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Krylova ES. [Depression in patients with personality disorder in youth]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:4-10. [PMID: 30251971 DOI: 10.17116/jnevro20181180814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To define clinical specifics of depression in patients with personality disorders (PD) in youth and work out differential/diagnostic criteria of these states. MATERIAL AND METHODS One hundred and sixty patients (136 men, 24 women, mean age19.5±3.2 years) were studied. Later 42 patients from this group participated in the follow-up study. RESULTS The following types of depression were described: 'with overvalued ideas', 'with neurotic disorders', 'with predominant addictions', 'with youth asthenic incapacity' and 'with attenuated psychotic symptoms'. These types clearly correlate with the type of PD. CONCLUSION Personality abnormality plays a role in the pathogenesis of these states. This finding contributes to the more accurate diagnosis, prognostic and therapeutic solutions.
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Affiliation(s)
- E S Krylova
- Mental Health Research Center, Moscow, Russia
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Mitchell RH, Metcalfe AW, Islam AH, Toma S, Patel R, Fiksenbaum L, Korczak D, MacIntosh BJ, Goldstein BI. Sex differences in brain structure among adolescents with bipolar disorder. Bipolar Disord 2018; 20:448-458. [PMID: 29956452 DOI: 10.1111/bdi.12663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Bipolar disorder (BD) is twice as prevalent amongst female as amongst male adolescents. Thus far, little is known regarding the neurostructural substrates underlying this disparity. We therefore examined sex differences in neurostructural magnetic resonane imaging (MRI) phenotypes amongst adolescents with BD. METHODS T1-weighted structural MRI was acquired from 44 BD (25 female [F] and 19 male [M]) and 58 (28 F and 30 M) healthy control (HC) adolescents (13-21 years old). Whole-brain and region-of-interest (ROI) analyses examined structural volume and cortical thickness using FreeSurfer. ROIs included the ventrolateral prefrontal cortex (vlPFC), anterior cingulate cortex (ACC), amygdala and hippocampus. General linear models evaluated sex-by-diagnosis interactions, controlling for age and intracranial volume. RESULTS Whole-brain analysis revealed sex-by-diagnosis interactions in the left supramarginal gyrus (SMG) (P = .02, η2 = 0.02) and right inferior parietal lobule (IPL) volumes (P = .04, η2 = 0.01). Sex differences in HCs were found in the SMG (M > F) and IPL (F > M). In BD, sex differences were reversed and of smaller magnitude in the SMG (M < F) and of greater magnitude in the IPL (F > M), driven by trends towards smaller SMG and IPL in BD vs HC male participants (P = .05 and .14). Whole-brain analyses for cortical thickness, and ROI analyses for volume and cortical thickness, were not significant. CONCLUSIONS Normative sex differences may be disrupted in adolescent BD in the SMG and IPL, heteromodal association network hubs responsible for higher order integration of cognitive and emotional processing. Unexpectedly, these findings may inform our understanding of aberrant brain structure in adolescent BD male patients, rather than female patients. Future work should focus on replication, as well as the impact of puberty status and sex hormones on measures of brain structure and function.
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Affiliation(s)
- Rachel Hb Mitchell
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Arron Ws Metcalfe
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alvi H Islam
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Simina Toma
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ronak Patel
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Lisa Fiksenbaum
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Daphne Korczak
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
- Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
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Mitchell RHB, Timmins V, Collins J, Scavone A, Iskric A, Goldstein BI. Prevalence and Correlates of Disruptive Mood Dysregulation Disorder Among Adolescents with Bipolar Disorder. J Child Adolesc Psychopharmacol 2016; 26:147-53. [PMID: 26844707 DOI: 10.1089/cap.2015.0063] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the prevalence and correlates of disruptive mood dysregulation disorder phenotype (DMDDP) in a clinical population of adolescents with bipolar disorder (BD). METHODS DMDD criteria were modified and applied to a sample of 116 adolescents with BD-I (n = 30), BD-II (n = 46) or BD-not otherwise specified (NOS) (n = 40) from a tertiary teaching hospital. Diagnoses were determined via the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime version (KSADS-PL). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) DMDD Criteria A-G were derived from the KSADS oppositional defiant disorder (ODD) screening interview and supplement, as well as narrative summaries. Chi-square analyses or t tests (p < 0.05) were conducted as appropriate, followed by logistic regression. P values were adjusted using the false discovery rate (FDR) approach. RESULTS DMDDP criteria could not be determined for 8 adolescents because of missing data from the ODD supplement. Twenty-five percent of the remainder (27/108) met criteria for DMDDP. DMDDP was not associated with BD subtype or with family history of BD. In univariate analyses, after controlling for age, sex, and race, DMDDP was associated with lower functioning, increased family conflict, assault history, and attention deficit and/or hyperactivity disorder (ADHD) (FDR adjusted p values: <0.0001, < 0.0001, 0.007, and 0.007, respectively). Lifetime substance use disorder and medication use approached significance (adjusted p = 0.05). In logistic regression, DMDDP was independently associated with greater parent-reported family conflict (odds ratio [OR] 1.17; confidence interval [CI- 1.06-1.30; p = 0.001) and greater functional impairment (OR 0.89; CI 0.82-0.97; p = 0.006). DMDDP was also associated with a threefold increase in ADHD, although ADHD was only marginally significant (OR 3.3; CI 0.98-10.94; p = 0.05). CONCLUSIONS Despite the positioning of DMDD as phenotypically and biologically distinct from BD, these phenotypes commonly overlap in clinical settings. This overlap is not explained by BD-NOS or by nonfamilial BD. The association of ADHD with DMDDP in this sample draws into question whether arousal symptoms should have been retained as originally elaborated in the severe mood dysregulation phenotype. Strategies to mitigate the excessive functional impairment of this comorbidity are warranted.
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Affiliation(s)
- Rachel H B Mitchell
- 1 Department of Psychiatry, University of Toronto , Toronto, Ontario, Canada
| | - Vanessa Timmins
- 2 Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Jordan Collins
- 2 Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Antonette Scavone
- 2 Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Adam Iskric
- 2 Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- 2 Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
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