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Henriques-Calado J, Pires R, Paulino M, Gama Marques J, Gonçalves B. Psychotic spectrum features in borderline and bipolar disorders within the scope of the DSM-5 section III personality traits: a case control study. Borderline Personal Disord Emot Dysregul 2023; 10:2. [PMID: 36647173 PMCID: PMC9841700 DOI: 10.1186/s40479-022-00205-w] [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: 08/18/2022] [Accepted: 11/14/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Psychotic spectrum features in borderline personality disorder (PD) are a long-standing phenomenon, but remarkably, to date, they have not been the focus of many empirical studies. Moreover, the comparative studies that acknowledge their links to affective psychoses are even more scarce. Likewise, the contributions of empirical research on the DSM-5 dimensional approach to this topic are also uncommon. This study seeks to identify the best set of pathological personality traits and/or symptoms that are predictors of psychotic features (psychoticism and ideation paranoid symptoms) in borderline PD and in bipolar disorder, based on the framework of the DSM-5 section III personality traits. METHODS A cross-sectional study of two clinical samples: 1) Borderline PD group of 63 participants; 2) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5 (PID-5); Brief Symptom Inventory (BSI). A series of linear and logistic regression analyses were computed. RESULTS Overall, the data emerging as common predictors are detachment, negative affectivity, psychoticism, depressivity, grandiosity, suspiciousness and interpersonal sensitivity symptoms. Borderline PD has the highest score in BSI paranoid ideation which emerges as its discriminating trait (Nagelkerke R2 = .58): cognitive and perceptual dysregulation (OR: 13.02), restricted affectivity (OR: 12.09), withdrawal (OR: 11.70), anhedonia (OR: 10.98) and emotional lability (OR: 6.69). CONCLUSIONS Besides the commonality that appears to overlap both disorders with a psychosis superspectrum, the patterns of the pathological personality-symptoms underlying the psychotic features appear to reinforce a position between schizophrenia and bipolar disorders that borderline PD may occupy, highlighting the possibility of its intersection with schizoaffective/psychosis spectra. The pathological personality nature of the psychotic features emerges as a potential comprehensive trait of the phenomenological dimensions.
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Affiliation(s)
- Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal. .,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.
| | - Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil, 53, 1749-002, Lisboa, Portugal
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal
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Garza Guerra ADJ, Adame Rocha GH, Rodríguez Lara FJ. Clinical differences between bipolar disorder and borderline personality disorder: a case report. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:330-334. [PMID: 36443209 DOI: 10.1016/j.rcpeng.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/28/2020] [Indexed: 06/16/2023]
Abstract
The clinical difference between bipolar disorder and borderline personality disorder has always been a diagnostic challenge, especially with type II bipolar disorder and subthreshold symptoms, opening a diagnostic bias with the consequent repercussions of inappropriate treatment. Both pathologies are often misdiagnosed initially. The objective of this article is to emphasise the main clinical differences between the two pathologies. We present the case of a patient with a long history of psychiatric symptoms that started in childhood, with considerable functional impairment, who met the criteria for both disorders, pointing to comorbidity. During follow-up, she responded favourably to psychotropic drugs, pushing the diagnosis towards the bipolar spectrum, due to the notable improvement. However, comorbidity should not be neglected due to its high presentation.
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Affiliation(s)
- Alfredo de Jesús Garza Guerra
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México.
| | - Gabriela Hilian Adame Rocha
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Francisco Javier Rodríguez Lara
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
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Miola A, Cattarinussi G, Antiga G, Caiolo S, Solmi M, Sambataro F. Difficulties in emotion regulation in bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2022; 302:352-360. [PMID: 35093412 DOI: 10.1016/j.jad.2022.01.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a severe mental disorder characterized by mood swings and functional impairment. Although alterations in emotional regulation (ER) are a key feature, a comprehensive meta-analysis on abnormalities in emotion regulation in BD is still lacking. METHODS We performed a random-effects meta-analysis on studies comparing the ER measured with the Difficulties in Emotion Regulation Scale (DERS) in BD and healthy controls (HC) or borderline personality disorder (BPD) and calculated the standardized mean difference (SMD) of the total DERS score between those with BD and HC (primary outcome). Secondary outcomes were the SMD of the DERS subscales between BD and HC, as well as the SMD of the total score of DERS and the subscales between BD and BPD. RESULTS Twelve studies (858 BD, 540 BPD, 285 HC) were included. Compared to HC, BD showed significantly higher total DERS score (k=8, SMD 0.962, p<0.001) and subscale scores, including non-acceptance (k=6, SMD=0.85, p<0.001), goal-directed behavior (k=6, SMD=0.894, p<0.001), impulse control (k=6, SMD=1.08, p<0.001), strategies (k=6, SMD=1.25, p<0.001) and emotional clarity (k=6, SMD=0.694, p=0.001). Relative to BPD, BD presented significantly lower scores in all the DERS subscales. Sensitivity analyses confirmed the main analyses. The age of the participants and sample size moderated the primary outcome. LIMITATIONS The small number of studies and the cross-sectional design limit the generalizability of the results. CONCLUSIONS Our findings suggest that alterations of specific ER abilities are present in BD and their magnitude is smaller relative to BPD. Future therapeutic interventions should target ER strategies.
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Affiliation(s)
- Alessandro Miola
- Department of Neuroscience (DNS), University of Padova, Padua, Italy;; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy;; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Gilberto Antiga
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Stefano Caiolo
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy;; Padua Neuroscience Center, University of Padova, Padua, Italy.
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Henriques-Calado J, Gonçalves B, Marques C, Paulino M, Gama Marques J, Grácio J, Pires R. In light of the DSM-5 dimensional model of personality: Borderline personality disorder at the crossroads with the bipolar spectrum. J Affect Disord 2021; 294:897-907. [PMID: 34375218 DOI: 10.1016/j.jad.2021.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/22/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND State-of-the-art research highlights that borderline personality disorder (PD) and bipolar spectrum disorders have clinical characteristics in common, which imply uncertainty in differential diagnoses. Although there is a growing body of literature on the DSM-5 dimensional model of personality disorder, its discriminative features between these clinical samples are still understudied. In this study, we seek to identify the best set of predictors that differentiate between borderline PD and bipolar spectrum, based on pathological and normative personality traits and symptoms. METHODS A cross-sectional study of three clinical samples: 1) Borderline PD group of 63 participants; 2) Major depressive disorder group of 89 participants; 3) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5; Brief Symptom Inventory; FFM Inventory. A series of one-way ANOVAs and logistic regression analyses were computed. RESULTS The major set of data emerging as common discriminants of borderline PD across the bipolar spectrum are unusual beliefs & experiences, paranoid ideation, obsession-compulsion and extraversion. Depressivity (OR: 34.95) and impulsivity (OR: 22.35) pathological traits displayed the greatest predictive values in the differential diagnosis. LIMITATIONS The small size of the samples; a lack of data from participants' previous clinical history. CONCLUSIONS Findings support the DSM-5 pathological traits as differentiating borderline PD through bipolar spectrum, and reinforcing the joint use of symptom-related pathological functioning and normal-range personality traits. Alongside the bipolar spectrum, borderline pathology sheds light upon a hypothetical overlap along the depressive and schizoaffective/schizophrenia spectra, representing a borderland space at a crossroads with the psychopathology of a meta-spectrum.
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Affiliation(s)
- Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal.
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - Catarina Marques
- Instituto Universitário de Lisboa (ISCTE-IUL), Business Research Unit, Av. das Forças Armadas, 1649-026 Lisboa, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - João Gama Marques
- Clínica de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil, 53, 1749-002 Lisboa, Portugal; Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Jaime Grácio
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal; Champalimaud Research, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal; NOVA Medical School/ Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
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A novel multidimensional questionnaire for the assessment of emotional dysregulation in adolescents: Reactivity, Intensity, Polarity and Stability questionnaire-youth version (RIPoSt-Y). J Affect Disord 2021; 291:359-367. [PMID: 34089928 DOI: 10.1016/j.jad.2021.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/09/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The failure to regulate emotions, namely emotional dysregulation (ED), is a relevant construct in adolescent psychiatry, in terms of prognostic and developmental implications. We developed and validated a novel self-report questionnaire for the assessment of ED, the RIPoSt-Y, both in clinical and non-clinical samples. METHODS Items selection and subscales construction were conducted on healthy controls (n=374), while test-retest reliability was evaluated in a subsample (n=72); internal consistency was examined both in the control group and in two clinical samples, respectively including patients with Bipolar Spectrum Disorders (BSD; n=44) and ADHD (n=34). Construct, concurrent and convergent validity were also assessed. RESULTS Thirty-one items were finally retained, and three subscales were identified (Affective Instability, Emotional Reactivity, Interpersonal Sensitivity). Test-retest was significant for each subscale with moderate-to-good correlations, and internal consistency showed good-to-excellent coefficients. Construct validity was supported by significant differences between patients and controls and gender-related differences. Concurrent validity was confirmed through significant associations with two subscales of the CHT-Q, while convergent validity proved to be significant with the CBCL/YSR dysregulation-profile. Cut-offs were also computed to discriminate clinically significant scores of ED. LIMITATIONS The use of a school-based survey to recruit controls could have biased our results; gender distributions between clinical and non-clinical samples were significantly different. CONCLUSIONS Our novel questionnaire proved to be a valid and reliable tool able to assess the presence of ED in youths and to characterize this fundamental construct in its multidimensional facets.
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Antonietta Furio M, Popovic D, Vieta E, Stukalin Y, Hagin M, Torrent C, Azorin JM, Angst J, Bowden CL, Mosolov S, Young AH, Perugi G. Characterization of rapid cycling bipolar patients presenting with major depressive episode within the BRIDGE-II-MIX study. Bipolar Disord 2021; 23:391-399. [PMID: 32959482 DOI: 10.1111/bdi.12994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as rapid cycling (RC). METHODS Psychiatric symptoms, socio-demographic, and clinical variables were collected from a sample of 2811 MDE patients, of which 726 (25.8%) were diagnosed with bipolar disorder (BD). The characteristics of bipolar patients with RC (BD-RC) and without (BD-NRC) RC were compared. RESULTS Of 726 BD patients, 159 (21.9%) met DSM-5 criteria for RC. BD-RC group presented a higher number of lifetime depressive episodes (p < 0.001) with shorter duration of depressive episodes, and more psychiatric comorbidities, as well as higher rates of atypical features (p = 0.016) and concomitant (hypo)manic symptoms (irritable mood (p = 0.001); risky behavior (p = 0.005); impulsivity (p = 0.006); and psychomotor agitation (p = 0.029)). Patients with RC had a worse functioning (p = 0.033), more obesity (p = 0.003), and were significantly more likely to be treated with three or more drugs (p = 0.007). CONCLUSIONS Important clinical differences between bipolar patients with and without a RC include more depressive morbidity, higher incidence of anxiety disorders, addiction, bulimia, and borderline personality disorder, as well as atypical features during depression and symptoms such as irritability, risky behavior, impulsivity, and agitation. RC patients had poorer functioning than patients without RC, more obesity, and had to be treated with more drugs.
