1
|
Rost F, Booker T, Gonsard A, de Felice G, Asseburg L, Malda-Castillo J, Koutoufa I, Ridsdale H, Johnson R, Taylor D, Fonagy P. The complexity of treatment-resistant depression: A data-driven approach. J Affect Disord 2024; 358:292-301. [PMID: 38697222 DOI: 10.1016/j.jad.2024.04.093] [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: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/21/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Recent systematic reviews highlight great variability in defining and assessing treatment-resistant depression (TRD). A key problem is that definitions are consensus rather than data-led. This study seeks to offer a comprehensive socio-demographic and clinical description of a relevant sample. METHODS As part of a pragmatic randomized controlled trial, patients (N = 129) were managed in primary care for persistent depression and diagnosed with TRD. Data included previous treatment attempts, characteristics of the depressive illness, functioning, quality of life, co-occurring problems including suicidality, psychiatric and personality disorders, physical health conditions, and adverse events. RESULTS Findings show a severe and chronic course of depression with a duration of illness of 25+ years. Overall, 82.9 % had at least one other psychiatric diagnosis and 82.2 % at least one personality disorder; 69.8 % had significant musculoskeletal, gastrointestinal, genitourinary, or cardiovascular and respiratory physical health problems. All but 14 had severe difficulties in social and occupational functioning and reported severely impaired quality of life. Suicidal ideation was high: 44.9 % had made at least one serious suicide attempt and several reported multiple attempts with 17.8 % reporting a suicide attempt during childhood or adolescence. Of the patients, 79.8 % reported at least one adverse childhood experience. LIMITATIONS Potential for recall bias, not examining possible interactions, and absence of a control group. CONCLUSIONS Our findings reveal a complex and multifaceted condition and call for an urgent reconceptualization of TRD, which encompasses many interdependent variables and experiences. Individuals with TRD may be at a serious disadvantage in terms of receiving adequate treatment.
Collapse
Affiliation(s)
- Felicitas Rost
- Tavistock and Portman NHS Foundation Trust, London, UK; The Open University, School of Psychology and Psychotherapy, Faculty of Arts and Social Sciences, Milton Keynes, UK.
| | - Thomas Booker
- Tavistock and Portman NHS Foundation Trust, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | | | | | | | | | | | | | | | - David Taylor
- Tavistock and Portman NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| |
Collapse
|
2
|
Maoz H, Grossman-Giron A, Sedoff O, Nitzan U, Kashua H, Yarmishin M, Arad O, Tzur Bitan D. Intranasal oxytocin as an adjunct treatment among patients with severe major depression with and without comorbid borderline personality disorder. J Affect Disord 2024; 347:39-44. [PMID: 37992767 DOI: 10.1016/j.jad.2023.11.053] [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: 08/24/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Results of studies concerning a possible beneficial effect of Intranasal-Oxytocin (IN-OT) as an add-on treatment for patients with major depression (MDD) have been inconsistent. One possible explanation to account for the difference in the effect of IN-OT is comorbid borderline personality disorder (BPD). This randomized controlled study was aimed to explore the differential effect of IN-OT administration among depressive patients with or without comorbid borderline personality disorder. METHODS A secondary analysis was conducted on a specific subset of patients who participated in an RCT evaluating the impact of IN-OT as add-on treatment for patients with severe mental illness. Patients treated in inpatient settings (N = 58) were randomized and double-blindly allocated to receive twice daily IN-OT (32 IU) or placebo for a period of four weeks. The effect of IN-OT on therapy process and outcome was examined among patients with (n = 35) and without (n = 23) comorbid BPD. RESULTS An interaction effect between diagnosis and group was observed on the Outcome Questionnaire-45 (B = 8.93, p = .007). Further analysis revealed that patients without BPD demonstrated significantly greater improvements following OT administration (B = -8.32, p = .001), whereas patients with BPD did not show significant improvement (B = 0.61, p = .76). The interactive pattern was also observed in the Hopkins Symptom Checklist (B = 0.25, p = .02), where patients without BPD demonstrated significantly larger improvements following OT administration (B = -0.29, p = .0009) as compared to placebo, while patients with BPD demonstrated no significant improvement (B = -0.04, p = .55). We did not find a harmful effect of IN-OT administration among patients with MDD and comorbid BPD. CONCLUSIONS Patients with MDD and comorbid BPD benefit less from IN-OT administration as compared to depressed patients without BPD. Future studies should aim to identify patients who are more likely to benefit from IN-OT administration.
Collapse
Affiliation(s)
- Hagai Maoz
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel.
| | - Ariella Grossman-Giron
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel; Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Omer Sedoff
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Uri Nitzan
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel
| | - Halil Kashua
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel
| | - Maya Yarmishin
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel
| | - Olga Arad
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel
| | - Dana Tzur Bitan
- Shalvata Mental Health Center, Affiliated with the School of Medicine, Tel-Aviv University, Tel-Aviv-Jaffa, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel
| |
Collapse
|
3
|
Reinhardt P, Ellbin S, Carlander A, Hadzibajramovic E, Jonsdottir IH, Lindqvist Bagge A. Is the road to burnout paved with perfectionism? The prevalence of obsessive-compulsive personality disorder in a clinical longitudinal sample of female patients with stress-related exhaustion. J Clin Psychol 2024; 80:391-405. [PMID: 37866970 DOI: 10.1002/jclp.23617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/24/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES Few studies have investigated the relationship between stress-related mental health problems and obsessive-compulsive personality disorder (OCPD). Similarly, little research has focused on the moderating effect of OCPD on recovery in clinical patients with stress-related mental health problems. The general aim of this study was to investigate the prevalence of OCPD and the associations between OCPD and level of burnout, anxiety, and depression symptoms, during a 7-years follow-up in a clinical longitudinal sample of female patients with stress-related exhaustion. METHOD The included patients (n = 84) were referred to a specialist outpatient clinic for patients with stress-related exhaustion between 2006 and 2011. Data was collected at the initial examination and during a 7-year treatment follow-up. RESULTS OCPD was the most common personality disorder in the present clinical sample, with 40% of patients fulfilling the criteria. There was a significant association between OCPD and the degree of burnout symptoms as well as the degree of depression, both at baseline and during the 7-year follow-up. No significant association between OCPD and levels of anxiety was observed. CONCLUSION The results support the hypothesis that there might be an association between OCPD and stress-related exhaustion, including preservation of symptoms over time. OCPD and its related traits, such as perfectionism, may be important factors to consider when constructing effective treatment and rehabilitation plans for these patients.
Collapse
Affiliation(s)
- P Reinhardt
- The Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
| | - S Ellbin
- The Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
| | - A Carlander
- SOM Institute, University of Gothenburg, Gothenburg, Sweden
| | - E Hadzibajramovic
- The Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingibjörg H Jonsdottir
- The Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | |
Collapse
|
4
|
Fuhr K, Meisner C, Batra A. Long-Term Outcomes of Depression Treatment With Hypnotherapy or Cognitive Behavioral Therapy. J Nerv Ment Dis 2023; 211:519-524. [PMID: 36928627 DOI: 10.1097/nmd.0000000000001647] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
ABSTRACT In a recent randomized controlled trial of mild to moderate depression, hypnotherapy (HT) was noninferior to cognitive behavioral therapy (CBT) after 6 months of outpatient treatment. In the present article, we extended the results in a secondary analysis and investigated how HT compares with CBT 1) during the course of the self-rated depressive symptoms throughout the 12-month follow-ups, 2) with regard to the rates of full remission, and 3) for the time to remission after treatment. Of the 152 randomized patients with current depression, 136 were available for the follow-up analyses. The course of self-rated depressive symptoms during follow-ups was analyzed with linear mixed-effects models. Time to a full remission, defined as eight consecutive weeks without depression, was compared between groups in a survival analysis. The self-reported depressive symptoms could be maintained on a low symptom level during the 12-month follow-up for both HT and CBT. Overall, both treatments achieved comparably high long-term remission rates of 73% after a median of 30 weeks. Outpatient psychotherapy with HT achieved good long-term results mostly comparable to CBT.
