Impulsivity & its treatment.

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1: Psychiatry Res. 2007 Jul 30;152(1):1-10. Epub 2007 Mar 23.
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Serum omega-3 fatty acids are associated with variation in mood, personality and behavior in hypercholesterolemic community volunteers.
Conklin SM, Harris JI, Manuck SB, Yao JK, Hibbeln JR, Muldoon MF.

Cardiovascular Behavioral Medicine Postdoctoral Training Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.

Low dietary intake of omega-3 polyunsaturated fatty acids has been linked to several features of psychiatric symptomatology, including depression, disorders of impulse control, and hostility. Preliminary intervention trials of omega-3 fatty acid supplementation for clinical depression and other disorders have reported benefit. However, few studies have investigated the relationships between these fatty acids and normative variability in mood, behavior and personality. Participants were 105 hypercholesterolemic, but otherwise healthy, non-smoking adults. Fasting serum alpha-linolenic (alpha-LNA), eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) were assayed with gas chromatography. Participants completed the Beck Depression Inventory (BDI), the NEO Five Factor Personality Inventory (NEO-FFI) and the Barratt Impulsiveness Scale (BIS). In multivariate analyses, higher levels of the long chain omega-3 PUFAs, EPA and DHA, were associated with significantly reduced odds of scoring >/=10 on the BDI. Similarly, DHA and EPA covaried inversely with NEO-Neuroticism scores, whereas DHA was positively associated with NEO-Agreeableness. On the BIS, DHA was inversely related to cognitive impulsivity and alpha-LNA was inversely related to motor and total impulsivity. These findings suggest that omega-3 fatty acid status is associated with variability in affect regulation, personality and impulse control.

PMID: 17383013 [PubMed - in process]

I haven't got the patience to try it. If anything doesn't work straight away I tend to forget about taking it.. which causes a bit of difficulty.

J Clin Psychopharmacol. 2001 Apr;21(2):223-8. Related Articles, Links


Comparing guanfacine and dextroamphetamine for the treatment of adult attention-deficit/hyperactivity disorder.

Taylor FB, Russo J.

Rainier Associates, Tacoma, Washington 98467, USA.

The objective of this study was to compare the efficacy of the alpha-2a agonist guanfacine with that of dextroamphetamine for the treatment of adult attention-deficit/hyperactivity disorder (ADHD). Seventeen adult outpatients who met DSM-IV criteria for ADHD participated in a double-blind, placebo-controlled, crossover study comparing drug effects on ADHD symptoms. Measures of change included the DSM-IV ADHD Behavior Checklist for Adults and the Copeland Symptom Checklist for Adult Attention Deficit Disorders. Cognitive measures of attention included the Stroop and Controlled Oral Word Association Test using the letters "C," "F," and "L" (COWAT, CFL version). For each trial, the drug was administered daily and titered up to optimal doses of maximum efficacy but with a minimum of side effects, and then data were collected. Both drugs significantly reduced ADHD symptoms on the DSM-IV Adult Behavior Checklist for Adults over placebo (p < 0.05). The Stroop Color subscale showed significant improvement for both drugs (p < 0.05), but the Color-Word measures showed significant improvement for guanfacine only (p < 0.01). The average dose of guanfacine was 1.10 (SD = 0.60), and the most common side effect of guanfacine was fatigue. No subjects discontinued drug trials. This preliminary study indicates that guanfacine may be a well-tolerated treatment option for adult ADHD.

Guanfacine treatment of comorbid attention-deficit hyperactivity disorder and Tourette's syndrome: preliminary clinical experience.
Chappell PB, Riddle MA, Scahill L, Lynch KA, Schultz R, Arnsten A, Leckman JF, Cohen DJ.

Child Study Center, Yale University School of Medicine, New Haven, CT; USA.

