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Förstner BR, Böttger SJ, Moldavski A, Bajbouj M, Pfennig A, Manook A, Ising M, Pittig A, Heinig I, Heinz A, Mathiak K, Schulze TG, Schneider F, Kamp-Becker I, Meyer-Lindenberg A, Padberg F, Banaschewski T, Bauer M, Rupprecht R, Wittchen HU, Rapp MA, Tschorn M. The associations of Positive and Negative Valence Systems, Cognitive Systems and Social Processes on disease severity in anxiety and depressive disorders. Front Psychiatry 2023; 14:1161097. [PMID: 37398596 PMCID: PMC10313476 DOI: 10.3389/fpsyt.2023.1161097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/19/2023] [Indexed: 07/04/2023] Open
Abstract
Background Anxiety and depressive disorders share common features of mood dysfunctions. This has stimulated interest in transdiagnostic dimensional research as proposed by the Research Domain Criteria (RDoC) approach by the National Institute of Mental Health (NIMH) aiming to improve the understanding of underlying disease mechanisms. The purpose of this study was to investigate the processing of RDoC domains in relation to disease severity in order to identify latent disorder-specific as well as transdiagnostic indicators of disease severity in patients with anxiety and depressive disorders. Methods Within the German research network for mental disorders, 895 participants (n = 476 female, n = 602 anxiety disorder, n = 257 depressive disorder) were recruited for the Phenotypic, Diagnostic and Clinical Domain Assessment Network Germany (PD-CAN) and included in this cross-sectional study. We performed incremental regression models to investigate the association of four RDoC domains on disease severity in patients with affective disorders: Positive (PVS) and Negative Valance System (NVS), Cognitive Systems (CS) and Social Processes (SP). Results The results confirmed a transdiagnostic relationship for all four domains, as we found significant main effects on disease severity within domain-specific models (PVS: β = -0.35; NVS: β = 0.39; CS: β = -0.12; SP: β = -0.32). We also found three significant interaction effects with main diagnosis showing a disease-specific association. Limitations The cross-sectional study design prevents causal conclusions. Further limitations include possible outliers and heteroskedasticity in all regression models which we appropriately controlled for. Conclusion Our key results show that symptom burden in anxiety and depressive disorders is associated with latent RDoC indicators in transdiagnostic and disease-specific ways.
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Affiliation(s)
- Bernd R. Förstner
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Sarah Jane Böttger
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Alexander Moldavski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Malek Bajbouj
- Charité–Universitätsmedizin Berlin, Department of Psychiatry, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - André Manook
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Marcus Ising
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Andre Pittig
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Ingmar Heinig
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy CCM, Charité–Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- JARA-Brain, Research Center Jülich, Jülich, Germany
| | - Thomas G. Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Behavioral Sciences, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, MD, United States
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- University Hospital Düsseldorf, Medical School, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Michael A. Rapp
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
| | - Mira Tschorn
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Potsdam, Germany
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Bauer EA, Wilson KA, Phan KL, Shankman SA, MacNamara A. A Neurobiological Profile Underlying Comorbidity Load and Prospective Increases in Dysphoria in a Focal Fear Sample. Biol Psychiatry 2023; 93:352-361. [PMID: 36280453 PMCID: PMC10866641 DOI: 10.1016/j.biopsych.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Knowledge of the neural mechanisms underlying increased disease burden in anxiety disorders that is unaccounted for by individual categorical diagnoses could lead to improved clinical care. Here, we tested the utility of a joint functional magnetic resonance imaging-electroencephalography neurobiological profile characterized by overvaluation of negative stimuli (amygdala) in combination with blunted elaborated processing of these same stimuli (the late positive potential [LPP], an event-related potential) in predicting increased psychopathology across a 2-year period in people with anxiety disorders. METHODS One hundred ten participants (64 female, 45 male, 1 other) including 78 participants with phobias who varied in the extent of their internalizing comorbidity and 32 participants who were free from psychopathology viewed negative and neutral pictures during separate functional magnetic resonance imaging blood oxygen level-dependent and electroencephalogram recordings. Dysphoria was assessed at baseline and 2 years later. RESULTS Participants with both heightened amygdala activation and blunted LPPs to negative pictures showed the greatest increases in dysphoria 2 years later. Cross-sectionally, participants with higher comorbidity load (≥2 additional diagnoses, n = 34) showed increased amygdala activation to negative pictures compared with participants with lower comorbidity load (≤1 additional diagnosis, n = 44) and compared with participants free from psychopathology. In addition, high comorbid participants showed reduced LPPs to negative pictures compared with low comorbid participants. CONCLUSIONS Heightened amygdala in response to negative stimuli in combination with blunted LPPs could indicate overvaluation of threatening stimuli in the absence of elaborated processing that might otherwise help regulate threat responding. This brain profile could underlie the worsening and maintenance of internalizing psychopathology over time.
