Personality in patients with substance use disorders according to the co-occurring severe mental illness: A study using the alternative five factor model

Circadian functioning and quality of life in substance use disorder patients with and without comorbid schizophrenia

Sleep disturbances are strongly linked with mental diseases such as substance use disorder (SUD) or schizophrenia (SZ) which can have a detrimental impact on quality of life (QOL), especially when both disorders are comorbid (dual disorder). In absence of studies about both circadian characteristics and QOL in patients with SUD and comorbid SZ (SUD + SZ), we examined a sample of 155 male under treatment, 75 with SUD + SZ and 80 only with SUD. Circadian functioning was evaluated by chronotype, social jet-lag and sleep quality (using the Pittsburgh Sleep Quality Index, PSQI), while the QOL was obtained by the World Health Organization's Quality of Life Questionnaire (WHOQOL)-BREF. SUD + SZ patients were more evening type than SUD, and this chronotype was linked to polydrug use in total sample and SUD + SZ group. We observed that the comorbidity did not lead to worse sleep quality in the SUD and SUD + SZ patients. QOL was poorer in SUD + SZ patients, who showed a negative association of Physical health, Psychological health and Social relationship with suicide attempts and severity of SZ. Lastly, patients with worse QOL also reported poorer sleep quality suggesting that treatment could include circadian adjustments along with a focused approach to lifestyle improvement.

Protocol for Characterization of Addiction and Dual Disorders: Effectiveness of Coadjuvant Chronotherapy in Patients with Partial Response

This protocol aims to characterize patients with dual disorders (DD; comorbid major depression and schizophrenia) compared with patients with only a diagnosis of substance use disorder (SUD) and those with only a diagnosis of severe mental illness (SMI; major depression and schizophrenia), evaluating clinical and personality characteristics, circadian rhythmic functioning, genetic polymorphism and neuropsychological performance in order to obtain a clinical endophenotype of differential vulnerability for these diagnostic entities. Patients will be divided into three groups: DD (45 men with comorbid schizophrenia, 45 men and 30 women with major depression), SUD (n = 90, with a minimum of 30 women) and SMI males (45 with schizophrenia, 45 with major depression). All patients will be under treatment, with at least three months of SUD abstinence and/or with SMI in remission or with stabilized symptoms. Outpatients of both sexes with insufficient restoration of circadian rhythmicity with SUD (n = 30) and dual depression (n = 30) will be asked to participate in a second two-month study, being alternately assigned to the condition of the chronobiological adjuvant approach to the treatment of regular hour habits and exposure to light or to the usual treatment (control). The effect of the intervention and patient compliance will be monitored with a Kronowise KW6® ambulatory device during the first two weeks of treatment and again at weeks 4 and 8 weeks. After completing the evaluation, follow-up of the clinical evolution will be carried out at 3, 6 and 12 months. This project will allow us to analyze the functional impact of DD comorbidity and to develop the first study of chronobiological therapy in the treatment of SUD and dual depression, with results transferable to the clinical setting with cost-effective recommendations for a personalized approach.

Circadian Characteristics in Patients under Treatment for Substance Use Disorders and Severe Mental Illness (Schizophrenia, Major Depression and Bipolar Disorder)

Dual disorders (substance use and mental illness comorbidity) are a condition that has been strongly associated with severe symptomatology and clinical complications. The study of circadian characteristics in patients with Severe Mental Illness or Substance Use Disorder (SUD) has shown that such variables are related with mood symptoms and worse recovery. In absence of studies about circadian characteristics in patients with dual disorders we examined a sample of 114 male participants with SUD and comorbid Schizophrenia (SZ+; n = 38), Bipolar Disorder (BD+; n = 36) and Major Depressive Disorder (MDD+; n = 40). The possible differences in the sample of patients according to their psychiatric diagnosis, circadian functioning with recordings of distal skin temperature during 48 h (Thermochron iButton^®), circadian typology and sleep-wake schedules were explored. MDD+ patients were more morning-type, while SZ+ and BD+ had an intermediate-type; the morning-type was more frequent among participants under inpatient SUD treatment. SZ+ patients had the highest amount of sleeping hours, lowest arousal and highest drowsiness followed by BD+ and MDD+, respectively. These observed differences suggest that treatment for patients with dual disorders could include chronobiological strategies to help them synchronize patterns with the day-light cycle, since morning-type is associated with better outcomes and recovery.

