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Lin Y, Guo Z, Zhou Y, Wei Y, Xu L, Tang X, Wang Z, Hu Y, Wang J, Mei Y, Wu H, Luo Y, Zhang T. Distribution of self-reported borderline personality disorder traits symptoms in a large-scale clinical population. Front Psychiatry 2024; 15:1424966. [PMID: 38988741 PMCID: PMC11234847 DOI: 10.3389/fpsyt.2024.1424966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/06/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Borderline Personality Disorder (BPD) traits play a crucial role in the prognosis of psychiatric disorders, as well as in assessing risks associated with negativity and impulsivity. However, there is a lack of data regarding the distribution characteristics of BPD traits and symptoms within clinical populations. Methods A total of 3015 participants (1321 males, 1694 females) were consecutively sampled from outpatients at the psychiatric and psycho-counseling clinics at the Shanghai Mental Health Center. BPD symptoms were assessed using a self-reported personality diagnostic questionnaire. Having BPD traits is defined as having five or more positive items in self-reported BPD characteristics. Participants were stratified into male and female groups, age groups, and diagnostic groups (schizophrenia, mood disorders, anxiety disorders). Exploratory factor analysis using principal components analysis was conducted. Three factors were identified: "F1: Affective Instability and Impulsivity", "F2: Interpersonal Unstable and Extreme Reactions", and "F3: Identity Disturbance". Results Among 3015 participants, 45.9% of the patients self-reported BPD traits. Comparing of male and female patients, there was no statistically significant difference in the occurrence rate of BPD traits (χ2 = 1.835, p=0.176). However, in terms of symptoms, female patients reported more symptoms than male patients. Female patients also exhibited more pronounced features on F2 compared to male patients (t =-1.972, p=0.049). There is a general decrease in BPD traits, symptoms, and factors with increasing age. Specifically, the proportion of positive BPD traits is approximately halved before the age of 30 and decreases to around one-third after the age of 30. BPD traits were most common in the Mood Disorders group at 55.7%, followed by the Anxiety Disorders group at 44.4%, and Schizophrenia group at 41.5% (χ2 = 38.084, p<0.001). Discussion Our study revealed the pervasive presence of BPD traits and symptoms among psychiatric outpatients, exhibiting distinctive distributions across gender, age, and diagnostic categories. These findings emphasize the significance of identifying and addressing BPD pathology in the clinical care of psychiatric outpatients.
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Affiliation(s)
- Yong Lin
- Department of Psychiatry, Kangci Hospital of Jiaxing, Tongxiang, Zhejiang, China
| | - ZiLei Guo
- Department of Psychiatry, Kangci Hospital of Jiaxing, Tongxiang, Zhejiang, China
| | - Yong Zhou
- Department of Psychiatry, Kangci Hospital of Jiaxing, Tongxiang, Zhejiang, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Zixuan Wang
- Department of Psychology, Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yi Mei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - HaiSu Wu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - YanLi Luo
- Department of Psychological Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Zhang T, Xu L, Wei Y, Cui H, Tang X, Hu Y, Tang Y, Wang Z, Liu H, Chen T, Li C, Wang J. Advancements and Future Directions in Prevention Based on Evaluation for Individuals With Clinical High Risk of Psychosis: Insights From the SHARP Study. Schizophr Bull 2024:sbae066. [PMID: 38741342 DOI: 10.1093/schbul/sbae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND HYPOTHESIS This review examines the evolution and future prospects of prevention based on evaluation (PBE) for individuals at clinical high risk (CHR) of psychosis, drawing insights from the SHARP (Shanghai At Risk for Psychosis) study. It aims to assess the effectiveness of non-pharmacological interventions in preventing psychosis onset among CHR individuals. STUDY DESIGN The review provides an overview of the developmental history of the SHARP study and its contributions to understanding the needs of CHR individuals. It explores the limitations of traditional antipsychotic approaches and introduces PBE as a promising framework for intervention. STUDY RESULTS Three key interventions implemented by the SHARP team are discussed: nutritional supplementation based on niacin skin response blunting, precision transcranial magnetic stimulation targeting cognitive and brain functional abnormalities, and cognitive behavioral therapy for psychotic symptoms addressing symptomatology and impaired insight characteristics. Each intervention is evaluated within the context of PBE, emphasizing the potential for tailored approaches to CHR individuals. CONCLUSIONS The review highlights the strengths and clinical applications of the discussed interventions, underscoring their potential to revolutionize preventive care for CHR individuals. It also provides insights into future directions for PBE in CHR populations, including efforts to expand evaluation techniques and enhance precision in interventions.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - ZiXuan Wang
- Department of Psychology, Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Ontario, Canada
- Labor and Worklife Program, Harvard University, Cambridge, MA, USA
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, PR China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
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Wang X, Ni X, Wei Y, Xu L, Tang X, Liu H, Wang Z, Chen T, Wang J, Zhang Q, Zhang T. Sex Differences in Personality Disorder and Childhood Maltreatment of Patients with Schizophrenia. Neuropsychiatr Dis Treat 2024; 20:989-999. [PMID: 38741581 PMCID: PMC11090116 DOI: 10.2147/ndt.s462346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Despite numerous studies investigating personality disorder (PD) and childhood maltreatment (CM) characteristics in individuals with schizophrenia (SZ), there remains a scarcity of research focusing on sex differences in PD and CM within large samples of SZ patients. Methods A total of 592 participants (257 males, 335 females) were consecutively sampled from patients diagnosed with SZ at the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. PDs were assessed using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were evaluated using the Chinese version of the Child Trauma Questionnaire Short Form. Results Male patients exhibited a prominent self-reported trait of antisocial PD (t=1.972, p=0.049), while female patients demonstrated a notable emphasis on histrionic PD traits (t=-2.057, p=0.040). Structured interviews for PD diagnoses further indicated a higher comorbidity of schizotypal (χ2=4.805, p=0.028) and schizoid (χ2=6.957, p=0.008) PDs among male patients compared to female patients. Additionally, male patients reported a higher degree (t=2.957, p=0.003) and proportion (χ2=5.277, p=0.022) of experiences of physical abuse in their self-reported CM. Logistic regression analyses highlight distinct factors: higher antisocial PD traits and physical abuse are associated with male patients, while histrionic PD traits and emotional abuse are associated with female patients. Discussion These findings underscore the importance of recognizing and addressing sex-specific manifestations of personality pathology and the nuanced impact of CM in the clinical management of individuals with SZ. The study advocates for tailored interventions that consider the distinct needs associated with sex differences in both personality traits and CM experiences among SZ patients.
