1
|
Miozzo R, Eaton W, Bienvenu OJ, Samuels J, Nestadt G. Psychiatric comorbidity in the Baltimore ECA follow-up study: the matrix approach. Soc Psychiatry Psychiatr Epidemiol 2023; 58:141-151. [PMID: 34820686 PMCID: PMC11100458 DOI: 10.1007/s00127-021-02184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/31/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psychiatric comorbidity is defined as the joint occurrence of two or more mental or substance use disorders. Widespread psychiatric comorbidity has been reported in treatment and population-based studies. The aim of this study was to measure the extent and impact of psychiatric comorbidity in a cohort of the Baltimore Epidemiologic Catchment Area study. METHODS We examined the comorbidity burden of 16 mental disorders in a cohort of 847 participants using both established and novel analytical approaches The Comorbidity to Diagnosis Inflation Ratio (CDIR), is a statistical instrument that quantifies impact of pairwise comorbid associations, both on the whole sample, as well as on each specific disorder. RESULTS Most anxiety disorders had substantial co-occurrence with each other, as well as with Major Depressive Disorder (MDD). In addition, mood disorders had a high degree of comorbidity with Alcohol Dependence (AD). The CDIR for the whole sample was 1.32, indicating a ratio of 132 comorbidities per 100 diagnoses. The conditions with high sample prevalence were relatively less comorbid than the low prevalence conditions. Obsessive Compulsive Disorder had a comorbidity burden that was 89% greater than the overall sample. CONCLUSION Anxiety disorders are highly interrelated, as well as highly comorbid with depression. The comorbidity phenomenon is linked to the differential prevalence of the analyzed conditions. Comorbidity frequency (most prevalent comorbid condition) appears mutually exclusive to comorbidity burden (most widely interrelated condition). While AD and MDD were the most frequently diagnosed disorders; low prevalence conditions as OCD and GAD were the most widely interrelated.
Collapse
Affiliation(s)
- Ruben Miozzo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 624 North Broadway, Baltimore, MD, 21205, USA.
- Graduate Training Program in Clinic Investigation, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
- Meyers Primary Care Institute, Worcester, MA, 01605, USA.
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
| | - William Eaton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 624 North Broadway, Baltimore, MD, 21205, USA
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 624 North Broadway, Baltimore, MD, 21205, USA
- Graduate Training Program in Clinic Investigation, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jack Samuels
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 624 North Broadway, Baltimore, MD, 21205, USA
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 624 North Broadway, Baltimore, MD, 21205, USA
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| |
Collapse
|
2
|
Asthma and early smoking associated with high risk of panic disorder in adolescents and young adults. Soc Psychiatry Psychiatr Epidemiol 2022; 57:583-594. [PMID: 34279695 DOI: 10.1007/s00127-021-02146-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Studies have reported a strong link between asthma and panic disorder. We conducted a 17-year community-based large cohort study to examine the relationship between asthma, early smoking initiation, and panic disorder during adolescence and early adulthood. METHODS A total of 162,766 participants aged 11-16 years were categorized into asthma and nonasthma groups at baseline and compared within the observation period. Covariates during late childhood or adolescence included parental education, cigarette smoking by family members of participants, and participant's gender, age, alcohol consumption, smoking, and exercise habits. Data for urbanicity, prednisone use, allergic comorbidity, and Charlson comorbidity index were acquired from the National Health Insurance Research Database. The Cox proportional-hazards model was used to evaluate the association between asthma and panic disorder. RESULTS Our findings revealed that asthma increased the risk of panic disorder after adjustment for key confounders in the Cox proportional hazard regression model (adjusted HR: 1.70, 95% CI 1.28-2.26). Hospitalizations or visits to the emergency department for asthma exhibited a dose-response effect on the panic disorder (adjusted HR: 2.07, 95% CI 1.30-3.29). Patients with asthma with onset before 20 years of age who smoked during late childhood or adolescence had the greatest risk for panic disorder (adjusted HR: 4.95, 95% CI 1.23-19.90). CONCLUSIONS Patients newly diagnosed with asthma had a 1.7-times higher risk of developing panic disorder. Smoking during late childhood or adolescence increased the risk for developing the panic disorder in patients with asthma.
Collapse
|
3
|
Abstract
Personality types are construed as constellations of features that uniquely define discrete groups of individuals. Types are conceptually convenient because they summarize many traits in a single label, but until recently most researchers agreed that there was little evidence for the existence of discrete personality types. Several groups of researchers have now proposed replicable, empirical person clusters based on measures of the Five‐Factor Model. We consider several methodological artifacts that might be responsible for these types, and conclude that these artifacts may contribute to the replicability of types, but cannot entirely account for it. The present research attempts to replicate these types in four large and diverse adult samples: the Baltimore Longitudinal Study of Aging (N = 1856); the East Baltimore Epidemiologic Catchment Area study (N = 486); the University of North Carolina Alumni Heart Study (N = 2420); and an HIV risk reduction intervention study (N = 274). A clear replication (kappa = 0.60) of the proposed types was found in only one sample by one standard of comparison. The failure of the three personality types to replicate in three of the four samples leads to the conclusion that they are not robust empirical entities. Type membership predicted psychosocial functioning and ego resiliency and control, but only because it summarized trait standing; dimensional trait measures were consistently better predictors. Nevertheless, while the types do not refer to distinct, homogeneous classes of persons, they do have utility as convenient labels summarizing combinations of traits that relate to important outcomes. Published in 2002 by John Wiley & Sons, Ltd.
Collapse
|
4
|
Miozzo R, Eaton WW, Bienvenu OJ, Samuels J, Nestadt G. The serotonin transporter gene polymorphism (SLC6A4) and risk for psychiatric morbidity and comorbidity in the Baltimore ECA follow-up study. Compr Psychiatry 2020; 102:152199. [PMID: 32911381 PMCID: PMC8442947 DOI: 10.1016/j.comppsych.2020.152199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/23/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The human serotonin transporter (SERT) gene polymorphism (5HTTLPR) has been associated with multiple psychiatric disorders, including major depression, anxiety disorders, and substance use disorders. This study investigated the association between 5HTTLPR and psychiatric morbidity and comorbidity in a psychiatrist-examined population sample. METHODS 628 participants, mean age 48.3 years old, were assessed by psychiatrists using the Schedules for Clinical Assessment in Neuropsychiatry. Associations between 5HTTLPR and the prevalence, comorbidity, and time-to-diagnoses for 16 psychiatric conditions were evaluated, using several analytical approaches. RESULTS The SERT S allele was significantly associated with an increased lifetime prevalence of panic disorder. There was a "protective" association between SERT gene S allele carrier status and the risk of obsessive-compulsive disorder (OCD) in time-to-event analysis. Carriers of the S allele had a significant increased risk of two specific comorbid disorder pairs: major depressive disorder (MDD) and social phobia, and MDD and agoraphobia. Overall, there was no increased risk of receiving an initial or an additional diagnosis for a mental disorder in the SERT S allele carriers CONCLUSIONS: The findings suggest that the S allele carrier status is associated with an increased prevalence of panic disorder in a community sample. There was an increased risk for comorbidity in a more homogeneous subgroup of cases with MDD and social phobia, as well as or agoraphobia. Our findings suggest a specific effect of the SERT promoter gene polymorphism on a subgroup of individuals identifiable by their comorbidity.
Collapse
Affiliation(s)
- Ruben Miozzo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States of America; Graduate Training Program in Clinic Investigation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States of America.
| | - William W Eaton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine. Baltimore, MD 21205,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Baltimore, MD 21205
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine. Baltimore, MD 21205,Graduate Training Program in Clinic Investigation, Johns Hopkins Bloomberg School of Public Health. Baltimore, MD 21205,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Baltimore, MD 21205
| | - Jack Samuels
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine. Baltimore, MD 21205,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Baltimore, MD 21205
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine. Baltimore, MD 21205,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Baltimore, MD 21205
| |
Collapse
|
5
|
Skapinakis P, Lewis G, Davies S, Brugha T, Prince M, Singleton N. Panic disorder and subthreshold panic in the UK general population: Epidemiology, comorbidity and functional limitation. Eur Psychiatry 2020; 26:354-62. [DOI: 10.1016/j.eurpsy.2010.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/14/2010] [Accepted: 06/23/2010] [Indexed: 10/19/2022] Open
Abstract
AbstractObjectiveThe epidemiology of panic disorder has not been investigated in the past in the UK using a nationally representative sample of the population. The aim of the present paper was to examine the epidemiology, comorbidity and functional impairment of subthreshold panic and panic disorder with or without agoraphobia.MethodWe used data from the 2000 Office for National Statistics Psychiatric Morbidity survey (N = 8580). Panic disorder and agoraphobia were assessed with the Revised Clinical Interview Schedule (CIS-R).ResultThe prevalence of panic disorder with or without agoraphobia was 1.70% (95% confidence interval: 1.41–2.03%). Subthreshold panic was more common. Economic inactivity was consistently associated with all syndromes. The comorbidity pattern of the panic syndromes and the associated functional impairment show that panic-related conditions are important public health problems, even in subthreshold status.ConclusionsThe findings show that efforts to reduce the disability associated with psychiatric disorders should include detection and management of panic disorder.
