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Salazar de Pablo G, Moreno D, Gonzalez-Pinto A, Paya B, Castro-Fonieles J, Baeza I, Graell M, Arango C, Rapado-Castro M, Moreno C. Affective symptom dimensions in early-onset psychosis over time: a principal component factor analysis of the Young Mania Rating Scale and the Hamilton Depression Rating Scale. Eur Child Adolesc Psychiatry 2022; 31:1715-1728. [PMID: 34052909 DOI: 10.1007/s00787-021-01815-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/23/2021] [Indexed: 12/11/2022]
Abstract
Early-onset psychosis (EOP) is a complex disorder characterized by a wide range of symptoms, including affective symptoms. Our aim was to (1) examine the dimensional structure of affective symptoms in EOP, (2) evaluate the predominance of the clinical dimensions and (3) assess the progression of the clinical dimensions over a 2-year period. STROBE-compliant prospective principal component factor analysis of Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale-21 (HDRS-21) at baseline, 6-months, 1-year and 2-year follow-up. We included 108 EOP individuals (mean age = 15.5 ± 1.8 years, 68.5% male). The factor analysis produced a four-factor model including the following dimensions: mania, depression/anxiety, sleep and psychosis. It explained 47.4% of the total variance at baseline, 60.6% of the total variance at 6-months follow-up, 54.5% of the total variance at 1-year follow-up and 49.5% of the total variance at 2-year follow-up. According to the variance explained, the mania factor was predominant at baseline (17.4%), 6-month follow-up (23.5%) and 2-year follow-up (26.1%), while the depression/anxiety factor was predominant at 1-year follow-up (23.1%). The mania factor was the most stable; 58.3% items that appeared in this factor (with a load > 0.4) at any time point appeared in the same factor at ≥ 3/4 time points. Affective symptoms are frequent and persistent in EOP. Mania seems to be the most predominant and stable affective dimension. However, depression and anxiety may gain predominance with time. A comprehensive evaluation of the dimensional structure and the progression of affective symptoms may offer clinical and therapeutic advantages.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain.,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dolores Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain
| | - Ana Gonzalez-Pinto
- Department of Psychiatry, Biomedical Research Networking Centre in Mental Health, BioAraba Research Institute, OSI Araba-University Hospital, University of the Basque Country (EHU/UPV), CIBERSAM, Vitoria, Spain
| | - Beatriz Paya
- Department of Child Psychiatry, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Josefina Castro-Fonieles
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesús, School of Medicine, Universidad Autónoma, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain
| | - Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain. .,Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Victoria, Australia.
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain
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Watson D, Levin-Aspenson HF, Waszczuk MA, Conway CC, Dalgleish T, Dretsch MN, Eaton NR, Forbes MK, Forbush KT, Hobbs KA, Michelini G, Nelson BD, Sellbom M, Slade T, South SC, Sunderland M, Waldman I, Witthöft M, Wright AGC, Kotov R, Krueger RF. Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum. World Psychiatry 2022; 21:26-54. [PMID: 35015357 PMCID: PMC8751579 DOI: 10.1002/wps.20943] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.
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Affiliation(s)
- David Watson
- Department of Psychology, University of Notre Dame, South Bend, IN, USA
| | | | - Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | | | - Tim Dalgleish
- Medical Research Council, Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Michael N Dretsch
- US Army Medical Research Directorate - West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Kelsey A Hobbs
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Giorgia Michelini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Tim Slade
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Susan C South
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Matthew Sunderland
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Irwin Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Michael Witthöft
- Department for Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
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Watson D, Clark LA. Personality traits as an organizing framework for personality pathology. Personal Ment Health 2020; 14:51-75. [PMID: 31309725 PMCID: PMC6960378 DOI: 10.1002/pmh.1458] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
Abstract
We review evidence establishing important parallels between the general structure of psychopathology, the more specific structure of personality pathology and the structure of normal-range personality. We then present data to explicate the nature of associations between the alternative model of personality disorder (AMPD)-as operationalized by the Personality Inventory for DSM-5-and the domains and facets subsumed within the five-factor model of personality. Our data demonstrate substantial links between four of the five domains within these models but also indicate that the AMPD could be realigned to enhance its convergence with the five-factor model of personality. Based on our data, we tentatively propose an expanded four-facet model of AMPD Negative Affectivity (Anxiousness, Depressivity, Hostility and Emotional Lability); an alternative bipolar scheme for Detachment that includes two positively keyed (Withdrawal and Anhedonia) and two negatively keyed (Risk Taking and Attention Seeking) facets; a broader five-facet model of Antagonism (Deceitfulness, Manipulativeness, Callousness, Grandiosity and Suspiciousness); and a reduced two-facet model of Disinhibition (Irresponsibility and Impulsivity). These alternative scores generally showed superior convergent and discriminant validity when compared with current measures of the AMPD domains but also raise other issues. Our findings highlight the strong overlap between normal and pathological personality and clarify the nature of the associations between them. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
