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Kim S, Hong S, Park DH, Ryu SH, Ha JH, Jeon HJ. Temperament Clusters in Patients With Panic Disorder in Relation to Character Maturity. Psychiatry Investig 2024; 21:174-180. [PMID: 38433416 PMCID: PMC10910162 DOI: 10.30773/pi.2023.0142] [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] [Received: 05/04/2023] [Accepted: 11/28/2023] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE This study explored whether temperament profiles are associated with psychological functioning and whether character maturity affects this association in patients with panic disorders (PD). METHODS A total of 270 patients with PD were enrolled in this study. Measurements included the Temperament and Character Inventory-revised-short (TCI-RS), a self-report version of the Panic Disorder Severity Scale (PDSS-SR), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Cluster analysis was used to define the patients' temperament profiles, and the differences in discrete variables among temperament clusters were calculated using a one-way analysis of variance. An analysis of covariance was conducted to control for the impact of character maturity on psychological functioning among clusters. RESULTS We identified four temperament clusters of patients with PD. Significant differences in the PDSS-SR, BDI-II, STAI-state, and STAI-trait scores among the four clusters were detected [F(3, 262)=9.16, p<0.001; F(3, 266)=33.78, p<0.001; F(3, 266)=19.12, p<0.001; F(3, 266)=39.46, p<0.001]. However, after controlling for the effect of character maturity, the effect of cluster type was either eliminated or reduced ([STAI-state] cluster type: F(3, 262)=0.94, p>0.05; SD+CO: F(1, 262)=65.95, p<0.001, ηp2 =0.20). CONCLUSION This study enabled a more comprehensive and integrated understanding of patients by exploring the configuration of all temperament dimensions together rather than each temperament separately. Furthermore, we revealed that depending on the degree of character maturity, the psychological functioning might differ even within the same temperament cluster. These results imply that character maturity can complement inherently vulnerable temperament expression.
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Affiliation(s)
- Seolmin Kim
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Psychology, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Sumin Hong
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Doo-Heum Park
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Jee Hyun Ha
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
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Nelson J, Kelly JM, Wadsworth L, Maloney E. Co-occurring OCD and Panic Disorder: A Review of Their Etiology and Treatment. J Cogn Psychother 2022; 36:JCP-2021-0009.R2. [PMID: 35470149 DOI: 10.1891/jcp-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Estimated rates of co-occurrence between obsessive and compulsive disorder (OCD) and panic disorder (PD) are notable, but vary considerably, with rates from epidemiological and clinical studies ranging from 1.8% to 22% (Rector et al., 2017). We reviewed the current empirical literature on the etiology, treatment, diagnostic assessment, and differential diagnosis of co-occurring OCD/PD. Best practices for cognitive-behavioral treatment, including identifying and addressing treatment barriers are also addressed. Although it is acknowledged in current literature that co-occurring OCD and PD levels may be clinically significant, there remains a need to thoroughly examine the possible consequences and future research directions of this overlap. Future research must continue to elucidate the biological and environmental causes of OCD/PD co-occurrence.