Functional and Mood Outcomes in Bipolar Disorder Patients With and Without Substance Use Disorders Undergoing Psychotherapy

Objectives: Research suggests that patients with co-morbid bipolar disorder (BD) and substance use disorder (SUD) have a poorer illness course and clinical outcome. The evidence is limited as SUD patients are often excluded from BD studies. In particular, evidence regarding long term outcomes from studies using psychotherapies as an adjunctive treatment is limited. We therefore examined data from two studies of Interpersonal Social Rhythm Therapy (IPSRT) for BD to determine whether lifetime or current SUD affected outcomes. Methods: Data were analyzed from two previous clinical trials of IPSRT for BD patients. Change in scores on the Social Adjustment Scale (SAS) from 0 to 78 weeks and cumulative mood scores from 0 to 78 weeks, measured using the Life Interval Follow-Up Evaluation (LIFE), were analyzed. Results: Of 122 patients (non-SUD n = 67, lifetime SUD but no current n = 43, current SUD n = 12), 79 received IPSRT and 43 received a comparison therapy-specialist supportive care-over 18 months. Lifetime SUD had a significant negative effect on change in SAS score but not LIFE score. There was no effect of current SUD on either change in score. Secondary analysis showed no correlation between symptom count and change in SAS total score or LIFE score. Conclusion: Current SUD has no impact on mood or functional outcomes, however, current SUD numbers were small, limiting conclusions. Lifetime SUD appears to be associated with impaired functional outcomes from psychotherapy. There is limited research on co-morbid BD and SUD patients undergoing psychotherapy.

Protective and Risk Factors for Adolescent Substance Use in Spain: Self-Esteem and Other Indicators of Personal Well-Being and Ill-Being

Although self-esteem has traditionally been considered as an important correlate of psychosocial adjustment, some empirical studies have found a positive relationship between some domains of self-esteem and drug use among adolescents. The present study analyzes self-esteem and other adjustment personal indicators as protective or risk factors for substance use. Participants were 644 Spanish adolescents aged 12–17 years. Substance use (cigarettes, alcohol, marijuana, and other illicit drugs), multidimensional self-esteem (academic, social, emotional, family, and physical), and other indicators of adolescents’ well-being and ill-being (psychological problems, behavior problems, and parenting) were measured. We observed, on the one hand, that substance use had a significant negative relationship with academic, family, and physical self-esteem. On the other hand, we also observed a significant positive relationship between drug use and social self-esteem. However, this significant relationship disappeared after statistically controlling for sex and age, using both partial correlation analyses and covariance analysis. Interestingly, beyond the importance of each factor related to drugs, prevention science should first of all be able to identify whether the main psychological variables (e.g., social or physical self-esteem) are risk or protective factors for drug use.

Temperament and Character Profile and Its Clinical Correlates in Male Patients with Dual Schizophrenia

Personality traits are relevant in understanding substance use disorders (SUD) and schizophrenia (SZ), but few works have also included patients with dual schizophrenia (SZ+) and personality traits. We explored personality profile in a sample of 165 male patients under treatment, using the Temperament and Character Inventory-Revised. The participants were assigned to three groups of 55 patients each, according to previous diagnosis: SUD, SZ- and SZ+ (without/with SUD). We analyzed their clinical characteristics, relating them to personality dimensions. The SUD and SZ+ groups scored higher than SZ- in Novelty/Sensation Seeking. SZ- and SZ+ presented higher Harm Avoidance and lower Persistence than the SUD group. SZ+ patients showed the lowest levels of Self-directedness, while SZ- and SZ+ had higher scores in Self-transcendence than the SUD group. Several clinical characteristics were associated with personality dimensions depending on diagnosis, and remarkably so for psychiatric symptoms in the SZ- and SZ+ groups. The three groups had a maladaptive personality profile compared to general population. Our results point to different profiles for SUD versus SZ, while both profiles appear combined in the SZ+ group, with extreme scores in some traits. Thus, considering personality endophenotypes in SZ+ could help in designing individualized interventions for this group.

Measuring Personality Problems in Patients With Substance Use Disorders: A Cross-Sample Validation

Objective: Co-occurrence of substance use disorder and personality disorder (PD) is associated with greater functional impairment and mutual deterioration of the prognosis. More information is needed about the extent of personality problems in substance use disorder patients and when these problems can be assessed in a reliable way. The aim of this study was to compare the levels and scale reliability of (mal)adaptive personality functioning in four different samples and to discuss the possible clinical implications. Methods: Personality problems were assessed using the self-report Severity Indices of Personality Problems (SIPP) questionnaire in four samples: (a) 136 patients in the detoxification phase, (b) 187 patients with substance use disorder in long-term inpatient treatment, (c) 1,399 patients with PD in day and outpatient treatment, and (d) a community population of 935 respondents. Scale reliability of the SIPP facets was computed for each sample and levels of personality problems were compared among samples. Results: The scale reliability was acceptable for most of the SIPP facets in both substance use disorder samples. The substance use disorder samples had scores on SIPP that reflected greater personality dysfunction compared with the general community population and at a level similar to the PD population. Conclusions: SIPP appears to be a promising instrument for assessing personality pathology in substance use disorder treatment. The finding of high levels of maladaptive personality functioning in substance use disorder populations challenges the clinical management of the substance use disorder patient group and supports the development of integrated treatment approaches.

