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Zhang J, Zhong H, Zhang Y, Yin J, Song X, Ye K, Song Z, Lai S, Zhong S, Wang Z, Jia Y. Personality traits as predictors for treatment response to sertraline among unmedicated obsessive-compulsive Disorder: A 12-weeks retrospective longitudinal study. J Psychiatr Res 2024; 170:245-252. [PMID: 38171218 DOI: 10.1016/j.jpsychires.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/02/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
The effectiveness of selective serotonin reuptake inhibitors (SSRIs) as a primary treatment for obsessive-compulsive disorder (OCD) remains uncertain. Even after undergoing standard SSRIs treatment, 40%-60% of individuals with OCD persistently endure symptoms. Recent studies proposed that personality traits may influence the diversity of OCD treatment results. Thus, in this retrospective study, we evaluated the Eysenck Personality Questionnaire (EPQ) scores of 51 untreated patients with OCD and 35 healthy controls. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was employed to assess OCD symptom severity at weeks 0, 2, 4, 8, and 12 of sertraline treatment. The primary outcome focused on the reduction rate of Y-BOCS scores (response: ≥25%; marked response: ≥50%). Our findings revealed that individuals with OCD demonstrated a significantly higher neuroticism score compared to healthy controls. Correlation analyses exposed a positive link between psychoticism and the duration of the disease. Moreover, family history strongly correlated with both obsessive thoughts and the total Y-BOCS score. Subsequent univariate Cox proportional analyses indicated that both low neuroticism and high extraversion traits could forecast the response to sertraline. Furthermore, only a high extraversion trait was linked to a marked response. Our results support the idea that personality traits may contribute to OCD vulnerability and predict sertraline treatment outcomes.
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Affiliation(s)
- Jianzhao Zhang
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Hui Zhong
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China; Department of Child and Adolescents Psychology, Anhui Mental Health Center, Hefei 230022, China
| | - Yiliang Zhang
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China.
| | - Jie Yin
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Xiaodong Song
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Kaiwei Ye
- School of Management, Jinan University, Guangzhou 510630, China
| | - Zijin Song
- School of Management, Jinan University, Guangzhou 510630, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China.
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Hoogerwerf E, Greeven A, Goekoop R, Spinhoven P. Personalized exposure and experience sampling method feedback versus exposure as usual for obsessive-compulsive disorder: a study protocol for a randomized controlled trial. Trials 2024; 25:43. [PMID: 38217045 PMCID: PMC10785525 DOI: 10.1186/s13063-023-07780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/06/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) suffer from repetitive fearful intrusions which they try to neutralize by performing compulsions. OCD is considered to be the most resistant anxiety disorder with a remission rate of only 53% after a year of an evidence-based treatment. Therefore, it remains an obligation to develop and investigate more effective treatment interventions. This study aims to compare personalized exposure with response prevention (ERP) using experience sampling methodology-based feedback to ERP as usual in patients with OCD. Personalized exposure will be provided screen-to-screen in an ecologically valid (real time and real place) context by means of a smartphone application. This app will also be used to collect both objective and subjective data by means of experience sampling methodology (ESM). This ESM data will be used to identify triggers and protective factors for symptom severity, provide personalized feedback and optimize the effect of ERP. The primary goal of this RCT is to compare the effectiveness of personalized ERP to ERP as usual in the traditional context of a therapist's room in patients with OCD in OCD symptom severity, as well as differences in quality of life, depressive symptoms and anxiety states. Since both self-efficacy and experiential avoidance are known to influence symptom severity in OCS, a secondary goal is to examine if a possible treatment effect is mediated by self-efficacy or experiential avoidance. METHODS This study involves a randomized controlled trial with 20 weekly sessions by 2 groups (ERP as usual versus personalized ERP), repeated measurements at baseline (T0), 5 weeks of treatment (T1), 10 weeks of treatment (T2), 15 weeks of treatment (T3), posttest at 20 weeks (T4), 6 weeks follow-up (T5), 3 months follow-up (T6), 6 months follow-up (T7) and a year follow-up (T8). A hundred and sixty patients with an OCD diagnosis according to DSM-5 criteria will participate. Half of the group will receive exposure with response prevention as usual, the other half will receive personalized exposure with response prevention with a smartphone application and personalized feedback sessions based on experience sampling data. Multilevel mixed modelling analysis will be used to investigate differences in treatment effect, as well as differences in quality of life, depressive symptoms and anxiety states. We will use the macro of Preacher and Hayes and apply bootstrapping methods to assess the possible mediating effect of changes in self-efficacy and experiential avoidance on subsequent treatment effects. DISCUSSION This randomized controlled trial is the first to assess the influence of delivering ERP through video-calling and the use of an ESM intervention on the symptom severity of OCD. Since the global pandemic COVID-19, the use of video-calling to deliver psychological treatments has become more common, increasing the relevance of this study. TRIAL REGISTRATION ICTRP Trial NL8254. Registered on 2019-12-24.
