1
|
Tagliabue I, Caldiroli A, Capuzzi E, Borgonovo R, Scalia A, Ferrè A, Sibilla M, Turco M, Affaticati LM, Crespi G, Galimberti G, Dakanalis A, Colmegna F, Buoli M, Clerici M. Which Factors Are Associated With Comorbid Psychiatric Conditions in Patients Affected by Substance Use Disorders? The Impact of COVID-19 Pandemic on Dual-Diagnosis Subjects. J Dual Diagn 2024; 20:201-209. [PMID: 38728603 DOI: 10.1080/15504263.2024.2346519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To investigate demographic/cinical variables associated to dual diagnosis and the psychological reaction of dual-diagnosis patients to COVID-19 pandemic. METHODS Information was collected at the Addiction Service of Monza, Italy. The Impact of Event Scale-Revised (IES-R), a self-report questionnaire measuring the subjective response to a traumatic event, was administered. Univariate analyses and binary logistic regression were performed. IES-R scores were compared between groups defined by qualitative variables through one-way analyses of variance (ANOVA). RESULTS 118 outpatients were included, 48.3% with dual diagnosis. Alcohol use disorder and being female were associated to dual diagnosis. IES-R scores were significantly higher in the dual-diagnosis group, especially for personality disorders (PDs). IES-R scores were higher in patients taking treatment for substance use disorder (SUD). CONCLUSIONS Females and alcohol abusers were at-risk subjects for dual diagnosis. Patients with SUD and PDs may benefit from additional support, especially when traumatic life events occur. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04694482.
Collapse
Affiliation(s)
- Ilaria Tagliabue
- Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
| | - Alice Caldiroli
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Monza Italy
| | - Enrico Capuzzi
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Monza Italy
| | - Riccardo Borgonovo
- Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
| | - Alberto Scalia
- Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
| | - Alessandro Ferrè
- Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
| | - Matteo Sibilla
- Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
| | - Marco Turco
- Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
| | | | - Giovanna Crespi
- Department of Mental Health and Addiction, ASST Brianza, Vimercate, Italy
| | | | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Monza Italy
| | - Fabrizia Colmegna
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Monza Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Monza Italy
| |
Collapse
|
2
|
Pan B, Wang W. Practical implications of ICD-11 personality disorder classifications. BMC Psychiatry 2024; 24:191. [PMID: 38454364 PMCID: PMC10921591 DOI: 10.1186/s12888-024-05640-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
Personality disorders (PDs) are associated with an inferior quality of life, poor health, and premature mortality, leading to heavy clinical, familial, and societal burdens. The International Classification of Diseases-11 (ICD-11) makes a thorough, dramatic paradigm shift from the categorical to dimensional diagnosis of PD and expands the application into adolescence. We have reviewed the recent literature on practical implications, and severity and trait measures of ICD-11 defined PDs, by comparing with the alternative model of personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), by mentioning the relevance in forensic and social concerns, and by referencing the developmental implication of life span, especially in adolescence. Study results strongly support the dimensional utility of ICD-11 PD diagnosis and application in adolescence which warrants early detection and intervention. More evidence-based research is needed along the ICD-11 PD application, such as its social relevance, measurement simplification, and longitudinal design of lifespan observation and treatment.
Collapse
Affiliation(s)
- Bing Pan
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Wang
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
| |
Collapse
|
3
|
Arble E. Antisocial Personality Traits, Substance Use, and Somatization: A Brief Consideration of Their Interrelation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:61. [PMID: 38248526 PMCID: PMC10815217 DOI: 10.3390/ijerph21010061] [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: 10/31/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024]
Abstract
The relationship between antisocial personality traits and the expression of somatic symptoms has been the subject of several theoretical and empirical investigations. The present study sought to advance the understanding of the relationship between these variables by testing two moderation models. It was hypothesized that the relationship between antisocial traits and somatization would be moderated by alcohol use, such that the presence of alcohol dependence would strengthen the relationship between antisocial traits and somatization. It was also hypothesized that gender would play a moderating role in the relationship between ASPD and somatization, such that the relationship would be stronger among women than among men. These models were tested in a sample of 787 criminal offenders. Gender did not emerge as a significant moderator in the relationship between antisocial traits and somatization. Although substance use did significantly moderate the relationship between antisocial traits and somatization, the direction of the effect ran counter to expectations: among participants reporting a history of alcohol dependency, the relationship between antisocial features and somatization was diminished. The implications of these findings are discussed.
Collapse
Affiliation(s)
- Eamonn Arble
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI 48197, USA
| |
Collapse
|
4
|
Renu K, Myakala H, Chakraborty R, Bhattacharya S, Abuwani A, Lokhandwala M, Vellingiri B, Gopalakrishnan AV. Molecular mechanisms of alcohol's effects on the human body: A review and update. J Biochem Mol Toxicol 2023; 37:e23502. [PMID: 37578200 DOI: 10.1002/jbt.23502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Alcohol consumption has been linked to numerous negative health outcomes although it has some beneficial effects on moderate dosages, the most severe of which being alcohol-induced hepatitis. The number of people dying from this liver illness has been shown to climb steadily over time, and its prevalence has been increasing. Researchers have found that alcohol consumption primarily affects the brain, leading to a wide range of neurological and psychological diseases. High-alcohol-consumption addicts not only experienced seizures, but also ataxia, aggression, social anxiety, and variceal hemorrhage that ultimately resulted in death, ascites, and schizophrenia. Drugs treating this liver condition are limited and can cause serious side effects like depression. Serine-threonine kinases, cAMP protein kinases, protein kinase C, ERK, RACK 1, Homer 2, and more have all been observed to have their signaling pathways disrupted by alcohol, and alcohol has also been linked to epigenetic changes. In addition, alcohol consumption induces dysbiosis by changing the composition of the microbiome found in the gastrointestinal tract. Although more studies are needed, those that have been done suggest that probiotics aid in keeping the various microbiota concentrations stable. It has been argued that reducing one's alcohol intake may seem less harmful because excessive drinking is a lifestyle disorder.