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Saini B, Bansal PD, Bahetra M, Sharma A, Bansal P, Singh B, Moria K, Kumar R. Relationship Pattern of Personality Disorder Traits in Major Psychiatric Disorders: A Cross-Sectional Study. Indian J Psychol Med 2021; 43:516-524. [PMID: 35210680 PMCID: PMC8826195 DOI: 10.1177/0253717621999537] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Normal personality development, gone awry due to genetic or environmental factors, results in personality disorders (PD). These often coexist with other psychiatric disorders, affecting their outcome adversely. Considering the heterogeneity of data, more research is warranted. METHODS This was a cross-sectional study on personality traits in psychiatric patients of a tertiary hospital, over 1 year. Five hundred and twenty-five subjects, aged 18-45 years, with substance, psychotic, mood, or neurotic disorders were selected by convenience sampling. They were evaluated for illness-related variables using psychiatric pro forma; diagnostic confirmation and severity assessment were done using ICD-10 criteria and suitable scales. Personality assessment was done using the International Personality Disorder Examination after achieving remission. RESULTS Prevalence of PD traits and PDs was 56.3% and 4.2%, respectively. While mood disorders were the diagnostic group with the highest prevalence of PD traits, it was neurotic disorders for PDs. Patients with PD traits had a past psychiatric history and upper middle socioeconomic status (SES); patients with PDs were urban and unmarried. Both had a lower age of onset of psychiatric illness. Psychotic patients with PD traits had higher and lower PANSS positive and negative scores, respectively. The severity of personality pathology was highest for mixed cluster and among neurotic patients. Clusterwise prevalence was cluster C > B > mixed > A (47.1%, 25.2%, 16.7%, and 11.4%). Among subtypes, anankastic (18.1%) and mixed (16.7%) had the highest prevalence. Those in the cluster A group were the least educated and with lower SES than others. CONCLUSIONS PD traits were present among 56.3% of the patients, and they had many significant sociodemographic and illness-related differences from those without PD traits. Cluster C had the highest prevalence. Among patients with psychotic disorders, those with PD traits had higher severity of psychotic symptoms.
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Affiliation(s)
- Bhavneesh Saini
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Pir Dutt Bansal
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Mamta Bahetra
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Arvind Sharma
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Priyanka Bansal
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Baltej Singh
- Dept. of Community Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Kavita Moria
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Rakesh Kumar
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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Fidry M, Zugliani MM, do Valle CR, Martins RM, Cabo MCD, Nardi AE, Freire RC. Quality of life in panic disorder: the influence of clinical features and personality traits. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2020; 41:387-393. [PMID: 31967197 DOI: 10.1590/2237-6089-2019-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 04/02/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To identify which clinical features and personality traits are associated with quality of life (QoL) in panic disorder (PD) patients. METHODS This was a cross-sectional study with PD patients. The brief version of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and the Big Five Inventory (BFI) were used to assess QoL and personality traits respectively. The strength of correlations was measured with Pearson's, Spearman's, and point-biserial correlation coefficients. We also performed multiple linear regressions, considering sociodemographic data and scores from clinical scales as independent variables and QoL scores as dependent variables. RESULTS A total of 98 patients were evaluated. Depressive symptoms had a strong negative correlation with QoL and, to a lesser extent, panic and anxiety symptoms were also negatively correlated with QoL. While consciousness, extraversion, and agreeableness had mild positive correlations with QoL, neuroticism had a strong negative correlation. CONCLUSION Symptoms of depression, anxiety, and panic seem to have a negative impact on the QoL of PD patients. Personality traits, especially neuroticism, may also influence QoL in these patients.
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Affiliation(s)
- Marcos Fidry
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Morena Mourao Zugliani
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Clarissa Reis do Valle
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Renan Machado Martins
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mariana Costa do Cabo
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Antonio Egidio Nardi
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Rafael Christophe Freire
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Maccaferri GE, Dunker-Scheuner D, De Roten Y, Despland JN, Sachse R, Kramer U. Psychotherapy of Dependent Personality Disorder: The Relationship of Patient-Therapist Interactions to Outcome. Psychiatry 2020; 83:179-194. [PMID: 31614097 DOI: 10.1080/00332747.2019.1675376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
So far, only a few studies have focused on psychotherapy for Dependent Personality Disorder (DPD). DPD is marked by a repetitive pattern of efforts aiming at maintaining close relationships, which may present as a lack of assertiveness and as a difficulty in making routine decisions. The present study aims at exploring processes of change taking place during the working phase of a clarification-oriented psychotherapy (COP) by focusing on the in-session patient-therapist interaction, as it changes during treatment and their links with treatment outcome. Methods: N = 74 patients with DPD were recruited in a naturalistic setting; they underwent long-term COP. Sessions 15, 20 and 25 were video- or audio-recorded and analyzed using the Process-Content-Relationship Scale, an observer-rated instrument that measures the quality of the interaction processes from patient's and therapist's perspectives. Therapy outcomes were assessed with the Personality Inventory - Dependency Subscale, Beck Depression Inventory, Inventory of Interpersonal Problems and Self-efficacy Scale at intake and discharge of therapy. Three-level Hierarchical Linear Modeling was applied to test the hypotheses. Results: Improvement in interaction processes was observed in all patient's and therapist's variables over the sessions 15, 20, 25. Overall, this increase in quality of interaction process was unrelated with outcome, but decrease in dependency traits was predicted by increase in therapist's quality of relationship offer, understanding of content and directivity over the course of the working phase of COP. Conclusions: Studying interaction processes in DPD provides an initial understanding of differential roles of potential mechanisms of change in effective treatment.