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Affiliation(s)
- Elizabeth A Bauer
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas.
| | - Kayla A Wilson
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio
| | - Stewart A Shankman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, Illinois
| | - Annmarie MacNamara
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
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Förstner BR, Tschorn M, Reinoso-Schiller N, Maričić LM, Röcher E, Kalman JL, Stroth S, Mayer AV, Schwarz K, Kaiser A, Pfennig A, Manook A, Ising M, Heinig I, Pittig A, Heinz A, Mathiak K, Schulze TG, Schneider F, Kamp-Becker I, Meyer-Lindenberg A, Padberg F, Banaschewski T, Bauer M, Rupprecht R, Wittchen HU, Rapp MA. Mapping Research Domain Criteria using a transdiagnostic mini-RDoC assessment in mental disorders: a confirmatory factor analysis. Eur Arch Psychiatry Clin Neurosci 2022; 273:527-539. [PMID: 35778521 PMCID: PMC10085934 DOI: 10.1007/s00406-022-01440-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
This study aimed to build on the relationship of well-established self-report and behavioral assessments to the latent constructs positive (PVS) and negative valence systems (NVS), cognitive systems (CS), and social processes (SP) of the Research Domain Criteria (RDoC) framework in a large transnosological population which cuts across DSM/ICD-10 disorder criteria categories. One thousand four hundred and thirty one participants (42.1% suffering from anxiety/fear-related, 18.2% from depressive, 7.9% from schizophrenia spectrum, 7.5% from bipolar, 3.4% from autism spectrum, 2.2% from other disorders, 18.4% healthy controls, and 0.2% with no diagnosis specified) recruited in studies within the German research network for mental disorders for the Phenotypic, Diagnostic and Clinical Domain Assessment Network Germany (PD-CAN) were examined with a Mini-RDoC-Assessment including behavioral and self-report measures. The respective data was analyzed with confirmatory factor analysis (CFA) to delineate the underlying latent RDoC-structure. A revised four-factor model reflecting the core domains positive and negative valence systems as well as cognitive systems and social processes showed a good fit across this sample and showed significantly better fit compared to a one factor solution. The connections between the domains PVS, NVS and SP could be substantiated, indicating a universal latent structure spanning across known nosological entities. This study is the first to give an impression on the latent structure and intercorrelations between four core Research Domain Criteria in a transnosological sample. We emphasize the possibility of using already existing and well validated self-report and behavioral measurements to capture aspects of the latent structure informed by the RDoC matrix.
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Affiliation(s)
- Bernd R Förstner
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Am Neuen Palais 10, 14469, Potsdam, Germany
| | - Mira Tschorn
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Am Neuen Palais 10, 14469, Potsdam, Germany
| | - Nicolas Reinoso-Schiller
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Am Neuen Palais 10, 14469, Potsdam, Germany
| | - Lea Mascarell Maričić
- Department of Psychiatry and Psychotherapy CCM, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Erik Röcher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Annalina V Mayer
- Social Neuroscience Lab, Department of Psychiatry and Psychotherapy, Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Kristina Schwarz
- Department of Psychiatry and Psychotherapy, Mannheim, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Anna Kaiser
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - André Manook
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Marcus Ising
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Ingmar Heinig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Andre Pittig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Translational Psychotherapy, Department of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy CCM, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- JARA-Brain, Research Center Jülich, Jülich, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- University Hospital Düsseldorf, Medical School, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Mannheim, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Hans-Ulrich Wittchen
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Michael A Rapp
- Social and Preventive Medicine, Department of Sports and Health Sciences, University of Potsdam, Am Neuen Palais 10, 14469, Potsdam, Germany.
