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Mancheño-Velasco C, Narváez-Camargo M, Dacosta-Sánchez D, Sánchez-García M, Lozano ÓM. Examining Profiles and Treatment Outcomes in Dual Diagnosis: Comparison of Coordinated Treatment With Mental Health Services Versus Addiction Center Alone. A Real-World Data Analysis. J Dual Diagn 2024; 20:266-278. [PMID: 38478999 DOI: 10.1080/15504263.2024.2323976] [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: 06/28/2024]
Abstract
OBJECTIVE The aim of this work was to examine the profile and treatment outcomes of patients with dual pathology depending on whether the patients were attending addiction centers or are being treated in a coordinated model by mental health services. METHODS Data from 7225 dual diagnosis patients were used, of whom 2417 (33.5%) received treatment in the mental health coordinated modality. Clinical information was taken from the patients' electronic health record. RESULTS Differences were found in patients' sociodemographic and comorbidity profiles according to treatment modality. In general, coordinated care yielded favorable outcomes (higher attendance and lower dropout rates but no differences in retention). The logistic regression analysis identified predictors of patient profiles in coordinated care, emphasizing having a severe mental health disorder (OR = 3.878, 95% CI [3.443, 4.368]; p = .000), being referred by social/health services, or having retired status. Main differences were observed according to the comorbid diagnosis presented, particularly in cases in which the patient had impulse control, hyperkinetic, or cluster C personality disorder. CONCLUSIONS While therapeutic outcomes are influenced by associated comorbidities, the disorders prognosis can be favorable with appropriate treatment. Furthermore, analysis of differences according to treatment modality allows for predicting the type of patient who will receive a particular service, which enables the development of tailored treatments.
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Affiliation(s)
| | - Marta Narváez-Camargo
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
| | | | - Manuel Sánchez-García
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Óscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
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Lee YJ, Kweon YS, Kang YH, Yoon KH, Lee MS, Bhang SY, Hong HJ. Suicide warning signs that are challenging to recognize: a psychological autopsy study of Korean adolescents. Child Adolesc Psychiatry Ment Health 2024; 18:41. [PMID: 38528559 DOI: 10.1186/s13034-024-00731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND In South Korea, the leading cause of youth death has been suicide for about 20 years. In this study, we conducted a multi-method psychological autopsy to identify the psychiatric diagnosis, developmental history, personality traits, family history, school life, warning signs of suicide, and risk factors related to suicide for the first time in Korea. METHODS This was a postmortem, retrospective, and descriptive study of 36 adolescents who died by suicide between August 2015 and July 2021 in South Korea. We obtained qualitative and quantitative data from the Korean Psychological Autopsy of Adolescent, conducted by the Suicide and School Mental Health Institute, the official student mental health policy-focused research institute of the Korean Ministry of Education. RESULTS The adolescents comprised equal percentage of girls and boys. Approximately half of the deaths (55.6%) occurred at home and most (72.2%) involved jumping from a height. Most of the adolescents (97.2%) had one major psychiatric disorder before death, with depressive disorder being the most prevalent (75%). They were at a high risk for internet addiction before death. The most common personality trait was avoidance (28.6%), followed by submissiveness (27.3%). Half of the parents reported that the adolescents were satisfied with their school life and the teachers observed that they had no behavioral problems. One year before death, seven (19.4%) adolescents injured themselves and five (13.9%) had attempted suicide. Most of the deceased (80.6%) had expressed suicide warning signs to their families within one year before death. Adolescents had a long experience of family-related adverse events. CONCLUSIONS Most of the adolescents had mental health disorders and expressed suicidal intentions using verbal and nonverbal signs. However, it was challenging for families to recognize the risk signs because of adolescents' personality traits or a good school life. To prevent adolescent suicide, adolescents, parents, and teachers need to be educated to recognize signs of suicide warning signs and equipped to guide adolescents to appropriate care.