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Affiliation(s)
- Maria Antonietta Furio
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Dina Popovic
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Abarbanel Mental Health Center, Bat Yam, Israel
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Yelena Stukalin
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel-Aviv, Israel
| | - Michal Hagin
- Sheba Medical Center, Tel Hashomer University Hospital, Ramat Gan, Israel
| | - Carla Torrent
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Jules Angst
- Psychiatrische Universitätsklinik, Zürich, Switzerland
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Comparison of Emotional Dysregulation Features in Cyclothymia and Adult ADHD. ACTA ACUST UNITED AC 2021; 57:medicina57050489. [PMID: 34066126 PMCID: PMC8151096 DOI: 10.3390/medicina57050489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 01/16/2023]
Abstract
Background and Objectives: Emotional dysregulation is central to the problem of the overlap between attention-deficit/hyperactivity disorder (ADHD) and cyclothymia. The aim of the study was to evaluate comorbidity rates between ADHD and cyclothymic disorder and to explore demographic and clinical differences among the groups, focusing on affective temperament and emotional dysregulation. Materials and Methods: One hundred sixty-five outpatients attending the Second Psychiatry Unit at the Santa Chiara University Hospital (Pisa) were consecutively recruited: 80 were diagnosed with ADHD, 60 with cyclothymic disorder, and 25 with both conditions. Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-M) and the 40-item version of Reactivity, Intensity, Polarity, and Stability questionnaire (RI-PoSt-40) were administered. Results: Cyclothymic patients were more frequently female and older with respect to the ADHD groups. Both comorbid and non-comorbid ADHD patients showed significantly lower educational attainment and more frequently had substance use disorders. Panic disorder was common in non-comorbid cyclothymic patients, who showed significantly higher rates of familial panic disorder, major depressive disorder and suicide attempts in comparison with patients only diagnosed with ADHD. Cyclothymic patients without ADHD were also characterized by fewer hyperthymic temperamental traits, higher depressive and anxious dispositions, and a greater negative emotionality. No significant differences among groups were observed for cyclothymic temperament and overall negative emotional dysregulation, but comorbid patients with both conditions scored the highest in these subscales. This group also showed significantly higher affective instability with respect to ADHD patients without cyclothymia and was less frequently diagnosed with bipolar disorder type II than patients from both the other groups. Conclusions: ADHD and cyclothymia often co-occur and show similar levels of emotional dysregulation. However, cyclothymic patients may be more prone to negative emotionality in clinical settings. Subjects with “sunny” cyclothymic features might escape the attention of clinicians unless ADHD is present.
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Garza Guerra ADJ, Adame Rocha GH, Rodríguez Lara FJ. Clinical Differences between Bipolar Disorder and Borderline Personality Disorder: A Case Report. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(21)00029-9. [PMID: 33734997 DOI: 10.1016/j.rcp.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/14/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
The clinical difference between bipolar disorder and borderline personality disorder has always been a diagnostic challenge, especially with type II bipolar disorder and subthreshold symptoms, opening a diagnostic bias with the consequent repercussions of inappropriate treatment. Both pathologies are often misdiagnosed initially. The objective of this article is to emphasise the main clinical differences between the two pathologies. We present the case of a patient with a long history of psychiatric symptoms that started in childhood, with considerable functional impairment, who met the criteria for both disorders, pointing to comorbidity. During follow-up, she responded favourably to psychotropic drugs, pushing the diagnosis towards the bipolar spectrum, due to the notable improvement. However, comorbidity should not be neglected due to its high presentation.
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Affiliation(s)
- Alfredo de Jesús Garza Guerra
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México.
| | - Gabriela Hilian Adame Rocha
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Francisco Javier Rodríguez Lara
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
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Psychiatric Aspects of Obesity: A Narrative Review of Pathophysiology and Psychopathology. J Clin Med 2020; 9:jcm9082344. [PMID: 32717793 PMCID: PMC7463475 DOI: 10.3390/jcm9082344] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 12/16/2022] Open
Abstract
In the last decades, obesity has become a major concern for clinical and public health. Despite the variety of available treatments, the outcomes remain—by and large—still unsatisfactory, owing to high rates of nonresponse and relapse. Interestingly, obesity is being associated with a growing surge of neuropsychiatric problems, certainly related to the pathogenesis of this condition, and likely to be of great consequence as for its treatment and prognosis. In a neurobiologic direction, a sturdy body of evidence has recently shown that the immune–metabolic–endocrine dyscrasias, notoriously attached to excess body weight/adiposity, affect and impair the morpho-functional integrity of the brain, thus possibly contributing to neuroprogressive/degenerative processes and behavioral deviances. Likewise, in a neuropsychiatric perspective, obesity displays complex associations with mood disorders and affective temperamental dimensions (namely cyclothymia), eating disorders characterized by overeating/binge-eating behaviors, ADHD-related executive dysfunctions, emotional dysregulation and motivational–addictive disturbances. With this review, we attempt to provide the clinician a synoptic, yet exhaustive, tool for a more conscious approach to that subset of this condition, which could be reasonably termed “psychiatric” obesity.
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Kaleda VG, Zyablov VA. [Continuous cycling bipolar affective disorders in youth]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:14-22. [PMID: 32490613 DOI: 10.17116/jnevro202012004114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To reveal psychopathological characteristics and core dynamic patterns of continuous cycling bipolar affective disorders in youth. MATERIAL AND METHODS One hundred and seven patients (62 men and 45 women), including 59 patients of the clinical group and 48 of the follow-up group, were examined. RESULTS AND CONCLUSION Three types of continuous cycling bipolar affective disorders in youth are described: rhythmic, dysrhythmic and pseudorhythmic. A correlation between the dynamics of affective disorders in youth and the nosological affiliation of each of the identified types of continuous cycling course was found. The results may be useful for solving differential/diagnostic, prognostic and therapeutic tasks.
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Affiliation(s)
- V G Kaleda
- Mental Health Research Centre, Moscow, Russia
| | - V A Zyablov
- Mental Health Research Centre, Moscow, Russia
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Azorin J, Kaladjian A, Adida M, Fakra E, Belzeaux R, Hantouche E, Lancrenon S. Factors associated with borderline personality disorder in major depressive patients and their relationship to bipolarity. Eur Psychiatry 2020; 28:463-8. [DOI: 10.1016/j.eurpsy.2012.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/12/2012] [Accepted: 11/23/2012] [Indexed: 12/31/2022] Open
Abstract
AbstractObjectiveTo analyze the interface between borderline personality disorder (BPD) and bipolarity in depressed patients comorbid with BPD.MethodsAs part of National Multi-site Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 19 (3.9%) had comorbid BPD (BPD+), whereas 474 (96.1%) did not manifest this comorbidity (BPD−).ResultsCompared to BPD (−), BPD (+) patients displayed higher rates of bipolar (BP) disorders and temperaments, an earlier age at onset with a family history of affective illness, more comorbidity, more stressors before the first episode which was more often depressive or mixed, as well as a greater number and severity of affective episodes.ConclusionsThe hypothesis which fitted at best our findings was to consider BPD as a contributory factor in the development of BP disorder, which could have favoured the progression from unipolar major depression to BP disorder. We could not however exclude that some features of BP disorder may have contributed to the development of BPD.
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Bayes A, Parker G, Paris J. Differential Diagnosis of Bipolar II Disorder and Borderline Personality Disorder. Curr Psychiatry Rep 2019; 21:125. [PMID: 31749106 DOI: 10.1007/s11920-019-1120-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW Differentiating bipolar (BP) disorders (in particular BP II) from borderline personality disorder (BPD) is a common diagnostic dilemma. We sought to critically examine recent studies that considered clinical differences between BP II and BPD, which might advance their delineation. RECENT FINDINGS Recent studies focused on differentiating biological parameters-genetics, epigenetics, diurnal rhythms, structural and functional neuroimaging-with indicative differences not yet sufficient to guide diagnosis. Key differentiating factors include family history, developmental antecedents, illness course, phenomenological differences in mood states, personality style and relationship factors. Less differentiating factors include impulsivity, neuropsychological profiles, gender distribution, comorbidity and treatment response. This review details parameters offering differentiation of BP II from BPD and should assist in resolving a frequent diagnostic dilemma. Future studies should specifically examine the BP II subtype directly with BPD, which would aid in sharpening the distinction between the disorders.
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Affiliation(s)
- Adam Bayes
- School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia. .,Black Dog Institute, Sydney, NSW, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Perugi G, Pacchiarotti I, Mainardi C, Verdolini N, Menculini G, Barbuti M, Angst J, Azorin JM, Bowden CL, Mosolov S, Young AH, Vieta E. Patterns of response to antidepressants in major depressive disorder: Drug resistance or worsening of depression are associated with a bipolar diathesis. Eur Neuropsychopharmacol 2019; 29:825-834. [PMID: 31227264 DOI: 10.1016/j.euroneuro.2019.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 01/01/2023]
Abstract
Resistance and worsening of depression in response to antidepressants (ADs) are major clinical challenges. In a large international sample of patients with major depressive disorder (MDD), we aim to explore the possible associations between different patterns of response to ADs and bipolarity. A total of 2811 individuals with a major depressive episode (MDE) were enrolled in the BRIDGE-II-MIX study. This post-hoc analysis included only 1329 (47%) patients suffering from MDD. Patients with (TRD-MDD, n = 404) and without (NTRD-MDD, n = 925) history of resistance to AD treatment and with (n = 184) and without (n = 1145) previous AD-induced irritability and mood lability (AIM) were compared using Chi-square, t-Student's test and logistic regression models. TRD-MDD patients resulted significantly associated with higher rates of AIM, psychotic features, history of suicide attempts, emotional lability and impulsivity, comorbid borderline personality disorder and polipharmacological treatment, compared to NTRD-MDD group. In comparison to NAIM-MDD patients, subjects in the AIM-MDD group showed significantly higher rates of first-degree family history for BD, previous TRD, atypical features, mixed features, psychiatric comorbidities, lifetime suicide attempts and lower age at first psychiatric symptoms. In addition, patients with AIM presented more often almost all the hypomanic symptoms evaluated in this study. Among these latter symptoms, logistic regressions showed that distractibility, impulsivity and hypersexuality were significantly associated with AIM-MDD. In conclusion, in MDD patients, a lifetime history of resistance and/or irritability/mood lability in response to ADs was associated with the presence of mixed features and a possible underlying bipolar diathesis.
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Affiliation(s)
- Giulio Perugi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Isabella Pacchiarotti
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
| | - Cecilia Mainardi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy; Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy; FIDMAG Germanes Hospitalàries Research Foundation, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Giulia Menculini
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Margherita Barbuti
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Jules Angst
- Psychiatric Hospital, University of Zurich, Switzerland
| | | | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sergey Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London SE5 8AZ, United Kingdom
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain.
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Scheffers F, van Vugt E, Lanctôt N, Lemieux A. Experiences of (young) women after out of home placement: An examination of personality disorder symptoms through the lens of child maltreatment. CHILD ABUSE & NEGLECT 2019; 92:116-125. [PMID: 30974255 DOI: 10.1016/j.chiabu.2019.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 03/23/2019] [Accepted: 03/31/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Child maltreatment has been associated with the development of various mental health problems, including the development of personality disorders. OBJECTIVE This study investigated the association between child maltreatment and personality disorder symptoms in 125 women who transitioned out of residential care. METHOD The Child Trauma Questionnaire was used for the measurement of child maltreatment, and Personality disorder symptoms were measured using the Personality Diagnostic Questionnaire 4 + . The Psychological Distress Index was used to control for symptoms of distress. RESULTS A Stepwise regression analysis showed that the majority of the associations were found between self-reported emotional abuse, neglect and personality disorder symptoms. Emotional abuse was significantly related to the Paranoid (β = .42, p<0.001), Schizoid (β = .18, p <0.05), Schizotypal (β = .18, p<0.05), Histrionic (β = .22, p<0.05), Avoidant (β = .31, p < .001), Dependent (β = 0.31, p < .001), Obsessive Compulsive (β = 0.29, p = .001), Passive Aggressive (β = 0.23, p<0.01) and the Depressive personality disorder (β = .38, p < .001). Emotional neglect was significantly associated to the Borderline Personality Disorder (β = .32, p<0.001) and the Paranoid Personality Disorder (β =-0.22, p<0.05). CONCLUSIONS The current study underlines the detrimental effects of childhood maltreatment, and in particular the effects of emotional abuse and neglect.
