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Skowroński B. The Development and Validation of the Antisocial Preferences Scale. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2366. [PMID: 36767732 PMCID: PMC9916389 DOI: 10.3390/ijerph20032366] [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: 12/16/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to create a new instrument measuring antisocial preferences based on the Theory of Social Derailment of Czesław Czapów, who indicated the role of antisocial preferences in predicting antisocial behavior. The measures used were the Antisocial Preferences Scale (APS), BPAQ, Mach-IV, and IVE questionnaires. The participants were 718 prisoners. CFA techniques were used to investigate the construct validity of the Antisocial Preferences Scale. Four alternative models of the APS were specified and tested, namely: one-factor, second-order, multi-factor, and bi-factor. CFA analyses revealed that the best-fitting model was the bifactor. This conceptualization contains seven subscales, namely: aggressiveness, lack of guilt or remorse, breaking legal norms, incapacity for mutually intimate relationships, impulsiveness, risk-taking, and egocentrism.
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Affiliation(s)
- Bartłomiej Skowroński
- Institute of Social Prevention and Resocialization, Faculty of Applied Social Sciences and Resocialization, University of Warsaw, ul. Podchorążych 20, 00-721 Warsaw, Poland
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Skowroński B. Introduction and validation of the Antisocial Beliefs Scale in a sample of Polish prisoners. Front Psychol 2022; 13:991687. [PMID: 36337561 PMCID: PMC9632426 DOI: 10.3389/fpsyg.2022.991687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/05/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose The goal of this study was to create and validate a brief self-report scale of antisocial beliefs. Methods The Antisocial Beliefs Scale (ABS), the Buss–Perry Aggression Questionnaire (BPAQ), the Mach-IV, the IVE Questionnaire were administrated to 718 prisoners. Dimensionality and construct validity of the ABS was investigated using CFA techniques, along with confirmatory bifactor analysis and second-order factor analysis. Four alternatives models of the ABS were specified and tested using Mplus (WLSMV estimation). A comparison sample of adult male non-offenders (n = 339) was also recruited. This sample completed only the ABS. Results The bi-factor model offered the best representation of the data. Results suggest that the ABS consists of eight subscales (physical aggression, lack of empathy, absence of prosocial standards, lack of guilt or remorse, incapacity for mutually intimate relationships, risk taking, egocentrism and manipulativeness). The ABS showed different levels of antisocial beliefs in offenders and non-offenders. The factors of ABS correlate significantly with external variables. The Antisocial Beliefs Scale demonstrated very good internal consistency. Conclusion The Antisocial Beliefs Scale can be used among participants with criminal history.
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Guillot-Valdés M, Guillén-Riquelme A, Buela-Casal G. Content Validity through Expert Judgment for the Depression Clinical Evaluation Test. Int J Clin Health Psychol 2022; 22:100292. [PMID: 35572073 PMCID: PMC9055062 DOI: 10.1016/j.ijchp.2022.100292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Background/Objective The evaluation of depression requires valid and reliable measuring instruments, which collect a wide spectrum of symptoms that this disorder displays, in order to carry out an accurate and differential diagnosis. The objective of this work is the construction of the Depression Clinical Evaluation Test (DCET), where affective, somatic, cognitive, behavioral and interpersonal symptoms are considered and also analyze its content validity through an expert judgment. Method Based on different diagnostic and manual classifications, a specification table for a depression test was established. In its evaluation, 16 experts in Psychological Assessment, Psychometry and/or Psychopathology participated. A total of 300 items were created. The experts had to assess the items according to the criteria of Content, Relevance, Clarity, Comprehension, Sensitivity, and Offensiveness. In addition, 50 adults, evaluated the compression of the items. Results The degree of understanding for all the items was high and the expert judgment favoured the suppression of 104 items, thus obtaining a shorter measuring instrument with a total of 196 items for ease of application. Conclusions The content validity of the test is adequate and fits the agreed definition of depression.
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Ho W, Kolla NJ. The endocannabinoid system in borderline personality disorder and antisocial personality disorder: A scoping review. BEHAVIORAL SCIENCES & THE LAW 2022; 40:331-350. [PMID: 35575169 DOI: 10.1002/bsl.2576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/06/2022] [Accepted: 03/31/2022] [Indexed: 06/15/2023]
Abstract
Individuals with borderline personality disorder (BPD) or antisocial personality disorder (ASPD) are overrepresented in forensic settings. Yet, despite the burden these disorders place on healthcare and criminal justice systems, there remains a lack of evidence-based pharmacological treatments. Epidemiological data have shown that comorbid cannabis use disorders are common in BPD and ASPD. ∆9 -Tetrahydrocannabinol, the primary psychoactive constituent of cannabis, is an exogenous cannabinoid that stimulates the endocannabinoid system (ECS). Hence, an investigation of the ECS in these conditions is warranted. This scoping review screened 105 records and summarized the extant research on the ECS in ASPD (n = 69) and BPD (n = 61) participants. Preliminary results suggest that alterations of the ECS may be present in these disorders. Although research examining the ECS in personality disorders is still in its infancy, more research is warranted given initial positive findings.