Collapse
Affiliation(s)
- Kristina Fuhr
- Department of Psychiatry and Psychotherapy at the University Hospital of Tuebingen, Tuebingen
| | - Christoph Meisner
- Study Center, Robert Bosch Society for Medical Research, Stuttgart, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy at the University Hospital of Tuebingen, Tuebingen
| |
Collapse
|
5
|
Altaweel N, Upthegrove R, Surtees A, Durdurak B, Marwaha S. Personality traits as risk factors for relapse or recurrence in major depression: a systematic review. Front Psychiatry 2023; 14:1176355. [PMID: 37215669 PMCID: PMC10196019 DOI: 10.3389/fpsyt.2023.1176355] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
Background Major depressive disorder (MDD) is highly recurrent. Identifying risk factors for relapse in depression is essential to improve prevention plans and therapeutic outcomes. Personality traits and personality disorders are widely considered to impact outcomes in MDD. We aimed to evaluate the role of personality aspects in the risk of relapse and recurrence in MDD. Method A PROSPERO-registered systematic review was conducted using Medline, Embase, PsycINFO, Web of Science and CINAHL as data sources, together with hand searching of four journals over the five years till 2022. There was independent abstract selection, quality assessment and data extraction from each study. Results Twenty two studies me t eligibility criteria involving 12,393 participants. Neurotic personality features are significantly associated with the risk of relapse and recurrence of depression, though the data is not uniform. There is some, though limited, evidence that borderline, obsessive-compulsive and dependent personality traits or disorders increase the risk for relapse in depression. Limitations The small number, in addition to the methodological heterogeneity of the included studies, did not allow further analysis, such as meta-analysis. Conclusion People with high neuroticism and dependent personality traits, borderline personality disorder or obsessive-compulsive personality disorder, compared to those without, may be at a higher risk of experiencing relapse or recurrence of MDD. Specific and targeted interventions may potentially reduce relapse and recurrence rates in these groups and could improve outcomes. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=235919, identifier: CRD42021235919.
Collapse
Affiliation(s)
- Nada Altaweel
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Department of Psychology, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Rachel Upthegrove
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Woman's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Surtees
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Woman's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Buse Durdurak
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Steven Marwaha
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Woman's and Children's NHS Foundation Trust, Birmingham, United Kingdom
- Specialist Mood Disorders Clinic, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
6
|
Jo R, Broadbear JH, Hope J, Rao S. Late manifestation of borderline personality disorder: Characterization of an under-recognized phenomenon. Personal Ment Health 2022; 17:165-175. [PMID: 36379721 DOI: 10.1002/pmh.1571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/11/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
Although uncommon, borderline personality disorder (BPD) may manifest for the first time later in life. A retrospective clinical file audit was used to identify the clinical manifestation of BPD for the first time at or above the age of 30, and to examine whether particular clinical and psychosocial factors may be associated with a later-in-life manifestation of BPD. Twenty-three cases of late manifestation BPD were identified. People with late manifestation of BPD had similar risk factors and vulnerabilities, including childhood trauma, to the broader BPD population. They were distinguished by having higher levels of education, employment, and long-term intimate relationships. Interpersonal problems, loss of employment and reminders of past sexual trauma were key precipitating factors. The findings underscore the legitimacy of a late-manifestation diagnosis of BPD by demonstrating that BPD does not present exclusively during adolescence and early adulthood. BPD may present for the first time in later life in response to loss of protective factors or triggering of past trauma. This understanding may reduce misdiagnosis or delayed diagnosis, prescription of inappropriate treatments or delays in receiving BPD-appropriate treatments.
Collapse
Affiliation(s)
- Rachel Jo
- Spectrum Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia.,Mental Health Program, Eastern Health, Box Hill, Victoria, Australia
| | - Jillian H Broadbear
- Spectrum Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia.,Personality Disorder & Complex Trauma Research and Innovation Centre, Richmond, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Judith Hope
- Mental Health Program, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Sathya Rao
- Spectrum Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia.,Personality Disorder & Complex Trauma Research and Innovation Centre, Richmond, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
7
|
Choi-Kain LW, Sahin Z, Traynor J. Borderline Personality Disorder: Updates in a Postpandemic World. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:337-352. [PMID: 37200886 PMCID: PMC10187392 DOI: 10.1176/appi.focus.20220057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Progress in understanding borderline personality disorder has unfolded in the last decade, landing in a new COVID-19-influenced world. Borderline personality disorder is now firmly established as a valid diagnosis, distinct from its co-occurring mood, anxiety, trauma-related, and behavioral disorders. Further, it is also understood as a reflection of general personality dysfunction, capturing essential features shared among all personality disorders. Neuroimaging research, representing the vast neurobiological advances made in the last decade, illustrates that the disorder shares frontolimbic dysfunction with many psychiatric diagnoses but has a distinct signature of interpersonal and emotional hypersensitivity. This signature is the conceptual basis of the psychotherapies and clinical management approaches proven effective for the disorder. Medications remain adjunctive and are contraindicated by some guidelines internationally. Less invasive brain-based therapeutics show promise. The most significant change in the treatment landscape is a focus on briefer, less intensive formats of generalist management. Shorter variants of therapies, such as dialectical behavior therapy and mentalization-based treatment, are in the process of being shown to be adequately effective. Earlier intervention and greater emphasis on functional improvement are needed to more effectively curb the disabilities and risks of borderline personality disorder for patients and their families. Remote interventions show promise in broadening access to care.
Collapse
Affiliation(s)
- Lois W Choi-Kain
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| | - Zeynep Sahin
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| | - Jenna Traynor
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| |
Collapse
|
8
|
Constantinou MP, Frueh BC, Fowler JC, Allen JG, Madan A, Oldham JM, Fonagy P. Predicting depression outcomes throughout inpatient treatment using the general and specific personality disorder factors. Psychol Med 2022; 52:1838-1846. [PMID: 33028440 DOI: 10.1017/s003329172000361x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clinical intuition suggests that personality disorders hinder the treatment of depression, but research findings are mixed. One reason for this might be the way in which current assessment measures conflate general aspects of personality disorders, such as overall severity, with specific aspects, such as stylistic tendencies. The goal of this study was to clarify the unique contributions of the general and specific aspects of personality disorders to depression outcomes. METHODS Patients admitted to the Menninger Clinic, Houston, between 2012 and 2015 (N = 2352) were followed over a 6-8-week course of multimodal inpatient treatment. Personality disorder symptoms were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition Axis II Personality Screening Questionnaire at admission, and depression severity was assessed using the Patient Health Questionnaire-9 every fortnight. General and specific personality disorder factors estimated with a confirmatory bifactor model were used to predict latent growth curves of depression scores in a structural equation model. RESULTS The general factor predicted higher initial depression scores but not different rates of change. By contrast, the specific borderline factor predicted slower rates of decline in depression scores, while the specific antisocial factor predicted a U shaped pattern of change. CONCLUSIONS Personality disorder symptoms are best represented by a general factor that reflects overall personality disorder severity, and specific factors that reflect unique personality styles. The general factor predicts overall depression severity while specific factors predict poorer prognosis which may be masked in prior studies that do not separate the two.