Collapse
Affiliation(s)
- Kaviyarasi Renu
- Department of Biochemistry, Centre of Molecular Medicine and Diagnostics (COMManD), Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Haritha Myakala
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Rituraj Chakraborty
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Sharmishtha Bhattacharya
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Asmita Abuwani
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Mariyam Lokhandwala
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Balachandar Vellingiri
- Department of Zoology, Stem Cell and Regenerative Medicine/Translational Research, School of Basic Sciences, Central University of Punjab (CUPB), Bathinda, Punjab, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| |
Collapse
|
5
|
Li W, Zhou H, Thygesen JH, Heydtmann M, Smith I, Degenhardt F, Nöthen M, Morgan MY, Kranzler HR, Gelernter J, Bass N, McQuillin A. Genome-wide association study of antisocial personality disorder diagnostic criteria provides evidence for shared risk factors across disorders. Psychiatr Genet 2023; 33:233-242. [PMID: 37756443 PMCID: PMC10635348 DOI: 10.1097/ypg.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/19/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION While progress has been made in determining the genetic basis of antisocial behaviour, little progress has been made for antisocial personality disorder (ASPD), a condition that often co-occurs with other psychiatric conditions including substance use disorders, attention deficit hyperactivity disorder (ADHD), and anxiety disorders. This study aims to improve the understanding of the genetic risk for ASPD and its relationship with other disorders and traits. METHODS We conducted a genome-wide association study (GWAS) of the number of ASPD diagnostic criteria data from 3217 alcohol-dependent participants recruited in the UK (UCL, N = 644) and the USA (Yale-Penn, N = 2573). RESULTS We identified rs9806493, a chromosome 15 variant, that showed a genome-wide significant association ( Z -score = -5.501, P = 3.77 × 10 -8 ) with ASPD criteria. rs9806493 is an eQTL for SLCO3A1 (Solute Carrier Organic Anion Transporter Family Member 3A1), a ubiquitously expressed gene with strong expression in brain regions that include the anterior cingulate and frontal cortices. Polygenic risk score analysis identified positive correlations between ASPD and smoking, ADHD, depression traits, and posttraumatic stress disorder. Negative correlations were observed between ASPD PRS and alcohol intake frequency, reproductive traits, and level of educational attainment. CONCLUSION This study provides evidence for an association between ASPD risk and SLCO3A1 and provides insight into the genetic architecture and pleiotropic associations of ASPD.
Collapse
Affiliation(s)
- Wenqianglong Li
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK
| | - Hang Zhou
- Department of Psychiatry, Yale School of Medicine, New Haven
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Johan H. Thygesen
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Mathis Heydtmann
- Royal Alexandria Hospital, NHS Greater Glasgow and Clyde, Paisley, UK
- Department of Gastroenterology, Dumfries & Galloway Royal Infirmary, Cargenbridge, Dumfries, Scotland
| | - Iain Smith
- Substance misuse service, Mayfield Centre, St Ninians, Stirling, UK
| | - Franziska Degenhardt
- Department of Child and Adolescent Psychiatry, University of Duisburg-Essen, Essen
| | - Markus Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Marsha Y. Morgan
- UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
- Departments of Genetics and Neuroscience, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nicholas Bass
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK
| | - Andrew McQuillin
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK
| |
Collapse
|
6
|
Stetsiv K, McNamara IA, Nance M, Carpenter RW. The Co-occurrence of Personality Disorders and Substance Use Disorders. Curr Psychiatry Rep 2023; 25:545-554. [PMID: 37787897 PMCID: PMC10798162 DOI: 10.1007/s11920-023-01452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW Despite significant negative outcomes, the co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) continues to be underrecognized, and the mechanisms contributing to this co-occurrence remain unclear. This review summarizes recent work on PD-SUD co-occurrence, with a focus on borderline and antisocial PDs, general substance use patterns among those with PDs, and the association of personality traits with SUDs. RECENT FINDINGS The prevalence of co-occurring PD-SUD is generally high, with estimates ranging depending on the type of PD and SUD, the population assessed, and the sampling methods and measures used. Current theoretical explanations for co-occurrence include shared etiology and predisposition models, with research highlighting the importance of transactional processes. Potential underlying mechanisms include personality traits and transdiagnostic characteristics. Recent research has increased focus on substances besides alcohol, dimensional models of personality pathology, and transactional explanations of co-occurrence, but more research is needed to disentangle the nuanced PD-SUD relationship.
Collapse
Affiliation(s)
- Khrystyna Stetsiv
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Ian A McNamara
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Melissa Nance
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri, St. Louis, USA.
| |
Collapse
|
7
|
Sesso G, Masi G. Pharmacological strategies for the management of the antisocial personality disorder. Expert Rev Clin Pharmacol 2023; 16:181-194. [PMID: 36787887 DOI: 10.1080/17512433.2023.2181159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Antisocial personality disorder (AsPD) is a pervasive pattern of violation of others' rights, related to the concept of psychopathy. AsPD is stable over time from adolescence, with evidence of conduct disorder (CD) before 15 years. DSM-5 included a specifier 'with limited prosocial emotions' (LPE), which characterizes adolescents with higher developmental vulnerability to develop AsPD. Despite being relatively frequent with considerable societal impact, AsPD is a difficult-to-treat condition with high comorbidity rates and poor evidence for effective pharmacological interventions. AREAS COVERED We conducted a narrative review and searched PubMed up to September 2022. We included RCTs and naturalistic studies evaluating pharmacological interventions on AsPD in adults, including those with comorbid substance use disorder or psychopathic traits. Evidence in youths with CD, callous-unemotional (CU) traits and aggression were also reviewed, exploring the role of CU traits as moderators of response. EXPERT OPINION Psychosocial interventions are the first option, with possible improvement of CU traits, beyond behavioral and affective symptoms, particularly if implemented early during development. Limited information, based on low-quality studies, supports the pharmacological options. Second-generation antipsychotics, lithium, anti-epileptic drugs, and stimulants are first-line medications, according to different target symptoms. Developmental pathways including ADHD suggest a specific role of psychostimulants.
Collapse
Affiliation(s)
- Gianluca Sesso
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca, Italy
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| |
Collapse
|
8
|
Merrick TT, Louie E, Cleary M, Molloy L, Baillie A, Haber P, Morley KC. A systematic review of the perceptions and attitudes of mental health nurses towards alcohol and other drug use in mental health clients. Int J Ment Health Nurs 2022; 31:1373-1389. [PMID: 35909095 PMCID: PMC9796325 DOI: 10.1111/inm.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 01/01/2023]
Abstract
Mental and substance use disorders are leading contributing factors for the Australian non-fatal burden of disease. These disorders frequently co-occur in the mental health population, and mental health nurses are the largest group of professionals treating dual diagnosis. A comprehensive understanding of mental health nurses' attitudes and perceptions is required to inform future implementation of dual diagnosis training programs. A systematic literature review of sources derived from electronic databases including Medline, CINAHL, SCOPUS review, and PsychINFO, along with Connected Papers. Selection criteria included a focus on mental health nurses' attitudes towards dual diagnosis of mental illness and substance use. Extracted data was qualitatively synthesized. Of the 5232 articles retrieved initially, 12 were included in the review. Four themes emerged from the synthesis: drug and alcohol use among mental health consumers (seven studies), caring for dual diagnosis consumers (eight studies), role perception (six studies), and treatment optimism (five studies). Salient beliefs included substance use as a self-inflicted choice (71%) or a form of 'self-medication' (29%); a lack of willingness to provide care (75%), or a strong commitment to care (25%); greater comfort with screening and acute medical management rather than ongoing management (83%); and pessimism about treatment effectiveness (100%). Mental health nurses' beliefs and attitudes towards dual diagnosis were often negative, which is likely to result in poor quality care and treatment outcomes. However, the lack of recent studies in this research area indicates the need for up-to-date knowledge that can inform the development of training programs.