OBJECTIVE: Many children with Tourette's syndrome (TS) are handicapped more by difficulties with inattention, impulsivity, and hyperactivity than by their tics. However, stimulant medications used to treat attention-deficit hyperactivity disorder (ADHD) can exacerbate tics. Guanfacine is an alpha 2-adrenergic agonist that may have beneficial effects on attention, without the hypotensive or sedative effects of clonidine, which is often used as an alternative to stimulants. METHOD: An open-label study of guanfacine was performed in 10 children with TS+ADHD, aged 8 to 16 years. The duration of follow-up was 4 to 20 weeks, and the majority of subjects were treated with 1.5 mg/day. Ratings of tic severity and ADHD symptoms were obtained using the Yale Global Tic Severity Scale (YGTSS), the Tic Symptom Self Report (TSSR), and the Conners Parent Rating Scale. In addition, blind Continuous Performance Tests (CPTs) were performed at baseline and at two follow-up intervals in eight subjects. RESULTS: Guanfacine was associated with significant decreases in both commission errors (p < .02) and omission errors (p < .01) on the CPT. In addition, guanfacine caused a significant decrease in severity of motor (p < .02) and phonic (p < .02) tics as measured by the TSSR and the YGTSS, respectively. The most common side effects were transient sedation and headaches. CONCLUSION: Guanfacine may provide a safe alternative therapy for children with ADHD in the presence of tics. Future double-blind, controlled trials should be undertaken.

Atomoxetine for hyperactivity in autism spectrum disorders: placebo-controlled crossover pilot trial.
Arnold LE, Aman MG, Cook AM, Witwer AN, Hall KL, Thompson S, Ramadan Y.

The authors are with Ohio State University's Nisonger Center, Columbus, OH 43210, USA. [email protected]

OBJECTIVE: To explore placebo-controlled efficacy and safety of

ATX) for attention-deficit/hyperactivity disorder (ADHD) symptoms in children with autism spectrum disorders (ASD). METHOD: Children ages 5 to 15 with ASD and prominent ADHD symptoms were randomly assigned to order in a crossover of clinically titrated ATX and placebo, 6 weeks each, separated by 1-week washout. Slopes for each condition were compared by paired t test. RESULTS: In 2004-2005, 12 boys and 4 girls (7 with autistic disorder, 1 Asperger's, 8 pervasive developmental disorder not otherwise specified) all completed at least 3 weeks of each condition. On the primary outcome, the Hyperactivity subscale of the Aberrant Behavior Checklist, ATX was superior to placebo (p =.043, effect size d = 0.90). It was also superior on a 0 to 3 rating of nine DSM-IV ADHD hyperactive/impulsive symptoms (p =.005, d = 1.27), but missed significance on nine inattentive symptoms (p =.053, d= 0.89). Nine subjects responded to ATX, four to placebo (25% improvement on the Hyperactivity subscale plus Clinical Global Impressions-Improvement of 1-2. One was rehospitalized for recurrent violence on ATX. Adverse events were otherwise tolerable, with no tendency to stereotypy. CONCLUSIONS: ATX appears safe and effective for treating hyperactivity in some children with autism spectrum disorders. The effect appears as large as in a multisite methylphenidate trial in the same population, with fewer intolerable side effects. Further study in autism spectrum disorders is indicated.

This study is not yet open for patient recruitment.
Verified by Hospital University Vall d'Hebron February 2007Sponsored by: Hospital University Vall d'Hebron
Information provided by: Hospital University Vall d'Hebron
ClinicalTrials.gov Identifier: NCT00437099



Purpose

Borderline Personality Disorder (BDP) is a serious mental disorder that affects about 1-2% of the general population, and it is characterized by severe psychosocial impairment and a high mortality rate due to suicide. Currently, the most effective treatments for BPD are psychotherapy (cognitive behaviour therapy – CBT -) and pharmacotherapy (often as an important adjunctive role, especially for disminution of symptoms such as affective instability, impulsivity, psychotic-like symptoms and self-destructive behaviour). Nevertheless, although several drugs are used in these patients, these srugs induce an improvement of some symptoms but do not cause the remission of BPD. Thus, identification of novel treatments is needed.

