ASP but fail to meet the criteria for childhood conduct disorder. Sociodemographic data, medical history, and psychiatric symptoms exhibited during a recent hospital admission were compared in the two groups by chart review. The two groups were virtually indistinguishable, except that patients without childhood conduct disorder were less likely to smoke or consume alcohol, were less likely to have spent time in a training school/boot camp as a child or adolescent, were less likely to have been admitted for a recent suicide attempt, and were less likely to have conned others. We conclude that persons meeting the adult criteria for ASP but not the childhood conduct disorder criteria essentially suffer the same disorder as those who meet full ASP criteria but are less severely affected.     

Externalizing psychopathology and marital adjustment in long-term marriages: Results from a large combined sample of married couples.

The current study evaluated the associations between externalizing psychopathology and marital adjustment in a combined sample of 1,805 married couples. We further considered the role of personality in these associations, as personality has been found to predict both the development of externalizing psychopathology as well as marital distress and instability. Diagnostic interviews assessed conduct disorder, adult symptoms of antisocial personality disorder, and alcohol dependence. Personality was assessed using the Multidimensional Personality Questionnaire. The Dyadic Adjustment Scale was used to measure marital adjustment. Results indicate that more externalizing psychopathology, greater negative emotionality, and lower communal positive emotionality were associated with reduced marital adjustment in both individuals and their spouses. Low constraint was associated with reduced marital adjustment for individuals but not for their spouses. Multivariate analyses indicated externalizing psychopathology continued to predict marital adjustment even when accounting for overlap with personality. These results highlight the importance of examining the presence of externalizing psychopathology and the personality attributes of both members of a dyad when considering psychological predictors of marital adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of neuropsychological functioning in Alzheimer's disease and frontotemporal dementia

Neuropsychological changes distinguishing mild Alzheimer's disease (AD) from frontotemporal dementia (FTD) have been described, but empirical verification of differential cognitive characteristics is lacking. Archival neuropsychological data on 15 FTD patients, 16 AD patients, and 16 controls were compared. Controls outperformed both patient groups on measures of verbal and nonverbal memory, executive ability, and constructional skill, with AD patients showing more widespread memory decline. No differences were found between the 3 groups in confrontation naming, recognition memory, or basic attention. Patient groups differed only in nonverbal memory, with FTD patients performing significantly better than AD patients. However, patient groups also differed in pattern of performance across executive and memory domains. Specifically, AD patients exhibited significantly greater impairment on memory than executive tasks, whereas the opposite pattern characterized the FTD group. These findings suggest that examination of relative rankings of scores across cognitive domains, in addition to interpretation of individual neuropsychological scores, may be useful in differential diagnosis of FTD versus AD.     

Cognitive estimation impairment in Alzheimer disease and mild cognitive impairment.

Intact executive functioning is believed to be required for performance on tasks requiring cognitive estimations. This study used a revised version of a cognitive estimations test (CET) to investigate whether patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) were impaired on the CET compared with normal elderly controls (NECs). Neuropsychological tests were administered to determine the relationship between CET performance and other cognitive domains. AD patients displayed impaired CET performance when compared with NECs but MCI patients did not. Negative correlations between tests of working memory (WM) and semantic memory and the CET were found in NECs and AD patients, indicating that these cognitive domains were important for CET performance. Regression analysis suggests that AD patients were unable to maintain semantic information in WM to perform the task. The authors conclude that AD patients display deficits in working memory, semantic memory, and executive function, which are required for adequate CET performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Externalizing behavior problems and academic underachievement in childhood and adolescence: Causal relationships and underlying mechanisms.