Collapse
Affiliation(s)
- Matthew P Constantinou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - B Christopher Frueh
- Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
- Department of Psychology, University of Hawaii, Hilo, HI, USA
| | - J Christopher Fowler
- Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
- Houston Methodist Hospital, Houston, TX, USA
| | - Jon G Allen
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alok Madan
- Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
- Houston Methodist Hospital, Houston, TX, USA
| | - John M Oldham
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- The Menninger Clinic, Houston, TX, USA
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- The Menninger Clinic, Houston, TX, USA
| |
Collapse
|
9
|
Wen YJ, Bo QJ, Hou WP, Mao Z, Li F, He F, Dong F, Ma X, Tang YL, Li XB, Wang CY. The effects of childhood trauma on personality in unaffected first-degree relatives of patients with major depressive disorder. BMC Psychiatry 2022; 22:312. [PMID: 35505314 PMCID: PMC9063055 DOI: 10.1186/s12888-022-03909-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
ABSTRAC OBJECTIVES: This study aimed to preliminarily and exploratorily examine the associations between childhood trauma (CT), its subtypes, and personality traits among unaffected first-degree relatives (FDR, children, or siblings) of patients with major depressive disorder (MDD). METHODS The study sample included three subgroups: MDD patients (N = 85), Patients' FDRs (N = 35), and healthy control individuals (HC, N = 89). The Childhood Trauma Questionnaire (CTQ) was used to assess childhood trauma and the Eysenck Personality Questionnaire was used to assess personality traits. RESULTS Significant differences were found in a few personality traits (p < 0.05 for extraversion, neuroticism, and psychoticism) among MDD patients, FDR, and HC, and there were no significant differences between HC and FDR. In the FDR group, compared with those without CT, participants with CT scored significantly higher for neuroticism (N) (F = 3.246, p = 0.046). CT was significantly associated with N, psychoticism (P) and Lie (L), and the strongest association was between CT total score and N. Significantly positive correlations were found between N and sexual abuse (SA) (r = 0.344, p = 0.043), emotional neglect (EN) (r = 0.394, p = 0.019), physical neglect (PN) (r = 0.393, p = 0.019), and CTQ total score (r = 0.452, p = 0.006); between P and CTQ total score (r = 0.336, p = 0.049); and significant negative correlations were found between L and EN (r = -0.446, p = 0.007), CTQ total score (r = -0.375, p = 0.027). CONCLUSION In unaffected FDRs, there were significant associations between childhood trauma and a few personality traits, including neuroticism, psychoticism, and lie, and emotional neglect was significantly associated with neuroticism.
Collapse
Affiliation(s)
- Yu-jie Wen
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No.5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 PR China ,grid.24696.3f0000 0004 0369 153XAdvanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qi-jing Bo
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No.5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 PR China ,grid.24696.3f0000 0004 0369 153XAdvanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wen-peng Hou
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No.5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 PR China
| | - Zhen Mao
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No.5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 PR China ,grid.24696.3f0000 0004 0369 153XAdvanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Feng Li
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No.5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 PR China ,grid.24696.3f0000 0004 0369 153XAdvanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Fan He
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No.5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 PR China ,grid.24696.3f0000 0004 0369 153XAdvanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Fang Dong
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No.5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 PR China ,grid.24696.3f0000 0004 0369 153XAdvanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xin Ma
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No.5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 PR China ,grid.24696.3f0000 0004 0369 153XAdvanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-lang Tang
- grid.414026.50000 0004 0419 4084Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA 30033 USA ,grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA
| | - Xian-bin Li
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No.5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 PR China ,grid.24696.3f0000 0004 0369 153XAdvanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chuan-yue Wang
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No.5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 PR China ,grid.24696.3f0000 0004 0369 153XAdvanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| |
Collapse
|
10
|
Simonsen S, Popolo R, Juul S, Frandsen FW, Sørensen P, Dimaggio G. Treating Avoidant Personality Disorder With Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment: A Pilot Study. J Nerv Ment Dis 2022; 210:163-171. [PMID: 34710894 DOI: 10.1097/nmd.0000000000001432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Avoidant personality disorder (AvPD) is a severe but understudied condition. The current pilot project reports data on acceptability and outcomes of a novel treatment combining biweekly individual metacognitive interpersonal therapy (MIT) and weekly mentalization-based therapy (MBT) group therapy. A total of 30 patients with AvPD were consecutively included in the program. The primary outcome was AvPD-specific personality functioning measured by self-report after treatment. Secondary outcomes were symptom distress, interpersonal problems, quality of life, and psychosocial functioning. Twenty-two patients completed treatment, with a mean duration of 13 months. On the primary outcome, effect sizes were generally moderate to large (effect size range: 0.59-1.10). On secondary outcomes, effect sizes were large (effect size range: 0.77-2.3). Both in terms of acceptability and outcomes, results are promising for the combination of MIT and MBT for AvPD. The approach is a strong candidate for further investigation in future large-scale randomized controlled trial.
Collapse
Affiliation(s)
- Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark
| | | | - Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark
| | | | - Per Sørensen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark
| | | |
Collapse
|
11
|
G. Lazar S. Il ruolo della terapia psicodinamica e gli ostacoli alla sua diffusione. PSICOTERAPIA E SCIENZE UMANE 2021. [DOI: 10.3280/pu2021-004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Dalle ricerche emerge che la terapia psicodinamica è efficace in modo specifico per pazienti con disturbi di personalità, disturbi cronici d'ansia e depressivi e anche disturbi cronici complessi. Inoltre, la frequenza settimanale e la durata della terapia hanno effetti positivi indipendenti tra loro. Uno degli ostacoli alla diffusione della terapia psicodinamica è il fatto che vengono preferiti i trattamenti brevi, in particolar modo la terapia cognitivo-comportamentale (CBT), considerata spesso il gold standard (cioè la terapia migliore che ci sia) nonostante i problemi che sono stati rilevati nelle metodologie delle ricerche sperimentali, nella validità dei risultati in suo favore, nella generalizzabilità dei risultati e nei metodi diagnostici utilizzati. Un altro ostacolo all'erogazione della terapia psicodinamica risiede nei protocolli delle compagnie assicurative vigenti in molti Paesi, che guardano al contenimento dei costi anziché fornire ai pazienti un trattamento ottimale; negli Stati Uniti, ad esempio, tradiscono il mandato del Mental Health Parity Act, la legge che obbliga che i limiti massimi di copertura assicurativa per i disturbi mentali non seguano criteri diversi da quelli per i trattamenti ottimali dei problemi medici o chirurgici.
Collapse
|
12
|
Stenmark L, Kellner CH, Landén M, Larsson I, Msghina M, Nordenskjöld A. Electroconvulsive therapy and psychiatric readmission in major depressive disorder - A population-based register study. Acta Psychiatr Scand 2021; 144:599-625. [PMID: 34523119 DOI: 10.1111/acps.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary aim was to determine whether electroconvulsive therapy (ECT) is associated with reduced risk of psychiatric readmission in major depressive disorder (MDD). METHODS This study was based on data from multiple Swedish population-based registries. All adult patients admitted to any Swedish hospital for moderate-to-severe MDD between 2012 and 2018 were included. Participants were divided into two groups depending on whether they received ECT during inpatient care. Follow-up was set at 30 and 90 days from discharge. Data were analyzed using logistic regression, and matching was conducted. RESULTS A total of 27,851 unique patients contributed to 41,916 admissions. ECT was used in 26.8% of admissions. In the main multivariate analysis, the risk of both 30- and 90-day readmission was lower in the ECT group than in the non-ECT group. In a matched sensitivity model, the results pointed in the same direction for readmission risk within 30 days, but statistical significance was not reached. ECT-treated subgroups with superior outcomes on readmission risk compared with non-ECT treatment were older, unemployed, married, or widowed patients, those treated with antipsychotics or benzodiazepines before admission, with psychotic features, prior psychiatric hospitalizations, or family history of suicide. However, in patients below 35 years of age, ECT was associated with increased readmission risk. CONCLUSION This study suggests that ECT reduces the risk of psychiatric readmission in certain subgroups of patients with MDD. Since patients receiving ECT tend to be more difficult to treat, there is a risk of residual confounding.