Collapse
Affiliation(s)
- Tammy Tran Merrick
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Eva Louie
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Edith Collins Centre for Translational Research, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michelle Cleary
- School of Nursing, Midwifery & Social Science, Central Queensland University, Queensland, Rockhampton, Australia
| | - Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Haber
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Edith Collins Centre for Translational Research, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kirsten C Morley
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Edith Collins Centre for Translational Research, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| |
Collapse
|
9
|
Boog M, Goudriaan AE, Wetering BJMVD, Franken IHA, Arntz A. Schema therapy for patients with borderline personality disorder and comorbid alcohol dependence: A multiple-baseline case series design study. Clin Psychol Psychother 2022; 30:373-386. [PMID: 36399433 DOI: 10.1002/cpp.2803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
This study tested the effectiveness of schema therapy (ST) for borderline personality disorder (BPD) and comorbid alcohol dependence (AD). Twenty patients participated in a case series study with multiple baselines. The baseline phase consisted of treatment as usual. It was followed by a case conceptualization phase, an experiential techniques phase and a behavioural change phase. Patients showed a significant decrease in BPD and AD symptoms; change was mainly accomplished in the experiential techniques phase, with medium to large effect sizes. Three months after termination of therapy, 68% of the patients had remitted from BPD, and the number of drinking days decreased clearly. This study shows that, although treatment is challenging in this group of patients, meaningful change can be obtained in patients with BPD and AD using ST.
Collapse
Affiliation(s)
- Michiel Boog
- Antes Mental Health Care, Rotterdam, the Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Arkin Mental Health Care, Amsterdam, the Netherlands
| | | | - Ingmar H A Franken
- Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
10
|
Defoe IN, Khurana A, Betancourt LM, Hurt H, Romer D. Cascades From Early Adolescent Impulsivity to Late Adolescent Antisocial Personality Disorder and Alcohol Use Disorder. J Adolesc Health 2022; 71:579-586. [PMID: 35934585 PMCID: PMC11184504 DOI: 10.1016/j.jadohealth.2022.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE The behavioral disinhibition model (BDM) posits that a liability toward impulsivity evident by early adolescence underlies the coemergence of antisocial behavior and alcohol use (i.e., problem behaviors) in early-adolescence to mid-adolescence, but that the subsequent development of these problem behaviors (rather than impulsivity itself) predicts the emergence of antisocial personality disorder (APD) and alcohol use disorder (AUD) in late adolescence. The present study was designed to test these predictions of the BDM from early to late adolescence. METHODS We used five-year longitudinal self-report data from the Philadelphia Trajectory Study that was collected from 2006-2012. Mediational analyses were performed using the Random Intercept Cross-lagged Panel Model, which enables the detection of within-person predictions of changes in problem behaviors during adolescence. The sample was ethnically and socioeconomically diverse, including 364 urban US community youth (at baseline: Mage = 13.51(.95); 49.1% female). RESULTS Consistent with the BDM, mediational analyses revealed that changes in early adolescent impulsivity predicted late adolescent APD and AUD criteria, mediated by changes in mid-adolescent alcohol use and conduct problems. DISCUSSION Interventions targeting impulsivity in early adolescence could potentially halt the cascading chain of events leading to both late adolescent APD and AUD by decelerating growth in antisocial behavior and alcohol use during early-adolescence to mid-adolescence. From mid-adolescence to late-adolescence, the consequences of early impulsivity, especially involvement in antisocial behaviors, become a more relevant predictor of both APD and AUD rather than impulsivity itself.
Collapse
Affiliation(s)
- Ivy N Defoe
- Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, The Netherlands.
| | - Atika Khurana
- Counseling Psychology and Human Services Department, University of Oregon, Eugene, Oregon
| | - Laura M Betancourt
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hallam Hurt
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel Romer
- Annenberg Public Policy Center, The University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
11
|
De la Rosa-Cáceres A, Narvaez-Camargo M, Blanc-Molina A, Romero-Pérez N, Dacosta-Sánchez D, González-Ponce BM, Parrado-González A, Torres-Rosado L, Mancheño-Velasco C, Lozano-Rojas ÓM. Bridge Nodes between Personality Traits and Alcohol-Use Disorder Criteria: The Relevance of Externalizing Traits of Risk Taking, Callousness, and Irresponsibility. J Clin Med 2022; 11:jcm11123468. [PMID: 35743541 PMCID: PMC9225009 DOI: 10.3390/jcm11123468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Personality disorders show strong comorbidities with alcohol-use disorder (AUD), and several personality traits have been found to be more frequent in people with AUD. This study analyzes which personality facets of those proposed in the Alternative Model of Personality Disorder (AMPD) of DSM-5 are associated with the diagnostic criteria of AUD. Methods: The sample was composed of 742 participants randomly selected from the Spanish population, and 243 patients attending mental health services. All participants were of legal age and signed an informed consent form. The instruments were administered to the community sample in an online format, and a psychologist conducted individual face-to-face interviews with the patients. AMPD facets were assessed through the Personality Inventory of DSM-5 Short-Form, and the AUD criteria through the Substance Dependence Severity Scale. A network analysis was applied to identify the personality facets mostly associated with the AUD criteria. Results: The network analysis showed the existence of three communities, grouping the AUD criteria, externalizing spectrum facets, and internalizing spectrum facets, respectively. Risk taking, callousness, and irresponsibility facets showed the strongest association with the AUD criteria, bridging externalizing personality traits with AUD criteria. Conclusions: The facets of risk taking, callousness, and irresponsibility should be accurately assessed in patients with AUD to differentiate between a possible primary personality disorder and a syndrome induced by alcohol addiction.