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Affiliation(s)
- Yeon Jung Lee
- Department of Psychiatry, College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yong-Sil Kweon
- Department of Psychiatry, College of Medicine, The Catholic University, Seoul, Republic of Korea
| | | | - Kyung Hee Yoon
- School Mental Health Resources and Research Center, Seoul, Republic of Korea
| | - Mi-Sun Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University, Seoul, Republic of Korea
| | - Soo-Young Bhang
- Department of Psychiatry, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
- Eulji Psychiatry and Medical Science Center, Eulji University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyun Ju Hong
- Suicide and School Mental Health Institute, Anyang, Republic of Korea.
- Department of Psychiatry, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Republic of Korea.
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Myhre MØ, Walby FA, Bramness JG, Mehlum L. The temporal association between suicide and comorbid mental disorders in people treated for substance use disorders: a National registry study. Addict Sci Clin Pract 2023; 18:59. [PMID: 37821976 PMCID: PMC10568834 DOI: 10.1186/s13722-023-00415-9] [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: 04/20/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The time after contact with specialized health services for mental health and substance use is associated with an increased risk of suicide, where temporal aspects of suicide and comorbid mental disorders in patients with substance use disorders could be associated. This study aimed to examine the temporal association between time from last treatment contact to suicide and comorbid mental disorders in patients with substance use disorders. METHODS This study is a historical prospective case series using nationwide registry data. It included 946 individuals registered the year before suicide with a substance use disorder (F10-F19) in Norway's specialized health services for treating substance use and mental health disorders between 2010 and 2020. The outcome was the number of weeks from the last contact with services to suicide. The exposure was comorbid mental disorders divided into 'no comorbid mental disorder'; 'psychosis or bipolar disorders' (F20-F31), 'depressive or anxiety disorders' (F32-F49); and 'personality disorders' (F60-F69). Covariates included gender, age, last diagnosed substance use disorder, registered deliberate self-harm last year, and the number of in- and outpatient contacts the previous year. RESULTS The number of weeks from last service contact to suicide differed (p = < 0.001) between patients with no comorbid mental disorders (Median = 7; IQR 2-23), psychosis or bipolar disorders (Median = 2; IQR = 1-7), depressive or anxiety disorders (Median = 3; IQR = 1-11) and personality disorders (Median = 1; IQR = 1-5.5). Significantly decreased adjusted incidence rate ratios (aIRR) were found for psychosis or bipolar disorders [aIRR = 0.67 (95% CI 0.53-0.85)] and personality disorders [aIRR = 0.56 (0.42-0.77)] compared to no comorbid mental disorder when adjusted for individual characteristics and service contact. For depressive and anxiety disorders compared to no comorbid mental disorder, the association was significant when adjusted for individual characteristics [aIRR = 0.55 (0.46-0.66)]. CONCLUSIONS While patients with substance use disorders generally died by suicide a short time after contact with services, patients with comorbid mental disorders died an even shorter time after such contact and significantly shorter than patients without such comorbidities.
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Affiliation(s)
- Martin Ø Myhre
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, University of Oslo, Sognsvannveien 21, 0372, Oslo, Norway.
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, University of Oslo, Sognsvannveien 21, 0372, Oslo, Norway
| | - Jørgen G Bramness
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- UiT- The Arctic University of Norway, Tromsø, Norway
- Norwegian National Competency Centre for Drug Abuse and Mental Illness, Brumunddal, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, University of Oslo, Sognsvannveien 21, 0372, Oslo, Norway
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McClelland H, Cleare S, O'Connor RC. Suicide Risk in Personality Disorders: A Systematic Review. Curr Psychiatry Rep 2023; 25:405-417. [PMID: 37642809 PMCID: PMC10506938 DOI: 10.1007/s11920-023-01440-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW This systematic review aimed to distil recent literature investigating psychosocial factors which may account for the association between personality disorder (PD) and suicide attempt or suicide death. RECENT FINDINGS Suicide risk is particularly elevated in people with PD compared to those with no, or many other, mental health diagnoses. Despite this, suicide prevention strategies for PD populations have not progressed markedly in recent years. It is critical, therefore, to identify additional factors associated with suicide in PD populations. Of the 34 studies included in this review, most identified a relationship between personality disorder and suicide attempt and/or death. Historical interpersonal factors (e.g., childhood trauma), drug and alcohol use, and ideation-to-enaction factors were commonly associated with suicide-related outcomes. Interventions that provide interpersonal support may reduce suicide attempts. Limitations of the review include the heterogeneity of studies and small sample sizes.