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Affiliation(s)
| | | | - Nadine Lanctôt
- Université de Sherbrooke, Canada Research Chair in Adolescent Delinquency, Canada
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Sarhan ZAE, El Shinnawy HA, Eltawil ME, Elnawawy Y, Rashad W, Saadeldin Mohammed M. Global functioning and suicide risk in patients with depression and comorbid borderline personality disorder. NEUROLOGY, PSYCHIATRY AND BRAIN RESEARCH 2019; 31:37-42. [DOI: 10.1016/j.npbr.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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16
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Szmulewicz AG, Martino DJ, Strejilevich SA. Characterization of Mood Instability through Bipolar Disorders: A cluster-analytic approach using weekly prospective life-chart methodology. Eur Psychiatry 2019; 57:52-57. [PMID: 30677548 DOI: 10.1016/j.eurpsy.2018.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 02/08/2023] Open
Abstract
BackgroundThe aim of this study was to characterize mood instability (MI) in Bipolar Disorder (BD) and to investigate potential differences between subtype I and II. MethodsLife-charts from weekly mood ratings of 90 patients were used to compute: weeks spent with symptoms, number of episodes, and MI. Regression analyses were conducted to assess the relationship between BD subtype and MI adjusting by all potential confounding factors. Hierarchical cluster analysis was performed to determine the appropriate number of clusters that described the data and to assign subjects to a specific cluster based on their MI. We then compared clusters on clinical and psychosocial outcomes. ResultsMedian follow-up was 5 years (IQR: 3.6-7.9). Patients spent 15.2%, 5%, and 3% of follow-up with depressive, manic, and mixed symptoms, respectively. BD type II presented higher MI (β = 1.83, 95% CI: 0.66-3.00) and subsydromal symptoms than BD type I patients. No differences in functioning or recurrences were found between subtypes. Differences in MI between the two clusters mimicked those between type I and II but enhanced (β = 3.86, 95%CI -4.72, -2.66). High MI (n = 43) patients presented poorer functioning and higher recurrences compared to Low MI patients (n = 43). ConclusionBD type II presented higher MI and subsyndromal symptoms than BD type I patients. However, these differences did not translate into clinically relevant outcomes. A classification based on MI may provide useful clinical insights.
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Affiliation(s)
- A G Szmulewicz
- ÁREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - D J Martino
- ÁREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - S A Strejilevich
- ÁREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina; Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina.
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17
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Fornaro M, Anastasia A, Valchera A, Carano A, Orsolini L, Vellante F, Rapini G, Olivieri L, Di Natale S, Perna G, Martinotti G, Di Giannantonio M, De Berardis D. The FDA "Black Box" Warning on Antidepressant Suicide Risk in Young Adults: More Harm Than Benefits? Front Psychiatry 2019; 10:294. [PMID: 31130881 PMCID: PMC6510161 DOI: 10.3389/fpsyt.2019.00294] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 04/15/2019] [Indexed: 12/11/2022] Open
Abstract
The decision made in the year 2004 by the U.S. Food and Drug Administration (FDA) to require a boxed warning on antidepressants regarding the risk of suicidality in young adults still represents a matter of controversy. The FDA warning was grounded on industry-sponsored trials carried one decade ago or earlier. However, within the past decade, an increasing number of reports have questioned the actual validity of the FDA warning, especially considering a decline in the prescription of the antidepressant drugs associated with an increase in the rate of suicidal events among people with severe depression. The present report provides an overview of the FDA black box warning, also documenting two Major Depressive Disorder patients whose refusal to undergo a pharmacological antidepressant treatment possibly led to an increased risk for suicidal behaviors. The concerns raised by the FDA black box warning need to be considered in real-world clinical practice, stating the associated clinical and public health implications.
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Affiliation(s)
- Michele Fornaro
- Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy.,Polyedra Research Group, Teramo, Italy
| | - Annalisa Anastasia
- Polyedra Research Group, Teramo, Italy.,Alma Mater S.P.A. Villa Camaldoli, Naples, Italy
| | - Alessandro Valchera
- Alma Mater S.P.A. Villa Camaldoli, Naples, Italy.,Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Alessandro Carano
- Polyedra Research Group, Teramo, Italy.,NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
| | - Laura Orsolini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, United Kingdom
| | - Federica Vellante
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
| | - Gabriella Rapini
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
| | - Luigi Olivieri
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
| | - Serena Di Natale
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
| | - Giampaolo Perna
- Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences, Villa San Benedetto Menni, Como, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Chair of Psychiatry, University G. D'Annunzio, Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University G. D'Annunzio, Chieti, Italy
| | - Domenico De Berardis
- Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy.,Polyedra Research Group, Teramo, Italy.,NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital G. Mazzini, ASL Teramo, Teramo, Italy
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18
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Fekih-Romdhane F, AbdelAziz IB, Ridha R, Zouari M, Cheour M. Étude des tempéraments affectifs chez des patients épileptiques en Tunisie. ANNALES MEDICO-PSYCHOLOGIQUES 2018. [DOI: 10.1016/j.amp.2017.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fornaro M, Anastasia A, Monaco F, Novello S, Fusco A, Iasevoli F, De Berardis D, Veronese N, Solmi M, de Bartolomeis A. Clinical and psychopathological features associated with treatment-emergent mania in bipolar-II depressed outpatients exposed to antidepressants. J Affect Disord 2018. [PMID: 29525354 DOI: 10.1016/j.jad.2018.02.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Treatment-emergent affective switch (TEAS), including treatment-emergent mania (TEM), carry significant burden in the clinical management of bipolar depression, whereas the use of antidepressants raises both efficacy, safety and tolerability concerns. The present study assesses the prevalence and clinical correlates of TEM in selected sample of Bipolar Disorder (BD) Type-II (BD-II) acute depression outpatients. METHODS Post-hoc analysis of the clinical and psychopathological features associated with TEM among 91 BD-II depressed outpatients exposed to antidepressants. RESULTS Second-generation antipsychotics (SGA) (p = .005), lithium (≤ .001), cyclothymic/irritable/hyperthymic temperaments (p = ≤ .001; p = .001; p = .003, respectively), rapid-cycling (p = .005) and depressive mixed features (p = .003) differed between TEM+ cases vs. TEM- controls. Upon multinomial logistic regression, the accounted psychopathological features correctly classified as much as 88.6% of TEM+ cases (35/91 overall sample, or 38.46% of the sample), yet not statistically significantly [Exp(B) = .032; p = ns]. Specifically, lithium [B = - 2.385; p = .001], SGAs [B = - 2.354; p = .002] predicted lower rates of TEM+ in contrast to the number of lifetime previous psychiatric hospitalizations [B = 2.380; p = .002], whereas mixed features did not [B = 1.267; p = ns]. LIMITATIONS Post-hoc analysis. Lack of systematic pharmacological history record; chance of recall bias and Berkson's biases. Permissive operational criterion for TEM. Relatively small sample size. CONCLUSIONS Cyclothymic temperament and mixed depression discriminated TEM+ between TEM- cases, although only lithium and the SGAs reliably predicted TEM+/- grouping. Larger-sampled/powered longitudinal replication studies are warranted to allow firm conclusions on the matter, ideally contributing to the identification of clear-cut sub-phenotypes of BD towards patient-tailored-pharmacotherapy.
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Affiliation(s)
- Michele Fornaro
- New York State Psychiatric Institute, Columbia University, NYC, NY, USA; Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
| | - Annalisa Anastasia
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
| | - Francesco Monaco
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neuroscience, University of Salerno, Salerno, Italy.
| | - Stefano Novello
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
| | - Andrea Fusco
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
| | - Felice Iasevoli
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
| | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, 64100 Teramo, Italy.
| | | | - Marco Solmi
- Azienda Ospedaliera di Padova, Padua Hospital, Psychiatry Unit, Padua, Italy.
| | - Andrea de Bartolomeis
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
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20
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Perugi G, Hantouche E, Vannucchi G. Diagnosis and Treatment of Cyclothymia: The "Primacy" of Temperament. Curr Neuropharmacol 2018; 15:372-379. [PMID: 28503108 PMCID: PMC5405616 DOI: 10.2174/1570159x14666160616120157] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/25/2016] [Accepted: 05/24/2016] [Indexed: 01/30/2023] Open
Abstract
Background: Contrary to DSM-5 definition based on recurrence of low grade hypomanic and depressive symptoms, cyclothymia is better defined in a neurodevelopmental perspective as an exaggeration of cyclothymic temperament. Emotional dysregulation with extreme mood instability and reactivity is the core features of the complex symptomatology. Method: In the present article, we critically reviewed the literature on the diagnosis and treatment of cyclothymia, focusing on the temperamental and neurodevelopmental perspectives. Results: Current epidemiological and clinical research showed the high prevalence and the validity of cyclothymia as a distinct form of bipolarity, frequently associated with multiple comorbidities with anxiety, impulse control, substance use, and so called “personality” disorders. Many patients receive correct diagnosis and treatments after many years of illness, when the superposition of complications reduces the possibility of complete remission. A therapeutic model combining the focus on symptomatic presentations with a temperamental perspective seems to represent an effective approach for cyclothymic patients with complex clinical presentations. Conclusion: Cyclothymic mood instability is an understudied issue despite the evidence of its clinical relevance. Unresolved issues concern its diagnostic delimitation and the possible relationships with emotional dysregulation observed in other neurodevelopmental disorders. We need to confirm the specificity of the disorder and to improve its recognition in early phase of the life, especially in youth. Early recognition means avoiding unnecessary complications and establishing specific treatments and clinical management since the beginning.
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Affiliation(s)
- Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.,Institute of Behavioural Science,
"G.De Lisio", Pisa, Italy
| | - Elie Hantouche
- Centre des Troubles Anxieux et de l'Humeur, Anxiety & Mood Center, 117, Rue de Rennes, Paris 75006, France
| | - Giulia Vannucchi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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21
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Perugi G, Cesari D, Vannucchi G, Maccariello G, Barbuti M, De Bartolomeis A, Fagiolini A, Maina G. The impact of affective temperaments on clinical and functional outcome of Bipolar I patients that initiated or changed pharmacological treatment for mania. Psychiatry Res 2018; 261:473-480. [PMID: 29360052 DOI: 10.1016/j.psychres.2018.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/03/2018] [Accepted: 01/15/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Affective temperaments have been shown to impact on the clinical manifestations and the course of bipolar disorder. We investigated their influence on clinical features and functional outcome of manic episode. METHOD In a naturalistic, multicenter, national study, a sample of 194 BD I patients that initated or changed pharmacological treatment for DSM-IV-TR manic episode underwent a comprehensive evaluation including briefTEMPS-M, CTQ, YMRS, MADRS, FAST, and CGI-BP. Factorial, correlation and comparative analyses were conducted on different temperamental subtypes. RESULTS Depressive, cyclothymic, irritable and anxious temperaments resulted significantly correlated with each other. On the contrary, hyperthymic temperament scores were not correlated with the other temperamental dimensions. The factorial analysis of the briefTEMPS-M sub-scales total scores allowed the extraction of two factors: the Cyclothymic-Depressive-Anxious (Cyclo-Dep-Anx) and the Hyperthymic. At final evaluation Dominant Cyclo-Dep-Anx patients reported higer scores in MADRS and in CTQ emotional neglect and abuse subscale scores than Dominant Hyperthymic patients. The latter showed a greater functional outcome than Cyclo-Dep-Anx patients. CONCLUSIONS Affective temperaments seem to influence the course of mania. Childhood emotional abuse and neglect were related to the cyclothymic disposition. Cyclothymic subjects showed more residual depressive symptoms and Hyperthymic temperament is associated with a better short-term functional outcome.