Collapse
Affiliation(s)
- Ana De la Rosa-Cáceres
- Departamento de Psicología Clínica y Experimental, University of Huelva, 21071 Huelva, Spain; (A.D.l.R.-C.); (M.N.-C.); (A.B.-M.); (N.R.-P.); (D.D.-S.); (B.M.G.-P.); (A.P.-G.); (L.T.-R.); (C.M.-V.)
| | - Marta Narvaez-Camargo
- Departamento de Psicología Clínica y Experimental, University of Huelva, 21071 Huelva, Spain; (A.D.l.R.-C.); (M.N.-C.); (A.B.-M.); (N.R.-P.); (D.D.-S.); (B.M.G.-P.); (A.P.-G.); (L.T.-R.); (C.M.-V.)
| | - Andrea Blanc-Molina
- Departamento de Psicología Clínica y Experimental, University of Huelva, 21071 Huelva, Spain; (A.D.l.R.-C.); (M.N.-C.); (A.B.-M.); (N.R.-P.); (D.D.-S.); (B.M.G.-P.); (A.P.-G.); (L.T.-R.); (C.M.-V.)
| | - Nehemías Romero-Pérez
- Departamento de Psicología Clínica y Experimental, University of Huelva, 21071 Huelva, Spain; (A.D.l.R.-C.); (M.N.-C.); (A.B.-M.); (N.R.-P.); (D.D.-S.); (B.M.G.-P.); (A.P.-G.); (L.T.-R.); (C.M.-V.)
| | - Daniel Dacosta-Sánchez
- Departamento de Psicología Clínica y Experimental, University of Huelva, 21071 Huelva, Spain; (A.D.l.R.-C.); (M.N.-C.); (A.B.-M.); (N.R.-P.); (D.D.-S.); (B.M.G.-P.); (A.P.-G.); (L.T.-R.); (C.M.-V.)
| | - Bella María González-Ponce
- Departamento de Psicología Clínica y Experimental, University of Huelva, 21071 Huelva, Spain; (A.D.l.R.-C.); (M.N.-C.); (A.B.-M.); (N.R.-P.); (D.D.-S.); (B.M.G.-P.); (A.P.-G.); (L.T.-R.); (C.M.-V.)
| | - Alberto Parrado-González
- Departamento de Psicología Clínica y Experimental, University of Huelva, 21071 Huelva, Spain; (A.D.l.R.-C.); (M.N.-C.); (A.B.-M.); (N.R.-P.); (D.D.-S.); (B.M.G.-P.); (A.P.-G.); (L.T.-R.); (C.M.-V.)
| | - Lidia Torres-Rosado
- Departamento de Psicología Clínica y Experimental, University of Huelva, 21071 Huelva, Spain; (A.D.l.R.-C.); (M.N.-C.); (A.B.-M.); (N.R.-P.); (D.D.-S.); (B.M.G.-P.); (A.P.-G.); (L.T.-R.); (C.M.-V.)
| | - Cinta Mancheño-Velasco
- Departamento de Psicología Clínica y Experimental, University of Huelva, 21071 Huelva, Spain; (A.D.l.R.-C.); (M.N.-C.); (A.B.-M.); (N.R.-P.); (D.D.-S.); (B.M.G.-P.); (A.P.-G.); (L.T.-R.); (C.M.-V.)
| | - Óscar Martín Lozano-Rojas
- Departamento de Psicología Clínica y Experimental, University of Huelva, 21071 Huelva, Spain; (A.D.l.R.-C.); (M.N.-C.); (A.B.-M.); (N.R.-P.); (D.D.-S.); (B.M.G.-P.); (A.P.-G.); (L.T.-R.); (C.M.-V.)
- Research Center for Natural Resources, Health and Environment, University of Huelva, 21071 Huelva, Spain
- Correspondence:
| |
Collapse
|
12
|
Seid M, Anbesaw T, Melke S, Beteshe D, Mussa H, Asmamaw A, Shegaw M. Antisocial personality disorder and associated factors among incarcerated in prison in Dessie city correctional center, Dessie, Ethiopia: a cross-sectional study. BMC Psychiatry 2022; 22:53. [PMID: 35073903 PMCID: PMC8785502 DOI: 10.1186/s12888-022-03710-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/17/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Antisocial Personality Disorder (ASPD) describes individuals who engage in repetitive aggressiveness, deceitfulness, impulsivity, and unlawful behavior. It has a broad impact on families, relationships, and social functioning, and also people with ASPD make heavy demands on the judicial system, social and mental health services. Even though ASPD is a common problem among incarcerated in prisons, it is not well studied in developing countries including Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of ASPD among incarcerated in prison in Dessie city correctional center. METHOD A cross-sectional study design was conducted among 320 incarcerated in prison at Dessie correctional center, Ethiopia. The study subjects were selected by using a simple random sampling technique and the Diagnostic and Statistical Manual 5th text revision (DSM-5) was used to measure ASPD using face-to-face interviews. Social support was assessed using the Oslo social support scale (Oslo-3). The collected data were checked for completeness and entered into Epi-data Version 3.1 and then exported to SPSS version 26 for analysis. Bivariate and multivariable logistic regressions were done to identify factors related to antisocial personality disorder. In multivariable logistic regression variables with a p-value, less than 0.05 were considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association. RESULTS The current study showed that the prevalence of ASPD was found to be 30.6% (95% CI:25.6,35.9). In a multivariable analysis, being single [AOR = 2.33; 95%CI (1.39,3.89)], monthly income of 1000-2000 ETB (Ethiopian Birr) [AOR = 2.12; 95%CI (1.163,3.45)], reconviction [AOR = 2.37; 95%CI (1.08,5.19)], and alcohol use [AOR = 2.00; 95% CI (1.16,3.45)] were discovered to be predictors of antisocial personality disorder. CONCLUSION This study revealed that nearly one-third of incarcerated in prison were found to have an anti-social personality disorder. Being single, 1000-2000 ETB income, reconviction, and alcohol users were variables that are independent predictors of ASPD. A screening and intervention program is required and further research should be needed.
Collapse
Affiliation(s)
- Muhammed Seid
- grid.467130.70000 0004 0515 5212Department of Psychiatry, Wollo University College of Medicine and Health Science Department of Psychiatry, P.O. Box 1145, Dessie, Ethiopia
| | - Tamrat Anbesaw
- Department of Psychiatry, Wollo University College of Medicine and Health Science Department of Psychiatry, P.O. Box 1145, Dessie, Ethiopia.
| | - Shishigu Melke
- grid.467130.70000 0004 0515 5212Department of Psychiatry, Wollo University College of Medicine and Health Science Department of Psychiatry, P.O. Box 1145, Dessie, Ethiopia
| | - Dawit Beteshe
- grid.467130.70000 0004 0515 5212Department of Psychiatry, Wollo University College of Medicine and Health Science Department of Psychiatry, P.O. Box 1145, Dessie, Ethiopia
| | - Haydar Mussa
- grid.467130.70000 0004 0515 5212Department of Psychiatry, Wollo University College of Medicine and Health Science Department of Psychiatry, P.O. Box 1145, Dessie, Ethiopia
| | - Amare Asmamaw
- grid.467130.70000 0004 0515 5212Department of Psychiatry, Wollo University College of Medicine and Health Science Department of Psychiatry, P.O. Box 1145, Dessie, Ethiopia
| | - Maregu Shegaw
- grid.467130.70000 0004 0515 5212Department of Psychiatry, Wollo University College of Medicine and Health Science Department of Psychiatry, P.O. Box 1145, Dessie, Ethiopia
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW This review examines the prevalence of personality disorder in those with mental state disorder. Some challenges disentangling these psychopathologies are delineated and advances in understanding broadly are reviewed. RECENT FINDINGS Recent taxonomic changes to a dimensionally based classification system in the ICD-11 and DSM of mental disorders-V's alternative model of personality disorder include requiring cut offs to examine clinical outcomes akin to those in hypertension. These new criteria affect personality disorder prevalence where it is comorbid with mental state disorder, although more robust the dimensional approach complicates understanding both theoretically and practically. Such issues include: deciding the cut off for 'pathology', understanding if psychopathology is related to mental state disorder, personality disorder or both, and consideration of the clinical value of comorbidity. SUMMARY There is overlap between personality pathology and all types of mental state disorder. However, the shift to a dimensional framework of personality pathology means new methods to define and measure this comorbidity are needed. Dimensional conceptualisation of personality pathology challenges the underlying ontology of comorbidity in this area.