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Affiliation(s)
- XiaoLiang Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
| | - XiaoDong Ni
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - ZiXuan Wang
- Department of Psychology, Shanghai Xinlianxin Psychological Counseling Center, Shanghai, People’s Republic of China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Waterloo, Ontario, Canada
- Labor and Worklife Program, Harvard University, Cambridge, MA, USA
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
| | - Qing Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
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Wang W, Cui Y, Hu Q, Wei Y, Xu L, Tang X, Hu Y, Liu H, Wang Z, Chen T, Wang R, An C, Wang J, Zhang T. Childhood maltreatment and personality disorders in adolescents and adults with psychotic or non-psychotic disorders. Front Psychiatry 2024; 15:1336118. [PMID: 38577403 PMCID: PMC10991748 DOI: 10.3389/fpsyt.2024.1336118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction While the attention to personality disorders (PD) and childhood maltreatment (CM) has grown in recent years, there remains limited understanding of the prevalence and distinctions of PD and CM in clinical populations of Chinese adolescents in comparison to adults. Methods A total of 1,417 participants were consecutively sampled from patients diagnosed with either psychotic or non-psychotic disorders in the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. The participants were categorized into two groups based on their age: adolescents (aged 15-21 years) and adults (aged 22-35 years). PDs were evaluated using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were assessed using the Chinese version of the Child Trauma Questionnaire Short Form. Results When comparing self-reported PD traits and CM between adolescents and adults, differences emerge. Adolescents, particularly in the psychotic disorder group, exhibit more pronounced schizotypal PD traits (p=0.029), and this pattern extends to non-psychotic disorders (p<0.001). Adolescents in the non-psychotic disorder group also report higher levels of emotional abuse (p=0.014), with a notable trend in physical abuse experiences compared to adults (p=0.057). Furthermore, the most prevalent PDs in the clinical sample are avoidant, borderline, and obsessive-compulsive PDs. Among patients with psychotic disorders, adolescents exhibit higher rates of schizoid, schizotypal, and obsessive-compulsive PDs compared to adults. Logistic regression analyses highlight distinct predictors for psychotic and non-psychotic disorders in adolescents and adults. Discussion The findings emphasize distinct differences in PDs and CMs between adolescent and adult groups, shedding light on their potential roles in psychotic and non-psychotic disorders.
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Affiliation(s)
- WenZheng Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yin Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Qiang Hu
- Department of Psychiatry, ZhenJiang Mental Health Center, Zhenjiang, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, China
| | - ZiXuan Wang
- Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Waterloo, ON, Canada
- Labor and Worklife Program, Harvard University, Cambridge, MA, United States
| | - Ran Wang
- Department of Psychiatry, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - CuiXia An
- Hebei Technical Innovation Center, Mental Health Assessment and Intervention, Shijiazhuang, Hebei, China
- Hebei Clinical Research Center of Mental Disorders, Institute of Mental Health, Shijiazhuang, Hebei, China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Zhang L, Zhao N, Zhu M, Tang M, Liu W, Hong W. Adverse childhood experiences in patients with schizophrenia: related factors and clinical implications. Front Psychiatry 2023; 14:1247063. [PMID: 37701095 PMCID: PMC10493314 DOI: 10.3389/fpsyt.2023.1247063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
The relationship between adverse childhood experiences (ACEs) and the development of psychotic symptoms is not well understood. Therefore, this study aimed to investigate the frequency and distribution of ACEs among patients with schizophrenia and their potential correlation with symptomatology and personality pathology. We conducted a cross-sectional study involving 571 patients with schizophrenia in Shanghai, China. Symptomatology was assessed using the Positive and Negative Symptoms Scale (PANSS) and personality pathology was assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). ACEs were assessed using the Child Trauma Questionnaire-Short Form (CTQ-SF). ACEs were highly prevalent, with 80.8% of the patients with schizophrenia reporting at least one ACE. The three most common types of ACE were physical neglect (69.8%), emotional neglect (28.2%), and emotional abuse (22.9%). For specific ACE, emotional abuse was significantly associated with PD traits, whereas emotional and physical neglect types of ACE was significantly associated with negative symptoms. A higher level of physical abuse was more commonly reported by men, younger individuals, and those with a higher level of antisocial PD traits. Higher levels of physical neglect were associated with more severe negative symptoms. ACEs are commonly observed in patients with schizophrenia. Therefore, it is strongly recommended that this clinical population be provided with a comprehensive assessment and individualized intervention for those exposed to specific ACEs.
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Affiliation(s)
| | | | | | | | | | - Wenjuan Hong
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
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He H, Xu M, Fei Z, Xie Y, Gu X, Zhu H, Wang J. Sex differences in personality disorders in a Chinese clinical population. Front Psychiatry 2022; 13:1006740. [PMID: 36213898 PMCID: PMC9537623 DOI: 10.3389/fpsyt.2022.1006740] [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] [Received: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Sex differences in the frequency and severity of personality disorders (PDs) have been widely reported in Western countries. However, limited literature suggests a similar sex distribution in the Chinese clinical population. This study investigated sex differences in self-reported and interviewed patients with PDs in a clinical population in China. MATERIALS AND METHODS The participants were 1,389 consecutive outpatients with a mean age of 30.5 years, including 634 (45.6%) males and 755 (54.4%) females. Self-reported PD traits were assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). PDs were diagnosed according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis II (SCID-II). RESULTS Male outpatients reported more paranoid, schizotypal, antisocial, and passive-aggressive PD traits, whereas females reported more borderline PD traits on the PDQ-4+. Self-reported PD traits in male outpatients were more likely to reach the positive threshold of antisocial PD than in females (χ2 = 5.293, p = 0.021). Males were more likely to meet the criteria for schizoid (χ2 = 5.050, p = 0.025), narcissistic (χ2 = 27.244, p < 0.001), antisocial (χ2 = 11.430, p = 0.001), avoidant (χ2 = 5.098, p = 0.024), and obsessive-compulsive PD (χ2 = 5.496, p = 0.019) diagnoses in the SCID-II. In contrast, females were more likely to meet the criteria of histrionic (χ2 = 12.327, p = 0.001), borderline (χ2 = 28.538, p < 0.001), and dependent (χ2 = 4.919, p = 0.027) diagnoses. DISCUSSION These findings indicate gender differences in the traits, frequency, and pattern of PDs when assessed in a Chinese clinical population.