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Affiliation(s)
- G Perugi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy.
| | - D Cesari
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - G Vannucchi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - G Maccariello
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - M Barbuti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - A De Bartolomeis
- Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Section of Psychiatry, University Medical School of Naples Federico II, Italy
| | - A Fagiolini
- Department of Molecular Medicine, Psychiatry Division, University of Siena, Italy
| | - G Maina
- Department of Neurosciences, Polo Universitario San Luigi Gonzaga, University of Turin, Italy
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Rovai L, Maremmani AGI, Bacciardi S, Gazzarrini D, Pallucchini A, Spera V, Perugi G, Maremmani I. Opposed effects of hyperthymic and cyclothymic temperament in substance use disorder (heroin- or alcohol-dependent patients). J Affect Disord 2017; 218:339-345. [PMID: 28494392 DOI: 10.1016/j.jad.2017.04.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 04/21/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In the last decade, the comprehension of affective temperaments has helped us to outline the boundaries of mood disorders, and to expand our knowledge of nosographic areas other than those of affectivity, even if affectivity is closely related to them. In the field of substance use disorders, the temperamental profile of heroin addicts and alcoholics has been discussed elsewhere, but no comparison has yet been made between these two patient populations. Such a comparison would help to shed light on the pathogenetic mechanisms that link temperament with substance abuse. METHODS 63 Heroin Use Disorder (HUD) and 94 Alcohol Use Disorder (AUD) patients were compared with 130 healthy controls, with the aim of outlining affective temperament quantity and typology according to the formulation of Akiskal and Mallya. RESULTS Cyclothymic temperamental quantity differentiated - both at the univariate and multivariate levels - between patients who had various different types of Substance Use Disorder, largely irrespective of the principal substance of abuse (heroin or alcohol); irritable temperament quantity differentiated HUD patients from AUD patients. Hyperthymic temperament typology seemed to be more frequent in healthy controls at both univariate and multivariate levels. LIMITATION Cross-sectional study. CONCLUSIONS Our analyses suggest that cyclothymic temperament quantity could best correspond to the temperamental profile of Substance Use Disorder patients independently of principal substance of abuse (alcohol or heroin), and that irritable temperament quantity may differentiate HUD from AUD patients. Hyperthymic temperament typology seemed to be highly protective for HUD and, though a bit less, for AUD patients, and was a typical feature of healthy controls.
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Affiliation(s)
- Luca Rovai
- Association for the Application of Scientific Knowledge to Social Aims, (AU-CNS), Pietrasanta, Lucca, Italy; Psychiatric Department, Tuscany North-West Local Health Unit, Apuan Zone, Massa, Italy
| | - Angelo G I Maremmani
- Association for the Application of Scientific Knowledge to Social Aims, (AU-CNS), Pietrasanta, Lucca, Italy; Psychiatric Department, Tuscany North-West Local Health Unit, Versilia Zone, Viareggio, Italy; G. De Lisio Institute of Behavioural Sciences, Pisa, Italy
| | - Silvia Bacciardi
- Association for the Application of Scientific Knowledge to Social Aims, (AU-CNS), Pietrasanta, Lucca, Italy; Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, University of Pisa, Italy
| | - Denise Gazzarrini
- Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, University of Pisa, Italy
| | - Alessandro Pallucchini
- Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, University of Pisa, Italy
| | - Vincenza Spera
- Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, University of Pisa, Italy
| | - Giulio Perugi
- Psychiatric Unit2, Department of Clinical and Experimental Medicine, University of Pisa, Italy; G. De Lisio Institute of Behavioural Sciences, Pisa, Italy
| | - Icro Maremmani
- Association for the Application of Scientific Knowledge to Social Aims, (AU-CNS), Pietrasanta, Lucca, Italy; Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, University of Pisa, Italy; G. De Lisio Institute of Behavioural Sciences, Pisa, Italy.
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Marzola E, Fassino S, Amianto F, Abbate-Daga G. Affective temperaments in anorexia nervosa: The relevance of depressive and anxious traits. J Affect Disord 2017; 218:23-29. [PMID: 28456073 DOI: 10.1016/j.jad.2017.04.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/09/2017] [Accepted: 04/24/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Affective temperaments have been so far understudied in anorexia nervosa (AN) despite the relevance of personality and both affective and anxious comorbidity with regard to vulnerability, course, and outcome of this deadly disorder. METHODS Ninety-eight female inpatients diagnosed with AN and 131 healthy controls (HCs) were enrolled in this study and completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in addition to assessments of eating psychopathology, depression, and anxiety. RESULTS AN patients and HCs differed in all affective temperaments. The diagnostic subtypes of AN differed as well with binge-purging individuals being more cyclothymic and anxious than those with restricting-type AN. TEMPS-A scores correlated with body mass index and eating psychopathology but not with duration of illness. Concerning comorbidity, grater scores on the depressive and lower scores on the hyperthymic temperaments were found in depressed patients. Those who had either an anxious or irritable temperament were significantly more diagnosed with an anxious disorder than those who did not show this temperament. When logistic regression was performed, high depressive/low hyperthymic and high irritable/anxious traits resulted to be associated with depressive and anxious comorbidity, respectively, independently of confounding factors. LIMITATIONS Cross-sectional design, some patients on medications, few baseline clinical differences between diagnostic subtypes, no other personality assessments. CONCLUSIONS An affective continuum strongly associated with mood and anxious comorbidity emerged in AN. Such an evaluation could have several research and clinical implications given the need of improving treatment individualization and early interventions for such a complex disorder.
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Affiliation(s)
- Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
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24
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Bayes AJ, Parker GB. Clinical vs. DSM diagnosis of bipolar disorder, borderline personality disorder and their co-occurrence. Acta Psychiatr Scand 2017; 135:259-265. [PMID: 27976368 DOI: 10.1111/acps.12678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the extent and reasons contributing to discrepancies between those receiving a DSM as against a clinical diagnosis of a bipolar disorder (BP) and/or a borderline personality disorder (BPD). METHOD We interviewed participants previously receiving a BP or BPD diagnosis, studying those who met DSM or clinical criteria for one or both conditions. We compared the numbers of participants allocated to the three diagnostic categories according to rater strategy to calculate concordance rates and determine reasons for discordance. RESULTS Rates of assignment to BP, BPD and comorbid BP/BPD varied according to the diagnostic strategy. Concordance rates were reduced as BP disorder duration criteria were relaxed, with discordance mainly arising from clinical allocation of a BP disorder for those DSM assigned as unipolar depression. Rates of BPD allocation varied marginally, with discordance mostly arising from so clinically diagnosed receiving a comorbid BP/BPD DSM diagnosis. Finally, DSM overestimated comorbidity compared with clinician diagnoses. Of central importance, not imposing the DSM duration criteria for BP did not increase the prevalence of misdiagnosing BPD, a finding at variance with the literature. CONCLUSION Rates and reasons for discordance between clinical and DSM diagnosis are detailed, which should assist clinical decision-making.
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Affiliation(s)
- A J Bayes
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - G B Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
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25
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Abstract
The history and present status of the definition, prevalence, neurobiology, and treatment of atypical depression (AD) is presented. The concept of AD has evolved through the years, and currently, in Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, the specifier of depressive episode with atypical feature is present for both diagnostic groups, that is, depressive disorders and bipolar and related disorders. This specifier includes mood reactivity, hyperphagia, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. Prevalence rates of AD are variable, depending on the criteria, methodology, and settings. The results of epidemiological studies using DSM criteria suggest that 15%-29% of depressed patients have AD, and the results of clinical studies point to a prevalence of 18%-36%. A relationship of AD with bipolar depression, seasonal depression, and obesity has also been postulated. Pathogenic research has been mostly focused on distinguishing AD from melancholic depression. The differences have been found in biochemical studies in the areas of hypothalamic-pituitary-adrenal axis, inflammatory markers, and the leptin system, although the results obtained are frequently controversial. A number of findings concerning such differences have also been obtained using neuroimaging and neurophysiological and neuropsychological methods. An initial concept of AD as a preferentially monoamine oxidase inhibitor-responsive depression, although confirmed in some further studies, is of limited use nowadays. Currently, despite numerous drug trials, there are no comprehensive treatment guidelines for AD. We finalize the article by describing the future research perspectives for the definition, neurobiology, and treatment. A better specification of diagnostic criteria and description of clinical picture, a genome-wide association study of AD, and establishing updated treatment recommendations for this clinical phenomenon should be the priorities for the coming years.
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Affiliation(s)
| | - Janusz K Rybakowski
- Department of Adult Psychiatry.,Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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26
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Carta MG, Angst J. Screening for bipolar disorders: A public health issue. J Affect Disord 2016; 205:139-143. [PMID: 27442457 DOI: 10.1016/j.jad.2016.03.072] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 02/16/2016] [Accepted: 03/12/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) is a public health issue; it is one of the leading causes of disability and its late diagnosis heightens the impact of the condition. Screening tools for early detection could be extremely useful. METHODS Narrative review on screening of BD. RESULTS Screening questionnaires have high sensitivity but relatively low specificity if DSM diagnoses are taken as the "gold standard". Critics maintain that an excess of false positives makes such tools unnecessary for identifying cases and of little use in screening studies consisting of two phases. However, "positive" screening was frequently homogeneous with BD in terms of gender, age, level of distress, low social functioning and employment rate, comorbidity with alcohol and substance abuse, heavy recourse to health care, use of mood stabilizers and antidepressants, risk of suicide attempts, and high recurrence of depressive episodes. While none of these components is pathognomonic of BD, their co-occurrence could identify subthreshold "cases". The studies reviewed found positivity at screening to be associated with impaired quality of life, even without BD and independently of comorbidity. Patients with a neurological disease and positive at screening show homogenous brain lesions, different from those of patients screening negative. CONCLUSIONS The results are coherent with the hypothesis that positivity identifies a bipolar spectrum of clinical and public health interest, including sub-threshold bipolar cases, which do not fulfil the diagnostic criteria for BD.
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Affiliation(s)
- M G Carta
- Chair of Quality of Care and Applied Medical Technologies, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy.
| | - J Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
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27
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Edgcomb JB, Tseng CH, Kerner B. Medically unexplained somatic symptoms and bipolar spectrum disorders: A systematic review and meta-analysis. J Affect Disord 2016; 204:205-13. [PMID: 27371906 DOI: 10.1016/j.jad.2016.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/11/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with bipolar spectrum disorders (BSD) frequently report medically unexplained somatic symptoms. However, the prevalence and the consequences for treatment and outcome are currently unknown. METHODS To estimate the prevalence of somatic symptoms in BSD, we conducted a systematic review and meta-analysis of empirical studies published between 1980 and 2015. The odds for somatic symptoms in BSD were compared with unipolar depression (UPD) and general population or mixed psychiatric controls. Studies were retrieved from four electronic databases utilizing Boolean operations and reference list searches. Pooled data estimates were derived using random-effects methods. RESULTS Out of 2634 studies, 23 were eligible for inclusion, yielding an N of 106,785 patients. The estimated prevalence of somatic symptoms in BSD was 47.8%. The estimated prevalence of BSD in persons with somatic symptoms was 1.4%. Persons with BSD had a higher prevalence of somatic symptoms compared with population or mixed psychiatric controls (OR 1.82, 95% CI 1.14-2.92). Persons with BSD had a similar prevalence of somatic symptoms compared with UPD controls (OR 0.99, 95% CI 0.68-1.44). LIMITATIONS This study is correlational; thus causal inferences cannot be made. Reporting of somatic symptoms likely varies with BSD severity and subtype. Some studies reported insufficient information regarding comorbid medical conditions and medications. CONCLUSIONS Persons with BSD suffer from somatic symptoms at a rate nearly double that of the general population, a rate similar to persons with UPD. Our results suggest the utility of an integrated care model in which primary care and specialist physicians collaborate with mental health professionals to jointly address psychological and bodily symptoms.
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Affiliation(s)
- Juliet Beni Edgcomb
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Berit Kerner
- Berit Kerner, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Witten/Herdecke University, Witten, Germany.