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Affiliation(s)
- Elena Hoogerwerf
- Parnassia Groep Academie, Dadelplein 1, 2552DS, The Hague, The Netherlands.
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
| | - Anja Greeven
- Parnassia Groep Academie, Dadelplein 1, 2552DS, The Hague, The Netherlands
| | - Rutger Goekoop
- Parnassia Groep Academie, Dadelplein 1, 2552DS, The Hague, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Leiden, the Netherlands
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Koposov R, Stickley A, Ruchkin V. Non-Suicidal Self-Injury Among Incarcerated Adolescents: Prevalence, Personality, and Psychiatric Comorbidity. Front Psychiatry 2021; 12:652004. [PMID: 34093271 PMCID: PMC8170036 DOI: 10.3389/fpsyt.2021.652004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Incarcerated adolescents represent a risk group for non-suicidal self-injury (NSSI), but research on this population has been limited and no studies have been conducted in Russia. To address this deficit, this study examined NSSI and the factors associated with it among youth in a juvenile correctional facility in Russia. Methods: NSSI and psychopathology were assessed using a psychiatric interview and self-report questionnaire in 368 incarcerated male adolescents aged 14-19 years (mean age 16.4 years, S.D. 0.9) from Northern Russia. Results: 18.2% (N = 67) of the study participants had a history of NSSI and also had higher rates of anxiety, post-traumatic stress disorder (PTSD), depression, community violence exposure and scored higher on most of the Youth Self-Report problem scales. In addition, 31.3% of the NSSI group reported previous suicidal ideation and had thought about a specific suicide method compared to 12.0% in the No-NSSI group. Adolescents with NSSI also differed significantly from the No-NSSI group on self-directedness (lower) and self-transcendence (higher) personality traits. Conclusion: NSSI is common in incarcerated adolescents in Russia and is associated with extensive psychiatric comorbidity, suicidal ideation and specific personality traits.
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Affiliation(s)
- Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Epidemiology and Modern Technologies of Vaccination, Institute of Professional Education, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Center of Neurology and Psychiatry, Kodaira, Japan.,Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Child Study Center, Yale School of Medicine, New Haven, CT, United States.,Säter Forensic Psychiatric Clinic, Säter, Sweden
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Reyno SM, Simmons M, Kinley J. A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and nonclinical populations. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:439. [PMID: 32913826 PMCID: PMC7451292 DOI: 10.4081/ripppo.2020.439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/06/2020] [Indexed: 11/23/2022]
Abstract
Alexithymia and dissociation have been consistently linked in the literature, particularly in psychiatric populations. Both arise from a disconnection between conscious aspects of self-experiences and perceptions at both the mental self and bodily levels. This results in difficulty integrating thoughts, feelings and experiences into consciousness and memory, negatively impacting emotion awareness/regulation and reflective functioning. We conducted a meta-analysis to examine the strength of the relationship between alexithymia and dissociation in both clinical and non-clinical populations. Studies using two common measures of these constructs were included (i.e., the Toronto Alexithymia Scale - TAS, and the Dissociative Experiences Scale - DES). Analyzing the effect sizes derived from 19 studies (including a total of 4664 participants) revealed moderate to strong relationships between alexithymia and dissociation. The strength of the association was higher in clinical and younger aged non clinical populations. These findings are discussed in the context of treatment recommendations..