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Affiliation(s)
- HongZhen He
- Department of Clinical Psychology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mei Xu
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - ZhangYing Fei
- Wujiang Mental Rehabilitation Hospital, Suzhou, China
| | - Yuou Xie
- Department of Clinical Medicine, The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - XinYi Gu
- Department of Medical Information Management, Wenzhou Medical University, Wenzhou, China
| | - HongLiang Zhu
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - JunJie Wang
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
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Salazar de Pablo G, Woods SW, Drymonitou G, de Diego H, Fusar-Poli P. Prevalence of Individuals at Clinical High-Risk of Psychosis in the General Population and Clinical Samples: Systematic Review and Meta-Analysis. Brain Sci 2021; 11:brainsci11111544. [PMID: 34827543 PMCID: PMC8615691 DOI: 10.3390/brainsci11111544] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
(1) The consistency and magnitude of the prevalence of Clinical High-Risk for Psychosis (CHR-P) individuals are undetermined, limiting efficient detection of cases. We aimed to evaluate the prevalence of CHR-P individuals systematically assessed in the general population or clinical samples. (2) PRISMA/MOOSE-compliant (PROSPERO: CRD42020168672) meta-analysis of multiple databases until 21/01/21: a random-effects model meta-analysis, heterogeneity analysis, publication bias and quality assessment, sensitivity analysis—according to the gold-standard CHR-P and pre-screening instruments—leave-one-study-out analyses, and meta-regressions were conducted. (3) 35 studies were included, with 37,135 individuals tested and 1554 CHR-P individuals identified (median age = 19.3 years, Interquartile range (IQR) = 15.8–22.1; 52.2% females, IQR = 38.7–64.4). In the general population (k = 13, n = 26,835 individuals evaluated), the prevalence of the CHR-P state was 1.7% (95% Confidence Interval (CI) = 1.0–2.9%). In clinical samples (k = 22, n = 10,300 individuals evaluated), the prevalence of the CHR-P state was 19.2% (95% CI = 12.9–27.7%). Using a pre-screening instrument was associated with false negatives (5.6%, 95% CI = 2.2–13.3%) and a lower CHR-P prevalence (11.5%, 95% CI = 6.2–20.5%) compared to using CHR-P instruments only (28.5%, 95% CI = 23.0–34.7%, p = 0.003). (4) The prevalence of the CHR-P state is low in the general population and ten times higher in clinical samples. The prevalence of CHR-P may increase with a higher proportion of females in the general population and with a younger population in clinical samples. The CHR-P state may be unrecognized in routine clinical practice. These findings can refine detection and preventive strategies.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK;
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, 28040 Madrid, Spain;
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Scott W. Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA;
| | | | - Héctor de Diego
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, 28040 Madrid, Spain;
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK;
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
- Correspondence:
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Wu LZ, Asan AE, Halberstadt AL, Pincus AL. Comparing English-Language and Chinese-Language Assessment of DSM-5 Personality Disorders and Interpersonal Problems in Chinese Bilingual Speakers. J Pers Assess 2021; 104:509-521. [PMID: 34402349 DOI: 10.1080/00223891.2021.1960359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A review of the literature on Chinese translations of Western self-report personality disorder assessment measures indicates the need to empirically evaluate the validity of assessing Western personality disorder constructs in Chinese language and culture. The current study presents a novel approach to examining this critical question in cross-cultural clinical assessment science and practice. One hundred and ninety-nine (199) Mandarin Chinese and English bilingual participants (92 males and 107 females) provided both English and Chinese self-report ratings on the Inventory of Interpersonal Problems - Short Circumplex (IIP-SC) and The Personality Diagnostic Questionnaire - 4+ (PDQ-4+). The similarities and differences in associations between Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) personality disorders and interpersonal problems assessed across languages were examined. The structural summary method (SSM) for circumplex data and a bootstrapping methodology were used to compute confidence intervals around SSM parameters to analyze and compare the interpersonal problems profiles for each personality disorder scale (e.g. narcissistic) derived from English-language and Chinese-language data. The current study found highly similar interpersonal profiles for personality disorder scales assessed in English and Chinese, suggesting Western DSM-5 personality disorder constructs generally emphasize the same interpersonal problems in Chinese language and culture. The method employed in this study also has implications for understanding whether translated measures capture the same personality constructs.
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Affiliation(s)
- Leila Z Wu
- Department of Psychology, The Pennsylvania State University, University Park, PA
| | - A Esin Asan
- Department of Psychology, The Pennsylvania State University, University Park, PA
| | | | - Aaron L Pincus
- Department of Psychology, The Pennsylvania State University, University Park, PA
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Wu J, Long X, Liu F, Qi A, Chen Q, Guan X, Zhang Q, Yao Y, Shi J, Xie S, Yan W, Hu M, Yuan X, Tang J, Wu S, Zhang T, Wang J, Lu Z. Screening of the college students at clinical high risk for psychosis in China: a multicenter epidemiological study. BMC Psychiatry 2021; 21:253. [PMID: 34001048 PMCID: PMC8127262 DOI: 10.1186/s12888-021-03229-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To investigate a 3-stage screening procedure and explore the clinical features of subjects at Clinical High Risk (CHR) for psychosis in a representative sample of Chinese college students. METHODS An epidemiological survey of the prevalence of the CHR syndrome in Chinese college students that was selected by stratified random sampling from Shanghai, Nanjing and Nanchang cities was done following a 3-stage procedure. Participants were initially screened with the Prodromal Questionnaire-brief version (PQ-B), and whose distress score of PQ-B exceeded 24 would be invited to a telephone assessment using the subscale for positive symptoms of the Scale of Prodromal Symptoms (SOPS)/Structured Interview for Prodromal Syndromes (SIPS). Lastly, participants who scored 3 or higher in any item of the subscale would be administered with the SIPS interview conducted by trained researchers to confirm the diagnosis of CHR syndrome. RESULTS Twenty-three thousand sixty-three college students completed the survey during September 2017 to October 2018. Seventy-two students were diagnosed as CHR subjects, and the detection rate in the total sample was 0.3%. The peak age range for the first diagnosis of CHR was 17 to 20 years. Thirteen and forty-six were set as the cutoff points of PQ-B total score and distress score to balance the greatest sensitivity and specificity. Binary logistic regression revealed that 8 items in PQ-B showed significant distinction for detecting CHR subjects. CONCLUSIONS The 3-stage screening method can be utilized in the detection of CHR subjects for psychosis in the general population, during which delusional ideas, perceptual abnormalities and suspiciousness deserve great attention.