Collapse
|
6
|
van der Wal SJ, Bienvenu OJ, Romanoski AJ, Eaton WW, Nestadt G, Samuels J. Longitudinal relationships between personality disorder dimensions and depression in a community sample. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.npbr.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
7
|
Preti A, Vrublevska J, Veroniki AA, Huedo-Medina TB, Kyriazis O, Fountoulakis KN. Prevalence and treatment of panic disorder in bipolar disorder: systematic review and meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2018; 21:53-60. [PMID: 29636354 PMCID: PMC10702268 DOI: 10.1136/eb-2017-102858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/02/2018] [Accepted: 03/16/2018] [Indexed: 01/04/2023]
Abstract
QUESTION Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression. The literature on panic disorder (PD) comorbid with BD has been systematically reviewed and subject to meta-analysis. STUDY SELECTION AND ANALYSIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were thoroughly followed for literature search, selection and reporting of available evidence. The variance-stabilising Freeman-Tukey double arcsine transformation was used in the meta-analysis of prevalence estimates. Both fixed-effect and random-effects models with inverse variance method were applied to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran's Q and I2 statistics. FINDINGS Overall, 15 studies (n=3391) on cross-sectional prevalence and 25 independent lifetime studies (n=8226) were used to calculate pooled estimates. The overall random-effects point prevalence of PD in patients with BD, after exclusion of one potential outlier study, was 13.0% (95% CI 7.0% to 20.3%), and the overall random-effects lifetime estimate, after exclusion of one potential outlier study, was 15.5% (95% CI 11.6% to 19.9%). There were no differences in rates between BD-I and BD-II. Significant heterogeneity (I2 >95%) was found in both estimates. CONCLUSIONS Estimates that can be drawn from published studies indicate that the prevalence of PD in patients with BD is higher than the prevalence in the general population. Comorbid PD is reportedly associated with increased risk of suicidal acts and a more severe course. There is no clear indication on how to treat comorbid PD in BD. Findings from the current meta-analysis confirm the highly prevalent comorbidity of PD with BD, implicating that in patients with BD, PD might run a more chronic course.
Collapse
Affiliation(s)
- Antonio Preti
- Genneruxi Medical Center, Cagliari, Italy
- Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy
| | - Jelena Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | | | - Tania B Huedo-Medina
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Odysseas Kyriazis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
8
|
Zhou Z, Ni D. Impairment of Working Memory, Decision-making, and Executive Function in the First-Degree Relatives of People with Panic Disorder: A Pilot Study. Front Psychiatry 2017; 8:219. [PMID: 29163238 PMCID: PMC5675850 DOI: 10.3389/fpsyt.2017.00219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/20/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Panic disorder (PD) patients present impairments of working memory, decision-making, and executive function. However, whether the first-degree relatives (FDRs) of people with PD present abnormal characteristics, including clinical and neuropsychological aspects, in comparison to the general population, has not been studied. Investigation and understanding of the abnormal neuropsychological characteristics of the FDRs of people with PD will contribute to the prevention and treatment of PD. OBJECTIVE The purpose of this paper is to compare the working memory, decision-making, and executive function among people with PD, their FDRs, and controls. MATERIALS AND METHODS Neuropsychological functions of 30 people with PD, 30 FDRs of people with PD, and 30 controls were measured with a digit span task, Iowa Gambling Task (IGT), and Wisconsin Card Sorting Test (WCST). RESULTS Perseverative errors, failure to maintain set scores, and number of cards chosen from decks A, B, C, and D were higher for People with PD and their FDRs than those of controls. Furthermore, error rates for these tests were higher for people with PD than their FDRs. Forward scores and backward scores, percentage of conceptual level responses, the number of categories completed, choices from advantageous minus disadvantageous decks, and mean amount of money earned of people with PD and their FDRs were all lower than those of controls. Scores for these tests were also lower for people with PD than for their FDRs. CONCLUSION People with PD as well as their FDRs present different degrees of impairments of working memory, decision-making, and executive function. Impaired performance on three tasks appears to be associated with the diathesis for PD and may be a valuable indicator of susceptibility for this disorder.
Collapse
Affiliation(s)
- Zhenhe Zhou
- Department of Psychiatry, Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Dongjie Ni
- Grade 2013 Class 3, Basic Medicine College of Liaoning Medical University, Jinzhou, China
| |
Collapse
|
9
|
de Jonge P, Roest AM, Lim CC, Florescu SE, Bromet E, Stein D, Harris M, Nakov V, Caldas-de-Almeida JM, Levinson D, Al-Hamzawi AO, Haro JM, Viana MC, Borges G, O’Neill S, de Girolamo G, Demyttenaere K, Gureje O, Iwata N, Lee S, Hu C, Karam A, Moskalewicz J, Kovess-Masfety V, Navarro-Mateu F, Browne MO, Piazza M, Posada-Villa J, Torres Y, ten Have ML, Kessler RC, Scott KM. Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys. Depress Anxiety 2016; 33:1155-1177. [PMID: 27775828 PMCID: PMC5143159 DOI: 10.1002/da.22572] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/13/2016] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
CONTEXT The scarcity of cross-national reports and the changes in Diagnostic and Statistical Manual version 5 (DSM-5) regarding panic disorder (PD) and panic attacks (PAs) call for new epidemiological data on PD and PAs and its subtypes in the general population. OBJECTIVE To present representative data about the cross-national epidemiology of PD and PAs in accordance with DSM-5 definitions. DESIGN AND SETTING Nationally representative cross-sectional surveys using the World Health Organization Composite International Diagnostic Interview version 3.0. PARTICIPANTS Respondents (n = 142,949) from 25 high, middle, and lower-middle income countries across the world aged 18 years or older. MAIN OUTCOME MEASURES PD and presence of single and recurrent PAs. RESULTS Lifetime prevalence of PAs was 13.2% (SE 0.1%). Among persons that ever had a PA, the majority had recurrent PAs (66.5%; SE 0.5%), while only 12.8% fulfilled DSM-5 criteria for PD. Recurrent PAs were associated with a subsequent onset of a variety of mental disorders (OR 2.0; 95% CI 1.8-2.2) and their course (OR 1.3; 95% CI 1.2-2.4) whereas single PAs were not (OR 1.1; 95% CI 0.9-1.3 and OR 0.7; 95% CI 0.6-0.8). Cross-national lifetime prevalence estimates were 1.7% (SE 0.0%) for PD with a median age of onset of 32 (IQR 20-47). Some 80.4% of persons with lifetime PD had a lifetime comorbid mental disorder. CONCLUSIONS We extended previous epidemiological data to a cross-national context. The presence of recurrent PAs in particular is associated with subsequent onset and course of mental disorders beyond agoraphobia and PD, and might serve as a generic risk marker for psychopathology.
Collapse
Affiliation(s)
- Peter de Jonge
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Annelieke M. Roest
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Carmen C.W. Lim
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Silvia E. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Evelyn Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, USA
| | - Dan Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Meredith Harris
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Vladimir Nakov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Jose Miguel Caldas-de-Almeida
- Chronic Diseases research Center (CEDOC) and Department of Mental Health, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | | | - Josep Maria Haro
- CIBERSAM, Parc Sanitari Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espirito Santo, Brazil
| | - Gui Borges
- Instituo Nacional der Psiquiatria, Calzada Mexico Xochimilco, Mexico
| | - Siobhan O’Neill
- School of Psychology, University of Ulster, Londonderry, United Kingdom
| | | | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Noboru Iwata
- Department of Psychology, Hiroshima International University, Hiroshima, Japan
| | - Sing Lee
- Department of Psychiatry, The Chinese University of Hongkong, Hongkong, China
| | - Chiyi Hu
- Institute of Mental Health, Peking University, Beijing, China
| | - Aimee Karam
- Institute for Development, Research, Advocacy and applied Care (IDRAAC), Beirut, Lebanon
| | | | | | - Fernando Navarro-Mateu
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca. Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP)-Murcia. Subdirección General de Salud Mental y Asistencia Psiquiátrica. Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | - Mark Oakley Browne
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Maria Piazza
- National Institute of Health, Peru, Universidad Cayetano Hereidia, St Martin de Porres, Peru
| | | | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Margreet L. ten Have
- Trimbos Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard University Medical School, Boston, USA
| | - Kate M. Scott
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
10
|
Maccari S, Polese D, Reynaert ML, Amici T, Morley-Fletcher S, Fagioli F. Early-life experiences and the development of adult diseases with a focus on mental illness: The Human Birth Theory. Neuroscience 2016; 342:232-251. [PMID: 27235745 DOI: 10.1016/j.neuroscience.2016.05.042] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 12/18/2022]
Abstract
In mammals, early adverse experiences, including mother-pup interactions, shape the response of an individual to chronic stress or to stress-related diseases during adult life. This has led to the elaboration of the theory of the developmental origins of health and disease, in particular adult diseases such as cardiovascular and metabolic disorders. In addition, in humans, as stated by Massimo Fagioli's Human Birth Theory, birth is healthy and equal for all individuals, so that mental illness develop exclusively in the postnatal period because of the quality of the relationship in the first year of life. Thus, this review focuses on the importance of programming during the early developmental period on the manifestation of adult diseases in both animal models and humans. Considering the obvious differences between animals and humans we cannot systematically move from animal models to humans. Consequently, in the first part of this review, we will discuss how animal models can be used to dissect the influence of adverse events occurring during the prenatal and postnatal periods on the developmental trajectories of the offspring, and in the second part, we will discuss the role of postnatal critical periods on the development of mental diseases in humans. Epigenetic mechanisms that cause reversible modifications in gene expression, driving the development of a pathological phenotype in response to a negative early postnatal environment, may lie at the core of this programming, thereby providing potential new therapeutic targets. The concept of the Human Birth Theory leads to a comprehension of the mental illness as a pathology of the human relationship immediately after birth and during the first year of life.