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Affiliation(s)
- Heather McClelland
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland.
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
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Dupree J, South SC, Oltmanns TF. Late Onset Personality Disorders in Mid-Life and Older Adults. J Pers Disord 2023; 37:304-316. [PMID: 37367821 DOI: 10.1521/pedi.2023.37.3.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
There is little research on personality disorder (PD) onset in older age. Many studies have shown that normative personality traits change across the life span, even into later life. This study aimed to investigate the onset of PDs in later adulthood (>age 55), and the possible influence of major life events on predicting this late onset. The current analysis was conducted with data from the St. Louis Personality and Aging Network (SPAN). Structured diagnostic interviews were administered three times over five years. Logistic regressions were conducted predicting late onset PD from baseline to FU5 and from FU5 to FU10 as a function of each major life event. 75 PD onsets occurred from baseline to FU5, and 39 PD onsets occurred from FU5 to FU10. Personal illness predicted the onset of PDs from FU5 to FU10.
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Haslam R, Heiderscheit A, Himmerich H. A Systematic Review of Scientific Studies on the Effects of Music in People with Personality Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315434. [PMID: 36497510 PMCID: PMC9741013 DOI: 10.3390/ijerph192315434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/12/2022] [Accepted: 11/19/2022] [Indexed: 05/28/2023]
Abstract
Personality Disorders (PDs) are psychiatric conditions involving maladaptive personality traits and behaviours. Previous research has shown that musical preferences and the use of music may be related to personality traits. Additionally, music therapy is increasingly being used as a treatment option for people with PDs. Using the PRISMA guidelines, a systematic literature search was undertaken using three databases: PubMed, Web of Science, and PsycInfo. The following search terms were used: PubMed: "personality disorder" AND (music OR "music therapy"); Web of Science (advanced search): TS = (personality disorder) AND TS = (music or "music therapy"); PsycInfo: "personality disorder" AND (music OR "music therapy"). A total of 24 studies were included in this review and summarised into four categories: music preference, music therapy, music performance, and music imagery, all in relation to PDs or traits associated with PDs. The analysis found that individuals with personality traits associated with PDs may prefer different types or genres of music or interact with music differently than those without these traits. Additionally, music therapy (MT) was found to offer a potentially useful treatment option for PDs. The power of these findings was limited by the small number of included studies. This review offers a useful foundation upon which further research looking at MT as a potential treatment option for PDs can be built.
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Affiliation(s)
- Rowan Haslam
- Mental Health Studies Programme, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Annie Heiderscheit
- Department of Music Therapy, Augsburg University, Minneapolis, MN 55454, USA
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
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Kouppis E, Gerdin B, Björkenstam C, Björkenstam E, Ekselius L. Effect of comorbid ADHD on mortality in women with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:25. [PMID: 36316740 PMCID: PMC9623906 DOI: 10.1186/s40479-022-00196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Many similarities exist between borderline personality disorder (BPD) and attention-deficit/hyperactivity disorder (ADHD), more so in women than in men. People with comorbid ADHD and BPD represent a subgroup of BPD patients with distinct symptom expression and, consequently, a different prognosis. We used Swedish national high quality registers to assess whether such comorbidity is related to increased mortality risk. The study focused on women with BPD because they are more likely than men to be clinically diagnosed with BPD and present a higher mortality risk, especially for unnatural causes of death, including suicide. FINDINGS In a cohort of 15 847 women diagnosed with BPD a subsequent clinical diagnosis of ADHD did not influence the overall risk of mortality, including suicide. CONCLUSIONS Women with comorbid ADHD and BPD have a similar mortality risk as those only diagnosed with BPD.