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Affiliation(s)
| | - Maria Simmons
- Queen Elizabeth II Health Sciences Centre, Halifax NS
| | - Jackie Kinley
- Department of Psychiatry, Dalhousie University, Halifax NS, Canada
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Paiva RR, Batistuzzo MC, McLaughlin NC, Canteras MM, de Mathis ME, Requena G, Shavitt RG, Greenberg BD, Norén G, Rasmussen SA, Tavares H, Miguel EC, Lopes AC, Hoexter MQ. Personality measures after gamma ventral capsulotomy in intractable OCD. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:161-168. [PMID: 29100975 DOI: 10.1016/j.pnpbp.2017.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Neurosurgeries such as gamma ventral capsulotomy (GVC) are an option for otherwise intractable obsessive-compulsive disorder (OCD) patients. In general, clinical and neuropsychological status both improve after GVC. However, its consequences on personality traits are not well-studied. The objective of this study was to investigate personality changes after one year of GVC in intractable OCD patients. METHODS The personality assessment was conducted using the Revised NEO Personality Inventory (NEO PI-R) and Cloninger's Temperament and Character Inventory (TCI) in 14 intractable OCD patients before and one year after GVC. Comparisons of personality features between treatment responders (n=5) and non-responders (n=9) were performed. Multiple linear regression was also used for predicting changes in clinical and global functioning variables. RESULTS Overall, no deleterious effect was found in personality after GVC. Responders had a reduction in neuroticism (p=0.043) and an increase in extraversion (p=0.043). No significant changes were observed in non-responders. Increases in novelty seeking and self-directedness, and decreases in persistence and cooperativiness predicted OCD symptom improvement. Similary, improvement in functioning was also predicted by hgher novelty seeking and self-directedness after GVC, whereas better functioning was also associated with lower reward dependence and cooperativeness after surgery. CONCLUSIONS The pattern of changes in personality traits after GVC was generally towards that observed in nonclinical population, and does not raise safety concerns.
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Affiliation(s)
- Raquel R Paiva
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Marcelo C Batistuzzo
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nicole C McLaughlin
- Department of Psychiatry and Human Behavior, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Miguel M Canteras
- Institute of Neurological Radiosurgery, Hospital Santa Paula, São Paulo, Brazil
| | - Maria E de Mathis
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Guaraci Requena
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roseli G Shavitt
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Benjamin D Greenberg
- Department of Psychiatry and Human Behavior, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA; Center of Neurorestoration and Neurology, Providence VA Medical Center, RI, USA
| | - Georg Norén
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Steven A Rasmussen
- Department of Psychiatry and Human Behavior, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hermano Tavares
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eurípedes C Miguel
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Antonio C Lopes
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcelo Q Hoexter
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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The influence of personality traits and emotional and behavioral problems on repetitive nonsuicidal self-injury in a school sample. Compr Psychiatry 2017; 74:214-223. [PMID: 28231481 DOI: 10.1016/j.comppsych.2017.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/02/2017] [Accepted: 02/11/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is highly prevalent among adolescents and associated with various mental health problems and suicidality. Previous studies have found that certain personality traits are related to NSSI behavior, however only few studies examined personality traits in adolescents with NSSI. Our study aimed to assess the relationship between personality traits and emotional and behavioral problems in predicting repetitive NSSI among adolescents from a school sample. METHODS Four hundred and forty-seven students (M=14.95years, SD=0.74, 52% male) completed self-report measures on NSSI, personality traits, and emotional and behavioral problems. RESULTS The past year prevalence of occasional and repetitive NSSI was 4.9% and 6.3% respectively. Repetitive NSSI was significantly associated with female gender, higher levels of age, novelty seeking, harm avoidance, self-transcendence, antisocial behavior, and positive self and lower levels of persistence and self-directedness in univariate analyses. However, multivariate logistic regression analyses indicated that only high levels of antisocial behavior and low levels of self-directedness significantly predicted repetitive NSSI. CONCLUSIONS The association between a lack of self-directedness and NSSI emphasizes the significance of targeting self-directedness in psychotherapy by strengthening self-awareness, affect tolerance and emotion regulation, as well as establishing and pursuing long-term goals.
