1
|
Kwapil TR, Edmundson MS, Hernández LM, Kemp KC, Rbeiz KS, Clark HE, Bathery AJ, Raulin ML, Barrantes-Vidal N. Schizotypal ambivalence is associated with schizophrenia-spectrum and borderline personality traits in young adults: Converging results from three interview studies. JOURNAL OF RESEARCH IN PERSONALITY 2022. [DOI: 10.1016/j.jrp.2022.104312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
2
|
Diagnostic progression to schizophrenia in 35,255 patients with obsessive-compulsive disorder: a longitudinal follow-up study. Eur Arch Psychiatry Clin Neurosci 2022; 273:541-551. [PMID: 35332401 DOI: 10.1007/s00406-021-01361-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/24/2021] [Indexed: 11/03/2022]
Abstract
Evidence suggests a continuity between obsessive-compulsive disorder (OCD) and schizophrenia. However, the factors that may predict diagnostic progression from OCD to schizophrenia remain unclear. A total of 35,255 adolescents and adults with OCD (ICD-9-CM code: 300.3) were enrolled between 2001 and 2010 and followed up at the end of 2011 for the identification of de novo schizophrenia (ICD-9-CM code: 295). The Kaplan-Meier method was used to estimate incidence rates, and the Cox regression was used to determine the significance of candidate predictors. At the end of the 11-year follow-up period, the crude cumulative progression rate from OCD to schizophrenia was 6%, and the estimated progression rate totaled 7.80%. Male sex (hazard ratio: 1.23), obesity (1.77), autism spectrum disorder (1.69), bipolar disorder (1.69), posttraumatic stress disorder (1.65), cluster A personality disorder (2.50), and a family history of schizophrenia (2.57) also were related to an elevated likelihood of subsequent progression to schizophrenia in patients with OCD. Further study is necessary to elucidate the exact pathomechanisms underlying diagnostic progression to schizophrenia in patients with OCD.
Collapse
|
3
|
Goryunov AV. [History of the formation of views on schizotypal disorder in childhood]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:90-99. [PMID: 34693695 DOI: 10.17116/jnevro202112109190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article reflects the stages of development of views on schizotypal disorder (STD) in adults and children from the prenosological period to the present. It is shown how, after the recognition by the majority of psychiatrists of the concept of early dementia proposed by E. Kraepelin, there is a gradual recognition of the single essence of schizophrenia for childhood and adulthood, but with different, specific clinical manifestations at different age periods. The study of variants of schizophrenia without a fatal outcome in dementia, which led to the isolation of sluggish schizophrenia, including in childhood, begins with the works of E. Bleuler. The differences in approaches to the study and interpretation of sluggish schizophrenia in Russian, European and American psychiatry, which led to the isolation of STEs in the framework of personality disorders, are described. Three main concepts that exist at the present stage of research are presented, in which STD is considered as an independent disease in the spectrum of schizophrenic disorders, as one of the types of personality deviations with a high degree of vulnerability for the development of schizophrenia, and as one of the forms of the disease.
Collapse
|
4
|
Simon AE, Keller P, Cattapan K. Commentary about social avoidance and its significance in adolescents and young adults. Psychiatry Res 2021; 297:113718. [PMID: 33465524 DOI: 10.1016/j.psychres.2021.113718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/09/2021] [Indexed: 12/11/2022]
Abstract
Social avoidance in young patients is a clinically worrisome phenomenon that characterizes impending schizophrenia, but that also constitutes a core phenomenon in avoidant personality disorder (AvPD), schizoid personality disorder (ScPD), and in autism spectrum disorder (ASD). Especially in the absence of any other clinically relevant phenomena, understanding the origins of social avoidance may be one the most challenging tasks in assessing whether adolescents and young adults are at risk for developing schizophrenia. Descriptive and psychometric assessments only allow to comment on the absence or the presence of this phenomenon, but do not capture the origins and the meaning of social avoidance. Based on a narrative review, we highlight the importance of a phenomenological approach to unveil the Gestalt of social avoidance in these mental disorders, including and appraisal of the underlying mental structures and attachment styles. The phenomenological approach allows to distinguish the Gestalt of social avoidance between AvPD, ScPD, ASD, and beginning schizophrenia, to ensure correct diagnostic labelling and optimal treatment, and to avoid unwarranted stigmatization.
Collapse
Affiliation(s)
- Andor E Simon
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland; Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Binningen, Switzerland.
| | - Petra Keller
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Katja Cattapan
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland; Sanatorium Kilchberg/Zuerich, Private Hospital of Psychiatry, Kilchberg, Switzerland
| |
Collapse
|
5
|
Welander-Vatn A, Torvik FA, Czajkowski N, Kendler KS, Reichborn-Kjennerud T, Knudsen GP, Ystrom E. Relationships Among Avoidant Personality Disorder, Social Anxiety Disorder, and Normative Personality Traits: A Twin Study. J Pers Disord 2019; 33:289-309. [PMID: 29505386 DOI: 10.1521/pedi_2018_32_341] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Avoidant personality disorder (AvPD) and social anxiety disorder (SAD) share risk factors to a substantial degree, and both are characterized by the experience of anxiety in social situations. The authors investigated whether these disorders are differentially related to the Big Five personality traits. They also examined the underlying genetic and environmental influences on these associations. A population-based sample of 1,761 female twins was interviewed at baseline, and 1,471 of these were re-interviewed 10 years later. Associations between AvPD, SAD, and personality traits were investigated with multivariate biometric analyses. The authors found that AvPD and SAD are differentially related to several personality traits at the phenotypic, genetic, and environmental level. The genetic and environmental liability to AvPD could be fully accounted for by the genetic and environmental factors influencing SAD and personality. The findings may increase current etiological understanding of these disorders and inform future classification and treatment efforts.
Collapse
Affiliation(s)
- Audun Welander-Vatn
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Fartein Ask Torvik
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Nikolai Czajkowski
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Ted Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Adult Psychiatry Unit, Institute of Clinical Medicine, University of Oslo
| | - Gun Peggy Knudsen
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Eivind Ystrom
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo
| |
Collapse
|
6
|
Smulevich AB, Dubnitskaya EB, Lobanova VM, Voronova EI, Zhylin VO, Kolyutskaya EV, Samoilova ED, Sorokina OY. [Personality disorders and schizophrenic defect (problem of comorbidity)]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:4-14. [PMID: 30585598 DOI: 10.17116/jnevro20181181114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM To test the main hypothesis that the deficit phenomena in schizophrenia act not in the 'pure' form, but in the form of aggravating personality characteristics, forming so-called 'common' syndromes with personality disorders (PD). MATERIAL AND METHODS The results of the psychopathological study (with the use of psychometric methods) of deficit disorders in a sample of 170 patients with schizophrenia and schizophrenia spectrum disorders (63 men, 107 women) are presented in relation to the abnormal structure of premorbid personality (PD of clusters A, B, C). An analysis of negative symptoms according to the comparability of defect to the profile of premorbid personality made it possible to distinguish three groups of deficit states associated with PD - 'common syndromes': defensive schizoidy by the type of deficit schizoid and expansive schizoidy by the type of 'verschroben' (cluster A); pathological hysterical infantilism, malignant hysteria and defective erotomania (cluster B); pseudo-psychasthenia and pathological rationalism (cluster C). RESULTS It has been found that the symptomatology of 'common syndromes' is subject to patterns reflecting the dichotomy of the basic defect. This pattern is valid not only for one single cluster of PD, but extends to all psychopathy-like disorders, regardless of their affiliation with a particular cluster. The pathocharacterological component of the 'common syndromes' coexisting with the deficit symptom complexes is subject to the basic deficit component of the defect and is separated into polar dimensions (defensive-expansive) within specific clusters of PD, and then unified in accordance with the dichotomy of schizophrenic defect in categories with the predominance of emotional or apathoabulic disorders. CONCLUSION Psychopathy-like symptom complexes in the space of 'common syndromes' can be qualified as a psychopathological construct secondary to basic deficit disorders, and their isolation as an independent entity of negative disorders appears to be unjustified.