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Affiliation(s)
- Jiaxin Wu
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China ,grid.24516.340000000123704535Tongji University School of Medicine, Shanghai, 200092 PR China
| | - Xiangyun Long
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China ,grid.24516.340000000123704535Tongji University School of Medicine, Shanghai, 200092 PR China
| | - Fei Liu
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China
| | - Ansi Qi
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China
| | - Qi Chen
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China
| | - Xiaofeng Guan
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China
| | - Qiong Zhang
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China
| | - Yuhong Yao
- grid.24516.340000000123704535Tongji University School of Medicine, Shanghai, 200092 PR China
| | - Jingyu Shi
- grid.24516.340000000123704535Tongji University School of Medicine, Shanghai, 200092 PR China
| | - Shiping Xie
- grid.89957.3a0000 0000 9255 8984Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029 PR China
| | - Wei Yan
- grid.89957.3a0000 0000 9255 8984Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029 PR China
| | - Maorong Hu
- grid.412604.50000 0004 1758 4073Department of Psychiatry, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 PR China
| | - Xin Yuan
- grid.412604.50000 0004 1758 4073Department of Psychiatry, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 PR China
| | - Jun Tang
- grid.412604.50000 0004 1758 4073Department of Psychiatry, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 PR China
| | - Siliang Wu
- grid.412604.50000 0004 1758 4073Department of Psychiatry, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 PR China
| | - Tianhong Zhang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030 PR China
| | - Jijun Wang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030 PR China
| | - Zheng Lu
- Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, PR China. .,Tongji University School of Medicine, Shanghai, 200092, PR China.
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10
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Zhang F, Cho KIK, Tang Y, Zhang T, Kelly S, Biase MD, Xu L, Li H, Matcheri K, Whitfield-Gabrieli S, Niznikiewicz M, Stone WS, Wang J, Shenton ME, Pasternak O. MK-Curve improves sensitivity to identify white matter alterations in clinical high risk for psychosis. Neuroimage 2021; 226:117564. [PMID: 33285331 PMCID: PMC7873589 DOI: 10.1016/j.neuroimage.2020.117564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/30/2022] Open
Abstract
Diffusion kurtosis imaging (DKI) is a diffusion MRI approach that enables the measurement of brain microstructural properties, reflecting molecular restrictions and tissue heterogeneity. DKI parameters such as mean kurtosis (MK) provide additional subtle information to that provided by popular diffusion tensor imaging (DTI) parameters, and thus have been considered useful to detect white matter abnormalities, especially in populations that are not expected to show severe brain pathologies. However, DKI parameters often yield artifactual output values that are outside of the biologically plausible range, which diminish sensitivity to identify true microstructural changes. Recently we have proposed the mean-kurtosis-curve (MK-Curve) method to correct voxels with implausible DKI parameters, and demonstrated its improved performance against other approaches that correct artifacts in DKI. In this work, we aimed to evaluate the utility of the MK-Curve method to improve the identification of white matter abnormalities in group comparisons. To do so, we compared group differences, with and without the MK-Curve correction, between 115 individuals at clinical high risk for psychosis (CHR) and 93 healthy controls (HCs). We also compared the correlation of the corrected and uncorrected DKI parameters with clinical characteristics. Following the MK-curve correction, the group differences had larger effect sizes and higher statistical significance (i.e., lower p-values), demonstrating increased sensitivity to detect group differences, in particular in MK. Furthermore, the MK-curve-corrected DKI parameters displayed stronger correlations with clinical variables in CHR individuals, demonstrating the clinical relevance of the corrected parameters. Overall, following the MK-curve correction our analyses found widespread lower MK in CHR that overlapped with lower fractional anisotropy (FA), and both measures were significantly correlated with a decline in functioning and with more severe symptoms. These observations further characterize white matter alterations in the CHR stage, demonstrating that MK and FA abnormalities are widespread, and mostly overlap. The improvement in group differences and stronger correlation with clinical variables suggest that applying MK-curve would be beneficial for the detection and characterization of subtle group differences in other experiments as well.