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Use of the Temperament and Character Inventory to Predict Response to Repetitive Transcranial Magnetic Stimulation for Major Depression. J Psychiatr Pract 2016; 22:193-202. [PMID: 27123799 PMCID: PMC4852279 DOI: 10.1097/pra.0000000000000150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The goal of this study was to investigate the utility of the Temperament and Character Inventory (TCI) in predicting antidepressant response to repetitive transcranial magnetic stimulation (rTMS). BACKGROUND Although rTMS of the dorsolateral prefrontal cortex is an established antidepressant treatment, little is known about predictors of response. The TCI measures multiple personality dimensions (harm avoidance, novelty seeking, reward dependence, persistence, self-directedness, self-transcendence, and cooperativeness), some of which have predicted response to pharmacotherapy and cognitive-behavioral therapy. A previous study suggested a possible association between self-directedness and response to rTMS in melancholic depression, although this was limited by the fact that melancholic depression is associated with a limited range of TCI profiles. METHODS Nineteen patients with a major depressive episode completed the TCI before a clinical course of rTMS over the dorsolateral prefrontal cortex. Treatment response was defined as ≥50% decrease in scores on the Hamilton Rating Scale for Depression (Ham-D). Baseline scores on each TCI dimension were compared between responders and nonresponders through analysis of variance. Pearson correlations were also calculated for temperament/character scores in comparison with percentage improvement in Ham-D scores. RESULTS Eleven of the 19 patients responded to rTMS. T-scores for persistence were significantly higher in responders than in nonresponders (P=0.022). Linear regression revealed a correlation between persistence scores and percentage improvement in Ham-D scores. CONCLUSIONS Higher persistence scores predicted antidepressant response to rTMS. This may be explained by rTMS-induced enhancement of cortical excitability, which has been found to be decreased in patients with high persistence. Personality assessment that includes measurement of TCI persistence may be a useful component of precision medicine initiatives in rTMS for depression.
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Lester N, Garcia D, Lundström S, Brändström S, Råstam M, Kerekes N, Nilsson T, Cloninger CR, Anckarsäter H. The genetic and environmental structure of the character sub-scales of the temperament and character inventory in adolescence. Ann Gen Psychiatry 2016; 15:10. [PMID: 26973705 PMCID: PMC4788834 DOI: 10.1186/s12991-016-0094-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The character higher order scales (self-directedness, cooperativeness, and self-transcendence) in the temperament and character inventory are important general measures of health and well-being [Mens Sana Monograph 11:16-24 (2013)]. Recent research has found suggestive evidence of common environmental influence on the development of these character traits during adolescence. The present article expands earlier research by focusing on the internal consistency and the etiology of traits measured by the lower order sub-scales of the character traits in adolescence. METHODS The twin modeling analysis of 423 monozygotic pairs and 408 same sex dizygotic pairs estimated additive genetics (A), common environmental (C), and non-shared environmental (E) influences on twin resemblance. All twins were part of the on-going longitudinal Child and Adolescent Twin Study in Sweden (CATSS). RESULTS The twin modeling analysis suggested a common environmental contribution for two out of five self-directedness sub-scales (0.14 and 0.23), for three out of five cooperativeness sub-scales (0.07-0.17), and for all three self-transcendence sub-scales (0.10-0.12). CONCLUSION The genetic structure at the level of the character lower order sub-scales in adolescents shows that the proportion of the shared environmental component varies in the trait of self-directedness and in the trait of cooperativeness, while it is relatively stable across the components of self-transcendence. The presence of this unique shared environmental effect in adolescence has implications for understanding the relative importance of interventions and treatment strategies aimed at promoting overall maturation of character, mental health, and well-being during this period of the life span.