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Tseng WL, Abend R, Gold AL, Brotman MA. Neural correlates of extinguished threat recall underlying the commonality between pediatric anxiety and irritability. J Affect Disord 2021; 295:920-929. [PMID: 34706463 PMCID: PMC8554134 DOI: 10.1016/j.jad.2021.08.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/28/2021] [Accepted: 08/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anxiety and irritability frequently co-occur in youth and are mediated by aberrant threat responses. However, empirical evidence on neural mechanisms underlying this co-occurrence is limited. To address this, we apply data-driven latent phenotyping to data from a prior report of a well-validated threat extinction recall fMRI paradigm. METHODS Participants included 59 youth (28 anxiety disorder, 31 healthy volunteers; Mage=13.15 yrs) drawn from a transdiagnostic sample of 331 youth, in which bifactor analysis was conducted to derive latent factors representing shared vs. unique variance of dimensionally-assessed anxiety and irritability. Participants underwent threat conditioning and extinction. Approximately three weeks later, during extinction recall fMRI, participants made threat-safety discriminations under two task conditions: current threat appraisal and explicit recall of threat contingencies. Linear mixed-effects analyses examined associations of a "negative affectivity" factor reflecting shared anxiety and irritability variance with whole-brain activation and task-dependent amygdala connectivity. RESULTS During recall of threat-safety contingencies, higher negative affectivity was associated with greater prefrontal (ventrolateral/ventromedial, dorsolateral, orbitofrontal), motor, temporal, parietal, and occipital activation. During threat appraisal, higher negative affectivity was associated with greater amygdala-inferior parietal lobule connectivity to threat/safety ambiguity. LIMITATIONS Sample included only healthy youth and youth with anxiety disorders. Results may not generalize to other diagnoses for which anxiety and irritability are also common, and our negative affectivity factor should be interpreted as anxiety disorders with elevated irritability. Reliability of some subfactors was poor. CONCLUSIONS Aberrant amygdala-prefrontal-parietal circuitry during extinction recall of threat-safety stimuli may be a mechanism underlying the co-occurrence of pediatric anxiety and irritability.
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Affiliation(s)
- Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, Yale University, 230 S. Frontage Road, New Haven, CT 06519, USA.
| | - Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD 20854, USA
| | - Andrea L Gold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD 20854, USA
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Hettema JM, Bourdon JL, Sawyers C, Verhulst B, Brotman MA, Leibenluft E, Pine DS, Roberson-Nay R. Genetic and environmental risk structure of internalizing psychopathology in youth. Depress Anxiety 2020; 37:540-548. [PMID: 32369878 PMCID: PMC7656112 DOI: 10.1002/da.23024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/17/2020] [Accepted: 04/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Internalizing disorders (IDs), consisting of syndromes of anxiety and depression, are common, debilitating conditions often beginning early in life. Various trait-like psychological constructs are associated with IDs. Our prior analysis identified a tripartite model of Fear/Anxiety, Dysphoria, and Positive Affect among symptoms of anxiety and depression and the following constructs in youth: anxiety sensitivity, fearfulness, behavioral activation and inhibition, irritability, neuroticism, and extraversion. The current study sought to elucidate their overarching latent genetic and environmental risk structure. METHODS The sample consisted of 768 juvenile twin subjects ages 9-14 assessed for the nine, abovementioned measures. We compared two multivariate twin models of this broad array of phenotypes. RESULTS A hypothesis-driven, common pathway twin model reflecting the tripartite structure of the measures were fit to these data. However, an alternative independent pathway model provided both a better fit and more nuanced insights into their underlying genetic and environmental risk factors. CONCLUSIONS Our findings suggest a complex latent genetic and environmental structure to ID phenotypes in youth. This structure, which incorporates both clinical symptoms and various psychological traits, informs future phenotypic approaches for identifying specific genetic and pathophysiological mechanisms underlying ID risk.