Collapse
Affiliation(s)
| | - Sara Austin
- Northwestern University, Evanston, Illinois, USA
| | | |
Collapse
|
14
|
Birds of a Feather Flock Together: Concurrent Personality Disorders and Substance Use Disorders. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Pandey S, Bolstad I, Lien L, Bramness JG. Antisocial Personality Disorder Among Patients in Treatment for Alcohol Use Disorder (AUD): Characteristics and Predictors of Early Relapse or Drop-Out. Subst Abuse Rehabil 2021; 12:11-22. [PMID: 33907489 PMCID: PMC8064678 DOI: 10.2147/sar.s296526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background Patients with alcohol use disorders (AUD) vary significantly in many clinically important characteristics making them a heterogenous group. AUD patients with comorbid antisocial personality disorder (ASPD) form an important sub-group, and studies indicate that these patients may have poorer treatment outcomes. Therefore, we aimed to investigate the characteristics of AUD inpatients with comorbid ASPD and identify predictors of early relapse or treatment drop-out in these patients. Methods In a longitudinal study of AUD patients (n = 113; 30 females; aged 27 to 72 years) in treatment at three residential rehabilitation clinics in Norway, we used interviews and self-report questionnaires to collect data on alcohol use, mental health, and trauma experience. In addition, we assessed biochemical parameters. The patients were followed up at 6 weeks to identify early relapse or drop-out. Results Prevalence of ASPD among AUD patients was 15%. AUD patients with comorbid ASPD were exclusively male, of younger age, and reported more childhood trauma, and adult attention-deficit-hyperactivity-disorder symptoms. They reported more hazardous drinking behavior and more often had dependence on substances in addition to alcohol. The presence of ASPD did not predict early relapse or drop-out. However, early relapse or drop-out in ASPD patients was associated with childhood and adult trauma, younger age of drinking debut, and higher baseline prolactin levels. Conclusion AUD patients with ASPD had different clinical characteristics to other AUD patients and they had specific predictors of early relapse or drop-out. Our findings indicate that the early relapse or drop-out among AUD patients with ASPD may be attributed to environmental and possibly biological vulnerability. However, further studies with larger sample size are warranted to confirm these preliminary associations.
Collapse
Affiliation(s)
- Susmita Pandey
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingeborg Bolstad
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Health and Social Science, Innlandet University of Applied Science, Elverum, Norway
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Clinical Medicine, UiT - Norway's Arctic University, Tromsø, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
16
|
Alcohol use patterns and disorders among individuals with personality disorders in the Sao Paulo Metropolitan Area. PLoS One 2021; 16:e0248403. [PMID: 33755679 PMCID: PMC7987194 DOI: 10.1371/journal.pone.0248403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/25/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Alcohol Use Disorders are frequently comorbid with personality disorders. However, the heterogeneity of the prevalence estimates is high, and most data come from high income countries. Our aim is to estimate the prevalence and association between alcohol use outcomes and the three DSM-5 clusters of personality disorders in a representative sample of the São Paulo Metropolitan Area. Materials and methods A representative household sample of 2,942 adults was interviewed using the WHO Composite International Diagnostic Interview and the International Personality Disorder Examination Screening Questionnaire. Lifetime PD diagnoses were multiply imputed, and AUD diagnoses were obtained using DSM-5 criteria. We conducted cross-tabulations and logistic regression to estimate the associations between AUDs and PDs. Results and discussion Our study did not find significant associations of PDs with heavy drinking patterns or mild AUD. Cluster B PD respondents tended to show the highest conditional prevalence estimates of most alcohol use patterns and AUD, including its severity subtypes. When alcohol outcomes were regressed on all PD Clusters simultaneously, with adjustment for sex and age, only cluster B was significantly associated with past-year alcohol use (OR 3.0), regular drinking (OR 3.2), and AUDs (OR 8.5), especially moderate and severe cases of alcohol use disorders (OR 9.7 and 16.6, respectively). These associations between Cluster B PDs and these alcohol outcomes were shown to be independent of other PD Clusters and individuals´ sex and age. Conclusion The main finding of our study is that AUDs are highly comorbid with PDs. The presence of Cluster B PDs significantly increases the odds of alcohol consumption and disorders and of more severe forms of AUDs. Considering the local context of poor treatment provision, more specific prevention and intervention strategies should be directed to this population.
Collapse
|
17
|
Tyrer P, Tyrer H, Yang M. Premature mortality of people with personality disorder in the Nottingham Study of Neurotic Disorder. Personal Ment Health 2021; 15:32-39. [PMID: 31414571 DOI: 10.1002/pmh.1466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 11/07/2022]
Abstract
It is known that people with personality disorders die prematurely. This may be connected to high levels of co-morbidity with other psychiatric disorders. To test whether mortality was independent, deaths were examined in a 31-year cohort study of anxious and depressed patients (Nottingham Study of Neurotic Disorder) who also had their personality status assessed at baseline. The severity of personality disturbance was assessed using a method previously used to separate personality disorders into ICD-11 categories. Over the follow-up period, 71 of the cohort of 201 patients had died. Age at death was 5.1 (M) and 5.2 (F) years younger in those with personality disorder compared with no personality disorder, but after adjusting for age at randomization and clinical diagnosis at baseline, these differences reduced to 1.5 (M) and 1.6 (F) years. The longevity of the group was 12 to 18 years less than the general population (p < 0.0001), reinforcing previous findings of premature mortality in common mental illness. Analysis of causes of death showed no meaningful differences in personality groups. The hypothesis that premature death in personality disturbance is independent of mental health status was not supported in this study, despite other evidence from this cohort that general clinical outcome is worse in those with personality disorder. © 2019 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Peter Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | - Helen Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | - Min Yang
- West China School of Public Health, Sichuan University, Chengdu, China.,Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia
| |
Collapse
|
18
|
Høye A, Jacobsen BK, Bramness JG, Nesvåg R, Reichborn-Kjennerud T, Heiberg I. Total and cause-specific mortality in patients with personality disorders: the association between comorbid severe mental illness and substance use disorders. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1809-1819. [PMID: 33677644 PMCID: PMC8429406 DOI: 10.1007/s00127-021-02055-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the mortality in both in- and outpatients with personality disorders (PD), and to explore the association between mortality and comorbid substance use disorder (SUD) or severe mental illness (SMI). METHODS All residents admitted to Norwegian in- and outpatient specialist health care services during 2009-2015 with a PD diagnosis were included. Standardized mortality ratios (SMRs) with 95% confidence intervals (CI) were estimated in patients with PD only and in patients with PD and comorbid SMI or SUD. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% CIs in patients with PD and comorbid SMI or SUD compared to patients with PD only. RESULTS Mortality was increased in both in- and outpatients with PD. The overall SMR was 3.8 (95% CI 3.6-4.0). The highest SMR was estimated for unnatural causes of death (11.0, 95% CI 10.0-12.0), but increased also for natural causes of death (2.2, 95% CI 2.0-2.5). Comorbidity was associated with higher SMRs, particularly due to poisoning and suicide. Patients with comorbid PD & SUD had almost four times higher all-cause mortality HR than patients with PD only; young women had the highest HR. CONCLUSION The SMR was high in both in- and outpatients with PD, and particularly high in patients with comorbid PD & SUD. Young female patients with PD & SUD were at highest risk. The higher mortality in patients with PD cannot, however, fully be accounted for by comorbidity.