Collapse
Affiliation(s)
- Linnea Stenmark
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Irya Larsson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mussie Msghina
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | |
Collapse
|
13
|
Lazar SG. The Cost-Effectiveness of Psychodynamic Therapy: The Obstacles, the Law, and a Landmark Lawsuit. PSYCHOANALYTIC INQUIRY 2021. [DOI: 10.1080/07351690.2021.1983404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
14
|
Lipsitz-Odess I, Fisher H, Kartaginer O, Leibovich L, Zilcha-Mano S. When less is more: The perception of psychotherapy techniques as a function of patient personality disorder. Psychol Psychother 2021; 94:929-951. [PMID: 33989455 DOI: 10.1111/papt.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 04/20/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Psychopathology research suggests that individuals with higher levels of personality disorder (PD) traits, especially those with a comorbid major depressive disorder (MDD), tend to be highly aroused in interpersonal contexts, manifested by an intensified perception of interpersonal interactions. Little is known about the way this tendency manifests in the process of psychotherapy. The current study explored the patient's perception of techniques in psychotherapy among patients with higher vs. lower levels of PD, as well as the patient-therapist agreement on techniques used. DESIGN The study used an integration of qualitative and quantitative methodology on data from a randomized controlled trial (RCT) for the treatment of depression. METHOD Sixty-nine patients with MDD participated in the study and were evaluated for PD symptoms prior to treatment. A set of multilevel analyses were conducted to assess the association between PD and perception of techniques, as well as a zoom-in exploration within a case study. RESULTS Patients with higher levels of PD reported more techniques implemented by the therapist than patients with lower levels. In addition, the agreement between patient and therapist on techniques was lower, such that patients with PDs reported more techniques than their therapist. The case study supported these findings and illustrates the potential for patients with PDs to perceive a greater use of techniques as a sign of therapist investment. CONCLUSION Consistent with psychopathology research, the findings suggest that patients with PDs tend to experience techniques as more intense than the therapist, in comparison with patients without PD. PRACTITIONER POINTS There are indications that patients with higher levels of personality disorder traits will tend to experience the techniques in psychotherapy in a more intense manner than patients with lower level personality disorder traits. It is likely that patients with higher levels of personality disorder traits will experience their therapists as more active than therapists think they are. Therapists of patients with higher levels of personality disorders should be sensitive of each of their patients' experiences. As the case study demonstrated at least in some cases patients with higher levels of personality disorder may experience the techniques in an intense manner as a sign of therapist investment, however, other patients may experience this differently. Therefore, it is crucial for the therapist to be aware of how the patient experienced the encounter - investment or intrusiveness.
Collapse
Affiliation(s)
| | - Hadar Fisher
- The Department of Psychology, University of Haifa, Israel
| | - Ori Kartaginer
- The Department of Psychology, University of Haifa, Israel
| | - Liat Leibovich
- The Department of Psychology, University of Haifa, Israel
| | | |
Collapse
|
15
|
Romirowsky A, Zweig R, Glick Baker L, Sirey JA. The Relationship Between Maladaptive Personality and Social Role Impairment in Depressed Older Adults in Primary Care. Clin Gerontol 2021; 44:192-205. [PMID: 30362909 PMCID: PMC6486454 DOI: 10.1080/07317115.2018.1536687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Personality pathology is associated with impaired social functioning in adults, though further evidence is needed to examine the individual contributions of personality traits and processes to social functioning in depressed older adults. This study is a secondary analysis examining the relationship between maladaptive personality traits and processes and social role impairment in depressed older adults in primary care. Methods: Participants (N = 56) were 77% female and ranged in age between 55-89 (M = 66.82, SD = 8.75). Personality pathology was measured by maladaptive traits (NEO-FFI) and processes (Inventory of Interpersonal Problems; IIP-PD-15). Individual variable as well as combined predictive models of social role impairment were examined. Results: Higher neuroticism (β = 0.30, p < .05), lower agreeableness (β = -0.35 p < .001) and higher IIP-PD-15 (β = 0.28, p < .01) scores predicted greater impairment in social role functioning. A combined predictive model of neuroticism and IIP-PD-15 scores predicted unique variance in social role impairment (R2 = .71). Conclusion: These results link select personality traits and interpersonal processes to social role impairment, suggesting that these are indicators of personality pathology in older adults. Clinical Implications: These findings lend preliminary support for clinical screening of personality pathology in depressed older adults utilizing both personality trait and process measures.
Collapse
Affiliation(s)
| | - Richard Zweig
- Ferkauf Graduate School of Psychology, Yeshiva University
| | | | | |
Collapse
|
16
|
DSM-5 personality traits and cognitive risks for depression, anxiety, and obsessive-compulsive symptoms. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2020.110041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
17
|
Kavanagh BE, Ashton MM, Cowdery SP, Dean OM, Turner A, Berk M, Gwini SM, Brennan-Olsen SL, Koivumaa-Honkanen H, Chanen AM, Williams LJ. Systematic review and meta-analysis of the role of personality disorder in randomised controlled trials of pharmacological interventions for adults with mood disorders. J Affect Disord 2021; 279:711-721. [PMID: 33197840 DOI: 10.1016/j.jad.2020.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Personality disorder (PD) may affect the efficacy of pharmacological interventions for mood disorders, but the extent to which this occurs is uncertain. We aimed to examine the available published evidence concerning the role of PD in pharmacological treatment outcomes of randomised controlled trials (RCTs) for adults with mood disorders (i.e. depressive and bipolar spectrum disorders). METHODS A systematic search of Cochrane Central Register of Controlled Clinical Trials, PubMed, EMBASE, PsycINFO, CINAHL Complete, and Google Scholar databases was undertaken to identify studies of interest. Data were independently extracted by two reviewers. The Cochrane Risk of Bias tool was used to assess methodological quality and risk of bias. A random effects model was utilised and statistical heterogeneity was assessed using the I2 statistic. This systematic review was registered with PROSPERO (CRD42018089279) and the protocol is published. RESULTS The search yielded 11,640 studies. Subsequent to removing duplicates, 9657 studies were screened at title and abstract stage and 1456 were assessed at full-text stage. Eighteen studies met criteria for inclusion in this review. Meta-analysis did not reveal a significant difference between groups for treatment outcome (standardised mean difference 0.22 [-0.09, 0.54]; I2: 69%, p=0.17) and remission (risk ratio 0.84 [0.64, 1.11]; I2: 51%, p=0.22). LIMITATIONS This review was limited by lack of studies on bipolar disorder. CONCLUSION PD comorbidity does not appear to affect treatment efficacy of pharmacological interventions for adults with mood disorders.