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Affiliation(s)
- John M. Hettema
- Department of Psychiatry, Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia,Department of Psychiatry, Texas A&M Health Science Center, Bryan, Texas
| | - Jessica L. Bourdon
- Department of Psychiatry, Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia,Department of Psychiatry, Brown School of Social Work, Washington University, St. Louis, Missouri
| | - Chelsea Sawyers
- Department of Psychiatry, Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Brad Verhulst
- Department of Psychiatry, Texas A&M Health Science Center, Bryan, Texas
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Roxann Roberson-Nay
- Department of Psychiatry, Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
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Abstract
Research into irritability has focused largely on its developmental and child-adolescent manifestations. Although irritability appears to be as elemental an experience as anxiety or depression, diagnoses highlighting irritability as the focal ingredient have yet to be delineated for adults. Instead, irritability-related diagnoses in adults have largely emphasized externalizing behaviors, depressed mood, and personality. Consequently, patients complaining of irritability are sometimes shoehorned into diagnostic categories that they do not experience as authentic representations of their lived experiences. This article proposes that the symptom of irritability might be productively reenvisioned as a focal point, analogous to anxiety and depression, around which irritability-related syndromes and disorders in adults might coalesce. If anxiety, depressive, insomnia, and pain disorders, why not irritability disorders? Both state and trait characteristics of irritability can lend themselves to DSM diagnostic frames. Based on clinical observations, specific irritability disorders in adults can be envisioned, modeled as Irritability Disorder of Adulthood, Irritability Disorder Secondary to Another Medical Condition, Substance-Induced Irritability Disorder, Adjustment Disorder With Irritable Mood, and the like. Further delineation of irritability phenomena, syndromes, and possible disorders in adults is warranted to advance investigation, guide assessment, and improve treatment.
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Affiliation(s)
- Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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Wang J, Sun W, Tang X, Xu L, Wei Y, Cui H, Tang Y, Hui L, Jia Q, Zhu H, Wang J, Zhang T. Transdiagnostic Dimensions towards Personality Pathology and Childhood Traumatic Experience in a Clinical Sample: Subtype Classification by a Cross-sectional Analysis. Sci Rep 2019; 9:11248. [PMID: 31375755 PMCID: PMC6677786 DOI: 10.1038/s41598-019-47754-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/23/2019] [Indexed: 12/23/2022] Open
Abstract
Psychiatric disorders are highly heterogeneous syndromes often explained by underlying and internalized personality disorder(PD) traits that are affected by externalized childhood trauma experiences(CTE). The present study investigated the differential subtype model by examining the association between PD traits and CTE in a clinical sample with transdiagnostic psychopathology. Outpatients(n = 2090) presenting for psychiatric treatment completed self-reported measures of PD traits(Personality Diagnostic Questionnaire) and the childhood adversity(Child Trauma Questionnaire). Canonical variates were generated by canonical correlation analysis(CCA) and then used for hierarchical cluster analysis to produce subtypes. A support vector machine(SVM) model was used and validated using a linear kernel to assess the utility of the extracted subtypes of outpatients in clinical diagnosis classifications. The CCA determined two linear combinations: emotional abuse related dissociality PD traits(antisocial and paranoid PD) and emotional neglect related sociality PD traits(schizoid, passive-aggressive, depressive, histrionic, and avoidant PD). A cluster analysis revealed three subtypes defined by distinct and relatively homogeneous patterns along two dimensions, and comprising 17.5%(cluster-1, n = 365), 34.8%(cluster-2, n = 727), and 47.8%(cluster-3, n = 998) of the sample, each with distinctive features of PD traits and CTE. These subtypes suggest more distinct PD trait correlates of CTE manifestations than were captured by clinical phenomenological diagnostic definitions. Our results highlight important subtypes of psychiatric patients that highlight PD traits and CTE that transcend current diagnostic boundaries. The three different subtypes reflect significant differences in PD and CTE characteristics and lend support to efforts to develop PD and childhood trauma targeted psychotherapy that extends to clinical diagnosis-based interventions.
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Affiliation(s)
- JunJie Wang
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China
| | - Wei Sun
- Department of Neurosurgery, Pu Nan Hospital, Shanghai, 200125, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - Li Hui
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China
| | - QiuFang Jia
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China
| | - Hongliang Zhu
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China.