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Vulnerability to bipolar disorder is linked to sleep and sleepiness. Transl Psychiatry 2019; 9:294. [PMID: 31712668 PMCID: PMC6848097 DOI: 10.1038/s41398-019-0632-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/01/2019] [Accepted: 10/20/2019] [Indexed: 12/16/2022] Open
Abstract
Sleep impairments are a hallmark of acute bipolar disorder (BD) episodes and are present even in the euthymic state. Studying healthy subjects who are vulnerable to BD can improve our understanding of whether sleep impairment is a predisposing factor. Therefore, we investigated whether vulnerability to BD, dimensionally assessed by the hypomanic personality scale (HPS), is associated with sleep disturbances in healthy subjects. We analyzed participants from a population-based cohort who had completed the HPS and had either a 7-day actigraphy recording or a Pittsburgh sleep quality index (PSQI) assessment. In addition, subjects had to be free of confounding diseases or medications. This resulted in 771 subjects for actigraphy and 1766 for PSQI analyses. We found strong evidence that higher HPS scores are associated with greater intraindividual sleep variability, more disturbed sleep and more daytime sleepiness. In addition, factor analyses revealed that core hypomanic features were especially associated with self-reported sleep impairments. Results support the assumption of disturbed sleep as a possibly predisposing factor for BD and suggest sleep improvement as a potential early prevention target.
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Watson D, Stanton K, Khoo S, Ellickson-Larew S, Stasik-O'Brien SM. Extraversion and psychopathology: A multilevel hierarchical review. JOURNAL OF RESEARCH IN PERSONALITY 2019. [DOI: 10.1016/j.jrp.2019.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Carpenter RW, Stanton K, Emery NN, Zimmerman M. Positive and Negative Activation in the Mood Disorder Questionnaire: Associations With Psychopathology and Emotion Dysregulation in a Clinical Sample. Assessment 2019; 27:219-231. [PMID: 31137947 DOI: 10.1177/1073191119851574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Mood Disorder Questionnaire is a screening measure for bipolar disorder, previously found to comprise separate Positive and Negative Activation subscales. We sought to replicate these factors and examine their associations with a range of psychopathology. To further explicate the nature of Negative Activation, we examined associations with the Difficulties in Emotion Regulation Scale, a measure of emotion dysregulation. The sample consisted of 1,787 participants from an outpatient treatment facility. Confirmatory factor analysis replicated the existence of Positive and Negative Activation subscales. Logistic regressions, as hypothesized, found that Positive Activation was positively associated only with bipolar disorder, while Negative Activation was associated with almost all disorders. The Impulse and Goals subscales of the Difficulties in Emotion Regulation Scale were uniquely associated with Negative Activation, suggesting it may specifically assess impulsive behavior in emotional situations. The findings suggest that it may be important to attend to both Mood Disorder Questionnaire subscales.
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Affiliation(s)
| | - Kasey Stanton
- University of Western Ontario, London, Ontario, Canada
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Affiliation(s)
- Colin G. DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Robert F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
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Irak M, Albayrak EO. Psychometric Properties of the Expanded Version of the Inventory of Depression and Anxiety Symptoms in a Turkish Population. Psychol Rep 2018; 123:517-545. [DOI: 10.1177/0033294118813844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study examined psychometric properties of the Turkish version of the Inventory of Depression and Anxiety Symptoms-II (IDAS-II) in a Turkish sample. The sample consisted of nonclinical ( N = 931) and clinical ( N = 208) individuals. Confirmatory factor analysis showed that Turkish IDAS-II was similar to the original IDAS-II and supported the construct validity of the test. The Turkish IDAS-II showed good internal consistency, significant acceptable retest correlations, and was sensitive to changes over time. The Turkish IDAS-II also showed good convergent and discriminant validity in relation to the Beck Depression Inventory, the Beck Anxiety Inventory, the Mood Disorder Questionnaire, the Maudsley Obsessive Compulsive Inventory, the Panic Agoraphobia Scale, and the Post-Traumatic Stress Disorder Checklist-Civilian Version. Discriminant analyses revealed that the subscales of the Turkish IDAS-II significantly differentiated healthy controls from outpatients. The Turkish IDAS-II is a reliable and valid measure for assessing symptoms of depression and anxiety in Turkish-speaking participants.