Collapse
Affiliation(s)
- Anne Høye
- Department of Clinical Medicine, UiT-The Arctic University of Norway, pb 6124, 9291, Tromsø, Norway.
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway.
- Center for Clinical Documentation and Evaluation (SKDE), Tromsø, Norway.
| | - Bjarne K Jacobsen
- Center for Clinical Documentation and Evaluation (SKDE), Tromsø, Norway
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Centre for Sami Health Research, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Jørgen G Bramness
- Department of Clinical Medicine, UiT-The Arctic University of Norway, pb 6124, 9291, Tromsø, Norway
- Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hamar, Norway
| | - Ragnar Nesvåg
- Department of Clinical Medicine, UiT-The Arctic University of Norway, pb 6124, 9291, Tromsø, Norway
- Norwegian Medical Association, Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ina Heiberg
- Center for Clinical Documentation and Evaluation (SKDE), Tromsø, Norway
| |
Collapse
|
19
|
Khalifa NR, Gibbon S, Völlm BA, Cheung NHY, McCarthy L. Pharmacological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2020; 9:CD007667. [PMID: 32880105 PMCID: PMC8094881 DOI: 10.1002/14651858.cd007667.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Antisocial personality disorder (AsPD) is associated with rule-breaking, criminality, substance use, unemployment, relationship difficulties, and premature death. Certain types of medication (drugs) may help people with AsPD. This review updates a previous Cochrane review, published in 2010. OBJECTIVES To assess the benefits and adverse effects of pharmacological interventions for adults with AsPD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also checked reference lists and contacted study authors to identify studies. SELECTION CRITERIA Randomised controlled trials in which adults (age 18 years and over) with a diagnosis of AsPD or dissocial personality disorder were allocated to a pharmacological intervention or placebo control condition. DATA COLLECTION AND ANALYSIS Four authors independently selected studies and extracted data. We assessed risk of bias and created 'Summary of findings tables' and assessed the certainty of the evidence using the GRADE framework. The primary outcomes were: aggression; reconviction; global state/global functioning; social functioning; and adverse events. MAIN RESULTS We included 11 studies (three new to this update), involving 416 participants with AsPD. Most studies (10/11) were conducted in North America. Seven studies were conducted exclusively in an outpatient setting, one in an inpatient setting, and one in prison; two studies used multiple settings. The average age of participants ranged from 28.6 years to 45.1 years (overall mean age 39.6 years). Participants were predominantly (90%) male. Study duration ranged from 6 to 24 weeks, with no follow-up period. Data were available from only four studies involving 274 participants with AsPD. All the available data came from unreplicated, single reports, and did not allow independent statistical analysis to be conducted. Many review findings were limited to descriptive summaries based on analyses carried out and reported by the trial investigators. No study set out to recruit participants on the basis of having AsPD; many participants presented primarily with substance abuse problems. The studies reported on four primary outcomes and six secondary outcomes. Primary outcomes were aggression (six studies) global/state functioning (three studies), social functioning (one study), and adverse events (seven studies). Secondary outcomes were leaving the study early (eight studies), substance misuse (five studies), employment status (one study), impulsivity (one study), anger (three studies), and mental state (three studies). No study reported data on the primary outcome of reconviction or the secondary outcomes of quality of life, engagement with services, satisfaction with treatment, housing/accommodation status, economic outcomes or prison/service outcomes. Eleven different drugs were compared with placebo, but data for AsPD participants were only available for five comparisons. Three classes of drug were represented: antiepileptic; antidepressant; and dopamine agonist (anti-Parkinsonian) drugs. We considered selection bias to be unclear in 8/11 studies, attrition bias to be high in 7/11 studies, and performance bias to be low in 7/11 studies. Using GRADE, we rated the certainty of evidence for each outcome in this review as very low, meaning that we have very little confidence in the effect estimates reported. Phenytoin (antiepileptic) versus placebo One study (60 participants) reported very low-certainty evidence that phenytoin (300 mg/day), compared to placebo, may reduce the mean frequency of aggressive acts per week (phenytoin mean = 0.33, no standard deviation (SD) reported; placebo mean = 0.51, no SD reported) in male prisoners with aggression (skewed data) at endpoint (six weeks). The same study (60 participants) reported no evidence of difference between phenytoin and placebo in the number of participants reporting the adverse event of nausea during week one (odds ratio (OR) 1.00, 95% confidence interval (CI) 0.06 to 16.76; very low-certainty evidence). The study authors also reported that no important side effects were detectable via blood cell counts or liver enzyme tests (very low-certainty evidence). The study did not measure reconviction, global/state functioning or social functioning. Desipramine (antidepressant) versus placebo One study (29 participants) reported no evidence of a difference between desipramine (250 to 300 mg/day) and placebo on mean social functioning scores (desipramine = 0.19; placebo = 0.21), assessed with the family-social domain of the Addiction Severity Index (scores range from zero to one, with higher values indicating worse social functioning), at endpoint (12 weeks) (very low-certainty evidence). Neither of the studies included in this comparison measured the other primary outcomes: aggression; reconviction; global/state functioning; or adverse events. Nortriptyline (antidepressant) versus placebo One study (20 participants) reported no evidence of a difference between nortriptyline (25 to 75 mg/day) and placebo on mean global state/functioning scores (nortriptyline = 0.3; placebo = 0.7), assessed with the Symptom Check List-90 (SCL-90) Global Severity Index (GSI; mean of subscale scores, ranging from zero to four, with higher scores indicating greater severity of symptoms), at endpoint (six months) in men with alcohol dependency (very low-certainty evidence). The study measured side effects but did not report data on adverse events for the AsPD subgroup. The study did not measure aggression, reconviction or social functioning. Bromocriptine (dopamine agonist) versus placebo One study (18 participants) reported no evidence of difference between bromocriptine (15 mg/day) and placebo on mean global state/functioning scores (bromocriptine = 0.4; placebo = 0.7), measured with the GSI of the SCL-90 at endpoint (six months) (very low-certainty evidence). The study did not provide data on adverse effects, but reported that 12 patients randomised to the bromocriptine group experienced severe side effects, five of whom dropped out of the study in the first two days due to nausea and severe flu-like symptoms (very low-certainty evidence). The study did not measure aggression, reconviction and social functioning. Amantadine (dopamine agonist) versus placebo The study in this comparison did not measure any of the primary outcomes. AUTHORS' CONCLUSIONS The evidence summarised in this review is insufficient to draw any conclusion about the use of pharmacological interventions in the treatment of antisocial personality disorder. The evidence comes from single, unreplicated studies of mostly older medications. The studies also have methodological issues that severely limit the confidence we can draw from their results. Future studies should recruit participants on the basis of having AsPD, and use relevant outcome measures, including reconviction.