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Affiliation(s)
- Fan Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kang Ik Kevin Cho
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sinead Kelly
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; The Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - Maria Di Biase
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Huijun Li
- Department of Psychology, Florida A&M University, Tallahassee, FL,USA
| | - Keshevan Matcheri
- The Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - Susan Whitfield-Gabrieli
- Department of Psychology, Northeastern University, Boston, MA, USA; The McGovern Institute for Brain Research and the Poitras Center for Affective Disorders Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Margaret Niznikiewicz
- The Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - William S Stone
- The Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Martha E Shenton
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Ofer Pasternak
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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11
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Wang Q, Zhang L, Zhang J, Ye Z, Li P, Wang F, Cao Y, Zhang S, Zhou F, Ai Z, Zhao N. Prevalence of Comorbid Personality Disorder in Psychotic and Non-psychotic Disorders. Front Psychiatry 2021; 12:800047. [PMID: 35002814 PMCID: PMC8739447 DOI: 10.3389/fpsyt.2021.800047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The burden of personality disorders (PDs) in China is large and the focus on mental health services is increasing. However, there is a lack of sufficient evidence regarding the prevalence of comorbid PD in psychotic and non-psychotic disorders, and whether PDs have different distributions. We aimed to investigate the PD comorbidity distribution pattern between psychotic and non-psychotic disorders using a clinical population-based study. Materials and Methods: We conducted a cross-sectional study of 1,497 patients in Shanghai. PDs were screened using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). All patients were interviewed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis II (SCID-II). We compared the differences in PD comorbidities classified as the 10 types of PDs in the DSM-IV, in 531 patients with psychosis and 966 patients with non-psychotic disorders. Results: More than one-third (37%) of patients with psychotic disorders met the criteria of at least one PD. Approximately half (46%) of patients with non-psychotic disorders met the criteria of at least one PD. Patients with non-psychotic disorders were more likely to meet the criteria of borderline (χ2 = 20.154, p < 0.001) and obsessive-compulsive PD (χ2 = 21.164, p < 0.001) diagnoses compared to those with psychotic disorders. In contrast, patients with psychotic disorders were more likely to meet the criteria of paranoid (χ2 = 11.144, p = 0.001) and schizotypal PD (χ2 = 14.004, p < 0.001) diagnoses than those with non-psychotic disorders. Discussion: PD comorbidity is common and comorbidity distribution pattern is varied in patients with psychotic and non-psychotic disorders, implicating the development of specific strategies that could screen and assess PDs in psychiatric clinical practice.
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Affiliation(s)
- Qiang Wang
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China.,Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Lei Zhang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Jiechun Zhang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Zhihao Ye
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Ping Li
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Feng Wang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Yili Cao
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Shaojun Zhang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Fang Zhou
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Zisheng Ai
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
| | - Nan Zhao
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
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12
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Hou J, Schmitt S, Meller T, Falkenberg I, Chen J, Wang J, Zhao X, Shi J, Nenadić I. Cortical Complexity in People at Ultra-High-Risk for Psychosis Moderated by Childhood Trauma. Front Psychiatry 2020; 11:594466. [PMID: 33244301 PMCID: PMC7685197 DOI: 10.3389/fpsyt.2020.594466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Subjects with ultra-high risk (UHR) states for psychosis show brain structural volume changes similar to first-episode psychosis and also elevated incidence of environmental risk factors like childhood trauma. It is unclear, however, whether early neurodevelopmental trajectories are altered in UHR. We screened a total of 12,779 first-year Chinese students to enroll 36 UHR subjects (based on clinical interviews) and 59 non-UHR healthy controls for a case-control study of markers of early neurodevelopment. Subjects underwent 3T MRI scanning and clinical characterization, including the childhood trauma questionnaire (CTQ). We then used the CAT12 toolbox to analyse structural brain scans for cortical surface complexity, a spherical harmonics-based marker of early neurodevelopmental changes. While we did not find statistically significant differences between the groups, a trend level finding for reduced cortical complexity (CC) in UHR vs. non-UHR subjects emerged in the left superior temporal cortex (and adjacent insular and transverse temporal cortices), and this trend level association was significantly moderated by childhood trauma (CTQ score). Our findings indicate that UHR subjects tend to show abnormal cortical surface morphometry, in line with recent research; more importantly, however, this association seems to be considerably modulated by early environmental impacts. Hence, our results provide an indication of environmental or gene × environment interactions on early neurodevelopment leading up to elevated psychosis risk.
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Affiliation(s)
- Jiaojiao Hou
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg and Marburg University Hospital, Marburg, Germany
| | - Simon Schmitt
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg and Marburg University Hospital, Marburg, Germany
- Center for Mind, Brain, and Behavior, Philipps-Universität Marburg, Marburg, Germany
| | - Tina Meller
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg and Marburg University Hospital, Marburg, Germany
- Center for Mind, Brain, and Behavior, Philipps-Universität Marburg, Marburg, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg and Marburg University Hospital, Marburg, Germany
- Center for Mind, Brain, and Behavior, Philipps-Universität Marburg, Marburg, Germany
| | - Jianxing Chen
- Tongji University School of Medicine, Shanghai, China
| | - Jiayi Wang
- Tongji University School of Medicine, Shanghai, China
| | - Xudong Zhao
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Jingyu Shi
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
- Division of Medical Humanities & Behavioral Sciences, Tongji University School of Medicine, Shanghai, China
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg and Marburg University Hospital, Marburg, Germany
- Center for Mind, Brain, and Behavior, Philipps-Universität Marburg, Marburg, Germany
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13
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Millman ZB, Gold JM, Mittal VA, Schiffman J. The Critical Need for Help-Seeking Controls in Clinical High-Risk Research. Clin Psychol Sci 2019; 7:1171-1189. [PMID: 33614257 PMCID: PMC7891463 DOI: 10.1177/2167702619855660] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite rapidly growing knowledge of the clinical high-risk (CHR) state for psychosis, the vast majority of case-control studies have relied on healthy volunteers as a reference point for drawing inferences about the CHR construct. Researchers have long recognized that results generated from this design are limited by significant interpretive concerns, yet little attention has been given to how these concerns affect the growing field of CHR research. We argue that overreliance on healthy controls in CHR research threatens the validity of inferences concerning group differences, hinders advances in understanding the development of psychosis, and limits clinical progress. We suggest that the combined use of healthy and help-seeking (i.e., psychiatric) controls is a necessary step for the next generation of CHR research. We then evaluate methods for help-seeking control studies, identify the available CHR studies that have used such designs, discuss select findings in this literature, and offer recommendations for research.