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Affiliation(s)
- Nigel Lester
- />Department of Psychiatry, Center for Well-Being, Washington University School of Medicine, St. Louis, MO USA
| | - Danilo Garcia
- />Department of Psychiatry, Center for Well-Being, Washington University School of Medicine, St. Louis, MO USA
- />Blekinge Center of Competence, Blekinge County Council, Karlskrona, Sweden
- />Department of Psychology, University of Gothenburg, Gothenburg, Sweden
- />Department of Psychology, Lund University, Lund, Sweden
- />Network for Empowerment and Well-Being, Lyckeby, Sweden
- />Institute for Neuroscience and Physiology, Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- />Institute for Neuroscience and Physiology, Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
- />R&E unit, Swedish Prison and Probation Service, Norrköping, Sweden
- />Gillberg Neuropsychiatry Centre, Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sven Brändström
- />Institute for Neuroscience and Physiology, Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
| | - Maria Råstam
- />Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Nóra Kerekes
- />Institute for Neuroscience and Physiology, Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
- />R&E unit, Swedish Prison and Probation Service, Norrköping, Sweden
- />Institution for Health Sciences, University West, Trollhättan, Sweden
| | - Thomas Nilsson
- />Institute for Neuroscience and Physiology, Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
- />R&E unit, Swedish Prison and Probation Service, Norrköping, Sweden
| | - C. Robert Cloninger
- />Department of Psychiatry, Center for Well-Being, Washington University School of Medicine, St. Louis, MO USA
| | - Henrik Anckarsäter
- />Institute for Neuroscience and Physiology, Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
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Ociskova M, Prasko J, Latalova K, Kamaradova D, Grambal A. Psychological factors and treatment effectiveness in resistant anxiety disorders in highly comorbid inpatients. Neuropsychiatr Dis Treat 2016; 12:1539-51. [PMID: 27445474 PMCID: PMC4928674 DOI: 10.2147/ndt.s104301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anxiety disorders are a group of various mental syndromes that have been related with generally poor treatment response. Several psychological factors may improve or hinder treatment effectiveness. Hope has a direct impact on the effectiveness of psychotherapy. Also, dissociation is a significant factor influencing treatment efficiency in this group of disorders. Development of self-stigma could decrease treatment effectiveness, as well as several temperamental and character traits. The aim of this study was to explore a relationship between selected psychological factors and treatment efficacy in anxiety disorders. SUBJECTS AND METHODS A total of 109 inpatients suffering from anxiety disorders with high frequency of comorbidity with depression and/or personality disorder were evaluated at the start of the treatment by the following scales: the Mini-International Neuropsychiatric Interview, the Internalized Stigma of Mental Illness scale, the Adult Dispositional Hope Scale, and the Temperament and Character Inventory - revised. The participants, who sought treatment for anxiety disorders, completed the following scales at the beginning and end of an inpatient-therapy program: Clinical Global Impression (objective and subjective) the Beck Depression Inventory - second edition, the Beck Anxiety Inventory, and the Dissociative Experiences Scale. The treatment consisted of 25 group sessions and five individual sessions of cognitive behavioral therapy or psychodynamic therapy in combination with pharmacotherapy. There was no randomization to the type of group-therapy program. RESULTS Greater improvement in psychopathology, assessed by relative change in objective Clinical Global Impression score, was connected with low initial dissociation level, harm avoidance, and self-stigma, and higher amounts of hope and self-directedness. Also, individuals without a comorbid personality disorder improved considerably more than comorbid patients. According to backward-stepwise multiple regression, the best significant predictor of treatment effectiveness was the initial level of self-stigma. CONCLUSION The initial higher levels of self-stigma predict a lower effectiveness of treatment in resistant-anxiety-disorder patients with high comorbidity with depression and/or personality disorder. The results suggest that an increased focus on self-stigma during therapy could lead to better treatment outcomes.