Collapse
Affiliation(s)
- Stefania Maccari
- Univ. Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, 59000 Lille, France; IRCCS Neuromed, 86077, Italy; Sapienza University of Rome, 00185 Rome, Italy.
| | - Daniela Polese
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, Italy; Unit of Psychiatry, Federico II University of Naples, Italy
| | - Marie-Line Reynaert
- Univ. Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, 59000 Lille, France
| | | | - Sara Morley-Fletcher
- Univ. Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, 59000 Lille, France
| | - Francesca Fagioli
- Prevention and early Intervention Mental Health (PIPSM) ASL Rome 1, Italy
| |
Collapse
|
11
|
Liu Y, Sareen J, Bolton J, Wang J. Development and validation of a risk-prediction algorithm for the recurrence of panic disorder. Depress Anxiety 2015; 32:341-8. [PMID: 25774487 DOI: 10.1002/da.22359] [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: 11/06/2014] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To develop and validate a risk prediction algorithm for the recurrence of panic disorder. METHODS Three-year longitudinal data were taken from the National Epidemiologic Survey on Alcohol and Related Conditions (2001/2002-2004/2005). One thousand six hundred and eighty one participants with a lifetime panic disorder and who had not had panic attacks for at least 2 months at baseline were included. The development cohort included 949 participants; 732 from different census regions were in the validation cohort. Recurrence of panic disorder over the follow-up period was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, based on the DSM-IV criteria. Logistic regression was used for deriving the algorithm. Discrimination and calibration were assessed in the development and the validation cohorts. RESULTS The developed algorithm consisted of 11 predictors: age, sex, panic disorder in the past 12 months, nicotine dependence, rapid heartbeat/tachycardia, taking medication for panic attacks, feelings of choking and persistent worry about having another panic attack, two personality traits, and childhood trauma. The algorithm had good discriminative power (C statistic = 0.7863, 95% CI: 0.7487, 0.8240). The C statistic was 0.7283 (95% CI: 0.6889, 0.7764) in the external validation data set. CONCLUSIONS The developed risk algorithm for predicting the recurrence of panic disorder has good discrimination and excellent calibration. Data related to the predictors can be easily attainable in routine clinical practice. It can be used by clinicians to calculate the probability of recurrence of panic disorder in the next 3 years for individual patients, communicate with patients regarding personal risks, and thus improve personalized treatment approaches.
Collapse
Affiliation(s)
- Yan Liu
- Faculty of Medicine, Department of Psychiatry, University of Calgary, Calgary, Canada; Faculty of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | | | | | | |
Collapse
|
12
|
Pané-Farré CA, Stender JP, Fenske K, Deckert J, Reif A, John U, Schmidt CO, Schulz A, Lang T, Alpers GW, Kircher T, Vossbeck-Elsebusch AN, Grabe HJ, Hamm AO. The phenomenology of the first panic attack in clinical and community-based samples. J Anxiety Disord 2014; 28:522-9. [PMID: 24973697 DOI: 10.1016/j.janxdis.2014.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 05/22/2014] [Indexed: 11/24/2022]
Abstract
The purpose of the study was to contrast first panic attacks (PAs) of patients with panic disorder (PD) with vs. without agoraphobia and to explore differences between first PAs leading to the development of PD and those that remain isolated. Data were drawn from a community survey (N=2259 including 88 isolated PAs and 75 PD cases). An additional sample of 234 PD patients was recruited in a clinical setting. A standardized interview assessed the symptoms of the first PA, context of its occurrence and subsequent coping attempts. Persons who developed PD reported more severe first PAs, more medical service utilization and exposure-limiting coping attempts than those with isolated PAs. The context of the first PA did not differ between PD and isolated PAs. PD with agoraphobia was specifically associated with greater symptom severity and occurrence of first attacks in public. Future research should validate these findings using a longitudinal approach.
Collapse
Affiliation(s)
| | - Jan P Stender
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Kristin Fenske
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Ulrich John
- Institute of Epidemiology and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Andrea Schulz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Lang
- Christoph-Dornier-Stiftung for Clinical Psychology, Institute Bremen, Bremen, Germany
| | - Georg W Alpers
- Department of Clinical and Biological Psychology, School of Social Sciences and Otto-Selz-Institute, University of Mannheim, Mannheim, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | | | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany; HELIOS Hospital Stralsund, Stralsund, Germany
| | - Alfons O Hamm
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| |
Collapse
|
13
|
Gul IG, Karlidag R, Cumurcu BE, Turkoz Y, Kartalci S, Ozcan AC, Erdemli ME. The effect of agoraphobia on oxidative stress in panic disorder. Psychiatry Investig 2013; 10:317-25. [PMID: 24474979 PMCID: PMC3902148 DOI: 10.4306/pi.2013.10.4.317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 02/17/2013] [Accepted: 05/20/2013] [Indexed: 12/12/2022] Open
Abstract
We aimed to investigate whether agoraphobia (A) in panic disorder (PD) has any effects on oxidative and anti-oxidative parameters. We measured total antioxidant capacity (TAC), paraoxonase (PON), arylesterase (ARE) antioxidant and malondialdehyde (MDA) oxidant levels using blood samples from a total of 31 PD patients with A, 22 PD patients without A and 53 control group subjects. There was a significant difference between the TAC, PON, ARE and MDA levels of the three groups consisting of PD with A, PD without A and the control group. The two-way comparison to clarify the group creating the difference showed that the TAC, PON, and ARE antioxidants were significantly lower in the PD with A group compared to the control group while the MDA oxidant was significantly higher. There was no significant difference between the PD without A and control groups for TAC, PON, ARE and MDA levels. We clearly demonstrated that the oxidative stress and damage to the anti-oxidative mechanism are significantly higher in the PD group with A. These findings suggest that oxidative/anti-oxidative mechanisms may play a more important role on the pathogenesis of PB with A.
Collapse
Affiliation(s)
| | - Rifat Karlidag
- Inonu University Faculty of Medicine, Department of Psychiatry, Malatya, Turkey
| | | | - Yusuf Turkoz
- Inonu University Faculty of Medicine, Department of Biochemistry, Malatya, Turkey
| | - Sukru Kartalci
- Inonu University Faculty of Medicine, Department of Psychiatry, Malatya, Turkey
| | - A Cemal Ozcan
- Inonu University Faculty of Medicine, Department of Neurology, Malatya, Turkey
| | - M Erman Erdemli
- Inonu University Faculty of Medicine, Department of Biochemistry, Malatya, Turkey
| |
Collapse
|
14
|
Nay W, Brown R, Roberson-Nay R. Longitudinal course of panic disorder with and without agoraphobia using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Psychiatry Res 2013; 208:54-61. [PMID: 23587657 DOI: 10.1016/j.psychres.2013.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 03/05/2013] [Accepted: 03/07/2013] [Indexed: 01/22/2023]
Abstract
Few naturalistic, longitudinal studies of panic disorder with and without agoraphobia (PD/PDA) exist, limiting our knowledge of the temporal rates of incidence, relapse, and chronicity, or the factors that predict category transition. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave 1 (n=43,093) and wave 2 (n=34,653) were utilized to determine transitional rates, and predictors of category transitions, over a 3-year period. Analyses revealed very high 3-year remission rates for PD and PDA (75% and 67%, respectively), although relapse also was relatively frequent (PD=12%; PDA=21%). Logistic regression revealed previous history of panic attacks, generalized anxiety disorder/major depression (GAD/MDD), nicotine dependence, female sex, younger age, and major financial crises to be reliable predictors of incidence and relapse. The direction and magnitude of association of many predictor variables were similar for PD and PDA, with notable exceptions for social anxiety and romantic relationship factors. Clinicians should be aware of the relapsing-remitting nature of PD and PDA and, thus, take caution to not reduce or eliminate effective treatments prematurely. Similarly, the current study suggests clinicians pay particular attention to concurrent factors relevant to relapse in PD/PDA that may also be clinically addressed (e.g., co-morbid MDD/GAD and nicotine dependence).