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28
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Cohen LJ, Tanis T, Ardalan F, Yaseen Z, Galynker I. Maladaptive interpersonal schemas as sensitive and specific markers of borderline personality disorder among psychiatric inpatients. Psychiatry Res 2016; 242:395-403. [PMID: 27394052 DOI: 10.1016/j.psychres.2016.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/15/2022]
Abstract
Diagnostic criteria for borderline personality disorder (BPD) and mood and psychotic disorders characterized by major mood episodes (i.e., major depressive, bipolar and schizoaffective disorder) share marked overlap in symptom presentation, complicating differential diagnosis. The current study tests the hypothesis that maladaptive interpersonal schemas (MIS) are characteristic of BPD, but not of the major mood disorders. One hundred psychiatric inpatients were assessed by SCID I, SCID II and the Young Schema Questionnaire (YSQ-S2). Logistic regression analyses tested the association between MIS (measured by the YSQ-S2) and BPD, bipolar, major depressive and schizoaffective disorder. Receiver operator characteristic (ROC) curve analyses assessed the sensitivity and specificity of MIS as a marker of BPD. After covariation for comorbidity with each of the 3 mood disorders, BPD was robustly associated with 4 out of 5 schema domains. In contrast, only one of fifteen regression analyses demonstrated a significant association between any mood disorder and schema domain after covariation for comorbid BPD. ROC analyses of the 5 schema domains suggested Disconnection/Rejection had the greatest power for identification of BPD cases. These data support the specific role of maladaptive interpersonal schemas in BPD and potentially contribute to greater conceptual clarity about the distinction between BPD and the major mood disorders.
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Affiliation(s)
- Lisa J Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States.
| | - Thachell Tanis
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
| | - Firouz Ardalan
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
| | - Zimri Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
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29
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Veronezi BP, Moffa AH, Carvalho AF, Galhardoni R, Simis M, Benseñor IM, Lotufo PA, Machado-Vieira R, Daskalakis ZJ, Brunoni AR. Evidence for increased motor cortical facilitation and decreased inhibition in atypical depression. Acta Psychiatr Scand 2016; 134:172-82. [PMID: 27028276 DOI: 10.1111/acps.12565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) is a clinically heterogeneous condition. However, the role of cortical glutamate and gamma-aminobutyric acid (GABA) receptor-mediated activity, implicated in MDD pathophysiology, has not been explored in different MDD subtypes. Our aim was to assess the atypical and melancholic depression subtypes regarding potential differences in GABA and glutamate receptor-mediated activity through established transcranial magnetic stimulation (TMS) neurophysiological measures from the motor cortex. METHOD We evaluated 81 subjects free of antidepressant medication, including 21 healthy controls and 20 patients with atypical, 20 with melancholic, and 20 with undifferentiated MDD. Single and paired-pulse TMS paradigms were used to evaluate intracortical facilitation (ICF), cortical silent period (CSP), and short intracortical inhibition (SICI), which index glutamate, GABAB receptor-, and GABAA receptor-mediated activity respectively. RESULTS Patients with MDD demonstrated significantly decreased mean CSP values than healthy controls (Cohen's d = 0.22-0.3, P < 0.01 for all comparisons). Atypical depression presented a distinct cortical excitability pattern of decreased cortical inhibition and increased cortical facilitation, that is, an increased mean ICF and SICI ratios than other depression subtypes (d = 0.22-0.33, P < 0.01 for all comparisons). CONCLUSION Different MDD subtypes may demonstrate different neurophysiology in relation to GABAA and glutamatergic activity. TMS as an investigational tool might be useful to distinguish between different MDD subtypes.
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Affiliation(s)
- B P Veronezi
- Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of Sao Paulo, São Paulo, Brazil
| | - A H Moffa
- Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of Sao Paulo, São Paulo, Brazil
| | - A F Carvalho
- Department of Psychiatry and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceara, Brazil
| | - R Galhardoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,School of Arts, Science and Humanities, University of São Paulo, São Paulo, Brazil.,Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.,Medicine School of University City of São Paulo (UNICID), São Paulo, Brazil
| | - M Simis
- Institute of Physical Medicine and Rehabilitation, Clinics Hospital of the University of Sao Paulo Medical School, São Paulo, Brazil
| | - I M Benseñor
- Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of Sao Paulo, São Paulo, Brazil
| | - P A Lotufo
- Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of Sao Paulo, São Paulo, Brazil
| | - R Machado-Vieira
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health (NIH), Bethesda, MD, USA
| | - Z J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - A R Brunoni
- Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of Sao Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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30
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Dinsdale N, Mokkonen M, Crespi B. The ‘extreme female brain’: increased cognitive empathy as a dimension of psychopathology. EVOL HUM BEHAV 2016. [DOI: 10.1016/j.evolhumbehav.2016.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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31
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Solmi M, Zaninotto L, Toffanin T, Veronese N, Lin K, Stubbs B, Fornaro M, Correll CU. A comparative meta-analysis of TEMPS scores across mood disorder patients, their first-degree relatives, healthy controls, and other psychiatric disorders. J Affect Disord 2016; 196:32-46. [PMID: 26897455 DOI: 10.1016/j.jad.2016.02.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/12/2016] [Accepted: 02/06/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Temperament Evaluation Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS) is validated to assess temperament in clinical and non-clinical samples. Scores vary across bipolar disorder (BD), major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD), borderline personality disorder (BPD) and healthy controls (HCs), but a meta-analysis is missing. METHODS Meta-analysis of studies comparing TEMPS scores in patients with mood disorders or their first-degree relatives to each other, or to a psychiatric control group or HCs. RESULTS Twenty-six studies were meta-analyzed with patients with BD (n= 2025), MDD (n=1283), ADHD (n=56) and BPD (n=43), relatives of BD (n=436), and HCs (n=1757). Cyclothymic (p<0.001) and irritable TEMPS scores (p<0.001) were higher in BD than MDD (studies=12), and in MDD vs HCs (studies=8). Cyclothymic (p<0.001), irritable (p<0.001) and anxious (p=0.03) scores were higher in BD than their relatives, who, had higher scores than HCs. No significant differences emerged between ADHD and BD (studies=3); CONCLUSION Affective temperaments are on a continuum, with increasing scores ranging from HCs through MDD to BD regarding cyclothymic and irritable temperament, from MDD through BD to HC regarding hyperthymic temperament, and from HC through BD relatives to BD regarding cyclothymic, irritable and anxious temperament. Depressive and anxious temperaments did not differ between BD and MDD, being nonetheless the lowest in HCs. BD did not differ from ADHD in any investigated TEMPS domain. LIMITATIONS Different TEMPS versions, few studies comparing BD with ADHD or BPD, no correlation with other questionnaires.
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Affiliation(s)
- Marco Solmi
- Department of Neuroscience, University of Padova, Padova, Italy; Mental Health Department, Local Health Unit ULSS 17, Monselice, Padova, Italy.
| | - Leonardo Zaninotto
- Department of Biomedical and Neuro-Motor Sciences, University of Bologna, Bologna, Italy
| | | | - Nicola Veronese
- Department of Medicine - DIMED, Geriatrics Section, University of Padova, Italy
| | - Kangguang Lin
- Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, Box SE5 8 AF London, United Kingdom
| | - Michele Fornaro
- New York State Psychiatric Institute, Columbia University, NY, USA
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore, Glen Oaks, NY, USA; Hofsra North Shore LIJ School of Medicine, Hampstead, NY, USA
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32
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The prevalence and predictors of bipolar and borderline personality disorders comorbidity: Systematic review and meta-analysis. J Affect Disord 2016; 195:105-18. [PMID: 26881339 DOI: 10.1016/j.jad.2016.01.040] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/04/2016] [Accepted: 01/24/2016] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Data about the prevalence of borderline personality (BPD) and bipolar (BD) disorders comorbidity are scarce and the boundaries remain controversial. We conducted a systematic review and meta-analysis investigating the prevalence of BPD in BD and BD in people with BPD. METHODS Two independent authors searched MEDLINE, Embase, PsycINFO and the Cochrane Library from inception till November 4, 2015. Articles reporting the prevalence of BPD and BD were included. A random effects meta-analysis and meta-regression were conducted. RESULTS Overall, 42 papers were included: 28 considering BPD in BD and 14 considering BD in BPD. The trim and fill adjusted analysis demonstrated the prevalence of BPD among 5273 people with BD (39.94 ± 11.78 years, 44% males) was 21.6% (95% CI 17.0-27.1). Higher comorbid BPD in BD were noted in BD II participants (37.7%, 95% CI 21.9-56.6, studies=6) and North American studies (26.2%, 95% CI 18.7-35.3, studies=11). Meta regression established that a higher percentage of males and higher mean age significantly (p<0.05) predicted a lower prevalence of comorbid BPD in BD participants. The trim and fill adjusted prevalence of BD among 1814 people with BPD (32.22 ± 7.35 years, 21.5% male) was 18.5% (95% CI 12.7-26.1). LIMITATIONS Paucity of longitudinal/control group studies and accurate treatment records. CONCLUSIONS BPD-BD comorbidity is common, with approximately one in five people experiencing a comorbid diagnosis. Based on current diagnostic constructs, and a critical interpretation of results, both qualitative and quantitative syntheses of the evidence prompt out the relevance of differences rather similarities between BD and BPD.
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33
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Bayes AJ, McClure G, Fletcher K, Román Ruiz Del Moral YE, Hadzi-Pavlovic D, Stevenson JL, Manicavasagar VL, Parker GB. Differentiating the bipolar disorders from borderline personality disorder. Acta Psychiatr Scand 2016; 133:187-95. [PMID: 26432099 DOI: 10.1111/acps.12509] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify features differentiating bipolar disorder (BP) from borderline personality disorder (BPD) and with each condition variably defined. METHOD Participants were assigned a BP or BPD diagnosis on the basis of DSM criteria and, separately, by clinical judgment, and undertook a diagnostic interview and completed self-report measures. RESULTS Predictors of BPD status varied according to diagnostic decisions, but with the most consistent items being childhood sexual abuse, childhood depersonalization, personality variables relating to relationship difficulties and sensitivity to criticism, and the absence of any BP family history. Across diagnostic groups, personality measure items alone predicted diagnostic allocation with an accuracy of 81-84%, the refined study variables other than hypo/manic features improved the classification rates to 88%, and when the presence or absence of hypo/manic features was added, classification rates increased to 92-95%. CONCLUSION Study findings indicate that BPD can be differentiated from BP with a high degree of accuracy.
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Affiliation(s)
- A J Bayes
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - G McClure
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
| | - K Fletcher
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
| | | | - D Hadzi-Pavlovic
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
| | | | | | - G B Parker
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
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34
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Perugi G, Angst J, Azorin JM, Bowden CL, Caciagli A, Mosolov S, Vieta E, Young AH. Relationships between mixed features and borderline personality disorder in 2811 patients with major depressive episode. Acta Psychiatr Scand 2016; 133:133-143. [PMID: 26073759 DOI: 10.1111/acps.12457] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study focused on the relationship between mixed depression and borderline personality disorder (BPD). METHOD The sample comprised 2811 patients with a major depressive episode (MDE). Clinical characteristics were compared in patients with (BPD+) and without (BPD-) comorbid BPD and in BPD+ with (MXS+) and without (MXS-) mixed features according to DSM-5 criteria. RESULTS A total of 187 patients (6.7%) met the criteria for BPD. A DSM-IV-TR diagnosis of bipolar disorder (BD) was significantly more frequent in patients with BPD+ than in patients with BPD. Patients with BPD+ were significantly younger and reported lower age at onset than BPD-. Patients with BPD+ also showed more hypomania/mania in first-degree relatives in comparison with patients with BPD-, as well as more psychiatric comorbidity, mixed features, atypical features, suicide attempts, prior mood episodes and antidepressant-induced hypo/manic switches. Mixed features according to DSM-5 criteria were observed in 52 (27.8%) BPD+. In comparison with MXS-, MXS+ were significantly younger at age of onset and at prior mood episode and had experienced more mood episodes and hypo/manic switches with antidepressant treatments. CONCLUSION Major depressive episode patients with comorbid BPD reported a high prevalence of mixed features and BD. The presence of DSM-5 mixed features in MDE patients with BPD may be associated with complex course and reduced treatment response.