Collapse
Affiliation(s)
- Bianca E Kavanagh
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.
| | - Melanie M Ashton
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Stephanie P Cowdery
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Olivia M Dean
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, Parkville, Australia
| | - Alyna Turner
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Callaghan, Australia
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, Parkville, Australia; Department of Psychiatry University of Melbourne, The Melbourne Clinic, Professorial Unit, Richmond, Australia; Orygen, Melbourne, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia
| | - Stella M Gwini
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Sharon L Brennan-Olsen
- Deakin University, School of Health and Social Development, Geelong, Australia; Deakin University, Institute for Health Transformation, Geelong, Australia
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Department of Psychiatry, Oulu University Hospital, Finland
| | - Andrew M Chanen
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia
| | - Lana J Williams
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| |
Collapse
|
18
|
Post RM, Leverich GS, McElroy S, Kupka R, Suppes T, Altshuler L, Nolen W, Frye M, Keck P, Grunze H, Rowe M. Relationship of comorbid personality disorders to prospective outcome in bipolar disorder. J Affect Disord 2020; 276:147-151. [PMID: 32697693 DOI: 10.1016/j.jad.2020.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 02/08/2023]
Abstract
Introduction There is a high incidence of Axis II personality disorders (PDs) in patients with bipolar illness, but their influence on the prospectively measured course of bipolar disorder has been less well explicated. Methods 392 outpatients with bipolar disorder gave informed consent, completed the PDQ4 99 item personality disorder rating, and where clinically rated during at least one year of prospective naturalistic treatment. They were classified as Well on admission (N = 64) or Responders (N = 146) or Non-responders (N = 182) to treatment for at least six months. Results Patients who were positive for PDs were very infrequently represented in the category of Well on admission. In addition, patients with borderline, depressive, and schizoid PDs were significantly more likely to be Non-responders compared to Responders upon prospective naturalistic treatment in the network. Conclusions Patients with bipolar disorder and comorbid PDs were in general less likely to be Well from treatment in the community at network entry or to be a Responder to prospective treatment in the network. Therapeutic approaches to patients with PDs deserve specific study in an attempt to achieve a better long-term course of bipolar disorder.
Collapse
Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, United States.
| | | | - Susan McElroy
- Linder Center of Hope, Mason, OH, and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States
| | - Ralph Kupka
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Trisha Suppes
- 11 Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine and V.A. Palo Alto Health Care System Palo Alto, CA, United States
| | - Lori Altshuler
- UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA, United States
| | - Willem Nolen
- Universitair Medisch Centrum Groningen (UMCG), Groningen, the Netherlands
| | - Mark Frye
- Mayo Clinic, Rochester, MI, United States
| | - Paul Keck
- University of Cincinnati College of Medicine Cincinnati, Lindner Center of HOPE Mason, OH, United States
| | - Heinz Grunze
- Chefarzt, Allgemein Psychiatrie Ost am Klinikum am Weissenhof, Privat-Dozent der PMU Nürnberg, Germany
| | - Michael Rowe
- Biostatistician Bipolar Collaborative Network, Bethesda, MD, United States
| |
Collapse
|
19
|
Meems M, Hulsbosch L, Riem M, Meyers C, Pronk T, Broeren M, Nabbe K, Oei G, Bogaerts S, Pop V. The Brabant study: design of a large prospective perinatal cohort study among pregnant women investigating obstetric outcome from a biopsychosocial perspective. BMJ Open 2020; 10:e038891. [PMID: 33109659 PMCID: PMC7592269 DOI: 10.1136/bmjopen-2020-038891] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pregnancy is characterised by many biological and psychosocial changes. Adequate maternal thyroid function is important for the developing fetus throughout gestation. Latent class analyses recently showed three different patterns of change in thyroid function throughout pregnancy with different associations with obstetric outcome. Maternal distress during the pregnancy (anxiety and depression) negatively affects obstetric outcome. Pregnancy distress in turn may be affected by personality traits and attachment styles. Moreover, during the pregnancy, substantial social changes occur in the partner relationship and work experience. The aim of the Brabant study is to investigate the association between thyroid function trajectories and obstetric outcomes. Moreover, within the Brabant study, we will investigate how different trajectories of pregnancy distress are related to obstetric outcome, and the role of personality in this association. We will evaluate the possible role of maternal distress and attachment style on maternal-fetal bonding. Finally, we will study social changes in the perinatal period regarding partner relationship and well-being and performance at work. METHODS AND ANALYSIS The Brabant study is a longitudinal, prospective cohort study of an anticipated 4000 pregnant women. Women will be recruited at 8-10 weeks gestation among community midwife practices in South-East Brabant in the Netherlands. Thyroid function parameters (TSH and fT4), thyroid peroxidase antibody and human chorionic gonadotrophin will be assessed at 12, 20 and 28 weeks gestation. Moreover, at these three time points women will fill out questionnaires assessing demographic and obstetric features, life style habits and psychological and social variables, such as depressive symptoms, personality, partner relationship quality and burnout. Data from the obstetric records will also be collected. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethical Committee of the Máxima Medical Center Veldhoven. Results will be submitted to peer-reviewed journals in the relevant fields and presented on national and international conferences.
Collapse
Affiliation(s)
- Margreet Meems
- CoRPS - Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Lianne Hulsbosch
- CoRPS - Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Madelon Riem
- CoRPS - Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Christina Meyers
- Department of Human Resource Studies, Tilburg University, Tilburg, The Netherlands
| | - Tila Pronk
- Department of Social Psychology, Tilburg University, Tilburg, The Netherlands
| | - Maarten Broeren
- Laboratory of Clinical Chemistry and Hematology, Maxima Medical Center, Veldhoven, The Netherlands
| | - Karin Nabbe
- Clinical Laboratory, Diagnostiek voor U, Eindhoven, The Netherlands
| | - Guid Oei
- Department of Obstetrics and Gynecology, Maxima Medical Center, Eindhoven, The Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Victor Pop
- CoRPS - Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
20
|
Young M. Prognostic Significance of Personality Disorders in Patients with Major Depressive Disorder. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00227-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
21
|
Schlax J, Wiltink J, Beutel ME, Münzel T, Pfeiffer N, Wild P, Blettner M, Ghaemi Kerahrodi J, Michal M. Symptoms of depersonalization/derealization are independent risk factors for the development or persistence of psychological distress in the general population: Results from the Gutenberg health study. J Affect Disord 2020; 273:41-47. [PMID: 32421621 DOI: 10.1016/j.jad.2020.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptoms of depersonalization (DP) and derealization (DR) have a high prevalence in patient and community samples. Previous studies suggested that DP/DR symptoms might represent a marker of disease severity and poor prognosis. However, population-based studies investigating the impact of DP/DR symptoms on the course of depression and anxiety are sparse. Therefore, we aimed to analyze whether symptoms of DP/DR are longitudinally associated with the persistence or incidence of elevated symptoms of depression/anxiety. METHODS We analyzed observational data from a sample of 13.182 participants of the Gutenberg Health Study. The outcomes were elevated symptoms of depression/anxiety at the 2.5 years follow-up as determined by the 2-item depression scale (PHQ-2), the 2-item anxiety scale (GAD-2), and the compound measure PHQ-4 respectively. The predictor was the 2-item Cambridge Depersonalization Scale (CDS-2). RESULTS 8.7% of the sample were bothered by symptoms of DP/DR at baseline. They had an increased risk for elevated symptoms of depression/anxiety at the 2.5-year follow-up beyond baseline depression/anxiety and other factors. Each point increment in the CDS-2 scale, ranging from 0-6, was associated with a 21% increase of risk for PHQ-4 ≥ 3 at the follow-up (odds ratio 1.21, 95% confidence interval 1.11-1.32). LIMITATIONS The study was mostly questionnaire-based. CONCLUSION Symptoms of DP/DR are independent risk factors for the persistence or incidence of elevated symptoms of depression/anxiety. Symptoms of DP/DR represent an easily assessable risk factor for the course of mental disorders. Treatment and prevention of mental disorders might benefit from the broader recognition of these phenomena.