Collapse
Affiliation(s)
- William Nay
- Virginia Commonwealth University, Department of Psychiatry, P.O. Box 980253, Richmond, VA 23298-0253, USA.
| | | | | |
Collapse
|
15
|
Abstract
The evidence-based pharmacotherapy of panic disorder continues to evolve. This paper reviews data on first-line pharmacotherapy, evidence for maintenance treatment, and management options for treatment-refractory patients. A Medline search of research on pharmacotherapy was undertaken, and a previous systematic review on the evidence-based pharmacotherapy of panic disorder was updated. Selective serotonin reuptake inhibitors remain a first-line pharmacotherapy of panic disorder, with the serotonin noradrenaline reuptake inhibitor venlafaxine also an acceptable early option. Temporary co-administration of benzodiazepines can be considered. Maintenance treatment reduces relapse rates, but further research to determine optimal duration is needed. For patients not responding to first-line agents several pharmacotherapy options are available, but there is a notable paucity of data on the optimal choice.
Collapse
|
16
|
Nestadt G, Di C, Samuels JF, Cheng YJ, Bienvenu OJ, Reti IM, Costa P, Eaton WW, Bandeen-Roche K. Concordance between personality disorder assessment methods. Psychol Med 2012; 42:657-667. [PMID: 21861952 PMCID: PMC3698972 DOI: 10.1017/s0033291711001632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies have criticized the low level of agreement between the various methods of personality disorder (PD) assessment. This is an important issue for research and clinical purposes. METHOD Seven hundred and forty-two participants in the Hopkins Epidemiology of Personality Disorders Study (HEPS) were assessed on two occasions using the Personality Disorder Schedule (PDS) and the International Personality Disorder Examination (IPDE). The concordance between the two diagnostic methods for all DSM-IV PDs was assessed using standard methods and also two item response analytic approaches designed to take account of measurement error: a latent trait-based approach and a generalized estimating equations (GEE)-based approach, with post-hoc adjustment. RESULTS Raw criteria counts, using the intraclass correlation coefficient (ICC), κ and odds ratio (OR), showed poor concordance. The more refined statistical methods showed a moderate to moderately high level of concordance between the methods for most PDs studied. Overall, the PDS produced lower prevalences of traits but higher precision of measurement than the IPDE. Specific criteria within each PD showed varying endorsement thresholds and precision for ascertaining the disorder. CONCLUSIONS Concordance in the raw measurement of the individual PD criteria between the two clinical methods is lacking. However, based on two statistical methods that adjust for differential endorsement thresholds and measurement error in the assessments, we deduce that the PD constructs themselves can be measured with a moderate degree of confidence regardless of the clinical approach used. This may suggest that the individual criteria for each PD are, in and of themselves, less specific for diagnosis, but as a group the criteria for each PD usefully identify specific PD constructs.
Collapse
Affiliation(s)
- G Nestadt
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Panic disorder. ACTA ACUST UNITED AC 2012; 106:363-74. [DOI: 10.1016/b978-0-444-52002-9.00020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
|
18
|
Blom RM, Samuels JF, Riddle MA, Bienvenu OJ, Grados MA, Reti IM, Eaton WW, Liang KY, Nestadt G. Association between a serotonin transporter promoter polymorphism (5HTTLPR) and personality disorder traits in a community sample. J Psychiatr Res 2011; 45:1153-9. [PMID: 21450307 PMCID: PMC3128677 DOI: 10.1016/j.jpsychires.2011.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 02/21/2011] [Accepted: 03/03/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND The serotonin transporter (SERT) polymorphism (5HTTLPR) has been reported to be associated with several psychiatric conditions. Specific personality disorders could be intermediate factors in the known relationship between 5HTTLPR and psychiatric disorders. This is the first study to test the association between this polymorphism and dimensions of all DSM-IV personality disorders in a community sample. METHODS 374 white participants were assessed by clinical psychologists using the International Personality Disorder Examination (IPDE). Associations between dimensions of each DSM-IV personality disorder and the long (l) and short (s) alleles of the 5HTTLPR were evaluated using non-parametric tests and regression models. RESULTS The s allele of the 5HTTLPR polymorphism was significantly associated with higher avoidant personality trait scores in the whole sample. Males with the s allele had a significantly lower likelihood of higher obsessive-compulsive personality disorder (OCPD) trait scores, whereas females with the s allele were likely to have higher OCPD personality trait scores. CONCLUSION This paper provides preliminary data on the relationship between personality disorders and the 5HTTLPR polymorphism. The relationship of the s allele and avoidant PD is consistent with findings of a nonspecific relationship of this polymorphism to anxiety and depressive disorders. Concerning the unusual sexual dimorphic result with OCPD, several hypotheses are presented. These findings need further replication, including a more detailed study of additional variants in SERT.
Collapse
Affiliation(s)
- Rianne M. Blom
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jack F. Samuels
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark A. Riddle
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O. Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marco A. Grados
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irving M. Reti
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William W. Eaton
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kung-Yee Liang
- Department of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taiwan
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA,Corresponding author: Gerald Nestadt, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 113, Baltimore, MD 21287, USA, Phone: 410-614-4942 Fax: 410-614-8137,
| |
Collapse
|
19
|
Alvarado GF, Storr CL, Anthony JC. Suspected causal association between cocaine use and occurrence of panic. Subst Use Misuse 2010; 45:1019-32. [PMID: 20441448 DOI: 10.3109/10826080903534509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM To estimate a suspected causal association between cocaine use and the occurrence of panic. METHODS Data are from an epidemiologic sample of school-attending youths enrolled in primary school who were traced, rerecruited, and assessed via standardized interviews in young adulthood during 2000-2002. A total of 1,692 young adults comprised the analysis sample. Occurrences of panic and cocaine use were assessed in young adulthood, via standardized item sets from the Diagnostic Interview Schedule. A brief assessment of panic experiences had also been made when the youths were in early adolescence. RESULTS With statistical adjustment for important covariates, we found a modestly excess occurrence of panic attack-like experiences among those who had used cocaine at least once, relative to occurrence among young people who never had used cocaine (estimated odds ratio, OR = 1.9; p = .014 before exclusion of 288 with early onset panic attack-like experiences; p = .005 after this exclusion). DISCUSSION The main finding of this study was an association linking cocaine use and panic attack-like experiences, which was more modest than was observed in study samples that included older adults.
Collapse
Affiliation(s)
- G F Alvarado
- Facultad de Salud Publica, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | |
Collapse
|
20
|
In the Shadow of Academic Medical Centers: A Systematic Review of Urban Health Research in Baltimore City. J Community Health 2010; 35:433-52. [PMID: 20422444 DOI: 10.1007/s10900-010-9258-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
21
|
Batelaan NM, de Graaf R, Penninx BWJH, van Balkom AJLM, Vollebergh WAM, Beekman ATF. The 2-year prognosis of panic episodes in the general population. Psychol Med 2010; 40:147-157. [PMID: 19400975 DOI: 10.1017/s0033291709005625] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Panic disorder (PD) is generally considered to be a chronic or intermittent disorder. This view may be biased because of a lack of general population studies investigating panic from the onset of an episode onwards. Data regarding the course of subthreshold panic disorder (sub-PD) and predictors of its course are lacking. METHOD Using data from a large community-based survey, the Netherlands Mental Health and Incidence Study (NEMESIS), that retrospectively assessed the 2-year course of panic with a Life Chart Interview (LCI), this study investigated remission, chronicity and recurrence in subjects with new episodes of PD or sub-PD. Predictor variables of remission consisted of sociodemographics, psychobiological, environmental, psychiatric and panic-related factors. RESULTS In PD, remission of panic attacks occurred in 64.5% of subjects, mean time to remission was 5.7 months, and the remission rate was 5.8/100 person-months. In 43.3% of subjects panic was still present after 1 year. Recurrence of panic attacks occurred in 21.4% of those with PD who had achieved remission and for whom sufficient follow-up time was available. In general, the course of sub-PD was more favourable. Predictors of remission were female gender, the absence of ongoing difficulties, subthreshold panic and a low initial frequency of attacks. CONCLUSIONS These results suggest that the course of panic is diverse in the general population, thereby underlining the need for accurate predictors. This requires further research including biological data and additional psychological data. In addition, given the large proportion with a relapse, relapse prevention should be part of any treatment programme.