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Affiliation(s)
| | - J Angst
- Psychiatrische Universitätsklinik, Zürich, Switzerland
| | - J-M Azorin
- Hôpital Sainte-Marguerite, Marseille, France
| | - C L Bowden
- University of Texas Health Center, San Antonio, TX, USA
| | | | - S Mosolov
- Moscow Research Institute of Psychiatry, Moscow, Russia
| | - E Vieta
- Hospital Clinic at the University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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35
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Yen S, Frazier E, Hower H, Weinstock LM, Topor DR, Hunt J, Goldstein TR, Goldstein BI, Gill MK, Ryan ND, Strober M, Birmaher B, Keller MB. Borderline personality disorder in transition age youth with bipolar disorder. Acta Psychiatr Scand 2015; 132:270-80. [PMID: 25865120 PMCID: PMC4573347 DOI: 10.1111/acps.12415] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the longitudinal impact of borderline personality disorder (BPD) on the course and outcome of bipolar disorder (BP) in a pediatric BP sample. METHOD Participants (N = 271) and parents from the Course and Outcome of Bipolar Youth (COBY) study were administered structured clinical interviews and self-reports on average every 8.7 months over a mean of 93 months starting at age 13.0 ± 3.1 years. The structured interview for DSM-IV personality disorders (SIDP-IV) was administered at the first follow-up after age 18 to assess for symptoms of BPD. BPD operationalized at the disorder, factor, and symptom level, was examined as a predictor of poor clinical course of BP using all years of follow-up data. RESULTS The number of BPD symptoms was significantly associated with poor clinical course of BP, above and beyond BP characteristics. Affective dysregulation was most strongly associated with poor course at the factor level; the individual symptoms most strongly associated with poor course were dissociation/stress-related paranoid ideation, impulsivity, and affective instability. CONCLUSION BPD severity adds significantly to the burden of BP illness and is significantly associated with a more chronic and severe course and outcome beyond what can be attributable to BP characteristics.
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Affiliation(s)
- Shirley Yen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Butler Hospital, Providence, Rhode Island, United States
| | - Elisabeth Frazier
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, United States
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Butler Hospital, Providence, Rhode Island, United States
| | - David R. Topor
- VA Boston Healthcare System and Harvard Medical School, Cambridge, Massachusetts, United States
| | - Jeffrey Hunt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, United States
| | - Tina R. Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Benjamin I. Goldstein
- Department of Child Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Medical Center, Toronto, Ontario, Canada
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Neal D. Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, CA, United States
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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36
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Carta MG, Norcini-Pala A, Moro MF, Balestrieri M, Caraci F, Dell'Osso L, Sciascio GD, Faravelli C, Hardoy MC, Aguglia E, Roncone R, Nardi AE, Drago F. Does Mood Disorder Questionnaire identify sub-threshold bipolarity? Evidence studying worsening of quality of life. J Affect Disord 2015; 183:173-8. [PMID: 26021966 DOI: 10.1016/j.jad.2015.04.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE It is debated whether the Mood Disorder Questionnaire (MDQ) can generate false positives by screening other disorders as bipolar, or identify sub-threshold bipolarity. The aim is to verify if Quality of Life (QoL) impairment in MQD positives in the community is due to MDQ positivity itself, or to psychiatric diagnosis associated with MDQ positivity (supporting the former hypothesis). METHOD Community survey. Sample randomized after stratification of the adult population in the records of seven Italian regions. TOOLS MDQ; Short Form Health Survey (SF-12); semi-structured clinical interview carried out by clinicians. RESULTS Positives at MDQ show worsening QoL with an attributable burden of 2.8 ± 1.8 lower than in MDD (5.6 ± 3.6, p < 0.001) or Eating Disorders (4.4 ± 6.6, p < 0.03) and similar to Panic Disorder (2.9 ± 0.9, p = 0.44). The burden is lower in the middle-aged (25-59 years) than in the young (18-24) (4.65 ± 4.5 vs 2.58 ± 2.0, p=0.007) or in the elderly (≥60) (4.12 ± 3.2; p = 0.024). In the elderly the burden is independent from comorbid psychiatric disorders. LIMITATIONS This is a preliminary study based on one survey not designed to test this specific hypothesis, thus its results have a heuristic value only. CONCLUSIONS The worsening of QoL due to positivity at MDQ is largely independent from comorbid conditions, supporting the hypothesis that MDQ positivity identifies a specific area of suffering that is "subthreshold" to the psychiatric diagnosis, and relevant for public health.
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Affiliation(s)
| | | | - Maria Francesca Moro
- Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | - Filippo Caraci
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Institute of Psychiatry, University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Carlo Faravelli
- Department of Health Sciences, Psychology and Psychiatry Unit, University of Florence, Firenze, Italy
| | - Maria Carolina Hardoy
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - Rita Roncone
- Department of Health, Life and Environmental Sciences, Unit of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Antonio Egidio Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Filippo Drago
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
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Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. J Affect Disord 2015; 183:119-33. [PMID: 26005206 DOI: 10.1016/j.jad.2015.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 05/04/2015] [Indexed: 12/16/2022]
Abstract
Data emerging from both academic centers and from public and private outpatient facilities indicate that from 20% to 50% of all subjects that seek help for mood, anxiety, impulsive and addictive disorders turn out, after careful screening, to be affected by cyclothymia. The proportion of patients who can be classified as cyclothymic rises significantly if the diagnostic rules proposed by the DSM-5 are reconsidered and a broader approach is adopted. Unlike the DSM-5 definition based on the recurrence of low-grade hypomanic and depressive symptoms, cyclothymia is best identified as an exaggeration of cyclothymic temperament (basic mood and emotional instability) with early onset and extreme mood reactivity linked with interpersonal and separation sensitivity, frequent mixed features during depressive states, the dark side of hypomanic symptoms, multiple comorbidities, and a high risk of impulsive and suicidal behavior. Epidemiological and clinical research have shown the high prevalence of cyclothymia and the validity of the concept that it should be seen as a distinct form of bipolarity, not simply as a softer form. Misdiagnosis and consequent mistreatment are associated with a high risk of transforming cyclothymia into severe complex borderline-like bipolarity, especially with chronic and repetitive exposure to antidepressants and sedatives. The early detection and treatment of cyclothymia can guarantee a significant change in the long-term prognosis, when appropriate mood-stabilizing pharmacotherapy and specific psychological approaches and psychoeducation are adopted. The authors present and discuss clinical research in the field and their own expertise in the understanding and medical management of cyclothymia and its complex comorbidities.
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Fulford D, Eisner LR, Johnson SL. Differentiating risk for mania and borderline personality disorder: The nature of goal regulation and impulsivity. Psychiatry Res 2015; 227:347-52. [PMID: 25892256 DOI: 10.1016/j.psychres.2015.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 01/25/2015] [Accepted: 02/01/2015] [Indexed: 01/19/2023]
Abstract
Researchers and clinicians have long noted the overlap among features and high comorbidity of bipolar disorder and borderline personality disorder. The shared features of impulsivity and labile mood in both disorders make them challenging to distinguish. We tested the hypothesis that variables related to goal dysregulation would be uniquely related to risk for mania, while emotion-relevant impulsivity would be related to risk for both disorders. We administered a broad range of measures related to goal regulation traits and impulsivity to 214 undergraduates. Findings confirmed that risk for mania, but not for borderline personality disorder, was related to higher sensitivity to reward and intense pursuit of goals. In contrast, borderline personality disorder symptoms related more strongly than did mania risk with threat sensitivity and with impulsivity in the context of negative affect. Results highlight potential differences and commonalities in mania risk versus borderline personality disorder risk.
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Affiliation(s)
- Daniel Fulford
- University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave., San Francisco, CA 94143, USA; Palo Alto Medical Foundation Research Institute, 2350 West El Camino Real, Mountain View, CA 94040, USA.
| | - Lori R Eisner
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, 50 Staniford St., Ste 580, Boston, MA 02114, USA
| | - Sheri L Johnson
- University of California, Berkeley, Department of Psychology, 3417 Tolman Hall, Berkeley, CA 94720, USA
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Bebbington P. Unravelling psychosis: psychosocial epidemiology, mechanism, and meaning. SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27:70-81. [PMID: 26120255 PMCID: PMC4466846 DOI: 10.11919/j.issn.1002-0829.215027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/23/2015] [Indexed: 12/17/2022]
Abstract
This paper reviews a revolution in our understanding of psychosis over the last 20 years. To a
major extent, this has resulted from a process of cross-fertilization between psychosocial epidemiology
and cognitive behavior therapy for psychosis (CBT-p). This encouraged complementary strategies for the
acquisition and analysis of data. These include the use of a range of dependent variables related to psychosis,
and the exploitation of data from cross-sectional and longitudinal epidemiological surveys, virtual reality
experiments, experience sampling methodology, and treatment trials. The key element is to investigate social
and psychological measures in relation to each other. This research has confirmed the role of the external
social world in the development and persistence of psychotic disorder. In addition, several psychological
drivers of psychotic experiences have been identified. There is now persuasive evidence that the influence
of social factors in psychosis is significantly mediated by non-psychotic symptoms, particularly mood
symptoms and other attributes of affect such as insomnia. Psychotic symptoms are also driven by reasoning
biases such as jumping to conclusions and belief inflexibility, though little is known about social influences
on such biases. It is now clear that there are many routes to psychosis and that it takes many forms.
Treatment of all kinds should take account of this: the dependence of CBT-p on a detailed initial formulation
in terms of psychological processes and social influences is an example of the required flexibility. Individual
mediators are now being targeted in specific forms of CBT-p, with good effect. This in turn corroborates the
hypothesized role of non-psychotic symptoms in mediation, and attests to the power of the approaches
described.
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Affiliation(s)
- Paul Bebbington
- Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
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Co-morbidity of bipolar disorder and borderline personality disorder: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Compr Psychiatry 2015; 58:18-28. [PMID: 25666748 DOI: 10.1016/j.comppsych.2015.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Clinical studies suggest a high co-morbidity rate of borderline personality disorder (BPD) with bipolar disorder (BD). This study examines the prevalence and correlates of BPD in BD (I and II) in a longitudinal population-based survey. METHODS Data came from waves 1 and 2 (wave 2: N=34,653, 70.2% cumulative response rate; age ≥ 20 years) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Lay interviewers conducted in person interviews using the Alcohol Use Disorders and Associated Disabilities Interview (AUDADIS-IV), a reliable diagnostic tool of psychiatric disorders based on DSM-IV criteria. Subjects with BD I (n=812), BD I/BPD (n=360), BD II (n=327) and BD II/BPD (n=101) were examined in terms of sociodemographics, mood, anxiety, substance use and personality disorder co-morbidities and history of childhood traumatic experiences. RESULTS Lifetime prevalence of BPD was 29.0% in BD I and 24.0% in BD II. Significant differences were observed between co-morbid BD I/II and BPD versus BD I/II without BPD in terms of number of depressive episodes and age of onset, co-morbidity, and childhood trauma. BPD was strongly and positively associated with incident BD I (AOR=16.9; 95% CI: 13.88-20.55) and BD II (AOR=9.5; 95% CI: 6.44-13.97). CONCLUSIONS BD with BPD has a more severe presentation of illness than BD alone. The results suggest that BPD is highly predictive of a future diagnosis of BD. Childhood traumatic experiences may have a role in understanding this relationship.
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Eikenaes I, Egeland J, Hummelen B, Wilberg T. Avoidant personality disorder versus social phobia: the significance of childhood neglect. PLoS One 2015; 10:e0122846. [PMID: 25815817 PMCID: PMC4376891 DOI: 10.1371/journal.pone.0122846] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/19/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Avoidant personality disorder (AvPD) and social phobia (SP) are common disorders both in the community and in clinical settings. Whether the two disorders represent different severity levels of social anxiety disorder is currently in dispute. The relationship between AvPD and SP is probably more complex than previously assumed. Several environmental, temperamental, and constitutional factors may play a role in the etiology of AvPD and SP. Better knowledge about childhood experiences may shed light on similarities and differences between the two disorders. The aim of this study was to compare self-reported childhood experiences in AvPD and SP patients. DESIGN This is a cross-sectional multi-site study of 91 adult patients with AvPD and/ or SP. We compared patients with AvPD with and without SP (AvPD group) to patients with SP without AvPD (SP group). METHODS The patients were examined using structured diagnostic interviews and self-report measures, including Child Trauma Questionnaire, Parental Bonding Instrument, and Adult Temperament Questionnaire. RESULTS Both AvPD and SP were associated with negative childhood experiences. AvPD patients reported more severe childhood neglect than patients with SP, most pronounced for physical neglect. The difference between the disorders in neglect remained significant after controlling for temperamental factors and concurrent abuse. CONCLUSIONS The study indicates that childhood neglect is a risk factor for AvPD and may be one contributing factor to phenomenological differences between AvPD and SP.