Reviews conceptual and measurement issues surrounding externalizing behavior problems and academic underachievement, the strength and specificity of the covariation between these domains, and the viability of explanatory models that link these areas. In childhood, inattention and hyperactivity are stronger correlates of academic problems than is aggression; by adolescence, however, antisocial behavior and delinquency are clearly associated with underachievement. Whereas investigations with designs that allow accurate causal inference are scarce, unidirectional paths from one domain to the other have received little support. The overlap of externalizing problems with cognitive and readiness deficits early in development suggests the influence of antecedent variables. Low socioeconomic status (SES), family adversity, subaverage IQ, language deficits, and neurodevelopmental delay are explored as possible underlying factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences and developmental change in externalizing disorders from late adolescence to early adulthood: A longitudinal twin study.

Using data from over 1,000 male and female twins participating in the Minnesota Twin Family Study, the authors examined developmental change, gender differences, and genetic and environmental contributions to the symptom levels of four externalizing disorders (adult antisocial behavior, alcohol dependence, nicotine dependence, and drug dependence) from ages 17 to 24. Both men and women increased in symptoms for each externalizing disorder, with men increasing at a greater rate than women, such that a modest gender gap at age 17 widened to a large one at age 24. Additionally, a mean-level gender difference on a latent Externalizing factor could account for the mean-level gender differences for the individual disorders. Biometric analyses revealed increasing genetic variation and heritability for men but a trend toward decreasing genetic variation and increasing environmental effects for women. Results illustrate the importance of gender and developmental context for symptom expression and the utility of structural models to integrate general trends and disorder-specific characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive impairment in preclinical Alzheimer's disease: A meta-analysis.

To determine the size of the impairment across different cognitive domains in preclinical Alzheimer's disease (AD), a meta-analysis based on 47 studies involving 9,097 controls and 1,207 preclinical AD cases was conducted. There were marked preclinical deficits in global cognitive ability, episodic memory, perceptual speed, and executive functioning; somewhat smaller deficits in verbal ability, visuospatial skill, and attention; and no preclinical impairment in primary memory. Younger age (     

Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia.

The validity of subtypes based on antisocial personality disorder (APD) or childhood conduct disorder without adult APD (CD only) in patients with schizophrenia (or schizoaffective disorder) and a substance use disorder (abuse or dependence) was examined. APD patients scored lower on personality measures related to socialization and higher on antisocial bebavior, psychopathy, and aggression. APD patients also reported higher rates of aggression and legal problems. APD, and to a lesser extent CD only, was associated with more severe psychiatric symptoms, an earlier age of onset of substance abuse, more severe symptoms of substance abuse, and a stronger family history of substance abuse and psychiatric hospitalization. The findings suggest that schizophrenia patients with APD represent a high-risk subgroup vulnerable to more severe substance abuse, psychiatric impairment, aggression, and legal problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral disinhibition: Liability for externalizing spectrum disorders and its genetic and environmental relation to response inhibition across adolescence.

Behavioral disinhibition has been characterized as a generalized vulnerability to externalizing disorders. Despite increasing evidence for its validity and heritability, the structural stability of behavioral disinhibition across adolescence and the strength and etiology of its relation to executive functions have not been studied. In this multivariate twin study, the authors assessed behavioral disinhibition using measures tapping substance use, conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and novelty seeking at ages 12 and 17. Executive functions were assessed with laboratory-based cognitive tasks at age 17. Results indicated that, at age 12, behavioral disinhibition was dominated by ADHD and conduct problems and was highly heritable. At age 17, the contributions of the 4 components were more balanced, and the proportion of variance attributable to genetic factors was somewhat smaller, with additional variance due to shared environmental influences. At both ages, behavioral disinhibition was more closely related to response inhibition than other executive functions (working memory updating and task-set shifting), and this relationship was primarily genetic in origin. These results highlight the dynamic nature of behavioral disinhibition across adolescence and suggest that response inhibition may be an important mechanism underlying vulnerability to disinhibitory psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association between hyperactivity and executive cognitive functioning in childhood and substance use in early adolescence