Collapse
Affiliation(s)
- N M Batelaan
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
22
|
Nestadt G, Di C, Samuels JF, Bienvenu OJ, Reti IM, Costa P, Eaton WW, Bandeen-Roche K. The stability of DSM personality disorders over twelve to eighteen years. J Psychiatr Res 2010; 44:1-7. [PMID: 19656527 PMCID: PMC2813415 DOI: 10.1016/j.jpsychires.2009.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 06/17/2009] [Accepted: 06/26/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stability of personality disorders is assumed in most nomenclatures; however, the evidence for this is limited and inconsistent. The aim of this study is to investigate the stability of DSM-III personality disorders in a community sample of eastern Baltimore residents unselected for treatment. METHODS Two hundred ninety four participants were examined on two occasions by psychiatrists using the same standardized examination twelve to eighteen years apart. All the DSM-III criteria for personality disorders were assessed. Item-response analysis was adapted into two approaches to assess the agreement between the personality measures on the two occasions. The first approach estimated stability in the underlying disorder, correcting for error in trait measurement, and the second approach estimated stability in the measured disorder, without correcting for item unreliability. RESULTS Five of the ten personality disorders exhibited moderate stability in individuals: antisocial, avoidant, borderline, histrionic, and schizotypal. Associated estimated ICCs for stability of underlying disorder over time ranged between approximately 0.4 and 0.7-0.8. A sixth disorder, OCPD, exhibited appreciable stability with estimated ICC of approximately 0.2-0.3. Dependent, narcissistic, paranoid, and schizoid disorders were not demonstrably stable. CONCLUSIONS The findings suggest that six of the DSM personality disorder constructs themselves are stable, but that specific traits within the DSM categories are both of lesser importance than the constructs themselves and require additional specification.
Collapse
Affiliation(s)
- Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Meyer 113, Baltimore, Maryland 21287, USA.
| | - Chongzhi Di
- Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - J F Samuels
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - O J Bienvenu
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - I M Reti
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - P Costa
- Gerontology Research Center, National Institute on Aging, Baltimore, MD
| | - William W Eaton
- Department of Mental Hygiene, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Karen Bandeen-Roche
- Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
23
|
Grant BF, Goldstein RB, Chou SP, Huang B, Stinson FS, Dawson DA, Saha TD, Smith SM, Pulay AJ, Pickering RP, Ruan WJ, Compton WM. Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Mol Psychiatry 2009; 14:1051-66. [PMID: 18427559 PMCID: PMC2766434 DOI: 10.1038/mp.2008.41] [Citation(s) in RCA: 432] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study was to present nationally representative findings on sociodemographic and psychopathologic predictors of first incidence of Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) substance, mood and anxiety disorders using the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. One-year incidence rates of DSM-IV substance, mood and anxiety disorders were highest for alcohol abuse (1.02), alcohol dependence (1.70), major depressive disorder (MDD; 1.51) and generalized anxiety disorder (GAD; 1.12). Incidence rates were significantly greater (P<0.01) among men for substance use disorders and greater among women for mood and anxiety disorders except bipolar disorders and social phobia. Age was inversely related to all disorders. Black individuals were at decreased risk of incident alcohol abuse and Hispanic individuals were at decreased risk of GAD. Anxiety disorders at baseline more often predicted incidence of other anxiety disorders than mood disorders. Reciprocal temporal relationships were found between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. Borderline and schizotypal personality disorders predicted most incident disorders. Incidence rates of substance, mood and anxiety disorders were comparable to or greater than rates of lung cancer, stroke and cardiovascular disease. The greater incidence of all disorders in the youngest cohort underscores the need for increased vigilance in identifying and treating these disorders among young adults. Strong common factors and unique factors appear to underlie associations between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. The major results of this study are discussed with regard to prevention and treatment implications.
Collapse
Affiliation(s)
- Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Rise B. Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - S. Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Frederick S. Stinson
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Deborah A. Dawson
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - 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, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Roger P. Pickering
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Wilson M. Compton
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., M.S. 9589, Bethesda, MD, USA 20892-9589
| |
Collapse
|
24
|
Personality disorder traits as predictors of subsequent first-onset panic disorder or agoraphobia. Compr Psychiatry 2009; 50:209-14. [PMID: 19374963 PMCID: PMC2691589 DOI: 10.1016/j.comppsych.2008.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 08/25/2008] [Accepted: 08/27/2008] [Indexed: 11/23/2022] Open
Abstract
Determining how personality disorder traits and panic disorder and/or agoraphobia relate longitudinally is an important step in developing a comprehensive understanding of the etiology of panic/agoraphobia. In 1981, a probabilistic sample of adult (> or =18 years old) residents of east Baltimore were assessed for Axis I symptoms and disorders using the Diagnostic Interview Schedule (DIS); psychiatrists reevaluated a subsample of these participants and made Axis I diagnoses, as well as ratings of individual Diagnostic and Statistical Manual of Mental Disorders, Third Edition personality disorder traits. Of the participants psychiatrists examined in 1981, 432 were assessed again in 1993 to 1996 using the DIS. Excluding participants who had baseline panic attacks or panic-like spells from the risk groups, baseline timidity (avoidant, dependent, and related traits) predicted first-onset DIS panic disorder or agoraphobia over the follow-up period. These results suggest that avoidant and dependent personality traits are predisposing factors, or at least markers of risk, for panic disorder and agoraphobia-not simply epiphenomena.
Collapse
|
25
|
Abstract
Panic disorder (PD) is a disabling condition which appears in late adolescence or early adulthood and affects more frequently women than men. PD is frequently characterized by recurrences and sometimes by a chronic course and, therefore, most patients require long-term treatments to achieve remission, to prevent relapse and to reduce the risks associated with comorbidity. Pharmacotherapy is one of the most effective treatments of PD. In this paper, the pharmacological management of PD is reviewed. Many questions about this effective treatment need to be answered by the clinician and discussed with the patients to improve her/his collaboration to the treatment plan: which is the drug of choice; when does the drug become active; which is the effective dose; how to manage the side effects; how to manage nonresponse; and how long does the treatment last. Moreover, the clinical use of medication in women during pregnancy and breastfeeding or in children and adolescents was reviewed and its risk-benefit balance discussed.
Collapse
Affiliation(s)
- Carlo Marchesi
- Psychiatric Section, Department of Neuroscience, University of Parma Parma, Italy.
| |
Collapse
|
26
|
The relationship between the five-factor model and latent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorder dimensions. Compr Psychiatry 2008; 49:98-105. [PMID: 18063048 PMCID: PMC2180398 DOI: 10.1016/j.comppsych.2007.05.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 04/05/2007] [Accepted: 05/02/2007] [Indexed: 11/22/2022] Open
Abstract
This study compared the latent structure of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorders (PDs) with the 5-factor model (FFM) of general personality dimensions. The subjects in the study were 742 community-residing individuals who participated in the Hopkins Epidemiology of Personality Disorders Study. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PD traits were assessed by psychologists using the International Personality Disorder Examination, and PD dimensions were derived previously using dichotomous factor analysis. The Revised NEO Personality Inventory, a measure of the FFM, was administered to all subjects. The relationship between the 2 sets of personality-related constructs was examined using a construct validity framework and also using Pearson correlation coefficients, multiple linear regression models, and spline regression models. The 5 PD factors each exhibited small to moderate correlations with several NEO dimensions; together, the NEO domain and facet scores explained a fifth to a third of the variance in PD dimensions. Examples of nonlinear relationships between the personality dimensions were identified. There is a modest correspondence between the PD dimensions and FFM traits, and the traits of FFM only partially explain the variance of the PDs. Dimensional measures of general personality may be a suitable alternative to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Whether additional maladaptive traits would better define the domain of PDs remains an important objective for future research.
Collapse
|
27
|
Batelaan N, Smit F, de Graaf R, van Balkom A, Vollebergh W, Beekman A. Economic costs of full-blown and subthreshold panic disorder. J Affect Disord 2007; 104:127-36. [PMID: 17466380 DOI: 10.1016/j.jad.2007.03.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 03/26/2007] [Accepted: 03/26/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Data on the societal costs of mental disorders are necessary to inform health policies. METHODS This study assessed the costs of panic disorder and subthreshold panic disorder, compared these with costs of other mental disorders, and assessed the effects of (psychiatric and somatic) comorbidity and agoraphobia on the costs of panic. Using a large, population-based study in The Netherlands (n=5504), both medical and production costs were estimated from a societal perspective within a one-year timeframe. RESULTS Annual per capita costs of panic disorder were 10,269 euros, while subthreshold panic disorder generated 6384 euros. These costs were higher than those of the other mental disorders studied. About one quarter of the costs could be attributed to comorbidity. Agoraphobia was associated with higher costs. LIMITATIONS Methodological choices influence cost estimates. In the present study most of these will result in conservative cost estimates. CONCLUSIONS Panic thus causes substantial societal costs. Given the availability of effective treatment, treatment may not only benefit individual patients, but also have economic returns for society.
Collapse
Affiliation(s)
- Neeltje Batelaan
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
BACKGROUND Psychiatric epidemiologic surveys since 1980 have relied heavily on a small number of survey diagnostic instruments for case ascertainment, which encode reports of respondents to highly structured interview questions delivered by interviewers without clinical training. Many validations of these survey diagnostic instruments have been carried out. OBJECTIVE This paper reviews the success of the survey diagnostic instruments, for eight diagnostic categories, in validations with a psychiatrist examination as the gold standard. METHOD Public databases were searched for potentially relevant publications, of which more than 1000 were located. Tables show sensitivity, specificity, Kappa, sample source and size, survey instrument and validation method. RESULTS The number of validation studies relevant to the eight disorders ranged from 8 for schizophrenia to 29 for major depressive disorder. Reported sensitivities ranged from zero to 100%, and specificities from 22% to 100%. CONCLUSION Results for common mental disorders such as major depressive disorder, alcohol disorder, drug disorder, and agoraphobic disorder are better than for panic disorder, obsessive compulsive disorder, bipolar disorder, and schizophrenia. The validity of case ascertainment in psychiatric epidemiology is still in question.