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Affiliation(s)
- Marie Ociskova
- Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
| | - Klara Latalova
- Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
| | - Dana Kamaradova
- Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
| | - Ales Grambal
- Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
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Finkler DC, Wesner AC, Heldt E. Temperamento e Caráter na Resposta à Terapia Cognitivo-Comportamental para Transtorno de Pânico. PSICOLOGIA: TEORIA E PESQUISA 2016. [DOI: 10.1590/0102-3772e322217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O estudo investigou o impacto das características de temperamento e caráter na resposta à terapia cognitivo-comportamental (TCC) para pacientes com transtorno de pânico (TP). Um total de 55 pacientes realizou 12 sessões de TCC em grupo (TCCG). A gravidade dos sintomas foi verificada antes e após a intervenção, e o Inventário de Temperamento e Caráter de Cloninger foi aplicado no início do tratamento. Observou-se uma redução significativa na gravidade do TP após a intervenção. Análises de regressão indicaram que as características de temperamento (persistência) e caráter (autodirecionamento e cooperatividade) não se mostraram significativamente relacionadas à melhora da agorafobia e de sintomas depressivos, permanecendo a gravidade inicial desses sintomas como fatores independentes de resposta à TCCG.
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Terock J, Janowitz D, Spitzer C, Miertsch M, Freyberger HJ, Grabe HJ. Alexithymia and self-directedness as predictors of psychopathology and psychotherapeutic treatment outcome. Compr Psychiatry 2015; 62:34-41. [PMID: 26343465 DOI: 10.1016/j.comppsych.2015.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/28/2015] [Accepted: 06/06/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alexithymia, a common personality style of patients seeking psychotherapeutic help, is associated with illness severity and negative treatment outcome in various mental disorders. Still, it remains unclear how alexithymia influences psychopathology and the therapeutic processes. In previous studies, a strong association of alexithymia with self-directedness (SD), a dimension of Cloninger's Temperament and Character Inventory (TCI) has been shown. In this study, we investigated the interaction of alexithymia and SD, and their impact on general psychopathology and on treatment outcome. METHOD 716 consecutively admitted day-clinic outpatients were examined at admission (t0) and discharge (t1). The Toronto Alexithymia Scale 20 (TAS-20), the SD subscale of the TCI and the Symptom Checklist 90 (SCL-90-R) were administered. Linear regression analyses were performed to calculate associations and the predictive power of TAS-20 and SD on psychopathology at admission and treatment outcome. ANOVA was used to calculate interactions of TAS-20 and SD on treatment outcome. A general linear model was applied to compare the outcome of four subgroups, defined by high/low TAS-20 and SD scores. RESULTS Regression analyses revealed significant prediction of the baseline General Severity Index (GSIt0) by TAS-20 (df=4, 711; Beta: 0.385; p<0.001) and SD (Beta: -0.365; p<0.001). The whole model accounted for 41% of the explained variance. On subscale level, the 'Difficulties in identifying feelings' facet (DIF) of TAS-20 was the strongest predictor of GSIt0 (Beta: 0.478, P<0.001) and GSIt1 (Beta: 0.072, p=0.049). Therapeutic outcome measured by GSIt1 was significantly predicted by SD (df=5, 710; Beta: -0.065; p=0.041), but not by TAS-20 (Beta: 0.042; p=0.179). Change scores (∆) of TAS-20 and SD predicted GSIt1 (df=5, 710; TAS-20∆ Beta: -0.268; p<0.001; SD∆ Beta: 0.191; p<0.001) as well as GSI∆ (df=5, 710; TAS∆ Beta: 0.384; p<0.001; SD∆: -0.274; p<0.001) significantly. ANOVA revealed no significant interactions of TAS-20 and SD at admission on the treatment outcome (p>0.05). CONCLUSION Low SD was shown to be a common problem of alexithymic patients and both, alexithymia and SD were highly associated with general symptom severity. SD was found to have a greater impact on treatment outcome while adjusting for baseline GSI. Alexithymia and SD act as independent factors with no significant interaction in their impact on psychopathology at admission and discharge. As different interventions were shown to improve SD scores in previous studies, SD may represent a relevant psychotherapeutic target, worthy to be addressed especially in alexithymic patients. Future studies should investigate other dimensions of the TCI, especially harm avoidance and reward dependence.