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Affiliation(s)
- Wilson Ho
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nathan J Kolla
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
- Waypoint/University of Toronto Research Chair in Forensic Mental Health Science, Penetanguishene, ON, Canada
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Ball Cooper E, Anderson JL, Sharp C, Langley HA, Venta A. Attachment, Mentalization, and Criterion B of the Alternative DSM-5 Model for Personality Disorders (AMPD). Borderline Personal Disord Emot Dysregul 2021; 8:23. [PMID: 34334129 PMCID: PMC8327423 DOI: 10.1186/s40479-021-00163-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mentalization theory posits that interpersonal difficulties and maladaptive personality traits develop from an insecure attachment pattern with one's caregiver and corresponding deficits in mentalizing-the ability to understand others' and one's own mental states. Mentalizing deficits have been theorized as the basis for all psychopathology, with the paradigmatic case being Borderline Personality Disorder. Nevertheless, developments in the personality field indicate personality pathology is best represented dimensionally, and such a proposal was outlined by the Alternative DSM-5 Model for Personality Disorders (AMPD). Despite evidence linking the mentalization theory to personality disorders, however, it has yet to be applied to Criterion B of the AMPD. The aim of the present study was to evaluate the moderating role of mentalizing in the relation between attachment and Criterion B maladaptive trait function in a sample of undergraduates. We hypothesized a model in which: (1) attachment insecurity would be positively associated with the Negative Affectivity, Antagonism, and Disinhibition personality domains; (2) mentalizing ability would be negatively associated with these domains; and, (3) there would be an interaction effect between attachment and mentalizing when predicting these same domains. METHODS Personality domains were measured dimensionally via the Personality Inventory for DSM-5 (PID-5-SF), while the dependence and avoidance domains of attachment were assessed via the Relationship Questionnaire (RQ). Mentalizing ability was tapped by the Movie for the Assessment of Social Cognition (MASC). The AMPD personality domains and trait facets were examined as dependent variables; attachment dependence, attachment avoidance, and overall mentalizing ability were entered as independent variables; and interaction terms between mentalizing and each attachment dimension were used to test moderation via MANCOVAs. RESULTS Consistent with expectations, results indicated overall mentalizing moderated the relation between attachment avoidance and Negative Affectivity. Posthoc analyses revealed similar effects on the relations between attachment avoidance and the Emotional Lability, Hostility, and Perseveration trait facets; however, there were no significant moderation findings related to attachment dependence. CONCLUSIONS These results support the mentalization theory's application to Criterion B of the AMPD, particularly in relation to the links between Negative Affectivity and borderline-related traits, and encourage future research of dimensional maladaptive personality. They further bolster support for understanding maladaptive personality as a dimensional construct.
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Affiliation(s)
- Ericka Ball Cooper
- Psychology Department, Sam Houston State University, Huntsville, TX, USA.,NextSTEPS Worldwide, PLLC, McKinney, TX, USA
| | - Jaime L Anderson
- Psychology Department, Sam Houston State University, Huntsville, TX, USA
| | - Carla Sharp
- Psychology Department, University of Houston, Houston, TX, USA
| | - Hillary A Langley
- Psychology Department, Sam Houston State University, Huntsville, TX, USA
| | - Amanda Venta
- Psychology Department, University of Houston, Houston, TX, USA.
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Parents' Personality-Disorder Symptoms Predict Children's Symptoms of Anxiety and Depressive Disorders - a Prospective Cohort Study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1931-1943. [PMID: 31197502 DOI: 10.1007/s10802-019-00568-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Personality disorder (PD) symptomatology is characterized by interpersonal problems and emotional dysregulation, which may affect offspring of parents with PD symptoms. Notably though, studies are needed to discern (i) whether parental PDs forecast symptoms of psychiatric disorders in offspring during their childhood years and (ii) whether such prospective relations obtain after accounting for common causes (e.g., genetics, common methods). To address these issues, we followed up a community sample of Norwegian children biennially from ages 4 to 8 (n = 594), using a semi-structured psychiatric interview (PAPA/CAPA) to capture DSM-IV defined symptoms of emotional disorders. Parental symptoms of personality disorders were captured by the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q), whereas depression and anxiety in caregivers were measured using the Beck Depression Inventory -II and Beck Anxiety Inventory, respectively. Upon applying a hybrid fixed and random effects method that takes into account all unmeasured time-invariant confounders, we found that: (i) Parental symptoms of DSM-IV defined Cluster A and C were related to symptoms of anxiety disorders in offspring two years later, even after accounting for children's initial levels of anxiety and parental anxiety, whereas (ii) Parental DSM-IV Cluster B predicted symptoms of depressive disorders in children, adjusted for children's initial levels of depression and parental depression. Clinical implications of the results are discussed.