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Affiliation(s)
- Metehan Irak
- Department of Psychology, Bahçeşehir University, Istanbul, Turkey
| | - Ece Oral Albayrak
- Center for Individual and Academic Development, Sabancı University, Istanbul, Turkey
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Stanton K, Watson D. Explicating the structure and relations of the Mood Disorder Questionnaire: Implications for screening for bipolar and related disorders. J Affect Disord 2017; 220:72-78. [PMID: 28600930 DOI: 10.1016/j.jad.2017.05.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/29/2017] [Accepted: 05/28/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Mood Disorder Questionnaire (MDQ; Hirschfeld et al., 2000) is a widely used screening measure in bipolar disorder research. Although this measure assesses a heterogeneous range of content, only limited prior research utilizing relatively small sample sizes has examined its factor structure. METHODS The MDQ's structure was examined in 700 participants reporting current psychiatric treatment. We extended prior structural work on the MDQ by explicating relations between factors and a wide range of psychopathology and personality measures. RESULTS The MDQ items were best captured by a two-factor structure consisting of dimensions labeled Positive Activation and Negative Activation. These two factors showed very different patterns of associations with personality, other psychopathology, and ratings of significant impairment, the last of which is a requirement for a positive MDQ screen using traditional scoring methods. LIMITATIONS Our study did not include clinician or informant ratings of bipolar disorder, preventing us from examining associations with such scores. CONCLUSIONS Our findings indicate that although the MDQ items cohere to define a total score, their structure is best modeled by meaningful Positive Activation and Negative Activation factors. Researchers and clinicians should be aware of these distinct sets of MDQ content, as high scorers on Positive Activation are less likely to identify past symptoms as problematic and show distinct clinical profiles from high scorers on Negative Activation.
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Affiliation(s)
- Kasey Stanton
- Department of Psychology, University of Notre Dame, 118 Haggar Hall, Notre Dame, IN 46556, United States.
| | - David Watson
- Department of Psychology, University of Notre Dame, 118 Haggar Hall, Notre Dame, IN 46556, United States.
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Stanton K, McArtor DB, Watson D. Parsing the Hypomanic Personality: Explicating the Nature of Specific Dimensions Defining Mania Risk. Assessment 2017; 26:492-507. [PMID: 28800706 DOI: 10.1177/1073191117725170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Considerable research has used the Hypomanic Personality Scale (HPS) to assess traits conferring risk for hypomanic and manic episodes. Although the HPS has been shown to be defined by several distinct sets of content, most research has continued to rely exclusively on HPS total scores, due to (a) little research having examined its structure and (b) the discrepant structural results obtained in the few available studies. Therefore, we examined the structure and relations of the HPS in a large sample of community adults ( N = 737) receiving psychiatric treatment. Our structural results indicated a five-factor structure of Activation, Charisma, Intellectual Confidence, Lability, and Modesty. Subscales modeling these emergent factors showed divergent patterns of relations with personality and other forms of psychopathology. These findings underscore the importance of examining HPS subscale relations in addition to HPS total scores in future research.
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Measures of Psychopathology Characterized by Dominance: Articulating their Structure and Relations with Personality and Other Psychopathology. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gruber J, Van Meter A, Gilbert KE, Youngstrom EA, Youngstrom JK, Feeny NC, Findling RL. Positive Emotion Specificity and Mood Symptoms in an Adolescent Outpatient Sample. COGNITIVE THERAPY AND RESEARCH 2016; 41:393-405. [PMID: 28529394 DOI: 10.1007/s10608-016-9796-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research on positive emotion disturbance has gained increasing attention, yet it is not clear which specific positive emotions are affected by mood symptoms, particularly during the critical period of adolescence. This is especially pertinent for identifying potential endophenotypic markers associated with mood disorder onset and course. The present study examined self-reported discrete positive and negative emotions in association with clinician-rated manic and depressive mood symptoms in a clinically and demographically diverse group of 401 outpatient adolescents between 11-18 years of age. Results indicated that higher self reported joy and contempt were associated with increased symptoms of mania, after controlling for symptoms of depression. Low levels of joy and high sadness uniquely predicted symptoms of depression, after controlling for symptoms of mania. Results were independent of age, ethnicity, gender and bipolar diagnosis. These findings extend work on specific emotions implicated in mood pathology in adulthood, and provide insights into associations between emotions associated with goal driven behavior with manic and depressive mood symptom severity in adolescence. In particular, joy was the only emotion associated with both depressive and manic symptoms across adolescent psychopathology, highlighting the importance of understanding positive emotion disturbance during adolescent development.
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Affiliation(s)
- June Gruber
- University of Colorado Boulder, Department of Psychology and Neuroscience
| | | | | | - Eric A Youngstrom
- University of North Carolina at Chapel Hill, Department of Psychology
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