The objective of this study is to examine the efficacy of Omacor® ( a mixture of omega-3-acid ethyl esters: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) ) for BDP patients receiving CBT. Patients with BDP will be randomly allocated to the three arms of the study: 1- CBT+placebo, 2- CBT+Omacor 1680 mg/d, 3- CBT+Omacor 3360 mg/d. Follow up will last for 12 weeks. Assesment of affective symptoms, impulsivity and aggressivity will be carried out at baseline and at 2, 4, 6, 8, 10 and 12 weeks. Condition Intervention Phase
Borderline Personality Disorder. Drug: Omacor® Phase IV


MedlinePlus related topics: Personality Disorders

Study Type: Interventional
Study Design: Treatment, Randomized, Double-Blind, Placebo Control, Parallel Assignment, Efficacy Study

Official Title: Eficacy of Omega-3 Fatty Acids on Borderline Personality Disorder: a Randomised, Double Blind Clinical Trial.
Further study details as provided by Hospital University Vall d'Hebron:
Primary Outcome Measures:
Affective symptoms measured with the Hamilton Depression Scale (Ham-D) and the Young Mania Rating Scale (YMRS).
Impulsivity and aggressivity measured with a self-control task of impulsivity (Chereck y cols., 1997) and the the Point Subtraction Aggression Paradigm (PTSP; Dougherty y cols., 1999).

Secondary Outcome Measures:
Barratt Impulsivity Scale-11 (BIS-11)
State-Trait Anger Expression Inventory 2 (STAXI-2)
State-Trait Anxiety Inventory (STAI-E)
Brief Psychiatric Rating Scale (BPRS)
Global Activity Scale (EEAG)
Consumption of addictive substances with urine and breath drug testings.
Social Adaptation Self-evaluation Scale (SASS)
Number of suicidal and parasuicidal episodes.
Number of visits to a psychiatric emergency service.
Plasmatic BDNF.
Adverse events.

Total Enrollment: 102

Expected completion: April 2007

Eligibility
Ages Eligible for Study: 18 Years - 65 Years, Genders Eligible for Study: Both
Criteria

Inclusion Criteria:
Meet DSM-IV criteria for BPD assessed by the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II).
Clinical Global Impression of Severity for BDP > 3.
Age between 18 and 65 years.
Be able to give informed consent for participation.
Place of residency compatible with the assistance to the center.
If woman, use of effective contraception.

Exclusion Criteria:
Have a serious medical illness.
History of omacor® allergy.
Current diagnostic of ADHD, unipolar depression, bipolar disorder type I, Obsessive-Compulsive Disorder, schizophrenia and other psychotic disorders.
DIB-R > 8.
Suicidal thinking that requires hospital admission.
Meet DSM-IV criteria for alcohol, benzodiazepine, opioid or psychostimulant dependence in the six months prior to trial entry.
Transaminase elevation within three times the upper limits of normality.
Treatment with stable doses of antidepressants or mood stabilizers for less than six weeks.
Treatment with stable doses of antipsychotics for more than 1 week in the last three months.
Have received electroconvulsive therapy for the six months prior to trial entry.
Have received DBT in the last 12 months prior to trial entry.
Are pregnant or nursing.
Have participated in any other investigational study in the last 6 months prior to trial entry.
Current treatment or expectation to start any treatment with drugs that may interact with the study.

Location and Contact Information
Please refer to this study by ClinicalTrials.gov identifier NCT00437099

Miquel Casas, Prof 0034 93 489 42 94 [email protected]
Xavier Castells, MD 0034 93 489 42 94 [email protected]

Spain
Hospital Universitari Vall d'Hebron, Barcelona, 08035, Spain
Miquel Casas, MD., Prof. 0034 93 489 42 94 [email protected]
Marc Ferrer, MD, Sub-Investigator
Laura Alvarez, Sub-Investigator
Oscar Andion, Sub-Investigator
Jose L Matali, Sub-Investigator
Sergi Valero, Sub-Investigator
Xavier Castells, MD, Sub-Investigator

Study chairs or principal investigators

Miquel Casas, MD., Prof., Principal Investigator, Hospital Universitari Vall d'Hebron Barcelona, Catalonia, Spain

More Information
Study ID Numbers: TLP-OMEGA 3
Last Updated: March 27, 2007
Record first received: February 16, 2007
ClinicalTrials.gov Identifier: NCT00437099
Health Authority: Spain: Spanish Agency of Medicines
ClinicalTrials.gov processed this record on July 25, 2007