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Affiliation(s)
| | - James M. Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University
- Department of Psychiatry, Northwestern University
- Institute for Policy Research, Northwestern University
- Medical Social Sciences, Northwestern University
- Institute for Innovations in Developmental Sciences, Northwestern University
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County
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14
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Tang Y, Pasternak O, Kubicki M, Rathi Y, Zhang T, Wang J, Li H, Woodberry KA, Xu L, Qian Z, Zhu A, Whitfield-Gabrieli S, Keshavan MS, Niznikiewicz M, Stone WS, McCarley RW, Shenton ME, Wang J, Seidman LJ. Altered Cellular White Matter But Not Extracellular Free Water on Diffusion MRI in Individuals at Clinical High Risk for Psychosis. Am J Psychiatry 2019; 176:820-828. [PMID: 31230461 PMCID: PMC7142275 DOI: 10.1176/appi.ajp.2019.18091044] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Detecting brain abnormalities in clinical high-risk populations before the onset of psychosis is important for tracking pathological pathways and for identifying possible intervention strategies that may impede or prevent the onset of psychotic disorders. Co-occurring cellular and extracellular white matter alterations have previously been implicated after a first psychotic episode. The authors investigated whether or not cellular and extracellular alterations are already present in a predominantly medication-naive cohort of clinical high-risk individuals experiencing attenuated psychotic symptoms. METHODS Fifty individuals at clinical high risk, of whom 40 were never medicated, were compared with 50 healthy control subjects, group-matched for age, gender, and parental socioeconomic status. 3-T multishell diffusion MRI data were obtained to estimate free-water imaging white matter measures, including fractional anisotropy of cellular tissue (FAT) and the volume fraction of extracellular free water (FW). RESULTS Significantly lower FAT was observed in the clinical high-risk group compared with the healthy control group, but no statistically significant FW alterations were observed between groups. Lower FAT in the clinical high-risk group was significantly associated with a decline in Global Assessment of Functioning Scale (GAF) score compared with highest GAF score in the previous 12 months. CONCLUSIONS Cellular but not extracellular alterations characterized the clinical high-risk group, especially in those who experienced a decline in functioning. These cellular changes suggest an early deficit that possibly reflects a predisposition to develop attenuated psychotic symptoms. In contrast, extracellular alterations were not observed in this clinical high-risk sample, suggesting that previously reported extracellular abnormalities may reflect an acute response to psychosis, which plays a more prominent role closer to or at onset of psychosis.
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Affiliation(s)
- Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;,Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;,Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Marek Kubicki
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;,Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;,Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;,Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Junjie Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;,Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huijun Li
- Department of Psychology, Florida A&M University, Tallahassee, FL, USA
| | - Kristen A. Woodberry
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenying Qian
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anni Zhu
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Whitfield-Gabrieli
- McGovern Institute for Brain Research and Poitras Center for Affective Disorders Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Matcheri S. Keshavan
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Margaret Niznikiewicz
- Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - William S. Stone
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Robert W. McCarley
- Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;,Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;,Research and Development, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China;,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, China
| | - Larry J. Seidman
- Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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15
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Wang J, Sun W, Tang X, Xu L, Wei Y, Cui H, Tang Y, Hui L, Jia Q, Zhu H, Wang J, Zhang T. Transdiagnostic Dimensions towards Personality Pathology and Childhood Traumatic Experience in a Clinical Sample: Subtype Classification by a Cross-sectional Analysis. Sci Rep 2019; 9:11248. [PMID: 31375755 PMCID: PMC6677786 DOI: 10.1038/s41598-019-47754-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/23/2019] [Indexed: 12/23/2022] Open
Abstract
Psychiatric disorders are highly heterogeneous syndromes often explained by underlying and internalized personality disorder(PD) traits that are affected by externalized childhood trauma experiences(CTE). The present study investigated the differential subtype model by examining the association between PD traits and CTE in a clinical sample with transdiagnostic psychopathology. Outpatients(n = 2090) presenting for psychiatric treatment completed self-reported measures of PD traits(Personality Diagnostic Questionnaire) and the childhood adversity(Child Trauma Questionnaire). Canonical variates were generated by canonical correlation analysis(CCA) and then used for hierarchical cluster analysis to produce subtypes. A support vector machine(SVM) model was used and validated using a linear kernel to assess the utility of the extracted subtypes of outpatients in clinical diagnosis classifications. The CCA determined two linear combinations: emotional abuse related dissociality PD traits(antisocial and paranoid PD) and emotional neglect related sociality PD traits(schizoid, passive-aggressive, depressive, histrionic, and avoidant PD). A cluster analysis revealed three subtypes defined by distinct and relatively homogeneous patterns along two dimensions, and comprising 17.5%(cluster-1, n = 365), 34.8%(cluster-2, n = 727), and 47.8%(cluster-3, n = 998) of the sample, each with distinctive features of PD traits and CTE. These subtypes suggest more distinct PD trait correlates of CTE manifestations than were captured by clinical phenomenological diagnostic definitions. Our results highlight important subtypes of psychiatric patients that highlight PD traits and CTE that transcend current diagnostic boundaries. The three different subtypes reflect significant differences in PD and CTE characteristics and lend support to efforts to develop PD and childhood trauma targeted psychotherapy that extends to clinical diagnosis-based interventions.
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Affiliation(s)
- JunJie Wang
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China
| | - Wei Sun
- Department of Neurosurgery, Pu Nan Hospital, Shanghai, 200125, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - Li Hui
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China
| | - QiuFang Jia
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China
| | - Hongliang Zhu
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China.
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China. .,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, P.R. China. .,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China.
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16
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Schultze-Lutter F, Nenadic I, Grant P. Psychosis and Schizophrenia-Spectrum Personality Disorders Require Early Detection on Different Symptom Dimensions. Front Psychiatry 2019; 10:476. [PMID: 31354543 PMCID: PMC6637034 DOI: 10.3389/fpsyt.2019.00476] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/17/2019] [Indexed: 01/20/2023] Open
Abstract
Psychotic disorders and schizophrenia-spectrum personality disorders (PD) with psychotic/psychotic-like symptoms are considerably linked both historically and phenomenologically. In particular with regard to schizotypal and schizotypal personality disorder (SPD), this is evidenced by their placement in a joint diagnostic category of non-affective psychoses in the InternationaI Classification of Diseases 10th Revision, (CD-10) and, half-heartedly, the fifth edition of Diagnostic and Statistical Manual of Mental Disorders, (DSM-5). Historically, this close link resulted from observations of peculiarities that resembled subthreshold features of psychosis in the (premorbid) personality of schizophrenia patients and their biological relatives. These personality organizations were therefore called "borderline (schizophrenia)" in the first half of the 20th century. In the 1970s, they were renamed to "schizotypal" and separated from psychotic disorders on axis-I and from other PD on axis-II, including modern borderline PD, in the DSM. The phenomenological and historical overlap, however, has led to the common assumption that the main difference between psychotic disorders and SPD in particular was mainly one of severity or trajectory, with SPD representing a latent form of schizophrenia and/or a precursor of psychosis. Thus, psychosis proneness and schizotypy are often assessed using SPD questionnaires. In this perspective-piece, we revisit these assumptions in light of recent evidence. We conclude that schizotypy, SPD (and other schizophrenia-spectrum PD) and psychotic disorder are not merely states of different severity on one common but on qualitatively different dimensions, with the negative dimension being predictive of SPD and the positive of psychosis. Consequently, in light of the merits of early diagnosis, the differential early detection of incipient psychosis and schizophrenia-spectrum PD should be guided by the assessment of different schizotypy dimensions.