Collapse
Affiliation(s)
- A B Smulevich
- Mental Health Research Center, Moscow, Russia; Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | | - E I Voronova
- Mental Health Research Center, Moscow, Russia; Sechenov First Moscow State Medical University, Moscow, Russia
| | - V O Zhylin
- Mental Health Research Center, Moscow, Russia
| | - E V Kolyutskaya
- Mental Health Research Center, Moscow, Russia; Sechenov First Moscow State Medical University, Moscow, Russia
| | - E D Samoilova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | |
Collapse
|
7
|
Racioppi A, Sheinbaum T, Gross GM, Ballespí S, Kwapil TR, Barrantes-Vidal N. Prediction of prodromal symptoms and schizophrenia-spectrum personality disorder traits by positive and negative schizotypy: A 3-year prospective study. PLoS One 2018; 13:e0207150. [PMID: 30408119 PMCID: PMC6224105 DOI: 10.1371/journal.pone.0207150] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022] Open
Abstract
The present study extends previous cross-sectional findings by examining the predictive validity of positive and negative schizotypy in a young adult sample at a three-year follow-up. Schizotypy and schizophrenia share a comparable multidimensional structure with positive and negative dimensions being the most strongly supported factors. Previous cross-sectional and longitudinal studies employing the psychometric high-risk strategy indicated that schizotypy is a useful method for identifying risk and resilience factors for the development of schizophrenia-spectrum psychopathology. In the present study, 103 participants (77% of 134 candidate participants) were reassessed at a three-year follow-up. As hypothesized, positive schizotypy predicted psychotic-like symptoms, depression, low self-esteem, and general psychopathology. Negative schizotypy predicted emotional disturbances, schizoid personality traits, and mental health treatment during the past year. As expected, both schizotypy dimensions predicted schizotypal, paranoid, and avoidant personality traits, and impaired functioning. These longitudinal findings provide additional evidence supporting the multidimensional model of schizotypy as a valid framework for studying etiological mechanisms and trajectories of psychosis.
Collapse
Affiliation(s)
- Anna Racioppi
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tamara Sheinbaum
- Department of Psychology, University of Southern California, Los Angeles, California, United States of America
| | - Georgina M. Gross
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Sergi Ballespí
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas R. Kwapil
- Department of Psychology, University of Illinois at Urbana–Champaign, Champaign, Illinois, United States of America
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
- Sant Pere Claver–Fundació Sanitària, Barcelona, Spain
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| |
Collapse
|
8
|
Abstract
Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the "severity continuum hypothesis", in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment.
Collapse
Affiliation(s)
- Lisa Lampe
- Discipline of Psychiatry, University of Newcastle, Newcastle, NSW, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
9
|
Schizophrenia spectrum personality disorders in psychometrically identified schizotypes at two-year follow-up. Psychiatry Res 2017; 252:289-295. [PMID: 28288440 DOI: 10.1016/j.psychres.2017.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/05/2016] [Accepted: 03/06/2017] [Indexed: 11/21/2022]
Abstract
Earlier (Bolinskey et al., 2015), we reported that psychometrically identified schizotypes displayed greater symptom levels and higher incidences of schizophrenia spectrum (schizotypal, schizoid, paranoid, and avoidant) personality disorders (PDs). In this study, 49 schizotypes and 39 matched controls participated in follow-up assessments after two years. Participants were previously identified as schizotypes or controls based on scores on the Chapman Psychosis Proneness Scales (CPPS), and were interviewed at baseline and follow-up with the Personality Disorder Interview for DSM-IV (PDI-IV). At follow-up, schizotypes displayed significantly higher symptom levels compared to controls, with medium to large effects, and appeared to meet criteria for diagnosis of each PD more often than controls, although significant differences were only observed for paranoid PD. Overall, schizotypes were more likely to have met criteria for a diagnosis at either baseline or follow-up. Finally, we observed a widening disparity over time between schizotypes and controls in avoidant and schizoid PDs. These results suggest that schizophrenia spectrum PDs, as well as subthreshold symptoms of these disorders, can represent a greater liability for schizophrenia in individuals identified as at-risk on the basis of psychometric means only. Furthermore, these findings demonstrate that such differences persist, and in some cases increase, over time.
Collapse
|
10
|
Goghari VM. Personality dimensions in schizophrenia: A family study. Psychiatry Res 2017; 251:162-167. [PMID: 28208077 DOI: 10.1016/j.psychres.2017.01.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 12/27/2016] [Accepted: 01/16/2017] [Indexed: 11/19/2022]
Abstract
Studies have demonstrated that personality traits differ in schizophrenia patients and family members compared to controls, suggesting familial risk. This study evaluated personality traits in a family study of schizophrenia, as well as the relationship between personality traits and symptoms and social functioning in schizophrenia patients. Thirty-two schizophrenia patients, 28 adult non-psychotic relatives, and 27 community controls completed the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). Schizophrenia patients differed on many dimensions of the DAPP-BQ compared to controls and/or relatives: affective lability, anxiousness, callousness, conduct problems, cognitive dysregulation, identity problem, intimacy, insecure attachment, low affiliation, narcissism, oppositionality, restricted expression, self-harm, submissiveness, and suspiciousness. No differences were found between relatives and controls. Furthermore, in schizophrenia patients, associations were found between personality and particularly general symptoms, as well as social functioning. Personality traits can be conceptualized as an extended phenotype in schizophrenia patients.
Collapse
Affiliation(s)
- Vina M Goghari
- Departments of Psychology and Psychological Clinical Science, University of Toronto, Canada.
| |
Collapse
|
11
|
Wei Y, Zhang T, Chow A, Tang Y, Xu L, Dai Y, Liu X, Su T, Pan X, Cui Y, Li Z, Jiang K, Xiao Z, Tang Y, Wang J. Co-morbidity of personality disorder in schizophrenia among psychiatric outpatients in China: data from epidemiologic survey in a clinical population. BMC Psychiatry 2016; 16:224. [PMID: 27391323 PMCID: PMC4939030 DOI: 10.1186/s12888-016-0920-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 06/22/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The reported rates of personality disorder (PD) in subjects with schizophrenia (SZ) are quite varied across different countries, and less is known about the heterogeneity of PD among subjects with SZ. We examined the co-morbidity of PD among patients who are in the stable phase of SZ. METHOD 850 subjects were randomly sampled from patients diagnosed with SZ in psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. Co-morbidity of PDs was assessed through preliminary screening and patients were administered several modules of the SCID-II. Evidence of heterogeneity was evaluated by comparing patients diagnosed with SZ with those who presented with either affective disorder or neurosis (ADN). RESULTS 204 outpatients (24.0 %) in the stable phase of SZ met criteria for at least one type of DSM-IV PD. There was a higher prevalence of Cluster-A (odd and eccentric PD) and C (anxious and panic PD) PDs in SZ (around 12.0 %). The most prevalent PD was the paranoid subtype (7.65 %). Subjects with SZ were significantly more likely to have schizotypal PD (4.4 % vs. 2.1 %, p = 0.003) and paranoid PD (7.6 % vs. 5.4 %, p = 0.034), but much less likely to have borderline, obsessive-compulsive, depressive, narcissistic and histrionic PD. CONCLUSIONS These findings suggest that DSM-IV PD is common in patients with SZ than in the general population. Patterns of co-morbidity with PDs in SZ are different from ADN.