Collapse
Affiliation(s)
- Jasmin Schlax
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Philipp Wild
- Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology & Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Jasmin Ghaemi Kerahrodi
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
| |
Collapse
|
22
|
Nuggerud-Galeas S, Oliván Blázquez B, Perez Yus MC, Valle-Salazar B, Aguilar-Latorre A, Magallón Botaya R. Factors Associated With Depressive Episode Recurrences in Primary Care: A Retrospective, Descriptive Study. Front Psychol 2020; 11:1230. [PMID: 32581978 PMCID: PMC7290009 DOI: 10.3389/fpsyg.2020.01230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction and Objective The early identification of depressive patients having a poor evolution, with frequent relapses and/or recurrences, is one of the priority challenges in this study of high prevalence mental disorders, and specifically in depression. So, this study aims to analyze the factors that may be associated with an increased risk of recurrence of major depression episodes in patients treated in primary care. Methods A retrospective, descriptive study of cases-controls was proposed. The cases consisted of patients who had been diagnosed with major depression and who had presented recurrences (n = 101), in comparison with patients who had experienced a single major depression episode with no recurrence (n = 99). The variables of the study are age at first episode; number of episodes; perception of severity of the depression episode suffered prior to recurrence; number of residual symptoms; physical and psychiatric comorbidity; history of anxiety disorders; family psychiatric history; high incidence of stressful life events (SLEs); and experiences of physical, psychological, or sexual abuse in childhood. The differences of the variables were compared between the case subjects and the control subjects, using the Mann-Whitney, chi-square, and Fisher's U statistics. A multivariate analysis (ordinary logistic regression) was performed. Results The average age of those suffering more than one depressive episode is significantly older (5 years), and a higher percentage of subjects who have experienced more than one depressive episode have a history of anxiety disorders. In the multivariate analysis, the variables that obtained a significant value in the logistic regression analysis were age (OR: 1.03; value: 0.007) and having suffered sexual abuse during childhood (OR: 1.64; value: 0.072). Conclusion These indicators should be considered by primary care physicians when attending patients suffering from major depression.
Collapse
Affiliation(s)
- Shysset Nuggerud-Galeas
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván Blázquez
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - María Cruz Perez Yus
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Begoña Valle-Salazar
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Primary Health Care, Aragón Health Service, Zaragoza, Spain
| | | | - Rosa Magallón Botaya
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.,Primary Health Care, Aragón Health Service, Zaragoza, Spain
| |
Collapse
|
23
|
Asp M, Lindqvist D, Fernström J, Ambrus L, Tuninger E, Reis M, Westrin Å. Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care. PLoS One 2020; 15:e0227364. [PMID: 31895938 PMCID: PMC6939935 DOI: 10.1371/journal.pone.0227364] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/17/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care. METHODS 274 patients aged 18-77 were referred from four secondary psychiatric care clinics in Sweden during 2012-2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training. RESULTS SCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p<0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p<0,0001). CONCLUSIONS Important psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.
Collapse
Affiliation(s)
- Marie Asp
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
- * E-mail:
| | - Daniel Lindqvist
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Johan Fernström
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Livia Ambrus
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Eva Tuninger
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Margareta Reis
- Department of Clinical Pharmacology, Linköping University, Linköping, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| |
Collapse
|
24
|
Pilkonis PA, Lawrence SM, Johnston KL, Dodds NE. Screening for Personality Disorders: A Three-Item Screener From the Inventory of Interpersonal Problems (IIP-3). J Pers Disord 2019; 33:832-845. [PMID: 30650003 DOI: 10.1521/pedi_2019_33_369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To encourage screening for personality disorders (PDs), we developed (in previous work) self-report scales for PDs using the Inventory of Interpersonal Problems (IIP). The combined score from three of the scales-inter-personal sensitivity, interpersonal ambivalence, and aggression-requiring 15 items (IIP-15) did the best job of distinguishing between respondents with any versus no PD. The goals for the present work were (a) to cross-validate the IIP-15 by examining its performance using receiver operating characteristics (ROC) analyses in a new sample (N = 410), and (b) to investigate the utility of a brief three-item variant (IIP-3). The present results again documented the good operating characteristics of the IIP-15. Sensitivity, specificity, and positive and negative predictive values were all above. 70. The operating characteristics of the IIP-3 were nearly as good despite its brevity and support its use as an initial screen for PDs.
Collapse
Affiliation(s)
- Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Suzanne M Lawrence
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kelly L Johnston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nathan E Dodds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
25
|
Abstract
OBJECTIVE Borderline personality disorder (BPD) is frequently accompanied by low mood, the features of which may satisfy the diagnostic criteria for major depressive disorder (MDD). Treatment of depressive symptoms in the absence of BPD-appropriate treatment is less effective and may cause iatrogenic harm. This paper briefly reviews the co-occurrence of BPD and depressive disorder and suggests ways of differentiating these disorders and optimising treatment within the Australian Mental Health context. CONCLUSIONS Depressive symptoms are present in the majority of people with BPD. To address the difficulty differentiating clinically distinct MDD from depressive symptoms that are integral to BPD psychopathology, it is suggested that depressive symptoms arising from a primary diagnosis of BPD (i) may exhibit transience and be stress reactive, (ii) lack a robust clinical response to antidepressant medication and/or electroconvulsive treatment and (iii) are responsive to BPD-appropriate psychotherapy.
Collapse
Affiliation(s)
- Sathya Rao
- Executive Clinical Director, Spectrum Personality Disorder Service, Eastern Health, Richmond, VIC.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Jillian Broadbear
- Senior Research Fellow, Spectrum Personality Disorder Service, Eastern Health, Richmond, VIC.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| |
Collapse
|
26
|
Ramsauer B, Mühlhan C, Lotzin A, Achtergarde S, Mueller J, Krink S, Tharner A, Becker-Stoll F, Nolte T, Romer G. Randomized controlled trial of the Circle of Security-Intensive intervention for mothers with postpartum depression: maternal unresolved attachment moderates changes in sensitivity. Attach Hum Dev 2019; 22:705-726. [PMID: 31726954 DOI: 10.1080/14616734.2019.1689406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Postpartum depression is related to inadequately sensitive caregiving, putting infants at risk for insecure attachment. Therefore, promoting sensitive maternal caregiving and secure child attachment is particularly important in postpartum depressed mothers and their infants. In this randomized-controlled-trial, we evaluated the efficacy of the Circle of Security-Intensive (COS-I)-intervention in supporting maternal sensitivity and mother-infant-attachment compared to treatment-as-usual (TAU) with unresolved-maternal attachment as a moderator of treatment effect. Eligible mothers with infants (N=72) 4-9 months-old were randomly assigned to treatment (n=36 dyads). Infant attachment was rated at follow-up (child age 16-18 months) (Strange-Situation-procedure). Maternal sensitivity was measured at baseline and follow-up (Mini-Maternal-Behavior-Q-sort). Maternal-unresolved-attachment was assessed at baseline (Adult-Attachment-Interview). We found no significant differences between treatments in infant attachment nor changes in mothers' sensitivity. However, in COS-I, unresolved-mothers exhibited significantly more change in sensitivity than non-unresolved-mothers, whereas in TAU, the opposite was true. These findings may help to optimize clinical use of COS-I.