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Dogan B, Yoldas C, Kocabas O, Memis CO, Sevincok D, Sevincok L. The characteristics of the comorbidity between social anxiety and separation anxiety disorders in adult patients. Nord J Psychiatry 2019; 73:380-386. [PMID: 31322453 DOI: 10.1080/08039488.2019.1642381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n = 31) and without childhood and adulthood separation anxiety disorder (SeAD) (n = 50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables. Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation. Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD. Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.
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Affiliation(s)
- Bilge Dogan
- a Medical School, Department of Psychiatry, Adnan Menderes University , Aydin , Turkey
| | - Caner Yoldas
- b Medical School, Department of psychiatry, Ahi Evran University , Kirsehir , Turkey
| | - Oktay Kocabas
- c Department of Psychiatry, Turhal State Hospital , Tokat , Turkey
| | - Cagdas Oyku Memis
- a Medical School, Department of Psychiatry, Adnan Menderes University , Aydin , Turkey
| | - Doga Sevincok
- d Medical School, Department of Child and Adolescence Psychiatry, Adnan Menderes University , Aydin , Turkey
| | - Levent Sevincok
- a Medical School, Department of Psychiatry, Adnan Menderes University , Aydin , Turkey
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Bruno A, Muscatello MRA, Pandolfo G, Ciura GL, Quattrone D, Scimeca G, Mento C, Zoccali RA. Does Personality Matter? Temperament and Character Dimensions in Panic Subtypes. ACTA ACUST UNITED AC 2018; 55:325-329. [PMID: 30622388 DOI: 10.5152/npa.2017.20576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 07/09/2017] [Indexed: 11/22/2022]
Abstract
Introduction Symptomatic heterogeneity in the clinical presentation of Panic Disorder (PD) has lead to several attempts to identify PD subtypes; however, no studies investigated the association between temperament and character dimensions and PD subtypes. The study was aimed to verify whether personality traits were differentially related to distinct symptom dimensions. Methods Seventy-four patients with PD were assessed by the Mini-International Neuropsychiatric Interview (M.I.N.I.), and the Temperament and Character Inventory (T.C.I.). Thirteen panic symptoms from the M.I.N.I. were included in a factor analysis with varimax rotation. A correlation analysis (Pearson's correlation), a linear regression analysis, and a forward stepwise regression analysis between the identified factors and T.C.I. variables were performed for evaluating the association between panic subtypes and personality features. Results Three factors were obtained: "Somato-dissociative", "Respiratory", and "Cardiologic" explaining respectively 18.31%, 13.71%, and 12.78% of the total variance. Correlations analyses showed that only "Somato-dissociative" factor was significantly correlated with T.C.I. "Self-directedness" (p<0.0001) and "Cooperativeness" (p=0.009) variables. Results from the regression analysis indicate that the predictor models account for 33.3% and 24.7% of the total variance respectively in "Somatic-dissociative" (p<0.0001) and "Cardiologic" (p=0.007) factors, while they do not show statistically significant effects on "Respiratory" factor (p=0.222). After performing stepwise regression analysis, "Self-directedness" resulted the unique predictor of "Somato-dissociative" factor (R²=0.186; β=-0.432; t=-4.061; p<0.0001). Conclusion Current results, although preliminary, suggest the importance of assessing personality and temperament features that may be potentially related to poor treatment response for a better understanding and characterization of PD subtypes.