Collapse
Affiliation(s)
- YanYan Wei
- Department of Medical Psychology, Faculty of Mental Health, Second Military Medical University, Shanghai, 200433 People’s Republic of China ,Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030 People’s Republic of China
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030 People’s Republic of China
| | - Annabelle Chow
- Department of Psychological Medicine, Changi General Hospital, Singapore, Singapore
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030 People’s Republic of China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030 People’s Republic of China
| | - YunFei Dai
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030 People’s Republic of China
| | - XiaoHua Liu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030 People’s Republic of China
| | - Tong Su
- Department of Medical Psychology, Faculty of Mental Health, Second Military Medical University, Shanghai, 200433 People’s Republic of China
| | - Xiao Pan
- Department of Medical Psychology, Faculty of Mental Health, Second Military Medical University, Shanghai, 200433 People’s Republic of China
| | - Yi Cui
- Department of Medical Psychology, Faculty of Mental Health, Second Military Medical University, Shanghai, 200433 People’s Republic of China
| | - ZiQiang Li
- Department of Medical Psychology, Faculty of Mental Health, Second Military Medical University, Shanghai, 200433 People’s Republic of China
| | - KaiDa Jiang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030 People’s Republic of China
| | - ZePing Xiao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030 People’s Republic of China
| | - YunXiang Tang
- Department of Medical Psychology, Faculty of Mental Health, Second Military Medical University, Shanghai, 200433, People's Republic of China.
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, People's Republic of China. .,Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, People's Republic of China.
| |
Collapse
|
12
|
Roisko R, Wahlberg KE, Hakko H, Tienari P. Association of adoptive child's thought disorders and schizophrenia spectrum disorders with their genetic liability for schizophrenia spectrum disorders, season of birth and parental Communication Deviance. Psychiatry Res 2015; 226:434-40. [PMID: 25746170 DOI: 10.1016/j.psychres.2014.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/31/2014] [Accepted: 12/22/2014] [Indexed: 12/14/2022]
Abstract
Joint effects of genotype and the environment have turned out to be significant in the development of psychotic disorders. The purpose of the present study was to assess the association of an adoptive child׳s thought and schizophrenia spectrum disorders with genetic and environmental risk indicators and their interactions. A subgroup of the total sample used in the Finnish Adoptive Family Study was considered in the present study. The subjects were 125 adoptees at a high (n=53) or low (n=72) genetic risk of schizophrenia spectrum disorders and their adoptive parents. The risk factors evaluated were the adoptive child's genetic risk for schizophrenia spectrum disorders, winter or spring birth and parental Communication Deviance (CD). Thought disorders in the adoptees were assessed using the Thought Disorder Index and diagnoses were made according to DSM-III-R criteria. The adoptive child׳s Thought Disorder Index was only associated with parental Communication Deviance. The adoptive child's heightened genetic risk or winter or spring birth or parental CD or their interactions did not predict the adoptee's schizophrenia spectrum disorder. The results suggest that studies taking several risk indicators and their interactions into account may change views on the mutual significance of well-known risk factors.
Collapse
Affiliation(s)
- Riikka Roisko
- Oulu University Hospital, Department of Psychiatry, Box 26, FI-90029 OYS, Finland.
| | - Karl-Erik Wahlberg
- Institute of Clinical Medicine, Department of Psychiatry, University of Oulu, Oulu, Finland
| | - Helinä Hakko
- Institute of Clinical Medicine, Department of Psychiatry, University of Oulu, Oulu, Finland
| | - Pekka Tienari
- Institute of Clinical Medicine, Department of Psychiatry, University of Oulu, Oulu, Finland
| |
Collapse
|
13
|
Bolinskey PK, James AV, Cooper-Bolinskey D, Novi JH, Hunter HK, Hudak DV, Schuder KM, Myers KR, Iati CA, Lenzenweger MF. Revisiting the blurry boundaries of schizophrenia: spectrum disorders in psychometrically identified schizotypes. Psychiatry Res 2015; 225:335-40. [PMID: 25555416 DOI: 10.1016/j.psychres.2014.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 11/24/2022]
Abstract
Certain Personality Disorders (PDs) have been found to be present in the prodromal phase of schizophrenia at a higher rate than other personality disorders. Although schizotypal, paranoid, and schizoid PDs are traditionally viewed as spectra for schizophrenia, research suggests that avoidant PD should be included in this group (e.g., Fogelson et al., 2007). The present study examines whether a sample of psychometrically identified schizotypes (SZT) have higher incidence of schizophrenia-spectrum PDs, as well as more symptoms of these PDs, in general, than does a matched comparison (MC) sample. Eighty-five SZT and 78 MC participants were administered the Personality Disorder Interview for DSM-IV (PDI-IV) to assess PD symptoms and diagnoses. Results indicate that the SZT group evidenced significantly more symptoms of avoidant, schizoid, paranoid, and schizotypal PDs than did the MC group. Further, there were significant differences in the incidence of these PDs between the groups.
Collapse
Affiliation(s)
- P Kevin Bolinskey
- Department of Psychology, Indiana State University, Terre Haute, IN, USA.
| | - Alison V James
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | | | - Jonathan H Novi
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Helen K Hunter
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Daniel V Hudak
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Kelly M Schuder
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Kevin R Myers
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Carina A Iati
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mark F Lenzenweger
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY USA
| |
Collapse
|
14
|
Abstract
Avoidant personality disorder (AvPD) is regarded as a severe variant of social phobia (SP), consistent with a dimensional model. However, these conclusions are largely drawn from studies based on individuals with SP, with or without comorbid AvPD. The present study hypothesized that there are qualitative differences between AvPD and SP that are undermined by limiting research to participants with SP. The authors sought to test this hypothesis by comparing three groups-SP only, AvPD only, and SP+AvPD-using data extracted from an epidemiological sample of 10,641 adults aged 18 years and over. Screening questions were used in the epidemiological survey to identify ICD-10 personality disorders; from this the author developed a proxy measure for DSM-IV AvPD. Axis I diagnoses, including DSM-IV SP, were identified using the Composite International Diagnostic Interview (CIDI). In this sample, the majority of those with AvPD did not also have SP: The authors found 116 persons with AvPD only, 196 with SP only, and 69 with SP+AvPD. There was little difference between any of the groups on sex, marital status, employment, education, or impairment variables. The SP+AvPD group reported more distress and comorbidity than the SP only and AvPD only groups, which did not differentiate from each other. More feared social situations were endorsed in the SP only group compared to the AvPD only group. Although the finding of few differences between SP only and AvPD only groups among the variables measured in this epidemiological survey fails to provide support for the hypothesis of qualitative differences, the finding that the AvPD only group appears more similar to the SP only group than to the SP+AvPD group also fails to provide support for the alternative continuity hypothesis. The greater distress and additional comorbidity with depression associated with SP+AvPD may be due to the additional symptom load of a second disorder rather than simply representing a more severe variant of social phobia. The use of a proxy for AvPD is a limitation of the study. Future studies should focus on broader clinical variables that have been proposed as qualitatively different between these disorders, and on the possible genetic and environmental factors that might help explain such differences.