Collapse
Affiliation(s)
- Najat R Khalifa
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Simon Gibbon
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Natalie H-Y Cheung
- Forensic Research, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Lucy McCarthy
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| |
Collapse
|
20
|
Gibbon S, Khalifa NR, Cheung NHY, Völlm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2020; 9:CD007668. [PMID: 32880104 PMCID: PMC8094166 DOI: 10.1002/14651858.cd007668.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review). OBJECTIVES To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also searched reference lists and contacted study authors to identify studies. SELECTION CRITERIA Randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment. The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called 'standard Maintenance'(SM) in some studies). Eight of the 18 psychological interventions reported data on our primary outcomes. Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD. Data were available from only 10 studies involving 605 participants. Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands. Study duration ranged from 4 to 156 weeks (median = 26 weeks). Most participants (75%) were male; the mean age was 35.5 years. Eleven studies (58%) were funded by research councils. Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%. Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention. One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention. Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence). One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up. Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. 'Driving whilst intoxicated' programme (DWI) + incarceration versus incarceration One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months. Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years. The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19). The certainty of the evidence for all outcomes was very low. Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants' level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention. Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU. Psychosocial risk management (PSRM; 'Resettle') versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison. It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour. Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies. This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.
Collapse
Affiliation(s)
- Simon Gibbon
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Najat R Khalifa
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Natalie H-Y Cheung
- Forensic Research, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Lucy McCarthy
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| |
Collapse
|
21
|
Marshall CA, Jomeen J, Huang C, Martin CR. The Relationship between Maternal Personality Disorder and Early Birth Outcomes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165778. [PMID: 32785040 PMCID: PMC7460127 DOI: 10.3390/ijerph17165778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023]
Abstract
(1) Background: Women with personality disorder are at risk of social and emotional problems which impact deleteriously on everyday functioning. Moreover, a personality disorder diagnosis has been established to have an adverse impact upon pregnancy outcomes and child health. Understanding this impact is critical to improving both maternal and child outcomes. This systematic review and meta-analysis will evaluate the contemporary evidence regarding these relationships. (2) Methods: Prospero and Cochrane were searched for any systematic reviews already completed on this topic. Academic Search Premier, CINAHL Complete, MEDLINE, PsycARTICLES, PsycINFO via the EBSCO host, and the Web of Science Core Collection were searched to include research articles published between 1980 and 2019. A total of 158 records were identified; 105 records were screened by reviewing the abstract; 99 records were excluded; 6 full text articles were assessed for eligibility; 5 records were included in the review. (3) Results: All the included studies reported on preterm birth. The meta-analysis indicates significant risk of preterm birth in women with personality disorder (overall odds ratio (OR) 2.62; CI 2.24–3.06; p < 0.01). Three studies reported on low birth weight, with the meta-analysis indicating a raised risk of low birth weight of the babies born to women with personality disorder (overall OR 2.00 CI 1.12–3.57 (p = 0.02)). Three studies reported on appearance, pulse, grimace, activity, and respiration (APGAR) score, with the meta-analysis of OR’s indicating a risk of low APGAR score in women with personality disorder (overall OR 2.31; CI 1.17–4.55; p = 0.02). (4) Conclusions: The infants of women with personality disorder are at elevated risk of preterm birth, low birth weight and low APGAR score.
Collapse
Affiliation(s)
- Claire A. Marshall
- Perinatal Mental Health Liaison Team, Humber Teaching NHS Foundation Trust, Hull HU2 8TD, UK;
| | - Julie Jomeen
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW 2480, Australia;
| | - Chao Huang
- Hull York Medical School, University of Hull, Hull HU6 7RX, UK;
| | - Colin R. Martin
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull HU6 7RX, UK
- Correspondence:
| |
Collapse
|
22
|
The application of meta-analytic (multi-level) models with multiple random effects: A systematic review. Behav Res Methods 2020; 52:2031-2052. [DOI: 10.3758/s13428-020-01373-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
23
|
Müller M, Ajdacic-Gross V, Vetrella AB, Preisig M, Castelao E, Lasserre A, Rodgers S, Rössler W, Vetter S, Seifritz E, Vandeleur C. Subtypes of alcohol use disorder in the general population: A latent class analysis. Psychiatry Res 2020; 285:112712. [PMID: 31837815 DOI: 10.1016/j.psychres.2019.112712] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 02/04/2023]
Abstract
Alcohol use disorders (AUD) are often comorbid with other disorders with high levels of impairment, which is of relevance for the development and the progression of the disease. Evidence shows that AUD varies greatly with regard to its aetiology, which might lead to distinct clinical representations with important implications for treatment. The current study aimed to apply latent class analysis (LCA) techniques to investigate how comorbidity patterns in AUD vary with regard to specific explanatory factors. A Swiss community sample of N=439 individuals with AUD was subjected to LCA in order to find empirical AUD subtypes of comorbid psychiatric conditions. The subtypes were further validated based on a range of external criteria, including clinical and psycho-social factors as well as treatment variables. A three-class solution of empirical subtypes of AUD comorbidity (low, depressive-anxious, and drug-dependent antisocial) provided the best fit to the data. The three AUD subtypes showed homogeneous comorbidity patterns but varied along dimensions of psycho-social risk factors, consumption patterns and consequences as well as treatment history. Our findings provide strong evidence that AUD in non-treated samples can be described as a multidimensional disorder in terms of its comorbidity structure with distinct etiological factors and important consequences for treatment.