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Affiliation(s)
- Jan Terock
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany.
| | - Deborah Janowitz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
| | | | - Martin Miertsch
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
| | - Harald J Freyberger
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
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Mirshekarl EN, Rashidkhan B, Rezaiian F, Vahid F, Najafi R. Relationship Between Hardiness and Achieving Desired Body Mass Index. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/pjn.2015.50.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Rodríguez-Cano T, Beato-Fernandez L, Rojo-Moreno L, Vaz-Leal FJ. The role of temperament and character in the outcome of depressive mood in eating disorders. Compr Psychiatry 2014; 55:1130-6. [PMID: 24666713 DOI: 10.1016/j.comppsych.2014.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/16/2014] [Accepted: 02/17/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aims were to see which temperament and character dimensions were associated with depression, mainly with its outcome at two-year follow up in eating disorders (EDs). METHODS Participants (N=151) were 44 Anorexia nervosa (AN), 55 Bulimia nervosa (BN) and 52 Eating disorders not otherwise specified (EDNOS) patients. The Beck Depression Inventory (BDI), State and Trait Anxiety Inventory (STAI), Rosenberg Self Esteem Questionnaire (RSE), Eating Disorder Inventory (EDI-2) and Temperament and Character Inventory (TCI) were administered. RESULTS Depression at the beginning (t0) was severe in 22% of the cases. Harm Avoidance and Novelty Seeking had an effect on depressed mood at t0, mediated by Ineffectiveness. Responsibility (SD1) was associated with scores on the BDI at two-year follow up (β=-0.37, 95% CI -2.6, -0.6, p<0.01). CONCLUSION The evaluation of personality dimension in EDs has therapeutic and prognostic implications: To enhance self-efficacy and self-directness is crucial for good clinical outcome.
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Affiliation(s)
- Teresa Rodríguez-Cano
- Eating Disorders Unit, Department of Psychiatry, General Hospital of Ciudad Real, C/Obispo Torija s/n, 13005-Ciudad Real, Spain
| | - Luis Beato-Fernandez
- Eating Disorders Unit, Department of Psychiatry, General Hospital of Ciudad Real, C/Obispo Torija s/n, 13005-Ciudad Real, Spain.
| | - Luis Rojo-Moreno
- Department of Psychiatry, Faculty of Medicine, University of Valencia, Avda Blasco Ibañez nº 15, 46010-Valencia, Spain
| | - Francisco J Vaz-Leal
- Department of Psychiatry, Faculty of Medicine, University of Extremadura, Avda. De Elbas s/n, 06017-Badajoz, Spain
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Franz AP, Paim M, Araújo RMD, Rosa VDO, Barbosa ÍM, Blaya C, Ferrão YA. Treating refractory obsessive-compulsive disorder: what to do when conventional treatment fails? TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2013; 35:24-35. [DOI: 10.1590/s2237-60892013000100004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic and impairing condition. A very small percentage of patients become asymptomatic after treatment. The purpose of this paper was to review the alternative therapies available for OCD when conventional treatment fails. Data were extracted from controlled clinical studies (evidence-based medicine) published on the MEDLINE and Science Citation Index/Web of Science databases between 1975 and 2012. Findings are discussed and suggest that clinicians dealing with refractory OCD patients should: 1) review intrinsic phenomenological aspects of OCD, which could lead to different interpretations and treatment choices; 2) review extrinsic phenomenological aspects of OCD, especially family accommodation, which may be a risk factor for non-response; 3) consider non-conventional pharmacological approaches; 4) consider non-conventional psychotherapeutic approaches; and 5) consider neurobiological approaches.