Collapse
|
15
|
Bedwell JS, Compton MT, Jentsch FG, Deptula AE, Goulding SM, Tone EB. Latent factor modeling of four schizotypy dimensions with theory of mind and empathy. PLoS One 2014; 9:e113853. [PMID: 25415195 PMCID: PMC4240595 DOI: 10.1371/journal.pone.0113853] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/30/2014] [Indexed: 11/18/2022] Open
Abstract
Preliminary evidence suggests that theory of mind and empathy relate differentially to factors of schizotypy. The current study assessed 686 undergraduate students and used structural equation modeling to examine links between a four-factor model of schizotypy with performance on measures of theory of mind (Reading the Mind in the Eyes Test [MIE]) and empathy (Interpersonal Reactivity Index [IRI]). Schizotypy was assessed using three self-report measures which were simultaneously entered into the model. Results revealed that the Negative factor of schizotypy showed a negative relationship with the Empathy factor, which was primarily driven by the Empathic Concern subscale of the IRI and the No Close Friends and Constricted Affect subscales of the Schizotypal Personality Questionnaire. These findings are consistent with a growing body of literature suggesting a relatively specific relationship between negative schizotypy and empathy, and are consistent with several previous studies that found no relationship between MIE performance and schizotypy.
Collapse
Affiliation(s)
- Jeffrey S. Bedwell
- University of Central Florida, Department of Psychology, Orlando, Florida, United States of America
- * E-mail:
| | - Michael T. Compton
- Department of Psychiatry, Hofstra North Shore–LIJ School of Medicine at Hofstra University, Hempstead, New York, United States of America
| | - Florian G. Jentsch
- University of Central Florida, Department of Psychology, Orlando, Florida, United States of America
| | - Andrew E. Deptula
- University of Central Florida, Department of Psychology, Orlando, Florida, United States of America
| | - Sandra M. Goulding
- Graduate School of Arts and Sciences of Emory University, Department of Psychology, Atlanta, Georgia, United States of America
| | - Erin B. Tone
- Georgia State University, Department of Psychology, Atlanta, Georgia, United States of America
| |
Collapse
|
16
|
Foussias G, Agid O, Fervaha G, Remington G. Negative symptoms of schizophrenia: clinical features, relevance to real world functioning and specificity versus other CNS disorders. Eur Neuropsychopharmacol 2014; 24:693-709. [PMID: 24275699 DOI: 10.1016/j.euroneuro.2013.10.017] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/30/2013] [Accepted: 10/31/2013] [Indexed: 01/29/2023]
Abstract
Negative symptoms have long been recognized as a central feature of the phenomenology of schizophrenia, dating back to the early descriptions by Kraepelin and Bleuler. Over the ensuing century, there have been important clarifications and reconceptualizations regarding the phenomenology of negative symptoms in schizophrenia. This review explores these developments, including the delineation of two underlying subdomains of negative symptoms - amotivation (i.e., avolition/apathy and asociality) and diminished expression (i.e., poverty of speech and affective flattening). Further, advances in our understanding of specific motivational and hedonic deficits seen in schizophrenia are explored. The findings that negative symptoms stand apart from depressive and cognitive symptoms in schizophrenia are also discussed. In terms of the predictors of functional outcomes in schizophrenia, we explore both the direct role of negative symptoms in this regard, as well as their indirect role through cognition. We then broaden our examination of negative symptoms to related disorders across the schizophrenia spectrum, as well as to other neuropsychiatric illnesses, where negative symptoms have been increasingly recognized. We explore the differential characteristics of negative symptoms across these illnesses, and their relevance to functional outcomes. This transdiagnostic presence and relevance of negative symptoms highlights the need for continued exploration of their phenomenology and neurobiology as we move to develop effective interventions to address these debilitating symptoms and improve functional outcomes.
Collapse
Affiliation(s)
- George Foussias
- Centre for Addiction and Mental Health, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8.
| | - Ofer Agid
- Centre for Addiction and Mental Health, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8
| | - Gagan Fervaha
- Centre for Addiction and Mental Health, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| | - Gary Remington
- Centre for Addiction and Mental Health, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| |
Collapse
|
17
|
Maladaptive personality traits increase subjectively during the course of schizophrenia spectrum disorders. J Nerv Ment Dis 2014; 202:319-23. [PMID: 24647216 DOI: 10.1097/nmd.0000000000000125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We assessed both current maladaptive personality traits (MPTs) and, retrospectively, premorbid MPTs in patients with schizophrenia spectrum disorders (SSDs). This was to examine whether the patients had the impression that their personality had changed and which traits were affected. We also wanted to determine whether the perceived changes could be explained by SSD psychopathology. MPTs were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnoses, axis II disorders, screening questionnaire and interview, integrating questions on subjective estimation of premorbid MPTs in moderately ill SSD patients. Forty-five patients were included. Premorbid MPTs were remembered as significantly less pronounced than current MPTs for the whole spectrum of personality traits (p < 0.001). Antisocial traits had worsened significantly less (p < 0.001), and borderline and obsessive-compulsive traits had worsened significantly more (both p < 0.01) than the mean increase. Associations between MPT increase and SSD psychopathology were significant for schizotypal, avoidant, and depressive traits. According to the patients' retrospective assessment, MPTs increased through onset and course of SSDs. Memory bias, depressed mood, and SSD symptoms alone could not sufficiently explain these differences. Subjective MPT increase may play a role for the patients' concept of illness, quality of life, and adherence to therapeutic interventions. It should be addressed in SSD treatment.
Collapse
|
18
|
Skokou M, Gourzis P. Demographic features and premorbid personality disorder traits in relation to age of onset and sex in paranoid schizophrenia. Psychiatry Res 2014; 215:554-9. [PMID: 24495576 DOI: 10.1016/j.psychres.2014.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 01/08/2014] [Accepted: 01/11/2014] [Indexed: 11/25/2022]
Abstract
Personality disorders in the premorbid period of schizophrenia and particularly in relation to age of onset and sex, seem to be a rather under-researched area. In the present study, 88 patients with paranoid schizophrenia were examined, regarding demographic characteristics and premorbid personality disorder traits, in order to investigate for differences in the premorbid period of the disease, in relation to age of onset and sex. Age cutoff points were set at <30 years and ≥35 years of age for young and late onset groups, respectively. The Structured Clinical Interview for DSM-IV-Patient Edition for Axis I disorders (SCID-P) was used prospectively for diagnoses. Premorbid personality disorder traits were retrospectively assessed by using the Structured Clinical Interview for DSM-IV-Patient Edition for Axis II disorders (SCID-II). Comparisons were performed by applying the two-tailed Wilcoxon rank-sum and the χ(2) statistical tests. Young onset patients were characterized by significantly higher proportion of urban birth, single status, more avoidant premorbid personality disorder traits, and less passive-aggressive premorbid personality disorder traits, than late onset counterparts. Differences were more prominently shown in men. Earlier age of onset seems to be associated to increased social inhibition and worse psychosocial adaptation in the premorbid period of paranoid schizophrenia.