Collapse
Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Centre for Disaster and Military Psychiatry, University of Zurich, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland.
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
| | - Antonio Besi Vetrella
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Enrique Castelao
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Aurélie Lasserre
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
| | - Wulf Rössler
- Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - University Medicine Berlin, Germany
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Centre for Disaster and Military Psychiatry, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Caroline Vandeleur
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
24
|
Cavicchioli M, Ramella P, Movalli M, Prudenziati F, Vassena G, Simone G, Maffei C. DSM-5 Maladaptive Personality Domains among Treatment-Seeking Individuals with Alcohol Use Disorder: The Role of Disinhibition and Negative Affectivity. Subst Use Misuse 2020; 55:1746-1758. [PMID: 32410484 DOI: 10.1080/10826084.2020.1762650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Dimensional models of personality and personality disorders (PDs) have been widely investigated among individuals with alcohol use disorders (AUD). Nevertheless, DSM-5 maladaptive personality domains showed mixed associations with AUD. Furthermore, no studies have explored the role of DSM-5 maladaptive personality domains on the comorbidity between AUD and different PDs. Objective(s): This study aims at investigating whether DSM-5 maladaptive personality dimensions could differentiate individuals with AUD from normative and healthy controls (HCs) subjects. The study also investigated relationships between these personality dimensions and AUD clinical features (i.e. onset, severity of concurrent substance use disorders), as well as their role in accounting for the comorbidity between AUD and PDs. Methods: This study administered the personality inventory for DSM-5 (PID-5) to 99 treatment-seeking individuals (male 68.8%; female 31.2%; age: 48.12 (14.32)) with AUD (41 AUD only; 58 AUD with PDs), comparing the participants' levels of PID-5 domains with normative data and the data from a HC sample (N = 40; male 50%; female 50%; age: 48.12 (14.32)). Results: Disinhibition and negative affectivity were relevant maladaptive personality dimensions of AUD, even when controlling for the impact of PD diagnoses. Disinhibition and negative affectivity were associated to the onset of AUD and the severity of concurrent substance use disorders. The co-occurrence of AUD and PDs is related to other two domains, namely antagonism and detachment. Conclusions: AUD is a complex psychopathological disorder in which both externalizing and internalizing aspects determine relevant clinical features.
Collapse
Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Pietro Ramella
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Mariagrazia Movalli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Francesca Prudenziati
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Giulia Vassena
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Giulia Simone
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| |
Collapse
|
25
|
Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M. Psychiatric comorbidities in alcohol use disorder. Lancet Psychiatry 2019; 6:1068-1080. [PMID: 31630984 PMCID: PMC7006178 DOI: 10.1016/s2215-0366(19)30222-6] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 01/10/2023]
Abstract
Alcohol use disorder is a major contributor to the morbidity and mortality burden worldwide. It often coexists with other psychiatric disorders; however, the nature of this comorbidity is still a matter of debate. In this Series paper, we examine the main psychiatric disorders associated with alcohol use disorder, including the prevalence of co-occurring disorders, the temporal nature of the relationship, and mechanisms that might explain comorbidity across the lifespan. Overall, this disorder co-occurs with a wide range of other psychiatric disorders, especially those disorders involving substance use and violent or aggressive behaviour. The causal pathways between alcohol use disorder and other psychiatric disorders are heterogeneous. Hypotheses explaining these relationships include reciprocal direct causal associations, shared genetic and environmental causes, and shared psychopathological characteristics of broader diagnostic entities (eg, externalising disorders). Efforts to untangle the associations between alcohol use disorder and other disorders across the lifespan remain a crucial avenue of research.
Collapse
Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile; Department of Population Health, New York University School of Medicine, New York, NY, USA.
| | - Katherine M Keyes
- Department of Epidemiology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
26
|
Cavicchioli M, Prudenziati F, Movalli M, Ramella P, Maffei C. The Severity of Personality Pathology: A Risk Factor for Concurrent Substance Use Disorders in Alcohol Use Disorder. J Dual Diagn 2019; 15:159-171. [PMID: 31088228 DOI: 10.1080/15504263.2019.1612131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: Co-occurrence of substance use disorders (CO-substance use disorders) among individuals with alcohol use disorder (AUD) is largely recognized as a critical clinical issue. However, the specific clinical variables involved are still unclear. The recent findings are controversial in pointing out the unique contribution of both impulsivity and emotion dysregulation on CO-substance use disorders. Furthermore, the co-variation between AUD and other substance use disorders includes different aspects of maladaptive personality functioning (i.e., overall severity and specific features). Therefore, this study aims at clarifying the role of impulsivity, emotional dysregulation, and severity of personality pathology on CO-substance use disorders among treatment-seeking individuals with AUD. Methods: One hundred ninety-three treatment-seeking individuals with AUD (DSM-IV-TR) were consecutively recruited. Impulsivity (Barratt Impulsiveness Scale [BIS-11]), emotional dysregulation (Difficulties in Emotion Regulation Scale [DERS]), and personality pathology (Structured Clinical Interview for DSM-IV Axis II Personality Disorder [SCID-II]) were assessed after a 2-week detoxification period. The analyses were based on several stepwise forward logistic regressions. The total score of BIS-11 and DERS together with the number of SCID-II criteria were considered, in following the order, as independent variables controlling for the comorbidity with other lifetime Axis I disorders. CO-substance use disorders was the dependent variable (i.e., any CO-substance use disorders, benzodiazepine and cannabis/cocaine use disorders). Results: The number of SCID-II criteria was the only significant predictor of overall CO-substance use disorders, odds ratio (OR) = 1.16; 95% confidence interval (CI) [1.07, 1.26], p < .01, and cannabis/cocaine use disorders, OR = 1.19; 95% CI [1.08, 1.31], p < .01. On the contrary, DERS total score was the most robust predictor of benzodiazepine use disorder, OR = 1.02; 95% CI [1.01, 1.04], p < .01, albeit the severity of maladaptive personality functioning was also significantly associated with this disorder, OR = 1.09; 95% CI [1.00, 1.18], p < .05. Conclusions: The severity of maladaptive personality pathology represents one of the main aspects involved in CO-substance use disorders among individuals with AUD. This dimension predicts the CO-substance use disorders above and beyond specific personality dimensions and other psychiatric conditions. Therefore, personality functioning should be precisely assessed and personality pathology should be addressed in the framework of AUD treatments for promoting effective long-term outcomes.
Collapse
Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan , Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan , Italy
| | - Francesca Prudenziati
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan , Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan , Italy
| | - Mariagrazia Movalli
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan , Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan , Italy
| | - Pietro Ramella
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan , Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan , Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan , Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan , Italy
| |
Collapse
|