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Affiliation(s)
- Antonio Bruno
- Department of Psychiatry, University of Messina, Messina, Italy
| | | | | | - Giulia La Ciura
- Department of Psychiatry, University of Messina, Messina, Italy
| | - Diego Quattrone
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | | | - Carmela Mento
- Department of Psychiatry, University of Messina, Messina, Italy
| | - Rocco A Zoccali
- Department of Psychiatry, University of Messina, Messina, Italy
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Abstract
Panic disorder (PD) is often correlated with high neuroticism and low extraversion. This study aims to ascertain whether PD patients differ from healthy controls in regard to personality traits and determine if these traits are correlated with comorbid disorders, anxiety, and depression symptoms. Personality traits of 69 PD patients and 42 controls were compared using the Maudsley Personality Inventory. In PD patients, comorbidities, anxiety, and depression symptoms were also evaluated. PD patients showed higher neuroticism and lower extraversion compared with healthy controls. Patients without comorbidities presented similar results to controls, whereas those with comorbidities presented higher neuroticism and lower extraversion scores. PD per se may be unrelated to deviant personality traits, although comorbidities with major depressive disorder and agoraphobia are probably associated with high neuroticism and low extraversion. These traits show a strong correlation with the accumulation and severity of these disorders.
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Guimarães ATB, de Oliveira Ferreira R, de Souza JM, da Silva WAM, da Silva AR, de LimaRodrigues AS, de Melo E Silva D, Costa RME, da Silva Castro AL, Malafaia G. Anxiety and memory deficits induced by tannery effluent in C57BL/6J female mice. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:25323-25334. [PMID: 27696163 DOI: 10.1007/s11356-016-7746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/18/2016] [Indexed: 06/06/2023]
Abstract
This study aimed to evaluate the behavior of female C57Bl/6J mice exposed to tannery effluents diluted in drinking water. Female mice were divided into a control group, in which the animals received only drinking water, and experimental groups, which received raw tannery effluent in 7.5 and 15 % concentrations diluted in water (period of 60 days). In the last experimental week, the mice (in diestrus phase) were subjected to different behavioral tests: elevated plus-maze, open-field test, forced swim test, and object recognition test. Our data demonstrated that exposure to tannery effluent increased the anxiety index of animals and decreased the locomotion ratio in the central quadrants/total, indicating an increase in anxiety-like behavior. Regarding the forced swim test, we did not observe changes in the evaluated behaviors. There were no statistically significant differences in the recognition index of the novel and familiar object in the groups exposed to tannery effluent compared with the control group, indicating a possible influence of the constituents of tannery effluent on cognition. Thus, our findings support the hypothesis that effluents, containing neurotoxic substances, could cause behavioral disruptions in female C57Bl/6J mice.
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Affiliation(s)
| | | | - Joyce Moreira de Souza
- Laboratório de Pesquisas Biológicas, Instituto Federal Goiano, Câmpus Urutaí, Urutaí, GO, Brazil
| | | | - Anderson Rodrigo da Silva
- Laboratório de Estatística Experimental, Instituto Federal Goiano, Câmpus Urutaí, Urutaí, GO, Brazil
| | - Aline Sueli de LimaRodrigues
- Departamento de Ciências Biológicas, Laboratório de Pesquisas Biológicas, Instituto Federal Goiano, Câmpus Urutaí, Urutaí, GO, Brazil
| | - Daniela de Melo E Silva
- Departamento de Biologia Geral and Programa de Pós-Graduação em Biodiversidade Animal, Universidade Federal de Goiás, Câmpus Samambaia, Goiânia, Brazil
| | - Renata Mazaro E Costa
- Departamento de Farmacologia and Programa de Pós-Graduação em Biodiversidade Universidade Federal de Goiás, Câmpus Samambaia, Goiânia, Brazil
| | - André Luis da Silva Castro
- Departamento de Ciências Biológicas. Laboratório de Zoologia, Instituto Federal Goiano, Câmpus Urutaí, Urutaí, GO, Brazil
| | - Guilherme Malafaia
- Departamento de Ciências Biológicas, Laboratório de Pesquisas Biológicas, Instituto Federal Goiano, Câmpus Urutaí, Urutaí, GO, Brazil.