Collapse
Affiliation(s)
- Maria Skokou
- Department of Psychiatry, University Hospital of Patras, School of Medicine, University of Patras, University Campus, 26504 Rio, Patras, Greece.
| | - Philippos Gourzis
- Department of Psychiatry, University Hospital of Patras, School of Medicine, University of Patras, University Campus, 26504 Rio, Patras, Greece.
| |
Collapse
|
19
|
Zhang J, Wang W, Tan Z, Wu Q, Xiao W, Shang L, Zhang Y, Peng J, Miao D. Spatial analysis of schizotypal personality traits in Chinese male youths: evidence from a GIS-based analysis of Sichuan. Int J Ment Health Syst 2014; 8:3. [PMID: 24423022 PMCID: PMC3904416 DOI: 10.1186/1752-4458-8-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/08/2014] [Indexed: 11/21/2022] Open
Abstract
Background Schizotypal personality traits are associated with schizophrenia spectrum disorders, stating that schizotypal traits may represent a “prodrome” or other developmental precursor of schizophrenia. Genetic and environmental factors both play importanxt roles in the development of schizotypal traits. Different levels of schizotypal traits across regions may be indicative of similar differences in the incidence of schizophrenia. Aim The present study identifying where in a given region, schizotypal personality traits are more or less level of schizotypal personality scores in Chinese male youth of Sichuan province. Not only for research purposes but also for the evaluation of new draft and allocation policy initiatives intended to aid recruitment of mental health employees. Methods Data from the Psychological Selection Systems for Chinese Recruits, a mental health screening system used in China, collected in 2011 (67,558 copies) were used to map spatial distribution of schizotypal personality traits using geostatistics and geographic information system (GIS) techniques. Correlation analyses were conducted to explore the effects of years of education and illiterate rate on schizotypal personality traits. Results Maps for three schizotypal personality clinical scales (dissociative, Dit; neurotic, Net and sensitive, Set) showed similar geographical trends. The highest T scores were distributed mainly in the eastern and northern counties of Sichuan, with scores decreasing successively from east to west, with the eastern counties generally showing higher scores. Correlation analysis showed that t-scores of Set were negatively correlated with years of education, whereas t-scores of Net were negatively correlated with illiteracy rate. Conclusions Schizotypal personality traits in male youth showed specific geographical trends in Sichuan province, providing some evidence that kriging based on GIS can be used to geographically localize genetic and environmental factors associated with schizotypal personality traits. This approach could be used to help allocate public health resources to specific areas and could also have personnel selection applications.
Collapse
Affiliation(s)
- Jiaxi Zhang
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| | - Wei Wang
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| | - Zhijun Tan
- Department of Statistics, Fourth Military Medical University, Xi'an, China
| | - Qing Wu
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China.,Foreign Language Teaching and Researching Office of Basic Education Department, Chongqing Communication Institute, Chongqing, China
| | - Wei Xiao
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| | - Lei Shang
- Department of Statistics, Fourth Military Medical University, Xi'an, China
| | - Yan Zhang
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| | - Jiaxi Peng
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| | - Danmin Miao
- Department of Psychology, Fourth Military Medical University, Chang Le Western Street No.169, Xi'an, Shannxi, China
| |
Collapse
|
20
|
Eikenaes I, Hummelen B, Abrahamsen G, Andrea H, Wilberg T. Personality functioning in patients with avoidant personality disorder and social phobia. J Pers Disord 2013; 27:746-63. [PMID: 23786266 DOI: 10.1521/pedi_2013_27_109] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Avoidant personality disorder (APD) and social phobia (SP) are closely related, such that they are suggested to represent different severity levels of one social anxiety disorder. This cross-sectional study aimed to compare patients with APD to patients with SP, with particular focus on personality dysfunction. Ninety-one adult patients were examined by diagnostic interviews and self-report measures, including the Index of Self-Esteem and the Severity Indices of Personality Problems. Patients were categorized in three groups; SP without APD (n = 20), APD without SP (n = 15), and APD with SP (n = 56). Compared to patients with SP without APD, patients with APD reported more symptom disorders, psychosocial problems, criteria of personality disorders, and personality dysfunction regarding self-esteem, identity and relational problems. These results indicate that APD involves more severe and broader areas of personality dysfunction than SP, supporting the conceptualization of APD as a personality disorder as proposed for DSM-5.
Collapse
|
21
|
Abstract
Early phenomenological descriptions of schizophrenia have acknowledged the existence of milder schizophrenia spectrum disorders characterized by the presence of attenuated symptoms typically present in chronic schizophrenia. The investigation of the schizophrenia spectrum disorders offers an opportunity to elucidate the pathophysiological mechanisms giving rise to schizophrenia. Differences and similarities between subjects with schizotypal personality disorder (SPD), the prototypical schizophrenia personality disorder, and chronic schizophrenia have been investigated with genetic, neurochemical, imaging, and pharmacological techniques. Patients with SPD and the more severely ill patients with chronic schizophrenia share cognitive, social, and attentional deficits hypothesized to result from common neurodevelopmentally based cortical temporal and prefrontal pathology. However, these deficits are milder in SPD patients due to their capacity to recruit other related brain regions to compensate for dysfunctional areas. Individuals with SPD are also less vulnerable to psychosis due to the presence of protective factors mitigating subcortical DA hyperactivity. Given the documented close relationship to other schizophrenic disorders, SPD will be included in the psychosis section of DSM-5 as a schizophrenia spectrum disorder as well as in the personality disorder section.
Collapse
|
22
|
Murphy J, Shevlin M, Adamson G, Houston JE. From sexual abuse to psychosis: A pilot study exploring the social deafferentation hypothesis and the mediating role of avoidance. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2013. [DOI: 10.1080/17522439.2011.622781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
23
|
Abstract
Schizoid personality disorder (ScPD) is one of the "odd cluster" or "cluster A" personality disorders in DSM-IV. In the present article, the authors review information pertaining to the psychometric characteristics of ScPD as gleaned from a search of relevant publications as well as from databases of personality disorder study groups. Comparatively little evidence exists for the validity and reliability of ScPD as a separate, multifaceted personality disorder. Some authors, moreover, have contended that the group of patients termed "schizoid" actually fall into two distinct groups--an "affect constricted" group, who might better be subsumed within schizotypal personality disorder, and a "seclusive" group, who might better be subsumed within avoidant personality disorder. The research-based justification for retaining ScPD as an independent diagnosis is sufficiently sparse for it to seem reasonable to remove ScPD from the list of personality disorders in DSM-V, and instead to invite clinicians to code for schizoid traits using a dimensional model.
Collapse
|
24
|
Schultze-Lutter F, Klosterkötter J, Michel C, Winkler K, Ruhrmann S. Personality disorders and accentuations in at-risk persons with and without conversion to first-episode psychosis. Early Interv Psychiatry 2012; 6:389-98. [PMID: 22260339 DOI: 10.1111/j.1751-7893.2011.00324.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Cluster A personality disorders (PDs), particularly schizotypal PD, are considered a part of the schizophrenia spectrum and a risk factor of psychosis. The role of PDs and personality accentuations (PAs) in predicting conversion to psychosis was studied in patients symptomatically considered at risk, assuming a major role of the schizotypal subtype. METHODS PDs and PAs, assessed at baseline with a self-report questionnaire, were compared between risk-, gender- and age-matched at-risk patients with (n = 50) and without conversion to psychosis (n = 50). RESULTS Overall, Cluster A-PDs were the least frequent cluster (14%), and schizotypal PD was rare (7%). Yet, PDs in general were frequent (46%), especially Cluster B- (31%) and C-PDs (23%). Groups did not differ in frequencies of PDs, yet converters tended to have a higher expression of schizoid (P = 0.057) and Cluster A-PAs (P = 0.027). In regression analyses, schizoid PA was selected as sole but weak predictor of conversion (OR = 1.685; 95% CIs: 1.134/2.504). CONCLUSIONS Unexpectedly, schizotypal PD was infrequent and did not predict conversion. Conversion was best predicted by schizoid PA, indicating more severe, persistent social deficits already at baseline in later converters. This corresponds to premorbid social deficits reported for genetic high-risk children and low social functioning in at-risk patients later converting to psychosis. Further, PDs occurred frequently in at-risk patients irrespective of conversion. As psychopathology and personality relate closely to one another, this result highlights that, beyond the current narrow focus on schizotypal PD, personality-related factors should be considered more widely in the prevention of psychosis.