Collapse
Affiliation(s)
- William W Eaton
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | |
Collapse
|
29
|
Abstract
CONTEXT Bipolar/panic comorbidity has been observed in clinical, community and familial samples. As both are episodic disorders of affect regulation, the common pathophysiological mechanism is likely to involve deficits in amygdala-mediated, plasticity-dependent emotional conditioning. EVIDENCE Neuronal genesis and synaptic remodeling occur in the amygdala; bipolar and panic disorders have both been associated with abnormality in the amygdala and related structures, as well as in molecules that modulate plasticity, such as serotonin, norepinephrine, brain-derived neurotrophic factor (BDNF) and corticotrophin releasing factor (CRF). These biological elements are involved in behavioral conditioning to threat and reward. MODEL Panic attacks resemble the normal acute fear response, but are abnormally dissociated from any relevant threat. Abnormal reward-seeking behavior is central to both manic and depressive syndromes. Appetites can be elevated or depressed; satisfaction of a drive may fail to condition future behavior. These dissociations may be the result of deficits in plasticity-dependent processes of conditioning within different amygdala subregions. CONCLUSIONS This speculative model may be a useful framework with which to connect molecular, cellular, anatomic and behavioral processes in panic and bipolar disorders. The primary clinical implication is that behavioral treatment may be critical to restore function in some bipolar patients who respond only partially to medications.
Collapse
Affiliation(s)
- Dean F MacKinnon
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Meyer 3-181, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | | |
Collapse
|
30
|
Abstract
Panic disorder is a common mental disorder that affects up to 5% of the population at some point in life. It is often disabling, especially when complicated by agoraphobia, and is associated with substantial functional morbidity and reduced quality of life. The disorder is also costly for individuals and society, as shown by increased use of health care, absenteeism, and reduced workplace productivity. Some physical illnesses (eg, asthma) commonly occur with panic disorder, and certain lifestyle factors (eg, smoking) increase the risk for the disorder, but causal pathways are still unclear. Genetic and early experiential susceptibility factors also exist, but their exact nature and pathophysiological mechanisms remain unknown. Despite an imprecise, although increased, understanding of cause, strong evidence supports the use of several effective treatments (eg, pharmacological, cognitive-behavioural). The adaptation and dissemination of these treatments to the frontlines of medical-care delivery should be urgent goals for the public-health community.
Collapse
Affiliation(s)
- Peter P Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine at Harborview Medical Center, Seattle, WA 98104-2499, USA.
| | | | | |
Collapse
|
31
|
Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE. The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. ACTA ACUST UNITED AC 2006; 63:415-24. [PMID: 16585471 PMCID: PMC1958997 DOI: 10.1001/archpsyc.63.4.415] [Citation(s) in RCA: 455] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Only limited information exists about the epidemiology of DSM-IV panic attacks (PAs) and panic disorder (PD). OBJECTIVE To present nationally representative data about the epidemiology of PAs and PD with or without agoraphobia (AG) on the basis of the US National Comorbidity Survey Replication findings. DESIGN AND SETTING Nationally representative face-to-face household survey conducted using the fully structured World Health Organization Composite International Diagnostic Interview. PARTICIPANTS English-speaking respondents (N=9282) 18 years or older. MAIN OUTCOME MEASURES Respondents who met DSM-IV lifetime criteria for PAs and PD with and without AG. RESULTS Lifetime prevalence estimates are 22.7% for isolated panic without AG (PA only), 0.8% for PA with AG without PD (PA-AG), 3.7% for PD without AG (PD only), and 1.1% for PD with AG (PD-AG). Persistence, lifetime number of attacks, and number of years with attacks increase monotonically across these 4 subgroups. All 4 subgroups are significantly comorbid with other lifetime DSM-IV disorders, with the highest odds for PD-AG and the lowest for PA only. Scores on the Panic Disorder Severity Scale are also highest for PD-AG (86.3% moderate or severe) and lowest for PA only (6.7% moderate or severe). Agoraphobia is associated with substantial severity, impairment, and comorbidity. Lifetime treatment is high (from 96.1% for PD-AG to 61.1% for PA only), but 12-month treatment meeting published treatment guidelines is low (from 54.9% for PD-AG to 18.2% for PA only). CONCLUSION Although the major societal burden of panic is caused by PD and PA-AG, isolated PAs also have high prevalence and meaningful role impairment.
Collapse
Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Bienvenu OJ, Onyike CU, Stein MB, Chen LS, Samuels J, Nestadt G, Eaton WW. Agoraphobia in adults: incidence and longitudinal relationship with panic. Br J Psychiatry 2006; 188:432-8. [PMID: 16648529 DOI: 10.1192/bjp.bp.105.010827] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Theories regarding how spontaneous panic and agoraphobia relate are based mostly on cross-sectional and/or clinic data. AIMS To determine how spontaneous panic and agoraphobia relate longitudinally, and to estimate the incidence rate of and other possible risk factors for first-onset agoraphobia, using a general population cohort. METHOD A sample of 1920 adults in east Baltimore were assessed in 1981-1982 and the mid-1990s with the Diagnostic Interview Schedule (DIS). Psychiatrist diagnoses were made in a subset of the sample at follow-up (n = 816). RESULTS Forty-one new cases of DIS/DSM-III-R agoraphobia were identified (about 2 per 1000 person-years at risk). As expected, baseline DIS/DSM-III panic disorder predicted first incidence of agoraphobia (OR = 12, 95% CI 3.2-45), as did younger age, female gender and other age, female gender and other phobias. Importantly, baseline agoraphobia without spontaneous panic attacks also predicted first incidence of panic disorder (OR=3.9, 95% CI1.8-8.4). Longitudinal relationships between panic disorder and psychiatrist-confirmed agoraphobia were strong (panic before agoraphobia OR=20, 95% CI 2.3-180; agoraphobia before panic OR=16, 95% CI 3.2-78). CONCLUSIONS The implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM-IV appears incorrect.
Collapse
Affiliation(s)
- O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Nestadt G, Hsu FC, Samuels J, Bienvenu OJ, Reti I, Costa PT, Eaton WW. Latent structure of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorder criteria. Compr Psychiatry 2006; 47:54-62. [PMID: 16324903 DOI: 10.1016/j.comppsych.2005.03.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Accepted: 03/07/2005] [Indexed: 11/26/2022] Open
Abstract
AIMS This study investigated the internal construct validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) personality disorders and explored alternative models to characterize the personality disorder traits. The relationship between the obtained personality disorder dimensions and measures of functioning and disability was examined. METHODS The subjects in the study were 742 community-residing individuals who participated in the Hopkins Epidemiology of Personality Disorders Study. The presence of DSM-IV personality disorder traits was assessed by psychologists using the International Personality Disorder Examination (IPDE). Confirmatory factor analysis was performed on all the IPDE criteria for each of the 10 personality disorders using the Mplus program. Exploratory factor analysis of all personality disorder traits was completed using the same program. Factor scores were correlated with subjects' GAF ratings and number of missed days from work for physical and psychological reasons. RESULTS A single underlying factor was found for the IPDE item criteria of avoidant and dependent personality disorder, with less evidence for the other 8 personality disorders. Five factors were retained as the dimensional accounting for the personality disorder criteria. These factors were named compulsive, neurotic avoidant, aloof, impulsive callous, and egocentric. Of the five factors, 4 were associated with evidence of diminished functioning. CONCLUSIONS The IPDE pathological personality traits did not empirically cluster according to the current DSM-IV axis II diagnostic system but instead defined 5 relatively independent PD symptom dimensions that were related to functional impairments.
Collapse
Affiliation(s)
- Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | |
Collapse
|
34
|
Kikuchi M, Komuro R, Oka H, Kidani T, Hanaoka A, Koshino Y. Panic disorder with and without agoraphobia: comorbidity within a half-year of the onset of panic disorder. Psychiatry Clin Neurosci 2005; 59:639-43. [PMID: 16401237 DOI: 10.1111/j.1440-1819.2005.01430.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The present study was performed to compare the clinical features of patients with panic disorder with and without agoraphobia. The subjects were 233 outpatients with panic disorder (99 males and 134 females) diagnosed according to DSM-IV criteria. Sixty-three patients met the criteria for panic disorder without agoraphobia, and 170 met the criteria for panic disorder with agoraphobia. Patients with agoraphobia showed a significantly longer duration of panic disorder and higher prevalence of generalized anxiety disorder. However, there were no significant differences in prevalence of major depressive episodes, in current severity of panic attacks, or in gender ratio between the two groups. The second aim of the present study was to investigate the effects of onset age and sex differences on the development of agoraphobia within a half-year. The subjects were divided into two groups according to their self-report: patients who did or did not develop agoraphobia within 24 weeks of onset of panic disorder. A total of 40.6% of the patients developed agoraphobia within 24 weeks of the onset of panic disorder, and onset age and sex differences had no robust effect on the development of agoraphobia within 24 weeks.