- Programa de Pós-Graduação em Biodiversidade Animal, Universidade Federal de Goiás-Câmpus Samambaia, Goiânia, Brazil.
- Rodovia Geraldo Silva Nascimento, 2,5 km, Zona Rural, Urutaí, GO, CEP: 75790-000, Brazil.
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Mroczkowski MM, Goes FS, Riddle MA, Grados MA, Bienvenu OJ, Greenberg BD, Fyer AJ, McCracken JT, Rauch SL, Murphy DL, Knowles JA, Piacentini J, Cullen B, Rasmussen SA, Pauls DL, Nestadt G, Samuels J. Dependent personality, separation anxiety disorder and other anxiety disorders in OCD. Personal Ment Health 2016; 10:22-8. [PMID: 26542617 DOI: 10.1002/pmh.1321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/26/2015] [Accepted: 09/30/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The purpose of this study was to investigate whether dependent personality and/or general personality dimensions might explain the strong relationships between separation anxiety disorder (Sep-AD) and three other anxiety disorders (agoraphobia, panic disorder and social anxiety disorder) in individuals with obsessive compulsive disorder (OCD). METHODS Using data from 509 adult participants collected during the OCD Collaborative Genetic Study, we used logistic regression models to evaluate the relationships between Sep-AD, dependent personality score, general personality dimensions and three additional anxiety disorders. RESULTS The dependent personality score was strongly associated with Sep-AD and the other anxiety disorders in models adjusted for age at interview, age at onset of OC symptoms and worst ever OCD severity score. Several general personality dimensions, especially neuroticism, extraversion and conscientiousness, were also related to Sep-AD and the other anxiety disorders. Sep-AD was not independently related to these anxiety disorders, in multivariate models including general personality and dependent personality disorder scores. CONCLUSIONS The results suggest that Sep-AD in childhood and these other anxiety disorders in adulthood are consequences of dependent personality disorder (for agoraphobia and panic disorder) or introversion (for social phobia). It is unknown whether these results would be similar in a non-OCD sample.
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Affiliation(s)
- M M Mroczkowski
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - F S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M A Riddle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M A Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O J Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B D Greenberg
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - A J Fyer
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY, USA
| | - J T McCracken
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - S L Rauch
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - D L Murphy
- Laboratory of Clinical Science, NIMH, NIH, Bethesda, MD, USA
| | - J A Knowles
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J Piacentini
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - B Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S A Rasmussen
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - D L Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - G Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Samuels
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Finkler DC, Wesner AC, Heldt E. Temperamento e Caráter na Resposta à Terapia Cognitivo-Comportamental para Transtorno de Pânico. PSICOLOGIA: TEORIA E PESQUISA 2016. [DOI: 10.1590/0102-3772e322217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O estudo investigou o impacto das características de temperamento e caráter na resposta à terapia cognitivo-comportamental (TCC) para pacientes com transtorno de pânico (TP). Um total de 55 pacientes realizou 12 sessões de TCC em grupo (TCCG). A gravidade dos sintomas foi verificada antes e após a intervenção, e o Inventário de Temperamento e Caráter de Cloninger foi aplicado no início do tratamento. Observou-se uma redução significativa na gravidade do TP após a intervenção. Análises de regressão indicaram que as características de temperamento (persistência) e caráter (autodirecionamento e cooperatividade) não se mostraram significativamente relacionadas à melhora da agorafobia e de sintomas depressivos, permanecendo a gravidade inicial desses sintomas como fatores independentes de resposta à TCCG.