Collapse
Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry, Research Department, Bern, Switzerland.
| | | | | | | | | |
Collapse
|
25
|
Lynam DR, Loehr A, Miller JD, Widiger TA. A Five-Factor Measure of Avoidant Personality: The FFAvA. J Pers Assess 2012; 94:466-74. [DOI: 10.1080/00223891.2012.677886] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
26
|
Pulay AJ, Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Saha TD, Smith SM, Pickering RP, Ruan WJ, Hasin DS, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV schizotypal personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 11:53-67. [PMID: 19617934 DOI: 10.4088/pcc.08m00679] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 08/25/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To present nationally representative findings on the prevalence, correlates, and comorbidity of and disability associated with DSM-IV schizotypal personality disorder (SPD). METHOD This study used the 2004-2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, which targeted a nationally representative sample of the adult civilian population of the United States aged 18 years and older and residing in households and group quarters. In Wave 2, attempts were made to conduct face-to-face reinterviews with all respondents to the Wave 1 interview. RESULTS Lifetime prevalence of SPD was 3.9%, with significantly greater rates among men (4.2%) than women (3.7%) (p < .01). Odds for SPD were significantly greater among black women, individuals with lower incomes, and those who were separated, divorced, or widowed; odds were significantly lower among Asian men (all p < .01). Schizotypal personality disorder was associated with substantial mental disability in both sexes. Co-occurrence rates of Axis I and other Axis II disorders among respondents with SPD were much higher than rates of co-occurrence of SPD among respondents with other disorders. After adjustment for sociodemographic characteristics and additional comorbidity, associations remained significant in both sexes between SPD and 12-month and lifetime bipolar I disorder, social and specific phobias, and posttraumatic stress disorder, as well as 12-month bipolar II disorder, lifetime generalized anxiety disorder, and borderline and narcissistic personality disorders (all p < .01). CONCLUSIONS Common and unique factors may underlie associations of SPD with narcissistic and borderline personality disorders, whereas much of the comorbidity between SPD and most mood and anxiety disorders appears to reflect factors common to these disorders. Some of the associations with SPD were sex specific. Schizotypal personality disorder and dependent, avoidant, and borderline personality disorders were associated with the occurrence of schizophrenia or psychotic episode. Schizotypal personality disorder is a prevalent, fairly stable, highly disabling disorder in the general population. Sex differences in associations of SPD with other specific Axis I and II disorders can inform more focused, hypothesis-driven investigations of factors underlying the comorbid relationships. Schizotypal as well as borderline, dependent, and avoidant personality disorders may be components of the schizophrenia spectrum.
Collapse
Affiliation(s)
- Attila J Pulay
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Margari F, Petruzzelli MG, Lecce PA, Todarello O, De Giacomo A, Lucarelli E, Martinelli D, Margari L. Familial liability, obstetric complications and childhood development abnormalities in early onset schizophrenia: a case control study. BMC Psychiatry 2011; 11:60. [PMID: 21492438 PMCID: PMC3090339 DOI: 10.1186/1471-244x-11-60] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 04/14/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Genetic and environmental risk factors and gene-environment interactions are linked to higher likelihood of developing schizophrenia in accordance with the neurodevelopmental model of disease; little is known about risk factors and early development in early-onset schizophrenia (EOS) and very early-onset schizophrenia (VEOS). METHODS We present a case-control study of a sample of 21 patients with EOS/VEOS and a control group of 21 patients with migraine, recruited from the Child Neuropsychiatry Unit, Department of Neurologic and Psychiatric Science, University of Bari, Italy. The aim was to assess the statistical association between VEOS/EOS and family history for psychiatric disorders, obstetric complications and childhood developmental abnormalities using 2 × 2 tables and a Chi Squared or Fisher test. RESULTS The results show a statistical association between EOS/VEOS and schizophrenia and related disorders (P = 0.02) and personality disorders (P = 0.003) in relatives, and between EOS/VEOS and developmental abnormalities of early relational skills (P = 0.008) and learning (P = 0.04); there is not a statistically relevant difference between cases and controls (P > 0.05) for any obstetric complications (pre, peri and postpartum). CONCLUSIONS This study confirms the significant role of familial liability but not of obstetric complications in the pathogenesis of VEOS/EOS; the association between childhood developmental abnormalities and EOS/VEOS supports the neurodevelopmental model of disease.
Collapse
Affiliation(s)
- Francesco Margari
- Department of Neurologic and Psychiatric Sciences, Child Neuropsychiatric Unit, University of Bari, Bari, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Skodol AE, Bender DS, Morey LC, Clark LA, Oldham JM, Alarcon RD, Krueger RF, Verheul R, Bell CC, Siever LJ. Personality disorder types proposed for DSM-5. J Pers Disord 2011; 25:136-69. [PMID: 21466247 DOI: 10.1521/pedi.2011.25.2.136] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Personality and Personality Disorders Work Group has proposed five specific personality disorder (PD) types for DSM-5, to be rated on a dimension of fit: antisocial/psychopathic, avoidant, borderline, obsessive-compulsive, and schizotypal. Each type is identified by core impairments in personality functioning, pathological personality traits, and common symptomatic behaviors. The other DSM-IV-TR PDs and the large residual category of personality disorder not otherwise specified (PDNOS) will be represented solely by the core impairments combined with specification by individuals' unique sets of personality traits. This proposal has three main features: (1) a reduction in the number of specified types from 10 to 5; (2) description of the types in a narrative format that combines typical deficits in self and interpersonal functioning and particular configurations of traits and behaviors; and (3) a dimensional rating of the degree to which a patient matches each type. An explanation of these modifications in approach to diagnosing PD types and their justifications--including excessive co-morbidity among DSM-IV-TR PDs, limited validity for some existing types, lack of specificity in the definition of PD, instability of current PD criteria sets, and arbitrary diagnostic thresholds--are the subjects of this review.
Collapse
Affiliation(s)
- Andrew E Skodol
- University of Arizona College of Medicine and Sunbelt Collaborative, 6340 N. Campbell Ave., Tucson, AZ 85718, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Yu S, Li H, Liu W, Zheng L, Ma Y, Chen Q, Chen Y, Yu H, Lu Y, Pan B, Wang W. Alexithymia and personality disorder functioning styles in paranoid schizophrenia. Psychopathology 2011; 44:371-8. [PMID: 21847004 DOI: 10.1159/000325168] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 01/17/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Personality disorder functioning styles might contribute to the inconclusive findings about alexithymic features in schizophrenia. We therefore studied the relationship between alexithymia and personality styles in paranoid schizophrenia. METHODS We administered the Chinese versions of the Toronto Alexithymia Scale (TAS-20), the Parker Personality Measure (PERM), the Positive and Negative Syndrome Scale as well as the Hamilton Anxiety and Depression Scales to 60 paranoid schizophrenia patients and 60 healthy control subjects. RESULTS Patients scored significantly higher on the Positive and Negative Syndrome Scale, TAS 'difficulty identifying feelings' and 'difficulty describing feelings', Hamilton Depression Scale and most PERM scales. In healthy subjects, difficulty identifying feelings predicted the PERM 'dependent' style, and the Hamilton Anxiety Scale predicted difficulty identifying feelings and difficulty describing feelings. In patients, difficulty identifying feelings nonspecifically predicted all the PERM scales; by contrast, the PERM 'antisocial' style predicted difficulty identifying feelings, the 'avoidant' style predicted difficulty describing feelings, and the 'histrionic' and 'paranoid (-)' styles predicted 'externally oriented thinking'. CONCLUSIONS Personality disorder functioning styles - instead of anxiety, depression, psychotic symptoms or disease duration - were specifically associated with alexithymia scales in our patients, which sheds light on a cognitive-personological substrate in paranoid schizophrenia on the one hand, and calls for a longitudinal design to discover how premorbid or postacute residual personality styles contribute to the sluggish disorder on the other.
