The burden of personality disorders on the DSM 5 addiction to tobacco during pregnancy

Self-injurious thoughts and behaviors in Russian patients with epilepsy: A prospective observational study

OBJECTIVE

A two-stage study aimed to estimate the prevalence of different types of self-injurious behaviors (suicidal ideation (SI), suicide attempts (SA), and nonsuicidal self-injury (NSSI)) in Russian patients with epilepsy (PWE), to identify factors associated with such behaviors, and to assess their impact on 3-year mortality.

METHODS

We enrolled 459 consecutive adult PWE from two level 2 outpatient epilepsy centers in Moscow. The study consisted of two phases - first, we assessed all demographic and clinical characteristics and patients' history of SI, SA, and NSSI. In the second phase, three years after the initial screening, we analyzed patients' medical records to assess how self-injurious thoughts and behaviors were related to actual mortality.

RESULTS

In our sample, the total lifetime and 12-month prevalence of SI was 20% and 5.7%, of SA was 8.3% and 0.7%, and of NSSI was 15.3% and 2.8%, respectively. We found no differences between deceased and alive PWE regarding lifetime and 12-month prevalence of SI, SA, and NSSI. Higher seizure frequency, lifetime NSSI and lifetime diagnosis of mental disorder were associated with SI, whereas traumatic brain injury (TBI), substance abuse, and NSSI were associated with SA in PWE.

SIGNIFICANCE

Our study adds to the existing data on the prevalence of different types of suicidal behaviors in PWE and advances research on NSSI in this population. However, more research is needed on the long-term consequences of different types of self-injurious behaviors.

Cannabis and Pregnancy: A Psychiatric, Medical, or General Population Issue?

BACKGROUND

Cannabis use during pregnancy may adversely affect the health of pregnant women and their fetus. Several recent surveys led in the US general population in the last decade showed an increase in cannabis use during pregnancy from 1.95 to 7%, with a 0.5% for medical-only purposes.

OBJECTIVES

Our aim was to investigate if an increased incidence might be due to a greater public acceptability after introduction of cannabis medical use or due to psychiatric implications and unmet needs.

METHOD

500 pregnant women (302 psychiatric patients and 198 healthy controls) were tested with the Edimburgh Post-Natal Depression Scale, Beck Anxiety and Depression Inventory, and Structured Clinical Interview for the DSM-IV Axis II while substance use disorder was documented with the fulfillment of the DSM-5 criteria.

RESULTS

Five percent of the whole sample had a documented addiction to cannabis during pregnancy (all among psychiatric patients and none in the general population). All psychiatric patients with cannabis use disorder were affected by borderline personality disorder, except for 1 patient with cannabis and cocaine use disorders who suffered from adjustment disorder with anxiety.

CONCLUSIONS

Addiction to cannabis during pregnancy has an increased rate confirming surveys on the general US population but seem entirely linked to psychiatric issues, especially borderline personality disorder. Personality disorders may have been underestimated in surveys in the general population until now because these are usually not assessed.

What's old is new again: updated findings on personality disorders and substance use disorders

PURPOSE OF REVIEW

Personality disorders, mental disorders marked by long-term deviations from societal expectations that cause distress, and substance use and related disorders (SUDs), mental disorders marked by engaging with substances or behaviors that activate the brain's reward system to the point that normal activities are neglected, are common debilitating conditions. Personality disorders and SUDs are highly comorbid, potentially resistant to treatment, and their presence increases all-cause mortality, particularly when found together.

RECENT FINDINGS

The present review highlights the most notable findings on prevalence, comorbidity, biological and behavioral pathways between the disorders, impact on incarcerated people and treatment for the disorders.

SUMMARY

Personality disorders and SUDs are relatively common, highly comorbid, and increase the risk of all-cause mortality: particularly in those who have both conditions. Possible shared pathways between personality disorders and SUDs include emotional dysregulation, shared genes, and certain neurotransmitters. Personality disorders and SUDs are common in people who have been incarcerated, and this morbidity and comorbidity has been found throughout the world. Finally, comorbidity between personality disorders and SUDs greatly complicates treatment, with emerging treatment modalities such as mentalization-based treatment, schema modes, and attentional training showing potential, but lacking strong evidence of efficacy.