Collapse
Affiliation(s)
- Mitsuru Kikuchi
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
| | | | | | | | | | | |
Collapse
|
35
|
Godemann F, Butter C, Lampe F, Linden M, Schlegl M, Schultheiss H, Behrens S. Panic disorders and agoraphobia: side effects of treatment with an implantable cardioverter/defibrillator. Clin Cardiol 2004; 27:321-6. [PMID: 15237689 PMCID: PMC6654734 DOI: 10.1002/clc.4960270604] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Implantable cardioverter/defibrillator (ICD) treatment has reduced the mortality of patients with a high risk of sudden cardiac death. However, ICD discharges may cause anxiety with respect to new discharges and lead to preventive, for example, phobic, behavior. This study evaluated the frequency of panic disorders and agoraphobia in patients with ICD and assessed the risk factors in their development. HYPOTHESIS Treatment with ICD represents a risk factor in the development of anxiety disorders. METHODS Ninety patients with ICD were examined using a standardized lifetime Diagnostic Interview of Psychiatric Syndromes (DIPS). This interview makes it possible to estimate the incidence of panic disorders and agoraphobia. The impact of the severity of the underlying cardiac disease, the number of ICD discharges, and the subjective appraisal of the shock experience on the development of panic disorders and agoraphobia was assessed. RESULTS Fifteen patients (16.7%) developed anxiety disorders after ICD implantation. The incidence was 21% in patients with and 6.9% in patients without ICD discharge. In patients with two or more ICD discharges annually, the incidence of panic disorders and agoraphobia was higher than that in patients with a single ICD discharge annually (62 vs. 10%, p<0.01). The intensity of self-observation of their body was significantly related to the development of anxiety disorders (p<0.001). CONCLUSION Panic disorders and agoraphobia are frequent side effects of ICD treatment. Risk factors in the development of these disorders are two or more ICD discharges annually and a negative cognitive appraisal of ICD discharges. Therapeutic efforts should aim at reducing the number of ICD discharges and provide early psychological treatment.
Collapse
Affiliation(s)
- Frank Godemann
- Departments of Psychiatry and Psychotherapy of the Charité, Germany
| | | | - Felix Lampe
- Department of Cardiology of the Benjamin Franklin Hospital, Free University of Berlin, Germany
| | - Michael Linden
- Department of Behavioral Medicine, BFA Rehabilitation Center, Germany
| | | | - Hans‐Peter Schultheiss
- Department of Cardiology of the Benjamin Franklin Hospital, Free University of Berlin, Germany
| | - Steffen Behrens
- Department of Cardiology, Vivantes Humboldt, Berlin, Germany
| |
Collapse
|
36
|
Abstract
Previous studies have implicated antisocial personality disorder in criminal behavior, but little is known about the association between "normal" personality dimensions and arrest. We investigated the relationships between these personality dimensions and prior arrest in a sample of adults participating in a longitudinal epidemiological study. Between 1993 and 1999, psychiatrists re-examined subjects who were originally interviewed in Baltimore in 1981 as part of the Epidemiologic Catchment Area study; the psychiatrists diagnosed axis I and axis II disorders according to DSM-IV criteria. A total of 611 subjects also completed the Revised NEO Personality Inventory (NEO-PI-R), which assesses five broad factors and 30 facets of normal personality. History of criminal arrest in Maryland in the period 1981 to 1993 was determined from the state criminal justice database. Student's t test and logistic regression were used to evaluate relationships between NEO personality scores and prior arrest. Controlling for demographic characteristics, alcohol or drug use disorders, and DSM-IV personality disorder scores, the odds of prior arrest increased with scores on angry hostility, impulsiveness, and excitement-seeking dimensions. Prior arrest was inversely related to scores on trust, straightforwardness, compliance, modesty, dutifulness, and deliberation dimensions. The results suggest that specific dimensions of normal personality are related to criminal arrest in the community.
Collapse
Affiliation(s)
- Jack Samuels
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
Panic disorder occurs less frequently in the elderly than in younger adults and rarely starts for the first time in old age. Panic attacks that begin in late life should prompt the clinician to conduct a careful search for a depressive disorder, physical illness or drugs that could be contributing to their presence. When panic attacks do occur in the elderly, the symptoms are qualitatively similar to those experienced by younger people. The elderly, however, may have fewer and less severe symptoms and exhibit less avoidant behaviour. As panic disorder is typically a chronic or recurrent condition, its management requires a long-term approach. With the exception of one descriptive pilot study, there have been no randomised controlled trials of the treatment of panic disorder in later life. Therefore, recommendations regarding the management of this disorder in the elderly must be extrapolated from research pertaining to younger patients. Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines and cognitive behavioural therapy are efficacious treatments for panic disorder. There are no consistent differences in efficacy between classes of medications or between pharmacotherapy and cognitive behavioural therapy. Furthermore, there are no reliable predictors of response to one type of treatment compared with another. Treatment selection, therefore, depends on an individual assessment of the risks and benefits of each type of treatment (taking into account comorbid psychiatric and physical conditions), patient preference, cost and the availability of therapists skilled in cognitive behavioural techniques. As a general rule, antidepressant medication is preferable to a benzodiazepine as a first-line treatment for panic disorder in the elderly, especially given the high level of comorbidity between panic disorder and depressive disorders. Of the antidepressants, an SSRI is recommended as the initial choice of treatment in older patients. Anxious patients frequently misattribute somatic symptoms of anxiety to adverse effects of medication. Adherence with treatment, therefore, can be enhanced by starting antidepressant medication at a low dosage so as to avoid initial exacerbation of anxiety (but then gradually increasing the dosage to the therapeutic range), frequent follow-up during the first few weeks of treatment, discussion about potential adverse effects and addressing any other concerns the patient may have about taking medication. Given the delayed onset of action of antidepressant medication, the short-term use of adjunctive lorazepam in the first few weeks of treatment may be helpful in selected patients.
Collapse
Affiliation(s)
- Alastair J Flint
- Departments of Psychiatry, University Health Network and University of Toronto, Toronto, Ontario, Canada.
| | | |
Collapse
|
38
|
Abstract
There is a considerable literature linking aspects of experienced parenting to later personality disorders. Because dimensionally measured personality disorders are associated with variations in normal personality traits, it is important to understand the contribution of parenting experienced in childhood to later normal personality traits. In this report, 742 community-based individuals, subjects from the Hopkins Epidemiology of Personality Disorders Study, were assessed for normal personality traits, as measured by the Revised NEO Personality Inventory (NEO-PI-R) and the Temperament and Character Inventory (TCI), and for parental behavior experienced as children, as measured by the Parental Bonding Instrument (PBI). The PBI dimensions were significantly, but moderately, correlate with measures of normal personality, the strongest associations being with the NEO-PI-R factors, neuroticism and conscientiousness, and with the TCI factors, self-directedness and harm avoidance. Subjects who reported lower parental care and higher parental intrusiveness were more likely to be higher in neuroticism, lower in conscientiousness, lower in self-directedness, and higher in harm avoidance. Also, trends emerged suggesting both parent-specific and gender-specific differences in the relationship between the PBI dimensions and normal adult personality traits. As variations in normal personality traits are associated with dimensionally measured personality disorders, it is conceivable that the role of parenting in later personality disorder may be mediated by associations between parenting and normal personality traits.
Collapse
Affiliation(s)
- Irving M Reti
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Meyer 3-181, Baltimore, MD 21205, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Reti IM, Samuels JF, Eaton WW, Bienvenu OJ, Costa PT, Nestadt G. Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection. Acta Psychiatr Scand 2002; 106:126-33. [PMID: 12121210 DOI: 10.1034/j.1600-0447.2002.02305.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the role of parenting in the development of adult antisocial personality traits. METHOD A total of 742 community-based subjects were assessed for adult DSM-IV antisocial personality disorder traits and for measures of parental behavior experienced as children, including by the Parental Bonding Instrument (PBI). RESULTS Three fundamental dimensions of parental behavior - care, behavioral restrictiveness and denial of psychological autonomy - were derived by factor analysis from the PBI. These dimensions significantly correlated with measures of parental behavior considered influential in later antisocial behavior. Adult antisocial traits in males were associated with low maternal care and high maternal behavioral restrictiveness, and in females, antisocial traits were associated with low paternal care and high maternal denial of psychological autonomy. These dimensions did not, however, explain all variance parental behavior has on adult antisocial personality traits. CONCLUSION Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection.