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Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Igor Nenadic
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg/UKGM, Marburg, Germany
| | - Phillip Grant
- Psychology School, Faculty of Health and Social Sciences, Fresenius University of Applied Sciences, Frankfurt am Main, Germany
- Faculty of Life Science Engineering, Technische Hochschule Mittelhessen University of Applied Sciences, Giessen, Germany
- Department of Biological Psychology and Individual Differences, Justus-Liebig-University, Giessen, Germany
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17
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Jiang X, Wang J, Sun W, Xu L, Tang X, Cui H, Wei Y, Hui L, Qiao Y, Wang J, Zhang T. Frequency of narcissistic personality disorder in a counseling center population in China. BMC Psychiatry 2019; 19:212. [PMID: 31277613 PMCID: PMC6612070 DOI: 10.1186/s12888-019-2185-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Narcissistic personality disorder (NPD) has never been applied in Chinese clinical practice, and the distribution of NPD in the clinical population of China is largely unknown. The current study uses two-stage clinic-based screening to investigate the frequency and clinical features of NPD in a Chinese help-seeking sample. METHODS A total of 1402 consecutive outpatients ages 18-60 were recruited during their visit to the Shanghai Mental Health Center and screened with the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+) and Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Axis II (SCID-II). The structured clinical interview was administered to estimate the rate of NPD and the frequency of each disorder criterion. RESULTS The frequency estimate of NPD in the total sample was 4.0%. Among the 56 outpatients who met the criteria for NPD, there were more males than females, and many had a better educational background. The SCID-II interviews revealed high frequencies of diagnostic criterion 1 ("exaggerated sense of self-importance. NPD likely overlaps with Histrionic PD, Borderline PD, and Paranoid PD. This two stage screening method can enhance detection of Chinese NPD patients in clinical settings. CONCLUSIONS Narcissism pathology is not rare in the Chinese psychiatric community when using the DSM-IV NPD criteria. Existing evidence suggests, at least indirectly, that there are important benefits of NPD diagnosis in psychiatric practice.
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Affiliation(s)
- XueFeng Jiang
- 0000 0004 1782 6212grid.415630.5Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), 600 Wanping Nan Road, Shanghai, 200030 People’s Republic of China
| | - JunJie Wang
- 0000 0004 1782 6212grid.415630.5Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), 600 Wanping Nan Road, Shanghai, 200030 People’s Republic of China ,0000 0001 0198 0694grid.263761.7Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou, 215137 Jiangsu China
| | - Wei Sun
- Department of Neurosurgery, Pu Nan Hospital, Shanghai, 200125 China
| | - LiHua Xu
- 0000 0004 1782 6212grid.415630.5Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), 600 Wanping Nan Road, Shanghai, 200030 People’s Republic of China
| | - XiaoChen Tang
- 0000 0004 1782 6212grid.415630.5Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), 600 Wanping Nan Road, Shanghai, 200030 People’s Republic of China
| | - HuiRu Cui
- 0000 0004 1782 6212grid.415630.5Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), 600 Wanping Nan Road, Shanghai, 200030 People’s Republic of China
| | - YanYan Wei
- 0000 0004 1782 6212grid.415630.5Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), 600 Wanping Nan Road, Shanghai, 200030 People’s Republic of China
| | - Li Hui
- 0000 0001 0198 0694grid.263761.7Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou, 215137 Jiangsu China
| | - Yi Qiao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China.
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China. .,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, People's Republic of China. .,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China.
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China.
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18
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Wang J, Chen Z, Sun W, Zheng Y, Hui L, Liu X, Wang J, Wu H, Qiao Y, Zhang T. A Strategy to Address High Comorbidity of Personality Disorders in a Chinese Population: A Principal and Subordinate Diagnostic Model. Psychiatry 2019; 82:272-282. [PMID: 31017559 DOI: 10.1080/00332747.2019.1600218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Multiple and overlapping diagnoses of personality disorders (PDs) have been a major obstacle in clinical practice and research. This study aims to investigate the comorbidity of PDs in a sample of a high-risk clinical population. We propose a diagnostic model to address this critical issue. Methods: The sample population included 982 PD patients. The PD diagnoses were concluded based on self-reported and face-to-face interviews. To address the issue of overlapping PD diagnoses, we defined the criteria for clinically distinguishing principal and subordinate PDs, and determined the frequency of each condition. Results: Diagnostic overlap among PDs was quite common across all categories. Of all 982 PD patients, 436 (44.4%) met the criteria for more than one PD. In terms of specific PD diagnoses, the comorbidity rate of each PD was nearly 47.1-74.7%. The principal and subordinate PDs were distinguished accordingly. Avoidant, obsessive-compulsive, and borderline PD remain the most prevalent types of principal PD in this clinical population. Conclusions: The principal/subordinate model may be one strategy of resolving the issue of PD comorbidity in Chinese clinical settings.