Collapse
Affiliation(s)
- Brigitte Ramsauer
- Medical School Hamburg MSH, University of Applied Sciences and Medical University , Hamburg, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Christine Mühlhan
- Medical School Hamburg MSH, University of Applied Sciences and Medical University , Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Sandra Achtergarde
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Jessica Mueller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Stephanie Krink
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Anne Tharner
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | | | | | - Georg Romer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| |
Collapse
|
27
|
Predicting rehospitalization within 2 years of initial patient admission for a major depressive episode: a multimodal machine learning approach. Transl Psychiatry 2019; 9:285. [PMID: 31712550 PMCID: PMC6848135 DOI: 10.1038/s41398-019-0615-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 01/12/2023] Open
Abstract
Machine learning methods show promise to translate univariate biomarker findings into clinically useful multivariate decision support systems. At current, works in major depressive disorder have predominantly focused on neuroimaging and clinical predictor modalities, with genetic, blood-biomarker, and cardiovascular modalities lacking. In addition, the prediction of rehospitalization after an initial inpatient major depressive episode is yet to be explored, despite its clinical importance. To address this gap in the literature, we have used baseline clinical, structural imaging, blood-biomarker, genetic (polygenic risk scores), bioelectrical impedance and electrocardiography predictors to predict rehospitalization within 2 years of an initial inpatient episode of major depression. Three hundred and eighty patients from the ongoing 12-year Bidirect study were included in the analysis (rehospitalized: yes = 102, no = 278). Inclusion criteria was age ≥35 and <66 years, a current or recent hospitalisation for a major depressive episode and complete structural imaging and genetic data. Optimal performance was achieved with a multimodal panel containing structural imaging, blood-biomarker, clinical, medication type, and sleep quality predictors, attaining a test AUC of 67.74 (p = 9.99-05). This multimodal solution outperformed models based on clinical variables alone, combined biomarkers, and individual data modality prognostication for rehospitalization prediction. This finding points to the potential of predictive models that combine multimodal clinical and biomarker data in the development of clinical decision support systems.
Collapse
|
28
|
Gadelkarim W, Shahper S, Reid J, Wikramanayake M, Kaur S, Kolli S, Osman S, Fineberg NA. Overlap of obsessive-compulsive personality disorder and autism spectrum disorder traits among OCD outpatients: an exploratory study. Int J Psychiatry Clin Pract 2019; 23:297-306. [PMID: 31375037 DOI: 10.1080/13651501.2019.1638939] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Whereas the phenomenology of obsessive-compulsive personality disorder (OCPD) shows similarities to that of obsessive compulsive and related disorders (OCRDs) as well as with autism spectrum disorder (ASD), the relationship between these disorders is poorly understood.Aims: Within a clinical sample, we aimed to investigate the distribution of OCD, OCPD and ASD symptoms and traits and their interrelationship, as well as to evaluate insight and treatment refractoriness.Methods: Consecutive adult OCD outpatients were assessed for OCPD traits (Compulsive Personality Assessment Scale (CPAS)), OCD symptoms (Yale-Brown Obsessive Compulsive Scale (Y-BOCS)), ASD traits (Autism Spectrum Quotient (AQ)), insight (Brown Assessment of Beliefs Scale (BABS)) and treatment resistance (clinical records). Those scoring highly on the AQ underwent a diagnostic interview for ASD.Results: Sixty-seven consenting individuals completed the CPAS, BABS and AQ, and 65 completed the Y-BOCS. Twenty-four patients (35.8%) were diagnosed with OCPD. Patients with OCPD were less likely to be employed (p=.04). They demonstrated elevated AQ scores (p=.004) and rates of ASD diagnosis (54.2%) (p <.001). OCPD traits (CPAS) showed a highly significant correlation with ASD traits (AQ) (p<.001), and no association with Y-BOCS, BABS or treatment resistance.Conclusions: In an OCD cohort limited by small size, OCPD associated strongly with unemployment and ASD, with implications for diagnosis, treatment and outcome.KEY POINTSClinicians should exercise a high level of vigilance for OCPD and ASD in patients presenting with obsessive compulsive symptoms.The presence of OCPD may indicate a likelihood of disabling ASD traits, including cognitive inflexibility, poor central coherence and poor social communication.These neuropsychological factors may require separate clinical intervention strategies.
Collapse
Affiliation(s)
- W Gadelkarim
- Rosanne House, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,Derwent Centre, Essex Partnership University NHS Foundation Trust, Harlow, UK
| | - S Shahper
- Department of Life and Medical Science, University of Hertfordshire, Hatfield, UK
| | - J Reid
- Highly Specialised OCD/BDD Services, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - M Wikramanayake
- Cavell Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Peterborough, UK
| | - S Kaur
- Highly Specialised OCD/BDD Services, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - S Kolli
- East London NHS Foundation Trust, Bedford, UK
| | - S Osman
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - N A Fineberg
- Highly Specialised OCD/BDD Services, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK.,University of Cambridge, School of Clinical Medicine, Cambridge, UK
| |
Collapse
|
29
|
Grossfeld M, Calderón A, O’Keeffe S, Green V, Midgley N. Short-term psychoanalytic psychotherapy with a depressed adolescent with borderline personality disorder: an empirical, single case study. JOURNAL OF CHILD PSYCHOTHERAPY 2019. [DOI: 10.1080/0075417x.2019.1659387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Miriam Grossfeld
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, and University College London, London, UK
| | - Ana Calderón
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, and University College London, London, UK
| | - Sally O’Keeffe
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, and University College London, London, UK
- School of Health Sciences, City, University of London, London, UK
| | - Viviane Green
- Department of Psychosocial Studies, Birkbeck College, University of London, London, UK
| | - Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, and University College London, London, UK
| |
Collapse
|
30
|
Wongpakaran N, Wongpakaran T, Kuntawong P. A short screening tool for borderline personality disorder (Short-Bord): Validated by Rasch analysis. Asian J Psychiatr 2019; 44:195-199. [PMID: 31415930 DOI: 10.1016/j.ajp.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 11/26/2022]
Abstract
The study aimed to development a short screening scale for borderline personality disorder (Short-Bord), and to validate its psychometric properties using Rasch analysis. Ninety-eight outpatients undergoing psychotherapy were evaluated using a semistructured diagnostic interview for DSM-IV Personality disorders. Correlational analysis and Rasch analysis were used to identify the best-fitted items for the shorter scale. Rasch analysis identified three underfitted items. The best five items were selected for the Short-Bord using two analyses, resulting in two sets of Short-Bord which included item 1 (becoming frantic when someone left), item 2 (up- and- down relationships), item 3 (sudden change of sense of self), item 8 (self-harm or suicide), item 9 (self-mutilation), item 10 (sudden mood change) and item 11 (feeling empty inside). Each set of the five-item Short-Bord were tested against the original 15-item BPD scale. Results showed that both sets of the Short-Bord yielded minimally lower in area under curve (AUC = 0.95 and 0.96, respectively) compared with the total score of 15 items (AUC = 0.97), but none significantly differed (chi-square = 0.89-2.87, df 1, p >.05). Internal consistency for the set from Rasch analysis was slightly higher than correlation methods (Cronbach's alpha = 0.80, and 0.78, respectively). The Short-Bord presents promising tool to screen for borderline personality disorder. Its diagnostic validity was comparable to the total 15 items despite completing in a shorter time. The Short-Bord derived from Rasch analysis was, however, preferable as all items were shown to have unidimensional construct with good fit statistics and good internal consistency.
Collapse
Affiliation(s)
- Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pimolpun Kuntawong
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
31
|
Obsessive-compulsive personality disorder symptoms as a risk factor for postpartum depressive symptoms. Arch Womens Ment Health 2019; 22:475-483. [PMID: 30171361 PMCID: PMC6647494 DOI: 10.1007/s00737-018-0908-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/13/2018] [Indexed: 01/11/2023]
Abstract
For women with obsessive-compulsive personality disorder (OCPD) trait symptoms, coping with childbearing and parenting could be associated with postpartum depressive symptoms. Therefore, the possible relationship between OCPD trait symptoms and trajectories of postpartum depressive symptoms was examined. A cohort of 1427 women was followed from late pregnancy until 12 months' postpartum. Trajectories of postpartum depressive symptoms were determined using growth mixture modeling with five repeated assessments. Next, the relationship between OCPD trait symptoms and these trajectories was examined through multinomial regression. Three postpartum depressive symptom trajectories were identified: (1) low symptoms (92%), (2) increasing-decreasing symptoms (inverted u-shape) (5%), and (3) increasing symptoms (3%). OCPD trait symptoms were associated with a higher likelihood of the trajectories increasing-decreasing symptoms (OR 1.26; 95% CI 1.14-1.39) and increasing symptoms (OR 1.16; 95% CI 1.02-1.32), compared to reference trajectory (low symptoms), adjusted for age, educational level, unplanned pregnancy, previous depressive episode (s), and parity.