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Affiliation(s)
| | - Bengt Gerdin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Emma Björkenstam
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Ekselius
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
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Jorgensen A, Baago IB, Rygner Z, Jorgensen MB, Andersen PK, Kessing LV, Poulsen HE. Association of Oxidative Stress-Induced Nucleic Acid Damage With Psychiatric Disorders in Adults: A Systematic Review and Meta-analysis. JAMA Psychiatry 2022; 79:920-931. [PMID: 35921094 PMCID: PMC9350850 DOI: 10.1001/jamapsychiatry.2022.2066] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Nucleic acid damage from oxidative stress (NA-OXS) may be a molecular mechanism driving the severely increased morbidity and mortality from somatic causes in adults with psychiatric disorders. OBJECTIVE To systematically retrieve and analyze data on NA-OXS across the psychiatric disorder diagnostic spectrum. DATA SOURCES The PubMed, Embase, and PsycINFO databases were searched from inception to November 16, 2021. A hand search of reference lists of relevant articles was also performed. STUDY SELECTION Key study inclusion criteria in this meta-analysis were as follows: adult human study population, measurement of any marker of DNA or RNA damage from oxidative stress, and either a (1) cross-sectional design comparing patients with psychiatric disorders (any diagnosis) with a control group or (2) prospective intervention. Two authors screened the studies, and 2 senior authors read the relevant articles in full and assessed them for eligibility. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Two authors performed data extraction independently, and a senior coauthor was consulted in cases of disagreement. Data were synthesized with random-effects and multilevel meta-analyses. MAIN OUTCOMES AND MEASURES The predefined hypothesis was that individuals with psychiatric disorders have increased NA-OXS levels. The main outcome was the standardized mean differences (SMDs) among patients and controls in nucleic acid oxidation markers compared across diagnostic groups. Analyses were divided into combinations of biological matrices and nucleic acids. RESULTS Eighty-two studies fulfilled the inclusion criteria, comprising 205 patient vs control group comparisons and a total of 10 151 patient and 10 532 control observations. Overall, the data showed that patients with psychiatric disorders had higher NA-OXS levels vs controls across matrices and molecules. Pooled effect sizes ranged from moderate for urinary DNA markers (SMD = 0.44 [95% CI, 0.20-0.68]; P < .001) to very large for blood cell DNA markers (SMD = 1.12 [95% CI, 0.69-1.55; P < .001). Higher NA-OXS levels were observed among patients with dementias followed by psychotic and bipolar disorders. Sensitivity analyses excluding low-quality studies did not materially alter the results. Intervention studies were few and too heterogenous for meaningful meta-analysis. CONCLUSIONS AND RELEVANCE The results of this meta-analysis suggest that there is an association with increased NA-OXS levels in individuals across the psychiatric disorder diagnostic spectrum. NA-OXS may play a role in the somatic morbidity and mortality observed among individuals with psychiatric disorders.
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Affiliation(s)
- Anders Jorgensen
- Psychiatric Center Copenhagen, Mental Health Services Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ida Bendixen Baago
- Psychiatric Center Copenhagen, Mental Health Services Copenhagen, Copenhagen, Denmark
| | - Zerlina Rygner
- Psychiatric Center Copenhagen, Mental Health Services Copenhagen, Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Hillerød, Denmark,Department of Endocrinology, Copenhagen University Hospital, Hillerød, Denmark
| | - Martin Balslev Jorgensen
- Psychiatric Center Copenhagen, Mental Health Services Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Mental Health Services Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Hillerød, Denmark,Department of Endocrinology, Copenhagen University Hospital, Hillerød, Denmark
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