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Ramos JM, Broco L, Sánchez A, Doll A. La Personalidad como Vulnerabilidad Unidimensional y Bidimensional: el Papel Mediador de las Variables Cognitivas en la Gravedad Sintomatológica en una Muestra de Personas con Trastorno Grave de Personalidad. CLINICA Y SALUD 2020. [DOI: 10.5093/clysa2019a18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
OBJECTIVE Dimensional personality trait models have gained favor as an alternative to categorical personality disorder (PD) diagnosis; however, debate persists regarding whether these traits should be conceptualized as maladaptive at both extremes (i.e., maladaptively bipolar) or just one trait pole (i.e., unipolar). METHOD To inform the debate on maladaptive bipolarity, linear and nonlinear relations between personality traits and dysfunction were examined in a large psychiatric patient sample (N = 365). Participants self-reported on normal-range and pathological personality domains, life satisfaction, specific interpersonal problems, and broad psychosocial functioning. In addition, participants were interviewed regarding specific psychiatric symptoms and broad psychosocial functioning. RESULTS All traits related moderately to strongly with at least one dysfunction variable. All traits were predominantly correlated with dysfunction at one pole; however, several small linear relations provided some evidence for maladaptively high Extraversion and Agreeableness. None of the significant nonlinear effects provided clear evidence for maladaptivity at both ends of any trait. CONCLUSIONS Taken together, these results suggest that broad personality traits are predominantly maladaptive at one extreme; however, in limited cases, the opposite extreme may also be maladaptive.
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Fowler JC, Patriquin MA, Madan A, Allen JG, Frueh BC, Oldham JM. Incremental validity of the PID-5 in relation to the five factor model and traditional polythetic personality criteria of the DSM-5. Int J Methods Psychiatr Res 2017; 26:e1526. [PMID: 27670287 PMCID: PMC6877239 DOI: 10.1002/mpr.1526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/12/2016] [Accepted: 08/05/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study assessed the incremental validity of the Personality Inventory for DSM-5 (PID-5) beyond the impact of demographic, burden of illness, five-factor model of personality, and DSM-5 personality disorder criteria with respect to associations with admission psychiatric symptoms and functional disability. METHODS Psychiatric inpatients (N = 927) were administered the Big Five Inventory, PID-5, and personality disorder criteria counts. Prior treatment utilization, as well as baseline depression, anxiety, emotion regulation, and functional disability were administered within two days of the personality measures. Hierarchical regression models were used to explore the association of personality functioning with symptom functioning, emotion regulation and disability. RESULTS Neuroticism was associated with all symptom measures, providing further support for its relevance in clinical populations. Personality trait domains (negative affect, detachment, and psychoticism) from the PID-5 demonstrated incremental validity in predicting baseline symptom and disability functioning over and above demographic, burden of illness, and psychiatric comorbidity and five-factor model (FFM) personality traits. CONCLUSIONS Dimensional measures of personality functioning were consistently associated with baseline symptom functioning, supporting the relevance of personality functioning as it relates to psychiatric symptoms. The PID-5 uniquely contributed to the prediction of baseline symptom functioning, thus providing incremental validity over gold-standard personality trait measures.
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Affiliation(s)
- J. Christopher Fowler
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
| | - Michelle A. Patriquin
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
| | - Alok Madan
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
| | - Jon G. Allen
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
| | - B. Christopher Frueh
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
- Department of PsychologyUniversity of HawaiiHiloHawaiiUSA
| | - John M. Oldham
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
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Allen JG, Fowler JC, Madan A, Ellis TE, Oldham JM, Frueh BC. Discovering the impact of psychotherapeutic hospital treatment for adults with serious mental illness. Bull Menninger Clin 2017; 81:1-38. [DOI: 10.1521/bumc.2017.81.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jon G. Allen
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | | | - Alok Madan
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Thomas E. Ellis
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - John M. Oldham
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
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Treatment outcomes for inpatients with obsessive-compulsive personality disorder: An open comparison trial. J Affect Disord 2017; 209:273-278. [PMID: 27988411 DOI: 10.1016/j.jad.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/22/2016] [Accepted: 12/04/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The current case-control study compared rates of clinically significant and reliable change in psychopathology and global functioning, prevalence of clinical deterioration, and rates of symptom remission among adult patients with obsessive compulsive personality disorder OCPD (n=52) and well-matched inpatients with any other personality disorder (n=56) and no personality disorder (n=53). METHODS Propensity score matching (PSM) was utilized to select patients matched on specific criteria present in the OCPD group. Multivariate analysis of variance models measured differences in admission functioning and RCI change across depression and anxiety severity, emotion dysregulation and suicidal ideation. RESULTS Patients diagnosed with OCPD admit to treatment with higher rates of depression, anxiety, difficulty with emotion regulation and non-acceptance of emotional experience than inpatient controls. Furthermore, OCPD patients respond to treatment at a similar rate to inpatient controls, but experience lower rates of anxiety remission upon discharge. Post-hoc analyses indicate individuals meeting stubbornness and rigidity (OCPD Criteria 8) were nine times more likely to report moderate to severe anxiety at point of discharge. LIMITATIONS Limitations include a predominantly Caucasian, inpatient sample, use of self-report measures and a non-manualized treatment approach. CONCLUSIONS Overall, OCPD inpatients benefit from an intensive multimodal psychiatric treatment, but experience more anxiety than non-PD patients upon discharge.