Collapse
Affiliation(s)
- Shaohua Yu
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
|
31
|
Yang Y, Nuechterlein KH, Phillips O, Hamilton LS, Subotnik KL, Asarnow RF, Toga AW, Narr KL. The contributions of disease and genetic factors towards regional cortical thinning in schizophrenia: the UCLA family study. Schizophr Res 2010; 123:116-25. [PMID: 20817413 PMCID: PMC2988766 DOI: 10.1016/j.schres.2010.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 07/27/2010] [Accepted: 08/03/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cortical thickness reductions in prefrontal and temporal cortices have been repeatedly observed in patients with schizophrenia. However, it remains unclear whether regional variations in cortical thickness may be attributable to disease-related or genetic-liability factors. METHOD The structural magnetic resonance imaging data of 48 adult-onset schizophrenia patients, 66 first-degree non-psychotic relatives of schizophrenia patients, 27 community comparison (CC) probands and 77 CC relatives were examined using cortical pattern matching methods to map and compare highly localized changes in cortical gray matter thickness between groups defined by biological risk for schizophrenia. RESULTS Schizophrenia patients showed marked cortical thinning primarily in frontal and temporal cortices when compared to unrelated CC probands. Results were similar, though less pronounced when patients were compared with their non-psychotic relatives. Cortical thickness reductions observed in unaffected relatives compared to age-similar CC relatives suggestive of schizophrenia-related genetic liability were marginal, surviving correction for the left parahippocampal gyrus and inferior occipital cortex only. CONCLUSIONS Observations of pronounced fronto/temporal cortical thinning in schizophrenia patients replicate prior findings. The lack of marked cortical thickness alterations in non-psychotic relatives of patients, suggests that disease processes are primary contributors toward cortical thickness reductions in the disorder. However, genetic factors may have a larger influence on abnormalities in the medial temporal lobe.
Collapse
Affiliation(s)
- Yaling Yang
- Laboratory of Neuro Imaging, Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States.
| | - Keith H. Nuechterlein
- Department of Psychology, UCLA, Los Angeles, CA
,The Jane & Terry Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Owen Phillips
- Laboratory of Neuro Imaging, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Liberty S. Hamilton
- Laboratory of Neuro Imaging, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kenneth L. Subotnik
- The Jane & Terry Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Robert F. Asarnow
- Department of Psychology, UCLA, Los Angeles, CA
,The Jane & Terry Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Arthur W. Toga
- Laboratory of Neuro Imaging, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Katherine L. Narr
- Laboratory of Neuro Imaging, Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|
32
|
Fogelson DL, Asarnow RA, Sugar CA, Subotnik KL, Jacobson KC, Neale MC, Kendler KS, Kuppinger H, Nuechterlein KH. Avoidant personality disorder symptoms in first-degree relatives of schizophrenia patients predict performance on neurocognitive measures: the UCLA family study. Schizophr Res 2010; 120:113-20. [PMID: 20053537 PMCID: PMC2888850 DOI: 10.1016/j.schres.2009.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 12/02/2009] [Accepted: 12/04/2009] [Indexed: 11/30/2022]
Abstract
Whether avoidant personality disorder symptoms are related to neurocognitive impairments that aggregate in relatives of schizophrenics is unknown. We report the relationship between avoidant personality disorder symptoms and neurocognitive performance in the first-degree relatives of probands with schizophrenia. 367 first-degree relatives of probands with schizophrenia and 245 relatives of community controls were interviewed for the presence of avoidant personality symptoms and symptoms of paranoid and schizotypal personality disorders and administered neurocognitive measures. Relationships between neurocognitive measures and avoidant symptoms were analyzed using linear mixed models. Avoidant dimensional scores predicted performance on the span of apprehension (SPAN), 3-7 Continuous Performance Test (3-7 CPT), and Trail Making Test (TMT-B) in schizophrenia relatives. These relationships remained significant on the SPAN even after adjustment for paranoid or schizotypal dimensional scores and on the TMT-B after adjustment for paranoid dimensional scores. Moreover, in a second set of analyses comparing schizophrenia relatives to controls there were significant or trending differences in the degree of the relationship between avoidant symptoms and each of these neurocognitive measures even after adjustments for paranoid and schizotypal dimensional scores. The substantial correlation between avoidant and schizotypal symptoms suggests that these personality disorders are not independent. Avoidant and in some cases schizotypal dimensional scores are significant predictors of variability in these neurocognitive measures. In all analyses, higher levels of avoidant symptoms were associated with worse performance on the neurocognitive measures in relatives of schizophrenia probands. These results support the hypothesis that avoidant personality disorder may be a schizophrenia spectrum phenotype.
Collapse
Affiliation(s)
- D. L. Fogelson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA
| | - R. A. Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA.,Department of Psychology, UCLA
| | - C. A. Sugar
- Department of Biostatistics, UCLA School of Public Health
| | - K. L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA
| | - K. C. Jacobson
- Department of Psychiatry and Human Genetics, Medical College of Virginia, of Virginia Commonwealth University, Richmond, VA, USA
| | - M. C. Neale
- Department of Psychiatry and Human Genetics, Medical College of Virginia, of Virginia Commonwealth University, Richmond, VA, USA
| | - K. S. Kendler
- Department of Psychiatry and Human Genetics, Medical College of Virginia, of Virginia Commonwealth University, Richmond, VA, USA
| | - H. Kuppinger
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA
| | - K. H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA.,Department of Psychology, UCLA
| |
Collapse
|
33
|
Abstract
Genetic epidemiologic studies indicate that all ten personality disorders (PDs) classified on the DSM-IV axis II are modestly to moderately heritable. Shared environmental and nonadditive genetic factors are of minor or no importance. No sex differences have been identified. Multivariate studies suggest that the extensive comorbidity between the PDs can be explained by three common genetic and environmental risk factors. The genetic factors do not reflect the DSM-IV cluster structure, but rather: i) broad vulnerability to PD pathology or negative emotionality; ii) high impulsivity/low agreeableness; and iii) introversion. Common genetic and environmental liability factors contribute to comorbidity between pairs or clusters of axis I and axis II disorders. Molecular genetic studies of PDs, mostly candidate gene association studies, indicate that genes linked to neurotransmitter pathways, especially in the serotonergic and dopaminergic systems, are involved. Future studies, using newer methods like genome-wide association, might take advantage of the use of endophenotypes.
Collapse
Affiliation(s)
- Ted Reichborn-Kjennerud
- Division of Mental Health, Norwegian Institute of Public Health Institute of Psychiatry, University of Oslo, Norway.
| |
Collapse
|
34
|
BOLINSKEY PKEVIN, GOTTESMAN IRVINGI. Premorbid personality indicators of schizophrenia-related psychosis in a hypothetically psychosis-prone college sample. Scand J Psychol 2010; 51:68-74. [DOI: 10.1111/j.1467-9450.2009.00730.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
35
|
Bögels SM, Alden L, Beidel DC, Clark LA, Pine DS, Stein MB, Voncken M. Social anxiety disorder: questions and answers for the DSM-V. Depress Anxiety 2010; 27:168-89. [PMID: 20143427 DOI: 10.1002/da.20670] [Citation(s) in RCA: 239] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues. METHOD A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V. RESULTS/CONCLUSIONS Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a "predominantly performance" variety of SAD. A specifier based on "fear of showing anxiety symptoms" (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young child's avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options.