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Affiliation(s)
- Ingeborg Eikenaes
- Department of Group Psychotherapy, Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- * E-mail:
| | - Jens Egeland
- Department of Research, Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Benjamin Hummelen
- Department of Research and Development, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Theresa Wilberg
- Department for Research and Development, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Perugi G, Quaranta G, Belletti S, Casalini F, Mosti N, Toni C, Dell'Osso L. General medical conditions in 347 bipolar disorder patients: clinical correlates of metabolic and autoimmune-allergic diseases. J Affect Disord 2015; 170:95-103. [PMID: 25237732 DOI: 10.1016/j.jad.2014.08.052] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/29/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with bipolar disorder (BD) suffer from greater physical morbidity and mortality than the general population. The aim of the present study is to explore the prevalence and clinical correlates of General Medical Conditions (GMC) in a large consecutive sample of patients with BD. METHOD The study sample comprised of 347 patients who met DSM-IV-TR criteria for BD I (n=207, 59.7%), BD II or Cyclothymic Disorder (n=140, 40.3). Diagnostic information was collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders- Clinical Version (SCID-I), and information about personal and family history were collected by the Semi-Structured Interview for Mood Disorder-Revised (SIMD-R). Standardized procedure was used to assess the diagnosis of GMC, which was considered present only if a specific therapy to treat the condition was prescribed by a specialist or a general practitioner. In order to explore possible relationships between physical comorbidity and clinical features of BD, we compared patients with (MD) and without (No-MD) Metabolic Diseases (MD) and patients with (AAD) and without (No-AAD) Autoimmune-Allergic Diseases (AAD). RESULTS The most commonly reported GMCs were: Headache, Hypercholesterolemia (>200mg/dl), Chronic Constipation, Obesity, Arterial Hypertension (BP >140/90 mmHg), Hypothyroidism, Allergic Rhino-Conjunctivitis, Irritable Bowel Syndrome, Hypertriglyceridemia (>150 mg/dl), Metabolic Syndrome, Hiatus Hernia, Dysmenorrhea, Urticaria, Atopic Dermatitis, Psoriasis, Seborrheic Dermatitis, Diabetes Mellitus, Bronchial Asthma, Cardiac Arrhythmias, Biliary Lithiasis, and COPD. In our sample, MD (n=148, 42.7%) and AAD (n=167, 48.1%) were the most common categories of GMCs. Interestingly, the lifetime prevalence of cancer and neoplastic diseases was very low: 1 patient (.3%) reported Lung Adenocarcinoma and 2 (.6%) patients Bowel Cancer. In the group comparisons, length of pharmacological treatment (OR=1.054; 95% CI=1.030-1.078), age at onset of first major episode (OR=1.043; 95% CI=1.019-1.067), length of the current episode (OR=1.025; 95% CI=1.020-1.533) and absence of lifetime comorbid substance abuse (OR=.373; 95% CI=.141-.989) were statistically associated with the presence of comorbid MD; while only AD-induced hypomania (OR=1.62; 95% CI=1.011-2.597), and cyclothymic temperament (OR=1.051; 95% CI=1.016-1.087) were statistically associated with the presence of comorbid AAD. LIMITATIONS Possible referral and selection bias; retrospective, non-blind, cross-sectional evaluation. CONCLUSION MD and AAD were highly represented in our sample, while cancer and neoplastic diseases were uncommon. The clinical correlates of different sub-groups of GMC suggest different interpretations. The presence of MD seems to be correlated with the progression of BD and the chronic medication exposure, while comorbid AAD seems to correlate with a specific clinical subtype of BD, characterized by mood reactivity and temperamental mood instability. If the link with autoimmune-allergic diathesis will be confirmed, it could provide an interesting new paradigm for the study of the "systemic" nature of mood disorders and a promising target for future treatment options.
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Affiliation(s)
- Giulio Perugi
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy; Institute of Behavioural Sciences "G. De Lisio", Pisa, Italy.
| | - Giuseppe Quaranta
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy
| | - Serena Belletti
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy
| | - Francesca Casalini
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy
| | - Nicola Mosti
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy
| | - Cristina Toni
- Institute of Behavioural Sciences "G. De Lisio", Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy
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Bøen E, Hummelen B, Elvsåshagen T, Boye B, Andersson S, Karterud S, Malt UF. Different impulsivity profiles in borderline personality disorder and bipolar II disorder. J Affect Disord 2015; 170:104-11. [PMID: 25237733 DOI: 10.1016/j.jad.2014.08.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Borderline personality disorder (BPD) and bipolar II disorder (BP II) share clinical characteristics including impulsivity. Their relationship is disputed. In this study, we investigated self-reported impulsivity in these patient groups and in a healthy control group. Effects of current mood state and of traumatic childhood experiences were explored. METHODS Twenty-five patients with BPD without comorbid bipolar disorder; 20 patients with BP II without comorbid BPD; and 44 healthy control subjects completed the UPPS questionnaire which yields assessments of four components of impulsivity: Urgency, Lack of Premeditation, Lack of Perseverance, and Sensation Seeking. Current mood state was rated using the Montgomery Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). Traumatic childhood experiences were assessed using the Childhood Trauma Questionnaire (CTQ). Group differences in UPPS levels; and effects of mood state and CTQ score on UPPS scores in patients were investigated. RESULTS BPD patients showed significantly higher levels of Urgency and Lack of Perseverance than BP II patients and controls, and a significantly higher level of Lack of Premeditation than controls. BP II patients showed higher levels of Urgency and Lack of Perseverance than controls. In BP II, higher MADRS scores were associated with higher impulsivity scores. Also, higher CTQ scores were associated with higher Urgency scores in BP II. LIMITATIONS Relatively small sample size; cross-sectional assessment of influence of mood state. CONCLUSIONS BPD patients exhibited markedly elevated UPPS impulsivity scores compared with healthy controls and BP II patients, and the elevations were not related to current mood state. BP II patients showed moderately elevated impulsivity scores which were associated with a depressed mood state and to some extent with a history of childhood trauma. The findings suggest that BPD and BP II have different impulsivity profiles.
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Affiliation(s)
- Erlend Bøen
- Department of Psychosomatic Medicine, Oslo University Hospital, Post Box 4950 Nydalen, Oslo 0424, Norway; Norwegian Research Network on Mood Disorders (NORMOOD), Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Benjamin Hummelen
- Department for Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Department for Research and Education, Oslo University Hospital, Norway
| | - Torbjørn Elvsåshagen
- Department of Psychosomatic Medicine, Oslo University Hospital, Post Box 4950 Nydalen, Oslo 0424, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Birgitte Boye
- Department of Psychosomatic Medicine, Oslo University Hospital, Post Box 4950 Nydalen, Oslo 0424, Norway
| | - Stein Andersson
- Department of Psychosomatic Medicine, Oslo University Hospital, Post Box 4950 Nydalen, Oslo 0424, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Sigmund Karterud
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department for Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ulrik F Malt
- Department of Psychosomatic Medicine, Oslo University Hospital, Post Box 4950 Nydalen, Oslo 0424, Norway; Norwegian Research Network on Mood Disorders (NORMOOD), Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Fornaro M, Martino M, Mattei C, Prestia D, Vinciguerra V, De Berardis D, De Pasquale C, Iasevoli F, Mungo S, Fornaro P. Duloxetine-bupropion combination for treatment-resistant atypical depression: a double-blind, randomized, placebo-controlled trial. Eur Neuropsychopharmacol 2014; 24:1269-78. [PMID: 24842649 DOI: 10.1016/j.euroneuro.2014.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 02/26/2014] [Accepted: 04/27/2014] [Indexed: 01/11/2023]
Abstract
The efficacy, safety, and tolerability of combined bupropion versus placebo using duloxetine as active reference drug, in patients with a DSM-IV diagnosis of major depression with atypical features and a history of treatment resistance, were evaluated in this preliminary six-week study. Patients (n=46) had a baseline Hamilton Depression Scale (HAM-D) ≥14 and were randomly assigned to 150/300 mg/day bupropion vs. placebo, which was added to 60 to 120 mg/day duloxetine depending on baseline depression severity. Atypical features of depression were assessed using the additional eight-item module of the Structured Interview Guide for the HAM-D with the Atypical Depression Supplement. By week 6, only five (21.7%) patients receiving duloxetine+placebo vs. six (26.1%) patients on the bupropion combination achieved response. No significant difference in final HAM-D scores between the two groups was observed between those patients achieving response. The presence of a higher number of atypical features significantly predicted non-response, with the relevant binary logistic regression model correctly classifying 17 out 22 (77.3%) of non-responders [Exp(B)=0.294; p=0.016] vs. 17 out 23 (73.9%) [Exp(B)=0.353; p=0.028] non-responder cases in the "+placebo" and "+bupropion" groups, respectively. In those patients receiving bupropion, treatment-emergent adverse events leading to withdrawal were more common among those receiving lower doses of the combination drug, and no life-threating dangers were noted. Additional studies, including an adequate course of duloxetine trial, are nonetheless aimed to allow a firm conclusion about the usefulness of the combination of duloxetine and bupropion for treatment-resistant cases of major depression with atypical features.
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Affiliation(s)
- Michele Fornaro
- Department of Education Science, University of Catania, Catania, Italy.
| | - Matteo Martino
- Department of Neurosciences, Ophthalmology and Genetics - Section of Psychiatry, University of Genova, Genoa, Italy.
| | - Chiara Mattei
- Department of Neurosciences, Ophthalmology and Genetics - Section of Psychiatry, University of Genova, Genoa, Italy.
| | - Davide Prestia
- Department of Neurosciences, Ophthalmology and Genetics - Section of Psychiatry, University of Genova, Genoa, Italy.
| | - Valentina Vinciguerra
- Department of Neurosciences, Ophthalmology and Genetics - Section of Psychiatry, University of Genova, Genoa, Italy.
| | - Domenico De Berardis
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, "ASL 4", Teramo, Italy.
| | | | - Felice Iasevoli
- Laboratory of Molecular Psychiatry and Psychopharmacotherapeutics, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University School of Medicine" Federico II" of Naples, Italy.
| | - Sergio Mungo
- Department of Neurosciences, Ophthalmology and Genetics - Section of Psychiatry, University of Genova, Genoa, Italy.
| | - Pantaleo Fornaro
- Department of Neurosciences, Ophthalmology and Genetics - Section of Psychiatry, University of Genova, Genoa, Italy.