Omega 3 Fatty Acids in the Treatment of Children With Autism Spectrum Disorders

This study is currently recruiting patients.
Verified by University of Medicine and Dentistry New Jersey April 2007Sponsors and Collaborators: University of Medicine and Dentistry New Jersey
National Center for Complementary and Alternative Medicine (NCCAM)
Information provided by: University of Medicine and Dentistry New Jersey
ClinicalTrials.gov Identifier: NCT00467818



Purpose

Published studies on omega 3 fatty acids in the treatment of bipolar disorder and schizophrenia have shown reductions in time to recurrence, a decrease in the positive and negative symptoms of schizophrenia, and improvements in CGI, YMRS, and HAM-D scores. The following are the hypotheses:
Omega 3 fatty acids will be superior to placebo in the acute treatment of global autism.
Omega 3 fatty acids will be superior to placebo in improving aggressive and irritable autism.
Omega 3 fatty acids will be superior to placebo in improving functional ability.Condition Intervention Phase
Autism Drug: Omega 3 fatty acids Phase III


MedlinePlus related topics: Autism

Study Type: Interventional
Study Design: Treatment, Randomized, Double-Blind, Placebo Control, Parallel Assignment, Safety/Efficacy Study

Official Title: Omega 3 Fatty Acids in the Treatment of Children With Autism Spectrum Disorders
Further study details as provided by University of Medicine and Dentistry New Jersey:
Primary Outcome Measures:
Clinical Global Impression-Improvement (CGI), administered biweekly
Aberrant Behavior Checklist (ABC), administered every 4 weeks
Vineland Adaptive Behavior Scale, administered during the pre-study and on week 12

Secondary Outcome Measures:
Overt Aggression Scale-Modified, administered every 4 weeks
Parental Stress Index, administered during the baseline visit and on week 12

Total Enrollment: 60

Study start: January 2007; Expected completion: October 2007
This study is an innovative treatment approach to autism. It adapts a promising adjunct therapy for bipolar disorder and schizophrenia to a new population, that of children and adolescents with autism. It will analyze the possible relationship between dosage of omega 3 fatty acids and treatment outcomes. Finally, it will attempt to identify which specific subgroups of subjects will respond to this intervention, which components and associated features are most responsive and whether this impacts subjects' quality of life. The data generated by this study is intended to support the rationale for a full scale, large multi-site clinical trial.

Eligibility
Ages Eligible for Study: 5 Years - 17 Years, Genders Eligible for Study: Both
Criteria

Inclusion Criteria:
Child/Teen has autism.
He/She is between five and seventeen years of age.
He/She is not in the hospital.
He/She has a parent or legal guardian who is willing and able to sign the informed consent.

Exclusion Criteria:
Child/Teen has been diagnosed with a psychotic disorder (such as schizophrenia) or a mood disorder, including depression or bipolar disorder (manic depression).
He/She has caused visible harm to him/herself or is at risk for suicide.
He/She has an active seizure disorder or epilepsy (seizures within the past year).
He/She has an unstable medical illness, including heart disease.
He/She has experienced brain injury.
He/She has a history of diabetes.
He/She has a history of prior treatment with Omega 3 Fatty Acids.
He/She lives in a far away area and/or does not have regular access to transportation to the clinical facility.
A pregnant female or unwilling to use acceptable contraception if sexually active.

Location and Contact Information
Please refer to this study by ClinicalTrials.gov identifier NCT00467818

Annie Kutlik, BA, BS (732)-235-5690 [email protected]

United States, New Jersey
University Behavioral Health Care Building, UMDNJ-RWJMS, Piscataway, New Jersey, 08854, United States; Recruiting
Elizabeth Roberts, Ph.D, Sub-Investigator
Kevin Chen, Ph.D, Sub-Investigator
Annie Kutlik, BA, BS, Sub-Investigator

Study chairs or principal investigators

Sherie L. Novotny, MD, Principal Investigator, Division of Child and Adolescent Psychiatry at the University of Medicine and Dentistry of New Jersey

More Information

University Behavior Health Care official website
Study ID Numbers: 0220060238
Last Updated: April 30, 2007
Record first received: April 27, 2007
ClinicalTrials.gov Identifier: NCT00467818
Health Authority: United States: Institutional Review Board
ClinicalTrials.gov processed this record on July 25, 2007

I take omega 3's out the wazoo..they lessen, but don't completely vanquish alot of my symptoms...I can still be impulsive.