OBJECTIVE: To determine whether deficient executive cognitive functioning (ECF) in association with high behavioral activity level comprise components of the liability to substance abuse. METHOD: A high-risk (HR) group having fathers with a lifetime DSM-III-R diagnosis of a psychoactive substance use disorder was compared with a low-average-risk (LAR) group whose fathers had neither psychoactive substance use disorder nor another adult Axis I psychiatric disorder. ECF and behavioral activity were measured using neuropsychological tests, activity monitor, diagnostic interview, and informant ratings when the subjects were 10 to 12 years of age. Alcohol, tobacco, and cannabis use were measured at 2-year follow-up. RESULTS: At baseline, the HR group had a significantly higher behavioral activity level and exhibited poorer performance on ECF tests than the LAR group. By early adolescence, HR subjects had a higher lifetime rate of tobacco and cannabis use and earlier age at onset of cannabis use. ECF capacity, but not behavioral activity level, predicted tobacco and cannabis use, total number of drugs ever tried, and severity of drug involvement. ECF accounted for additional variance beyond the effects of conduct problems on these outcomes. CONCLUSION: Whereas behavioral activity and ECF capacity in late childhood distinguishes HR from LAR youth, childhood ECF capacity is the more salient predictor of drug use in early adolescence.     

Pathways of risk for accelerated heavy alcohol use among adolescent children of alcoholic parents

The current study examined two questions. First, do internalizing symptoms and externalizing behavior each mediate the relations between parent psychopathology (alcoholism, antisocial personality disorder, and affective disorder) and growth in adolescent heavy alcohol use? Second, are there gender differences in these mediated pathways? Using latent curve analyses, we examined these questions in a high-risk sample of 439 families (53% children of alcoholic parents; 47% female). Collapsing across gender, adolescent-reported externalizing behavior mediated both the relation between parent alcoholism and growth in heavy alcohol use and the relation between parent antisociality and growth in heavy alcohol use. Parent-reported externalizing behavior only mediated the relation between parent antisociality and growth in heavy alcohol use in males. No support was found for internalizing symptoms as a mediator of these relations. Avenues are suggested for further exploring and integrating information about different mediating processes accounting for children of alcoholics' risk for heavy alcohol use.     

Common genetic risk factors for conduct disorder and alcohol dependence.

The association between retrospectively reported childhood conduct disorder (CD) and a history of alcohol dependence (AD) was examined in a sample of 2,682 male, female, and unlike-sex adult twin pairs. There was a strong association between CD and AD in both men (tetrachoric r?=?.34, odds ratio?=?2.8) and women (tetrachoric r?=?.53, odds ratio?=?9.9). Genetic factors accounted for most of the association between CD and AD liability in men and women, with the remainder of the association being due to nonshared individual-specific environmental factors. Genetic influences common to CD and AD accounted for 17% and 35% of the genetic variation in AD liability in men and women, respectively, and accounted for 11% and 23% of the total variation in AD liability in men and women, respectively. The results suggest that there are common genetic risk factors for CD and AD or that CD itself is an important genetically influenced risk factor for AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential deficit in executive control in euthymic bipolar disorder.

Patients with remitted bipolar disorder (BD) have persistent cognitive deficits, but the nature and specificity of this deficit remain unclear. The authors evaluated the executive hypothesis of BD by determining whether (a) patients' executive deficits qualify as differential deficits, that is, that these significantly exceed deficits in other cognitive domains; (b) deficits in particular executive functions are evident, and (c) executive difficulties mediate declarative memory deficits in BD. The cognitive performance of 63 prospectively verified euthymic bipolar patients was compared with controls, using J. Baron and R. Trieman's (1980) method of testing for differences in nonindependent correlations. There were no differential deficits within the executive domain. Patients' generic executive performance was differentially impaired relative to primary verbal memory and retention in declarative memory, but not relative to their declarative recall, recognition, or their psychomotor performance. However, patients' executive deficit was not an artifact of their poor psychomotor performance. Executive performance accounted for all but a trivial portion of the between-group variance in declarative memory. Persistent cognitive difficulties in euthymic bipolar disorder (EBD) are thus usefully characterized as a generic dysexecutive syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)