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China. .,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, P.R. China. .,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China.
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Rappaport LM, Carney DM, Brotman MA, Leibenluft E, Pine DS, Roberson-Nay R, Hettema JM. A Population-Based Twin Study of Childhood Irritability and Internalizing Syndromes. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 49:524-534. [PMID: 30376640 DOI: 10.1080/15374416.2018.1514612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Childhood irritability exhibits significant theoretical and empirical associations with depression and anxiety syndromes. The current study used the twin design to parse genetic and environmental contributions to these relationships. Children ages 9-14 from 374 twin pairs were assessed for irritability and symptoms of depression, generalized anxiety, panic, social phobia, and separation anxiety using dimensional self-report instruments. Multivariate structural equation modeling decomposed the correlations between these syndromes into genetic and environmental components to examine shared and specific risk domains. Irritability had significant associations with each internalizing symptom domain. Genetic contributions to irritability are moderately correlated with genetic risk for symptoms of depression, generalized anxiety, and separation anxiety with weaker overlap with the other anxiety syndromes. Familial and specific environmental risk factors explained covariation among syndromes and indicated potential syndrome-specific risk. There is substantial overlap among the genetic and environmental factors that influence individual differences in irritability and those that increase liability for depression and anxiety symptoms in children. These findings deepen the current understanding of childhood internalizing risk factors and provide important implications for syndrome prediction and susceptibility gene discovery efforts.
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Affiliation(s)
| | - Dever M Carney
- Department of Psychiatry, Virginia Commonwealth University
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program
| | | | - John M Hettema
- Department of Psychiatry, Virginia Commonwealth University
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Lahti-Pulkkinen M, Cudmore MJ, Haeussner E, Schmitz C, Pesonen AK, Hämäläinen E, Villa PM, Mehtälä S, Kajantie E, Laivuori H, Reynolds RM, Frank HG, Räikkönen K. Placental Morphology Is Associated with Maternal Depressive Symptoms during Pregnancy and Toddler Psychiatric Problems. Sci Rep 2018; 8:791. [PMID: 29335435 PMCID: PMC5768752 DOI: 10.1038/s41598-017-19133-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022] Open
Abstract
Maternal depressive symptoms during pregnancy predict increased psychiatric problems in children. The underlying biological mechanisms remain unclear. Hence, we examined whether alterations in the morphology of 88 term placentas were associated with maternal depressive symptoms during pregnancy and psychiatric problems in 1.9-3.1-years old (Mean = 2.1 years) toddlers. Maternal depressive symptoms were rated biweekly during pregnancy with the Center of Epidemiological Studies Depression Scale (n = 86). Toddler psychiatric problems were mother-rated with the Child Behavior Checklist (n = 60). We found that higher maternal depressive symptoms throughout pregnancy [B = -0.24 Standard Deviation (SD) units: 95% Confidence Interval (CI) = -0.46; -0.03: P = 0.03; Mean difference = -0.66 SDs; 95% CI = -0.08; -1.23: P = 0.03; between those with and without clinically relevant depressive symptoms] were associated with lower variability in the placental villous barrier thickness of γ-smooth muscle actin-negative villi. This placental morphological change predicted higher total (B = -0.34 SDs: 95% CI = -0.60; -0.07: P = 0.01) and internalizing (B = -0.32 SDs: 95% CI = -0.56; -0.08: P = 0.01) psychiatric problems in toddlers. To conclude, our findings suggest that both maternal depressive symptoms during pregnancy and toddler psychiatric problems may be associated with lower variability in the villous membrane thickness of peripheral villi in term placentas. This lower heterogeneity may compromise materno-fetal exchange, suggesting a possible role for altered placental morphology in the fetal programming of mental disorders.
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Affiliation(s)
- Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland. .,British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom. .,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.
| | - Melissa Jane Cudmore
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Eva Haeussner
- Department of Anatomy II, LMU Munich, Munich, Germany
| | | | - Anu-Katriina Pesonen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Esa Hämäläinen
- HUSLAB and Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland
| | - Pia M Villa
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Mehtälä
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Kajantie
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland, HiLIFE Unit, University of Helsinki, Helsinki, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Rebecca M Reynolds
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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