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Gras A, Amad A, Thomas P, Jardri R. [Hallucinations and borderline personality disorder: a review]. Encephale 2014; 40:431-8. [PMID: 25063345 DOI: 10.1016/j.encep.2014.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 11/27/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hallucinations constitute understudied symptoms in borderline personality disorders (BPD), which can be observed in about 30% of the patients, essentially in the auditory modality. Most of these experiences are transitory, triggered by intermittent stressors, but chronicity remains a major cause of concern. In order to better circumscribe hallucinations in BPD, we summarized the literature on this particular phenomenon. METHODS We conducted a review using Medline, Scopus and Google Scholar databases up to March 2013, using the following keywords combinations: "borderline personality disorder", "hallucinat*" and "psychotic symptoms". Papers were included in the review if they were published in an English or French language peer-reviewed journal; the study enrolled patients with BPD; and the diagnosis was made according to the Diagnostic and Statistical Manual (DSM) criteria. Fifteen studies published between 1985 and 2012, merging a total of 635 patients, were retained. RESULTS The hallucinatory experiences observed in BPD appeared phenomenologically similar to those described in the schizophrenia spectrum in terms of vividness, duration, spatial localization, beliefs about malevolence or omnipotence. Conversely, the hallucinatory content appeared more negative and potentially more distressful. Crucially, this literature search also revealed that these symptoms have long been regarded as "pseudo-hallucinations" (or "hallucination-like symptoms"). This concept was judged of poor scientific validity, inducing stigma for BPD patients in that it casts doubt on the authenticity of these experiences while disqualifying the related distress. This situation points out that research should focus more on understanding hallucinations in BPD than questioning their existence. Interestingly, recent comorbidity studies reopened a 40-year debate on the potential links that may exist between BPD and psychosis. Initially considered as a para-psychotic disorder, BPD was effectively redefined as an independent category by Otto F. Kernberg, leading to the DSM-III definition, excluding any psychotic symptom. However, hallucinations per se remain insufficient to diagnose schizophrenia, while comorbid substance use disorders as well as mood disorders, cannot explain all the hallucination occurrences in BPD. By referring to the "psychotic-reactivity-to-stress" framework, we proposed to understand hallucinations in BPD in relation to a hyperactivity of the hypothalamic-pituitary-adrenal axis and of the dopaminergic system under stress. Childhood trauma may have a central role in such a model. The prevalence of childhood trauma is high in BPD but this factor was also evidenced strongly linked with hallucinations in non-clinical populations. Comparisons are finally made and discussed between hallucinations occurring in BPD and those observed in posttraumatic stress disorder, another frequent comorbid disorder. CONCLUSION Almost a third of patients with BPD experiences hallucinations, and future studies will have to clarify the pathophysiology of this symptom, still poorly understood. Both the models of psychotic-reactivity-to-stress, as well as the role of childhood trauma in the context of a gene X environment interaction, appear to be promising cues for future research.
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Affiliation(s)
- A Gras
- Université Droit et Santé Lille (UL2), UFR de Médecine, 59045 Lille cedex, France; Pôle de psychiatrie, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, CS 70001, 59037 Lille cedex, France.
| | - A Amad
- Université Droit et Santé Lille (UL2), UFR de Médecine, 59045 Lille cedex, France; Pôle de psychiatrie, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, CS 70001, 59037 Lille cedex, France
| | - P Thomas
- Université Droit et Santé Lille (UL2), UFR de Médecine, 59045 Lille cedex, France; Pôle de psychiatrie, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, CS 70001, 59037 Lille cedex, France
| | - R Jardri
- Université Droit et Santé Lille (UL2), UFR de Médecine, 59045 Lille cedex, France; Pôle de psychiatrie, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, CS 70001, 59037 Lille cedex, France
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Zimmerman M, Morgan TA. The relationship between borderline personality disorder and bipolar disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2014. [PMID: 24174890 PMCID: PMC3811087 DOI: 10.31887/dcns.2013.15.2/mzimmerman] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
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Comparison of clinical characteristics of bipolar and depressive disorders in Korean clinical sample of youth: a retrospective chart review. Eur Child Adolesc Psychiatry 2014; 23:307-16. [PMID: 23963644 DOI: 10.1007/s00787-013-0461-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 08/03/2013] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to compare the clinical characteristics of bipolar disorder I, II (BD I and II) and not otherwise specified (BD NOS) to those of major depressive disorder (MDD) in a clinical sample of Korean children and adolescents. This study was a cross-sectional review of longitudinal observational data. Two psychiatrists retrospectively reviewed the medical records of 198 children and adolescents (age 6-18) that were diagnosed as having bipolar or depressive disorders from March 2010 to February 2012 at Department of Psychiatry of Asan Medical Center, Seoul, Korea. Every subject's diagnoses were reviewed and confirmed. BD I, II and MDD were assessed according to the Diagnostic and Statistical Manual-IV criteria. BD NOS was defined based on the criteria for the Course and Outcome of Bipolar Youth study. Comparisons were made in demographic information, clinical characteristics, family history, and psychiatric comorbidities at baseline and during observation. Among 198 subjects, 20 (10.1 %) subjects were diagnosed as having BD I, 10 (5.1 %) as BD II, 25 (12.6 %) as BD NOS and 143 (73.7 %) as MDD. BD depression was associated with mood change while taking an antidepressant, familial bipolarity, aggressive behaviors, and atypical features. Comorbid obsessive-compulsive disorder tended to be higher in BD NOS than in MDD. Presence of psychosocial stressors was more common in MDD than in BD depression. In children and adolescents, bipolar depression is distinct from unipolar depression in family history, comorbidity, and clinical characteristics.
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48
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Gremaud-Heitz D, Riemenschneider A, Walter M, Sollberger D, Küchenhoff J, Dammann G. Comorbid atypical depression in borderline personality disorder is common and correlated with anxiety-related psychopathology. Compr Psychiatry 2014; 55:650-6. [PMID: 24457033 DOI: 10.1016/j.comppsych.2013.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The core features of borderline personality disorder (BPD) are affective instability, unstable relationships and identity disturbance. Axis I comorbidities are frequent, in particular affective disorders. The concept of atypical depression is complex and often underestimated. The purpose of the study was to investigate the comorbidity of atypical depression in borderline patients regarding anxiety-related psychopathology and interpersonal problems. METHODS Sixty patients with BPD were assessed with the Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID I, SCID II) as well as the Atypical Depression Diagnostic Scale (ADDS). Additionally, patients completed a questionnaire (SCL-90-R, BDI, STAI, STAXI, IIP-C). RESULTS Forty-five BPD patients (81.8%) had a comorbid affective disorder of which 15 (27.3%) were diagnosed with an atypical depression. In comparison to patients with major depressive disorder or no comorbid depression, patients with atypical depression showed significant higher scores in psychopathological symptoms regarding anxiety and global severity as well as interpersonal problems. CONCLUSIONS The presence of atypical depression in borderline patients is correlated with psychopathology, anxiety, and interpersonal problems and seems to be of clinical importance for personalized treatment decisions.
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Affiliation(s)
- Daniela Gremaud-Heitz
- Psychiatric Hospital, University of Basel, Basel, Switzerland; Psychiatric Hospital, Münsterlingen, Switzerland.
| | | | - Marc Walter
- Psychiatric Hospital, University of Basel, Basel, Switzerland
| | | | - Joachim Küchenhoff
- Psychiatric Hospital, University of Basel, Basel, Switzerland; Psychiatric Hospital, Liestal, Switzerland
| | - Gerhard Dammann
- Psychiatric Hospital, University of Basel, Basel, Switzerland; Psychiatric Hospital, Münsterlingen, Switzerland
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49
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Ehnvall A, Mitchell PB, Hadzi-Pavlovic D, Parker G, Frankland A, Loo C, Breakspear M, Wright A, Roberts G, Lau P, Perich T. Rejection sensitivity and pain in bipolar versus unipolar depression. Bipolar Disord 2014; 16:190-8. [PMID: 24636342 DOI: 10.1111/bdi.12147] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 07/17/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Recent neuroimaging studies support the contention that depression, pain distress, and rejection distress share the same neurobiological circuits. In two recently published studies we confirmed the hypothesis that the perception of increased pain during both treatment-refractory depression (predominantly unipolar) and difficult-to-treat bipolar depression was related to increased state rejection sensitivity (i.e., rejection sensitivity when depressed). In the present study, we aimed to compare the correlates of pain and rejection sensitivity in individuals with bipolar versus unipolar depression and test the hypothesis that bipolar disorder may be distinguished from unipolar depression both by an increased perception of pain and heightened rejection sensitivity during depression. METHODS We analyzed data from 113 bipolar and 146 unipolar depressed patients presenting to the Black Dog Institute, Sydney, Australia. The patients all met DSM-IV criteria for bipolar disorder or unipolar depression (major depressive disorder). RESULTS Bipolar disorder predicted a major increase in state rejection sensitivity when depressed (p = 0.001), whereas trait rejection sensitivity (i.e., a long-standing pattern of rejection sensitivity) was not predicted by polarity. A major increase in the experience of headaches (p = 0.007), chest pain (p < 0.001), and body aches and pains (p = 0.02) during depression was predicted by a major increase in state rejection sensitivity for both bipolar and unipolar depression. CONCLUSIONS State, but not trait, rejection sensitivity is significantly predicted by bipolar depression, suggesting that this might be considered as a state marker for bipolar depression and taken into account in the clinical differentiation of bipolar and unipolar depression.
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Affiliation(s)
- Anna Ehnvall
- Institute of Clinical Neuroscience; Gothenburg University and Psychiatric Outpatient Clinic; Varberg Sweden
| | - Philip B Mitchell
- School of Psychiatry; University of New South Wales and Black Dog Institute; Prince of Wales Hospital; Sydney NSW Australia
| | - Dusan Hadzi-Pavlovic
- School of Psychiatry; University of New South Wales and Black Dog Institute; Prince of Wales Hospital; Sydney NSW Australia
| | - Gordon Parker
- School of Psychiatry; University of New South Wales and Black Dog Institute; Prince of Wales Hospital; Sydney NSW Australia
| | - Andrew Frankland
- School of Psychiatry; University of New South Wales and Black Dog Institute; Prince of Wales Hospital; Sydney NSW Australia
| | - Colleen Loo
- School of Psychiatry; University of New South Wales and Black Dog Institute; Prince of Wales Hospital; Sydney NSW Australia
| | - Michael Breakspear
- School of Psychiatry; University of New South Wales and Black Dog Institute; Prince of Wales Hospital; Sydney NSW Australia
| | - Adam Wright
- School of Psychiatry; University of New South Wales and Black Dog Institute; Prince of Wales Hospital; Sydney NSW Australia
| | - Gloria Roberts
- School of Psychiatry; University of New South Wales and Black Dog Institute; Prince of Wales Hospital; Sydney NSW Australia
| | - Phoebe Lau
- School of Psychiatry; University of New South Wales and Black Dog Institute; Prince of Wales Hospital; Sydney NSW Australia
| | - Tania Perich
- School of Psychiatry; University of New South Wales and Black Dog Institute; Prince of Wales Hospital; Sydney NSW Australia
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50
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Fletcher K, Parker G, Bayes A, Paterson A, McClure G. Emotion regulation strategies in bipolar II disorder and borderline personality disorder: differences and relationships with perceived parental style. J Affect Disord 2014; 157:52-9. [PMID: 24581828 DOI: 10.1016/j.jad.2014.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Bipolar II disorder (BP II) and Borderline Personality Disorder (BPD) share common features and can be difficult to differentiate, contributing to misdiagnosis and inappropriate treatment. Research contrasting phenomenological features of both conditions is limited. The current study sought to identify differences in emotion regulation strategies in BP II and BPD in addition to examining relationships with perceived parental style. METHOD Participants were recruited from a variety of outpatient and community settings. Eligible participants required a clinical diagnosis of BP II or BPD, subsequently confirmed via structured diagnostic interviews assessing DSM-IV criteria. Participants completed a series of self-reported questionnaires assessing emotion regulation strategies and perceived parental style. RESULTS The sample comprised 48 (n=24 BP II and n=24 BPD) age and gender-matched participants. Those with BPD were significantly more likely to use maladaptive emotion regulation strategies, less likely to use adaptive emotion regulation strategies, and scored significantly higher on the majority of (perceived) dysfunctional parenting sub-scales than participants with BP II. Dysfunctional parenting experiences were related to maladaptive emotion regulation strategies in participants with BP II and BPD, however differential associations were observed across groups. LIMITATIONS Relatively small sample sizes; lack of a healthy control comparator group; lack of statistical control for differing sociodemographic and clinical characteristics, medication and psychological treatments; no assessment of state or trait anxiety; over-representation of females in both groups limiting generalisability of results; and reliance on self-report measures. CONCLUSIONS Differences in emotion regulation strategies and perceived parental style provide some support for the validity of distinguishing BP II and BPD. Development of intervention strategies targeting the differing forms of emotion regulatory pathology in these groups may be warranted.
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Affiliation(s)
- Kathryn Fletcher
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Adam Bayes
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Amelia Paterson
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Georgia McClure
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
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