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Güler Ö, Kaya V, Gezginç K, Kayhan F, Çiçek E, Sönmez Ö, Uğuz F. Pregnancy-Onset Panic Disorder: Incidence, Comorbidity and Associated Factors. Noro Psikiyatr Ars 2015; 52:216-220. [PMID: 28360713 DOI: 10.5152/npa.2015.7565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/31/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The present study aimed to investigate the incidence rate of pregnancy-onset panic disorder (POPD) among Turkish pregnant women using a diagnostic interview. Additionally, we examined whether the independent socio-demographic or clinical risk factors were associated with the risk of panic disorder in these women. METHODS The study sample comprised 1475 consecutive pregnant women who presented to the obstetric outpatient clinics of two research centers. The rate of POPD in these participants was 1.3% (Group 1, n=20). The 20 women with POPD were compared with 250 pregnant women without pregnancy-onset depression or anxiety (Group 2; controls). Panic disorder and other anxiety or mood disorders were determined by means of the Structured Clinical Interview for DSM-IV. Comorbid Axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders. RESULTS The incidence rate of panic disorder was 1.3% (n=20). In group 1, 55% (n=11) of the women with POPD had an additional mood or anxiety disorder. In addition, the prevalence rate of any cluster C personality disorder, including avoidant, passive-aggressive and obsessive-compulsive personality disorders, were significantly greater in the group 1 women with POPD than the control pregnant women without a panic disorder (group 2). CONCLUSION The women with POPD were more likely than the controls to have a cluster C Axis II disorder and a history of a pre-existing anxiety or mood disorder.
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Affiliation(s)
- Özkan Güler
- Department of Psychiatry, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Veli Kaya
- Department of Psychiatry, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Kazım Gezginç
- Department of Obstetrics and Gynaecology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Fatih Kayhan
- Department of Psychiatry, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Erdinç Çiçek
- Department of Psychiatry, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Önder Sönmez
- Department of Psychiatry, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Faruk Uğuz
- Department of Psychiatry, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
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Hengartner MP. The Detrimental Impact of Maladaptive Personality on Public Mental Health: A Challenge for Psychiatric Practice. Front Psychiatry 2015; 6:87. [PMID: 26106335 PMCID: PMC4460874 DOI: 10.3389/fpsyt.2015.00087] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/27/2015] [Indexed: 11/16/2022] Open
Abstract
Experts in personality psychology and personality disorders have long emphasized the pervasive and persistent detrimental impact of maladaptive personality traits on mental health and functioning. However, in routine psychiatric practice, maladaptive personality is readily ignored and personality traits are seldom incorporated into clinical guidelines. The aim of this narrative review is to outline how pervasively personality influences public mental health and how personality thereby challenges common psychiatric practice. A comprehensive search and synthesis of the scientific literature demonstrates that maladaptive personality traits and personality disorders, in particular high neuroticism and negative affectivity, first, are risk factors for divorce, unemployment, and disability pensioning; second, relate to the prevalence, incidence, and co-occurrence of common mental disorders; third, impair functioning, symptom remission, and recovery in co-occurring common mental disorders; and fourth, predispose to treatment resistance, non-response and poor treatment outcome. In conclusion, maladaptive personality is not only involved in the development and course of mental disorders but also predisposes to chronicity and re-occurrence of psychopathology and reduces the efficacy of psychiatric treatments. The pernicious impact of maladaptive personality on mental health and functioning demands that careful assessment and thorough consideration of personality should be compulsory in psychiatric practice.