Personality Profile and Clinical Correlates of Patients With Substance Use Disorder With and Without Comorbid Depression Under Treatment

Background: Among patients with substance use disorder (SUD), major depressive disorder (MDD) is highly prevalent. Even though, personality plays an important role in treatment outcomes for individuals with SUD and SUD + MDD, few studies have explored personality characteristics in these samples. This study aims to describe personality for patients with SUD taking into account the comorbid MDD, using the Alternative Five Factor Model (AFFM). We also aim to compare SUD + MDD patients with population norms and to elucidate possible personality clinical correlates. Methods: For our study, 116 male patients undergoing for SUD treatment were divided in two groups: SUD only (N = 58) and SUD + MDD (N = 58). To examine personality, we used the Zuckerman-Kuhlman Personality Questionnaire and multiple analyses of covariance were performed to identify differences. In a first analysis, age was introduced as a covariate whereas in a second analysis the continuous variables that showed to have a discriminant value for the groups were added as covariates. Variables predicting the presence of dual diagnosis and personality clinical correlates were analyzed by logistic and linear regression models, respectively. We observed that patients with SUD + MDD show distinctive personality characteristics compared with patients with SUD only and population norms. Results: According to the AFFM, SUD + MDD patients are characterized by higher Neuroticism-Anxiety (positively associated to depressive symptoms) and Impulsivity; and by lower Parties and Friends. Moreover, the probability of having a dual depressive disorder was represented by the amount of medications and substances used. The preference for hard work and the energy self-reported levels (Work Activity trait) are linked to these clinical variables rather than to the presence/absence of a dual depressive disorder. Conclusions: Even when controlling clinical variables related to a higher probability of having a dual depressive disorder, the Neuroticism-Anxiety is a personality trait that strongly differentiates between SUD only and SUD + MDD patients. Further investigation is needed to explore the role of this personality trait as endophenotype in dual depressive men. Our results underline the importance of a dimensional understanding of personality and its clinical correlates among patients with SUD + MDD; this approach could provide us information on specific treatment strategies to improve the prognosis of patients.

Temperament and character profiles associated with depression and treatment response in patients with or without comorbid substance abuse

There is limited knowledge on the relationship between temperament and character profiles and substance abuse comorbidity in depressed patients. We recruited 127 depressed patients without alcohol use problems (non-AUP) and 89 depressed patients with alcohol use problems (AUP). We assessed all patients using the Temperament and Character Inventory (TCI-R) at baseline and after 6 weeks of treatment. Using univariate general linear models (GLMs), we analyzed differences in TCI-R between AUP and non-AUP. GLMs were also used in analyzing the associations between TCI-R changes and antidepressive treatment responses measured with changes in Montgomery Åsberg Depression Rating Scale score (ΔMADRS). Alcohol use explained independently significant proportions of the variation in Novelty Seeking, Self-Directedness, and Persistence. Reward Dependence score change explained 14.1% of the ΔMADRS in AUP, but was non-significant in non-AUP. Character score changes in Self-Directedness and Self-Transcendence explained together 14.1% of ΔMADRS in non-AUP, whereas they were all non-significant in AUP. AUP compared with non-AUP patients had lower Self-Directedness and Persistence and higher Novelty Seeking scores. Detected changes in Reward Dependence and lower Self-Directedness in AUP patients could be reflective of different biological mechanisms associated with depressive symptomatology in alcohol abuse. Changes in character are associated with acute treatment response in non-AUP.

Personality profile of binge drinking in university students is modulated by sex. A study using the Alternative Five Factor Model

BACKGROUND

The prevalence of binge drinking (BD), found especially among young people, is increasing worldwide and has become an important social and health concern. We studied, for the first time, the personality profile, using the Alternative Five Factor Model, among university students with BD and healthy controls, taking into account the possible influence of sex.

METHODS

70 participants with BD (30 men) and 70 healthy controls (30 men) were included, selected to control for characteristics that are known to be related to BD (physical and mental disorders, consumption of other drugs, circadian rhythms), completed the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ).

RESULTS

The scores on Neuroticism-Anxiety and Impulsive Sensation-Seeking were higher in the BD group compared to the controls (p<0.001 in both cases). The higher scores in the BD group in Neuroticism-Anxiety are due to higher scores in the women's group (p=0.014), while those in Impulsive Sensation-Seeking are due to higher scores in the men's group (p=0.009), both in the Impulsivity and in the Sensation-Seeking subscales (p<0.045).

CONCLUSIONS

Sex could be a factor that modulates the endophenotype of drug dependence (impulsive and anxious personality) and the prevention and/or treatment programs for BD should include not only the management of the personality risk factors but also different tailored approaches according to sex.