Collapse
Affiliation(s)
- Susan M Bögels
- Child Development and Education, University of Amsterdam, 1018VZ Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
36
|
McMillan KA, Enns MW, Cox BJ, Sareen J. Comorbidity of Axis I and II mental disorders with schizophrenia and psychotic disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:477-86. [PMID: 19660170 DOI: 10.1177/070674370905400709] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the comorbidity of Axis I and II disorders within a community-based sample of adults with schizophrenia. METHODS The study was conducted using data from the National Epidemiologic Survey of Alcohol and Related Conditions. A diagnosis of schizophrenia was based on respondents' self-report that they had been diagnosed by a health professional with schizophrenia or a psychotic illness or episode (SPIE). Axis I disorders and Axis II personality disorders (PDs) were assessed using the Alcohol Use Disorders and Associated Disabilities Interview Schedule. Mental and physical quality of life were assessed using the Medical Outcomes Study Short Form 12 questionnaire. RESULTS The prevalence of SPIE was 0.9%. We used multiple logistic regression to examine the association between the presence and absence of SPIE in Axis I and II mental disorders. Each of the Axis I and II mental disorders examined were significantly associated with a diagnosis of SPIE after controlling for age, sex, education, marital status, and household income. CONCLUSIONS Clinicians should be aware of the patterns and extent of psychiatric comorbidities that may exist in schizophrenia. Possible mechanisms of these associations are discussed.
Collapse
|
37
|
Kendler KS, Aggen SH, Czajkowski N, Røysamb E, Tambs K, Torgersen S, Neale MC, Reichborn-Kjennerud T. The structure of genetic and environmental risk factors for DSM-IV personality disorders: a multivariate twin study. ACTA ACUST UNITED AC 2008; 65:1438-46. [PMID: 19047531 DOI: 10.1001/archpsyc.65.12.1438] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Although both genetic and environmental factors affect risk of individual personality disorders (PDs), we know little of how they contribute to the pattern of comorbidity between the PDs in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV). OBJECTIVE To clarify the structure of the genetic and environmental risk factors for the 10 DSM-IV PDs. DESIGN Assessment of PDs at personal interview and multivariate twin modeling with the Mx program. SETTING General community. PARTICIPANTS A total of 2794 young adult members of the Norwegian Institute of Public Health Twin Panel. Main Outcome Measure Number of endorsed criteria for the 10 DSM-IV PDs. RESULTS The best-fit multivariate twin model required 3 genetic and 3 individual-specific environmental factors and genetic and individual-specific factors unique to each PD. The first genetic factor had high loadings on PDs from all 3 clusters including paranoid, histrionic, borderline, narcissistic, dependent, and obsessive-compulsive. The second genetic factor had substantial loadings only on borderline and antisocial PD. The third genetic factor had high loadings only on schizoid and avoidant PD. Several PDs had substantial disorder-specific genetic risk factors. The first, second, and third individual-specific environmental factors had high loadings on the cluster B, A, and C PDs, respectively, with 1 exception: obsessive-compulsive PD loaded with cluster B and not cluster C PDs. CONCLUSIONS Genetic risk factors for DSM-IV PDs do not reflect the cluster A, B, and C typology. Rather, 1 genetic factor reflects a broad vulnerability to PD pathology and/or negative emotionality. The 2 other genetic factors are more specific and reflect high impulsivity/low agreeableness and introversion. Unexpectedly, the cluster A, B, and C typology is well reflected in the structure of environmental risk factors, suggesting that environmental experiences may be responsible for the tendency of cluster A, B, and C PDs to co-occur.
Collapse
Affiliation(s)
- Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, PO Box 980126, Richmond, VA 23298-0126, USA.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
This review of the literature on genetic contributions to the etiology of personality disorders broadly follows the DSM classification, and begins by evaluating the current evidence for genetic influences on the DSM axis II disorders. One of the most exciting directions in psychiatric genetics is the rapidly developing field of molecular genetic studies aiming to identify specific genes correlated with psychiatric phenotypes. Personality disorders, like most other psychiatric diagnostic categories, are etiologically complex, which implies that they are influenced by several genes and several environmental factors. The interplay between genes and the environment is a field that is receiving increasing attention and is addressed both in relation to quantitative and molecular methods.
Collapse
Affiliation(s)
- Ted Reichborn-Kjennerud
- Division of Mental Health, Department of Adult Mental Health, Norwegian Institute of Public Health, Box 4404 Nydalen, N-0403 Oslo, Norway
| |
Collapse
|
39
|
Smith MJ, Cloninger CR, Harms MP, Csernansky JG. Temperament and character as schizophrenia-related endophenotypes in non-psychotic siblings. Schizophr Res 2008; 104:198-205. [PMID: 18718739 PMCID: PMC2565802 DOI: 10.1016/j.schres.2008.06.025] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 06/27/2008] [Accepted: 06/29/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Quantitative endophenotypes are needed to better understand the pathogenesis of schizophrenia. The psychobiological model of temperament and character suggests that personality traits are heritable and regulated by brain systems influencing schizophrenia susceptibility. Thus, measures of temperament and character may serve as schizophrenia-related endophenotypes in individuals with schizophrenia and their non-psychotic siblings. METHODS Individuals with schizophrenia (n=35), their non-psychotic siblings (n=34), controls (n=63), and their siblings (n=56) participated in a study of the clinical, neurocognitive and neuromorphological characteristics of schizophrenia. A mixed-model approach assessed group differences on the Temperament and Character Inventory (TCI). Neurocognitive deficits and psychopathology were correlated with the TCI. Configurations of TCI domains were examined using a generalized linear model. RESULTS Individuals with schizophrenia and their non-psychotic siblings had higher harm avoidance than controls and their siblings. Individuals with schizophrenia had lower self-directedness and cooperativeness, and higher self-transcendence than their non-psychotic siblings, controls, and the siblings of controls. Neurocognition was not related to temperament and character in individuals with schizophrenia or either control group. In non-psychotic siblings, self-directedness and cooperativeness were correlated with working memory and crystallized IQ. CONCLUSION Evidence supports harm avoidance as a schizophrenia-related endophenotype. An increased risk of schizophrenia may be associated with asociality (configured as high harm avoidance and low reward dependence), schizotypy (configured as low self-directedness, low cooperativeness, and high self-transcendence), and neurocognitive deficits (poor executive functioning, working/episodic memory, attention, and low IQ). The non-psychotic siblings demonstrated features of a mature character profile including strong crystallized IQ, which may confer protection against psychopathology.
Collapse
Affiliation(s)
- Matthew J Smith
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL 60611, United States.
| | | | | | | |
Collapse
|
40
|
Gooding DC, Tallent KA, Matts CW. Rates of avoidant, schizotypal, schizoid and paranoid personality disorders in psychometric high-risk groups at 5-year follow-up. Schizophr Res 2007; 94:373-4. [PMID: 17543501 PMCID: PMC1989688 DOI: 10.1016/j.schres.2007.04.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Revised: 04/18/2007] [Accepted: 04/23/2007] [Indexed: 11/17/2022]
|