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Affiliation(s)
- Michael Pascal Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW) , Zurich , Switzerland
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15
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Bornstein RF. Toward a multidimensional model of personality disorder diagnosis: implications for DSM-5. J Pers Assess 2012; 93:362-9. [PMID: 22804675 DOI: 10.1080/00223891.2011.577474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article outlines a model of personality disorder (PD) diagnosis that combines clinically useful constructs from the Diagnostic and Statistical Manual of Mental Disorders (DSM) with assessment procedures that maximize reliability and clinical utility while minimizing problems associated with threshold-based PD classification. I begin by addressing limitations in the current DSM conceptualization of PDs: excessive comorbidity, use of arbitrary cutoffs to distinguish normal from pathological functioning, failure to capture variations in the adaptive value of PD symptoms, and inattention to situational influences that shape PD-related behaviors. The revisions proposed by the DSM-5 Personality and Personality Disorders Work Group help resolve some of these issues, but create new problems in other areas. A better solution would be to employ a multidimensional model of PD diagnosis in which clinicians (a) assign a single dimensional rating of overall level of personality dysfunction, (b) provide separate intensity and impairment ratings for each PD dimension, and (c) list those personality traits-including PD-related traits-that enhance adaptation and functioning. Preliminary evidence bearing on the multidimensional model is reviewed, and broader clinical and empirical implications of the model are discussed.
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Affiliation(s)
- Robert F Bornstein
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA.
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16
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Bamelis LLM, Evers SMAA, Arntz A. Design of a multicentered randomized controlled trial on the clinical and cost effectiveness of schema therapy for personality disorders. BMC Public Health 2012; 12:75. [PMID: 22272740 PMCID: PMC3305366 DOI: 10.1186/1471-2458-12-75] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 01/24/2012] [Indexed: 11/10/2022] Open
Abstract
Background Despite international guidelines describing psychotherapy as first choice for people with personality disorders (PDs), well-designed research on the effectiveness and cost-effectiveness of psychotherapy for PD is scarce. Schema therapy (ST) is a specific form of psychological treatment that proved to be effective for borderline PD. Randomized controlled studies on the effectiveness of ST for other PDs are lacking. Another not yet tested new specialized treatment is Clarification Oriented Psychotherapy (COP). The aim of this project is to perform an effectiveness study as well as an economic evaluation study (cost effectiveness as well as cost-utility) comparing ST versus COP versus treatment as usual (TAU). In this study, we focus on avoidant, dependent, obsessive-compulsive, paranoid, histrionic and narcissistic PD. Methods/Design In a multicentered randomized controlled trial, ST, and COP as an extra experimental condition, are compared to TAU. Minimal 300 patients are recruited in 12 mental health institutes throughout the Netherlands, and receive an extensive screening prior to enrolment in the study. When eligible, they are randomly assigned to one of the intervention groups. An economic evaluation and a qualitative research study on patient and therapist perspectives on ST are embedded in this trial. Outcome assessments (both for clinical effectiveness and economic evaluation) take place at 6,12,18,24 and 36 months after start of treatment. Primary outcome is recovery from PD; secondary measures include general psychopathological complaints, social functioning and quality of life. Data for the cost-effectiveness and cost-utility analyses are collected by using a retrospective cost interview. Information on patient and therapist perspectives is gathered using in-depth interviews and focus groups, and focuses on possible helpful and impeding aspects of ST. Discussion This trial is the first to compare ST and COP head-to-head with TAU for people with a cluster C, paranoid, histrionic and/or narcissistic PD. By combining clinical effectiveness data with an economic evaluation and with direct information from primary stakeholders, this trial offers a complete and thorough view on ST as a contribution to the improvement of treatment for this PD patient group. Trial registration Netherlands Trial Register (NTR): NTR566
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Affiliation(s)
- Lotte L M Bamelis
- Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, Maastricht, The Netherlands.