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Affiliation(s)
| | - Mariana Paim
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | | | | | | | - Carolina Blaya
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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Kipper L, Wachleski C, Salum GA, Heldt E, Blaya C, Manfro GG. Can psychopharmacological treatment change personality traits in patients with panic disorder? BRAZILIAN JOURNAL OF PSYCHIATRY 2011; 31:307-13. [PMID: 20098823 DOI: 10.1590/s1516-44462009000400005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 04/15/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects that a particular psychopharmacological treatment has on personality patterns in patients with panic disorder. METHOD Forty-seven patients with panic disorder and 40 controls were included in the study. The Mini International Neuropsychiatric Interview and Minnesota Multiphasic Personality Inventory were used to assess Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnoses and personality traits, respectively. Patients were treated with sertraline for 16 weeks. RESULTS There was a significant decrease in the score on 8 of the 10 Minnesota Multiphasic Personality Inventory scales. In addition, neurotic triad and psychasthenia personality scores were higher among panic disorder patients, even during the posttreatment asymptomatic phase, than among controls. CONCLUSION In the asymptomatic phase of the disease, panic disorder patients present a particular neurotic/anxious personality pattern. This pattern, although altered in the presence of acute symptoms, could be a focus of research.
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Affiliation(s)
- Letícia Kipper
- Postgraduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology 2010; 35:317-36. [PMID: 19759530 PMCID: PMC3055421 DOI: 10.1038/npp.2009.128] [Citation(s) in RCA: 268] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Psychiatric neurosurgery, specifically stereotactic ablation, has continued since the 1940s, mainly at a few centers in Europe and the US. Since the late 1990s, the resurgence of interest in this field has been remarkable; reports of both lesion procedures and the newer technique of deep brain stimulation (DBS) have increased rapidly. In early 2009, the US FDA granted limited humanitarian approval for DBS for otherwise intractable obsessive-compulsive disorder (OCD), the first such approval for a psychiatric illness. Several factors explain the emergence of DBS and continued small-scale use of refined lesion procedures. DBS and stereotactic ablation have been successful and widely used for movement disorders. There remains an unmet clinical need: current drug and behavioral treatments offer limited benefit to some seriously ill people. Understandings of the neurocircuitry underlying psychopathology and the response to treatment, while still works in progress, are much enhanced. Here, we review modern lesion procedures and DBS for OCD in the context of neurocircuitry. A key issue is that clinical benefit can be obtained after surgeries targeting different brain structures. This fits well with anatomical models, in which circuits connecting orbitofrontal cortex (OFC), medial prefrontal cortex (mPFC), basal ganglia, and thalamus are central to OCD pathophysiology and treatment response. As in movement disorders, dedicated interdisciplinary teams, here led by psychiatrists, are required to implement these procedures and maintain care for patients so treated. Available data, although limited, support the promise of stereotactic ablation or DBS in carefully selected patients. Benefit in such cases appears not to be confined to obsessions and compulsions, but includes changes in affective state. Caution is imperative, and key issues in long-term management of psychiatric neurosurgery patients deserve focused attention. DBS and contemporary ablation also present different patterns of potential benefits and burdens. Translational research to elucidate how targeting specific nodes in putative OCD circuitry might lead to therapeutic gains is accelerating in tandem with clinical use.
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