Collapse
Affiliation(s)
- I M Reti
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | |
Collapse
|
40
|
Abstract
OBJECTIVE This study examined predictors of fatigue severity and predictors of continued chronic fatigue status at wave 2 follow-up within a random, community-based sample of individuals previously evaluated in a wave 1 prevalence study of chronic fatigue and chronic fatigue syndrome that originally took place between 1995 and 1997. METHODS Wave 1 data were from a larger community-based prevalence study of chronic fatigue syndrome. In the present study, a second wave of data were collected by randomly selecting a sample of participants from the wave 1 sample of 18,675 adults and readministering a telephone screening questionnaire designed to assess symptoms of chronic fatigue syndrome. RESULTS Findings revealed that wave 1 fatigue severity was a predictor of fatigue severity at wave 2 in the overall sample of individuals with and without chronic fatigue. In the smaller sample of individuals with chronic fatigue, wave 1 fatigue severity, worsening of fatigue with physical exertion, and feeling worse for 24 hours or more after exercise significantly predicted continued chronic fatigue status (vs. improvement) at wave 2 follow-up. CONCLUSIONS These findings underscore the prognostic validity of postexertional malaise in predicting long-term chronic fatigue and also highlight the importance of using population-based, representative random samples when attempting to identify long-term predictors of chronic fatigue at follow-up.
Collapse
Affiliation(s)
- Renee R Taylor
- Department of Psychology, DePaul University, 2219 North Kenmore Avenue, Chicago, IL 60614, USA
| | | | | |
Collapse
|
41
|
Bienvenu OJ, Brown C, Samuels JF, Liang KY, Costa PT, Eaton WW, Nestadt G. Normal personality traits and comorbidity among phobic, panic and major depressive disorders. Psychiatry Res 2001; 102:73-85. [PMID: 11368842 DOI: 10.1016/s0165-1781(01)00228-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
High comorbidity among anxiety and depressive conditions is a consistent but not well-understood finding. The current study examines how normal personality traits relate to this comorbidity. In the Baltimore Epidemiologic Catchment Area Follow-up Study, psychiatrists administered the full Schedules for Clinical Assessment in Neuropsychiatry to 320 subjects, all of whom completed the Revised NEO Personality Inventory. The disorders of interest were simple phobia, social phobia, agoraphobia, panic disorder, and major depression. Analyses were carried out with second-order generalized estimating equations. The unadjusted summary odds ratio (SOR - or weighted mean odds ratio) for all five disorders was 1.72 (95% confidence interval=1.21-2.46). Neuroticism, introversion, younger age, and female gender were all significant predictors of prevalence of disorders. After adjustment for the relationships between these personality and demographic predictors and prevalence, the association among disorders was much weaker (SOR=1.11, 95% CI=0.79-1.56). However, subjects with high extraversion had a SOR 213% as high (95% CI=102-444%) as those with low extraversion (1.60 vs. 0.75). Therefore, neuroticism and introversion are associated with increased comorbidity due to relationships in common with the prevalence of the different disorders. In contrast, extraversion is associated with increased comorbidity per se.
Collapse
Affiliation(s)
- O J Bienvenu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University (JHU), , Baltimore, MD 21287, USA.
| | | | | | | | | | | | | |
Collapse
|
42
|
Bienvenu OJ, Nestadt G, Samuels JF, Costa PT, Howard WT, Eaton WW. Phobic, panic, and major depressive disorders and the five-factor model of personality. J Nerv Ment Dis 2001; 189:154-61. [PMID: 11277351 DOI: 10.1097/00005053-200103000-00003] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study investigated five-factor model personality traits in anxiety (simple phobia, social phobia, agoraphobia, and panic disorder) and major depressive disorders in a population-based sample. In the Baltimore Epidemiologic Catchment Area Follow-up Study, psychiatrists administered the Schedules for Clinical Assessment in Neuropsychiatry to 333 adult subjects who also completed the Revised NEO Personality Inventory. All of the disorders except simple phobia were associated with high neuroticism. Social phobia and agoraphobia were associated with low extraversion. In addition, lower-order facets of extraversion, agreeableness, and conscientiousness were associated with certain disorders (i.e., low positive emotions in panic disorder; low trust and compliance in certain phobias; and low competence, achievement striving, and self-discipline in several disorders). This study emphasizes the utility of lower-order personality assessments and underscores the need for further research on personality/psychopathology etiologic relationships.
Collapse
Affiliation(s)
- O J Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
OBJECTIVE To investigate gender-related differences in premorbid conditions and in the role of triggering events in the onset of panic disorder (PD). METHOD One hundred and eighty-four out-patients with a principal diagnosis of PD (DSM-IV) were evaluated with a semi-structured interview to generate Axis I and Axis II diagnoses according to DSM-IV, to collect family history of psychiatric disorders and life events. The statistical analysis was performed comparing men and women. RESULTS Men and women showed similar age at onset of PD. A family history of mood disorders characterized females. Men had higher rates of cyclothymia, body dysmorphic disorder and depersonalization disorder preceding PD, while women had higher rates of bulimia nervosa. Dependent and histrionic PDs were more common among women, while borderline and schizoid PDs were more common among men. Life events showed a significant role in precipitating PD onset in women. CONCLUSION Premorbid clinical conditions of PD seem to differentiate between males and females in the role of precipitating events.
Collapse
Affiliation(s)
- G Barzega
- Department of Neurosciences, University of Turin, Italy
| | | | | | | |
Collapse
|
44
|
Godemann F, Ahrens B, Behrens S, Berthold R, Gandor C, Lampe F, Linden M. Classic conditioning and dysfunctional cognitions in patients with panic disorder and agoraphobia treated with an implantable cardioverter/defibrillator. Psychosom Med 2001; 63:231-8. [PMID: 11292270 DOI: 10.1097/00006842-200103000-00006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A model for the development of anxiety disorders (panic disorder with or without agoraphobia) is needed. Patients with an implantable cardioverter/defibrillator (ICD) are exposed to repeated electric shocks. If the theory of anxiety development by aversive classic conditioning processes is valid, these repeated shocks should lead to an increased risk of anxiety disorders. To study this hypothesis, we retrospectively studied 72 patients after implantation of an automatic ICD. METHODS Patients were assessed with the semistructured Diagnostic Interview of Psychiatric Disease 1 to 6 years after implantation of an automatic ICD. Panic disorder and/or agoraphobia was diagnosed in patients who fulfilled all DSM-III-R criteria for those conditions. RESULTS Anxiety disorder developed in 15.9% of patients after ICD implantation. This was significantly related to the frequency of repeated defibrillation (shocks) to stop malignant ventricular arrhythmias. Dysfunctional cognitions are an additional vulnerability factor. CONCLUSIONS The data support both the conditioning hypothesis and the cognitive model of anxiety development. These findings suggest that ICD patients are an appropriate risk population for a prospective study of the development of anxiety disorders.
Collapse
Affiliation(s)
- F Godemann
- Department of Psychiatry, Free University of Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|
45
|
Chen L, Eaton WW, Gallo JJ, Nestadt G. Understanding the heterogeneity of depression through the triad of symptoms, course and risk factors: a longitudinal, population-based study. J Affect Disord 2000; 59:1-11. [PMID: 10814765 DOI: 10.1016/s0165-0327(99)00132-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is an ongoing research effort to test if depression is a homogeneous clinical syndrome and to identify valid and useful subtypes based on the number and nature of depressive symptoms. This study summarizes the patterns of depressive symptoms evident in a prospective study of the general population and examines the validity of potential subtypes by studying their course and etiologic heterogeneity. METHODS A general population sample of 1920 adults (aged 18-96) from the Baltimore Epidemiologic Catchment Area (ECA) follow-up study (1981 to 1993/6) were examined. Data on diagnoses, symptoms, course and risk factors were collected using the Diagnostic Interview Schedule (DIS). Latent class analysis was applied to summarize symptom patterns. Course characteristics and risk factor profiles were compared among potential subtypes based on the number of symptom groups or symptom patterns. Logistic regression models were used to examine the etiologic heterogeneity among potential subtypes based on symptoms. RESULTS The number of symptom groups gave the most efficient insight into differential etiologic processes. Severe depression (7-9 symptom groups) was associated with female gender, family history of depression but not with stressful life events before the onset of the first episode. Moderate (5-6 symptom groups) and mild depression (3-4 symptom groups) were associated with family history of depression, stressful life events before the onset, but not with female gender. The latent class model generated patterns of depressive psychopathology as follows: anhedonia, suicidal, psychomotor, and severely depressed subtypes. The Anhedonia subtype showed a course and risk factor profile distinct from the others. LIMITATIONS The measurement of psychopathology was based on self-reported DIS interviews instead of psychiatric assessments. Recall or report bias cannot be excluded in the ascertainment of family history and stressful life events. CONCLUSIONS Depression is heterogeneous, even below the threshold of syndromal diagnosis. The severity of an episode appears to be more informative than the pattern of symptoms, with the possible exception of a putative anhedonic subtype.
Collapse
Affiliation(s)
- L Chen
- Department of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | | | | | | |
Collapse
|