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Blom RM, Samuels JF, Riddle MA, Bienvenu OJ, Grados MA, Reti IM, Eaton WW, Liang KY, Nestadt G. Association between a serotonin transporter promoter polymorphism (5HTTLPR) and personality disorder traits in a community sample. J Psychiatr Res 2011; 45:1153-9. [PMID: 21450307 PMCID: PMC3128677 DOI: 10.1016/j.jpsychires.2011.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 02/21/2011] [Accepted: 03/03/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND The serotonin transporter (SERT) polymorphism (5HTTLPR) has been reported to be associated with several psychiatric conditions. Specific personality disorders could be intermediate factors in the known relationship between 5HTTLPR and psychiatric disorders. This is the first study to test the association between this polymorphism and dimensions of all DSM-IV personality disorders in a community sample. METHODS 374 white participants were assessed by clinical psychologists using the International Personality Disorder Examination (IPDE). Associations between dimensions of each DSM-IV personality disorder and the long (l) and short (s) alleles of the 5HTTLPR were evaluated using non-parametric tests and regression models. RESULTS The s allele of the 5HTTLPR polymorphism was significantly associated with higher avoidant personality trait scores in the whole sample. Males with the s allele had a significantly lower likelihood of higher obsessive-compulsive personality disorder (OCPD) trait scores, whereas females with the s allele were likely to have higher OCPD personality trait scores. CONCLUSION This paper provides preliminary data on the relationship between personality disorders and the 5HTTLPR polymorphism. The relationship of the s allele and avoidant PD is consistent with findings of a nonspecific relationship of this polymorphism to anxiety and depressive disorders. Concerning the unusual sexual dimorphic result with OCPD, several hypotheses are presented. These findings need further replication, including a more detailed study of additional variants in SERT.
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Affiliation(s)
- Rianne M. Blom
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jack F. Samuels
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark A. Riddle
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O. Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marco A. Grados
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irving M. Reti
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William W. Eaton
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kung-Yee Liang
- Department of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taiwan
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA,Corresponding author: Gerald Nestadt, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 113, Baltimore, MD 21287, USA, Phone: 410-614-4942 Fax: 410-614-8137,
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Abstract
Community studies conducted over the past decade have greatly increased our knowledge of the epidemiology of personality disorders. Here, we review the prevalence, distribution, and consequences of personality disorders, and potential risk factors for their development. An estimated 6-10% of individuals in the community have a personality disorder. The prevalence of personality disorders varies across sociodemographic groups, being higher, for example, in those who are separated or divorced and those who have dropped out of high school. Personality disorders are strongly associated with Axis I disorders in the community, including mood disorders, anxiety disorders, and alcohol and other substance use disorders, as well as with functional impairment. Personality disorders also are associated with medical service use and medical morbidity and mortality, especially related to cardiovascular disease. Individuals in the community with personality disorders are more likely to have a history of criminal arrest, interpersonal violence, and suicidal behaviours. Childhood adversities, especially abuse and neglect, are potential risk factors for the development of personality disorders. Additional prospective studies are needed to elucidate potential precursors and consequences of personality disorders. Furthermore, primary and secondary prevention strategies are needed to reduce the individual and societal burdens from personality disorders in the community.
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Affiliation(s)
- Jack Samuels
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Abstract
BACKGROUND Psychiatric conditions in which symptoms arise involuntarily ('diseases') might be assumed to be more heritable than those in which choices are essential (behavioral disorders). We sought to determine whether psychiatric 'diseases' (Alzheimer's disease, schizophrenia, and mood and anxiety disorders) are more heritable than behavioral disorders (substance use disorders and anorexia nervosa). METHOD We reviewed the literature for recent quantitative summaries of heritabilities. When these were unavailable, we calculated weighted mean heritabilities from twin studies meeting modern methological standards. RESULTS Heritability summary estimates were as follows: bipolar disorder (85%), schizophrenia (81%), Alzheimer's disease (75%), cocaine use disorder (72%), anorexia nervosa (60%), alcohol dependence (56%), sedative use disorder (51%), cannabis use disorder (48%), panic disorder (43%), stimulant use disorder (40%), major depressive disorder (37%), and generalized anxiety disorder (28%). CONCLUSIONS No systematic relationship exists between the disease-like character of a psychiatric disorder and its heritability; many behavioral disorders seem to be more heritable than conditions commonly construed as diseases. These results suggest an error in 'common-sense' assumptions about the etiology of psychiatric disorders. That is, among psychiatric disorders, there is no close relationship between the strength of genetic influences and the etiologic importance of volitional processes.
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Affiliation(s)
- O J Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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