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Chiesa M, Cirasola A, Williams R, Nassisi V, Fonagy P. Categorical and dimensional approaches in the evaluation of the relationship between attachment and personality disorders: an empirical study. Attach Hum Dev 2016; 19:151-169. [PMID: 27899055 DOI: 10.1080/14616734.2016.1261915] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although several studies have highlighted the relationship between attachment states of mind and personality disorders, their findings have not been consistent, possibly due to the application of the traditional taxonomic classification model of attachment. A more recently developed dimensional classification of attachment representations, including more specific aspects of trauma-related representations, may have advantages. In this study, we compare specific associations and predictive power of the categorical attachment and dimensional models applied to 230 Adult Attachment Interview transcripts obtained from personality disordered and nonpsychiatric subjects. We also investigate the role that current levels of psychiatric distress may have in the prediction of PD. The results showed that both models predict the presence of PD, with the dimensional approach doing better in discriminating overall diagnosis of PD. However, both models are less helpful in discriminating specific PD diagnostic subtypes. Current psychiatric distress was found to be the most consistent predictor of PD capturing a large share of the variance and obscuring the role played by attachment variables. The results suggest that attachment parameters correlate with the presence of PD alone and have no specific associations with particular PD subtypes when current psychiatric distress is taken into account.
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Affiliation(s)
- Marco Chiesa
- a Research Department of Clinical, Educational and Health Psychology, University College London , London , UK.,b Research Department, Cassel Hospital , Richmond , UK
| | - Antonella Cirasola
- c Child Attachment and Psychological Therapies Research Unit, The Anna Freud Centre & University College London
| | - Riccardo Williams
- d Department of Dynamic and Clinical Psychology , "Sapienza" University of Rome , Rome , Italy
| | - Valentina Nassisi
- d Department of Dynamic and Clinical Psychology , "Sapienza" University of Rome , Rome , Italy
| | - Peter Fonagy
- a Research Department of Clinical, Educational and Health Psychology, University College London , London , UK
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Calvo N, Valero S, Sáez-Francàs N, Gutiérrez F, Casas M, Ferrer M. Borderline Personality Disorder and Personality Inventory for DSM-5 (PID-5): Dimensional personality assessment with DSM-5. Compr Psychiatry 2016; 70:105-11. [PMID: 27624429 DOI: 10.1016/j.comppsych.2016.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Borderline personality disorder (BPD) diagnosis has been considered highly controversial. The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) proposes an alternative hybrid diagnostic model for personality disorders (PD), and the Personality Inventory for DSM-5 (PID-5) has adequate psychometric properties and has been widely used for the assessment of the dimensional component. METHODS Our aim was to analyze the utility of the personality traits presented in Section III of the DSM-5 for BPD diagnosis in an outpatient clinical sample, using the Spanish version of the PID-5. Two clinical samples were studied: BPD sample (n=84) and non-BPD sample (n=45). Between-sample differences in PID-5 scores were analyzed. RESULTS The BPD sample obtained significantly higher scores in most PID-5 trait facets and domains. Specifically and after regression logistic analyses, in BPD patients, the domains of Negative Affectivity and Disinhibition, and the trait facets of emotional lability, [lack of] restricted affectivity, and impulsivity were more significantly associated with BPD. CONCLUSIONS Although our findings are only partially consistent with the algorithm proposed by DSM-5, we consider that the combination of the PID-5 trait domains and facets could be useful for BPD dimensional diagnosis, and could further our understanding of BPD diagnosis complexity.
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Affiliation(s)
- Natalia Calvo
- Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Sergi Valero
- Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Naia Sáez-Francàs
- Psychiatry Department, Sant Rafael Hospital, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Miguel Casas
- Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Ferrer
- Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain
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