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A comparison of conversion rates, clinical profiles and predictors of outcomes in two independent samples of individuals at clinical high risk for psychosis in China. Schizophr Res 2018; 197:509-515. [PMID: 29287626 PMCID: PMC6019611 DOI: 10.1016/j.schres.2017.11.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 11/12/2017] [Accepted: 11/24/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE In a previous epidemiological study, we reported on the ascertainment and outcomes of "clinical high risk" (CHR) individuals at the Shanghai Mental Health Center (SMHC, "2011 cohort"). The current study compares demographic and clinical characteristics, including conversion rates, of this sample with a subsequently recruited, independent CHR sample and with published data from western samples. METHOD A new sample of 100 CHR subjects ("2013 cohort") was selected based on screening and semi-structured interviews. Both studies used the Structured Interview for Prodromal Syndromes (SIPS) for CHR assessment and conducted a naturalistic two-year follow-up. The two cohorts were compared on conversion rates, demographic and clinical characteristics, psychosis risk symptoms, and risk factors for psychotic conversion. RESULTS Ninety one (91%) of the 2013 cohort subjects completed the clinical two-year follow-up and 25 (27.5% of the 91) converted to a psychotic disorder over the follow-up period. A comparison of conversions to full psychosis between the 2013 and the 2011 cohorts showed no significant difference in time to conversion (Pairwise comparison: χ2=0.3, p=0.562). Both cohort studies showed that CHR subjects with more severe clinical symptoms at baseline and decline in functioning were more likely to convert to psychosis. CONCLUSIONS Conversion rates in this new, independent Chinese sample are similar to those reported in non-Chinese samples and to the 2011 cohort. Future research is needed to examine whether the implementation of early intervention for CHR/prodromal symptoms reduces the risk of psychosis and decreases the conversion rate.
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20
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Savill M, D'Ambrosio J, Cannon TD, Loewy RL. Psychosis risk screening in different populations using the Prodromal Questionnaire: A systematic review. Early Interv Psychiatry 2018; 12:3-14. [PMID: 28782283 PMCID: PMC5812357 DOI: 10.1111/eip.12446] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/18/2017] [Accepted: 03/18/2017] [Indexed: 01/31/2023]
Abstract
AIM Diagnosing individuals at ultra high risk (UHR) for psychosis can improve early access to treatment, and a two-stage model utilizing self-report screening followed by a clinical interview can be accurate and efficient. However, it is currently unclear which screening cut-offs to adopt with different populations. METHODS A systematic review of diagnostic accuracy studies evaluating the Prodromal Questionnaire (PQ) as a preliminary screener for UHR and psychosis was conducted to examine screening effectiveness in different contexts. MedLine, PsycInfo, SCOPUS and ProQuest Dissertations and Abstracts databases were electronically searched, along with a review screen and citation search of key papers. Findings were summarized in a narrative synthesis. RESULTS In total, 14 diagnostic accuracy studies and 45 studies using the PQ as a screening tool for UHR and psychosis were included. In all settings, the 3 different versions of the PQ were all found to accurately identify UHR and full psychosis. Higher cut-off points were required in non-help-seeking samples, relative to general help-seeking populations, which in turn were higher than those needed in samples highly enriched with UHR participants. CONCLUSION The findings support the use of the PQ as a preliminary screening tool for UHR in different settings; however, higher thresholds in lower UHR-prevalence populations are necessary to minimize false positives. Including the distress criteria, rather than just number of symptoms, may improve screening effectiveness. Different thresholds may be appropriate in different contexts depending on the importance of sensitivity vs specificity. Protocol registration: CRD42016033004.
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Affiliation(s)
- Mark Savill
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Jennifer D'Ambrosio
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, Connecticut
| | - Rachel L Loewy
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
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21
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A compromise solution between overlapping and overlooking DSM personality disorders in Chinese psychiatric practice. Soc Psychiatry Psychiatr Epidemiol 2018; 53:99-106. [PMID: 28956087 DOI: 10.1007/s00127-017-1444-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to examine the overlaps between the Diagnostic and Statistical Manual-5 (DSM-5) Personality Disorders (PDs) in a high-risk clinical population and to explore a transitional model for implementing DSM-5 PDs. METHOD A sample population of 982 outpatients with at least one diagnosed PD was selected from 3,075 outpatients of the Shanghai Mental Health Center. The diagnostic process comprised of a personality diagnostic questionnaire and a structured clinical interview. RESULTS 685 (22.3%) patients were diagnosed with at least one of six PDs (antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal) under the alternative DSM-5 model for personality disorders proposed in Section III of the DSM-5. Nearly 20.3% of the subjects with PD met criteria for at least two PDs (of the 685 PD patients/6 PD model). Cluster and principal component analyses suggest a transitional model for the 7 specific PD categories (among the 722 PD patients, the overlapping rate was 24.1%) will be more appropriate for PD diagnosis in China. CONCLUSIONS Using the simplified PD categories in the alternative DSM-5 model for personality disorders will reduce the overlaps in PD diagnoses in Chinese psychiatric practice, and should be preferred over the DSM-5 PD diagnostic system.
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Jakobsen KD, Skyum E, Hashemi N, Schjerning O, Fink-Jensen A, Nielsen J. Antipsychotic treatment of schizotypy and schizotypal personality disorder: a systematic review. J Psychopharmacol 2017; 31:397-405. [PMID: 28347257 DOI: 10.1177/0269881117695879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schizotypal personality disorder (SPD) is characterised by thought disorders, experiences of illusions, obsessive ruminations, bizarre or eccentric behaviour, cognitive problems and deficits in social functioning - symptoms that SPD shares with schizophrenia. Efforts have been undertaken to investigate the relationship between these conditions regarding genetics, pathophysiology, and phenomenology. However, treatment of SPD with antipsychotics has received less scientific attention. Embase and PubMed databases were searched using all known generic names of antipsychotics as search terms in combination with the following diagnostic terms: latent schizophrenia, schizotypal disorder, latent type schizophrenia, or SPD. Studies were categorised according to evidence level on the basis of their methodology from A, being the best, to E, being the worst. Five hundred and nine studies were retrieved and scrutinised. Sixteen studies, from the period 1972 to 2012, on antipsychotic treatment of SPD were extracted. Four studies were categorised as evidence level A, two as level B, six as level C and three as level D, with one study level E. Only four randomised, double-blind, placebo-controlled trials, on subjects with well-defined diagnoses, exists. Only amisulpride, risperidone and thiothixene have been studied according to evidence level A. This result warrants further high quality studies of the effects of antipsychotic treatment of SPD.
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Affiliation(s)
- Klaus Damgaard Jakobsen
- 1 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,2 Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Eva Skyum
- 2 Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Nasseh Hashemi
- 2 Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Schjerning
- 2 Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Fink-Jensen
- 3 Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Jimmi Nielsen
- 1 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,2 Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,3 Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
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