Collapse
|
32
|
An Old Treatment for an Even Older Problem. J Addict Nurs 2019; 30:4-13. [DOI: 10.1097/jan.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
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]
|
34
|
Jourdy R, Petot JM, Aguerre C. The relationships between personality traits and one-year outcomes in patients with major depressive disorder without psychotic features. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY 2018. [DOI: 10.1016/j.erap.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
35
|
Abstract
Psychodynamic treatment provides benefits for patients with personality disorders, chronic depressive and anxiety disorders, and chronic complex disorders, and its intensity and duration have independent positive effects. Obstacles to its provision include a bias privileging brief treatments, especially cognitive behavior therapy, seen as a gold standard of treatment, despite difficulties with the design of, and ability to generalize from, its supporting research and the diagnostic nosology of the illnesses studied. Another obstacle lies in insurance company protocols that violate the mandate for mental health parity and focus on conserving insurers' costs rather than the provision of optimum treatment to patients.
Collapse
|
36
|
de Jong K, Segaar J, Ingenhoven T, van Busschbach J, Timman R. Adverse Effects of Outcome Monitoring Feedback in Patients With Personality Disorders: A Randomized Controlled Trial in Day Treatment and Inpatient Settings. J Pers Disord 2018; 32:393-413. [PMID: 28594629 DOI: 10.1521/pedi_2017_31_297] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to evaluate the differential effect of outcome monitoring feedback to therapists and to patients on outcomes in cluster B, cluster C, and personality disorder not otherwise specified (PD-NOS) patients. Day treatment patients (n = 112) and inpatients (n = 94) were randomly assigned to a feedback to therapist (FbT), feedback to therapist and patient (FbTP), or no feedback (NFb) condition. Feedback was based on weekly administrations of the Outcome Questionnaire-45 (OQ-45). In cluster B and PD-NOS patients FbTP resulted in increased OQ-45 scores during the first 6 months of therapy for not on track (NOT) patients. In cluster C patients, no adverse effects of feedback were found. These results suggest that for certain personality disorder patient groups, providing feedback during treatment may not always be beneficial, although more research is needed to further assess these effects.
Collapse
Affiliation(s)
- Kim de Jong
- Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jaap Segaar
- GGZ Centraal, Expertise Centre for Personality Disorders
| | - Theo Ingenhoven
- Pro Persona, Center for Psychotherapy, Amersfoort, The Netherlands
| | - Jan van Busschbach
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.,De Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
| | - Reinier Timman
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
37
|
Treatment-Resistant Depression: The Importance of Identifying and Treating Co-occurring Personality Disorders. Psychiatr Clin North Am 2018; 41:249-261. [PMID: 29739524 DOI: 10.1016/j.psc.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Treatment-resistant depression (TRD) presents a significant burden to individuals and society, and comprehensive, individualized approaches are needed to address this complex clinical situation. Diagnostic reevaluation is indicated in cases of TRD to determine the numerous factors that could be playing a role in the treatment resistance. Factors to assess during the diagnostic reevaluation are discussed, including assessment for personality disorders, which are common contributors to treatment resistance and are often not adequately addressed. Two case studies are presented to illustrate the importance of addressing underlying personality disorders in the setting of chronic depression and TRD.
Collapse
|
38
|
Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity. J Psychiatr Pract 2018; 24:179-193. [PMID: 30015788 DOI: 10.1097/pra.0000000000000309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The founding members of the Coalition for Psychotherapy Parity present Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity. These guidelines support access to psychotherapy as prescribed by the clinician without arbitrary limitations on duration or frequency. The authors of the guidelines first review the evidence that psychotherapy is effective, cost-effective, and often provides a cost-offset in decreased overall medical expenses, morbidity, mortality, and disability. They highlight the disparity between clinicians' knowledge of generally accepted standards of care for mental health and substance use disorders and the much more limited "crisis stabilization" focus of many insurance companies. The clinical trials that health insurers cite as justification for authorizing only brief treatment for all patients involve highly selected, atypical populations that are not representative of the general population of patients in need of mental health care, who typically have complex conditions and chronic, recurring symptoms requiring ongoing availability of treatment. The standard for other medical conditions reimbursed by insurance is continuation of effective treatment until meaningful recovery, which is therefore the standard required by the Mental Health Parity and Addiction Equity Act for mental health care. However, insurance companies frequently evade the legal requirement to cover treatment of mental illness at parity with other medical conditions. They do this by applying inaccurate proprietary definitions of medical necessity and imposing utilization review procedures much more restrictively for mental health treatment than for other medical care to block access to ongoing care, thus containing insurance company costs in the short term without consideration of the adverse sequelae of undertreated illness (eg, increased costs of other medical services and increased morbidity, mortality, and costs to society in increased disability). The authors of the guidelines conclude that, given appropriate medical necessity guidelines at parity with other medical care, consistent with provider expertise and a broad range of psychotherapy research, there would be no need or place for utilization review protocols. Individuals and psychotherapy organizations are invited to visit the website psychotherapyparity.org to sign on to the guidelines to indicate agreement and support.
Collapse
|
39
|
Erkens N, Schramm E, Kriston L, Hautzinger M, Härter M, Schweiger U, Klein JP. Association of comorbid personality disorders with clinical characteristics and outcome in a randomized controlled trial comparing two psychotherapies for early-onset persistent depressive disorder. J Affect Disord 2018; 229:262-268. [PMID: 29329058 DOI: 10.1016/j.jad.2017.12.091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/24/2017] [Accepted: 12/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Persistent depressive disorder (PDD) is associated with high rates of comorbid personality disorders (PD). The association of comorbid PD and clinical characteristics has not been systematically studied in PDD. Results regarding effects on treatment outcome are heterogeneous. METHODS We analyzed the association of comorbid personality disorders with clinical characteristics and outcome in a randomized controlled trial comparing the disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) with nonspecific supportive psychotherapy (SP) in patients with early-onset PDD. The main outcome measure was the Hamilton Rating Scale for Depression (HRSD-24). Further baseline measures were comorbid axis-I diagnoses (SCID-I), quality of life (QLDS), global functioning (GAF), interpersonal problems (IIP-64) and childhood maltreatment (CTQ). RESULTS Out of the 268 patients, 103 (38.4%) met criteria for at least one PD. PD was associated with higher rates of axis I comorbidities (mainly anxiety disorders) and interpersonal problems (patients with PD were more vindictive, more self-sacrificing, less assertive and more inhibited socially than patients without PD). There was no significant main effect of PD on treatment outcome and no significant interaction between PD and treatment group. LIMITATIONS The main limitation was the exclusion of patients with certain personality disorders (antisocial, schizotypal, and borderline personality disorders). Furthermore, the study was underpowered to find interaction effects of small size. CONCLUSION Persistently depressed patients with and without comorbid PD primarily seemed to differ in the rate of axis I comorbidity and the severity of interpersonal problems. Treatment outcomes appear to be not significantly affected by the presence of PD.
Collapse
Affiliation(s)
- Nele Erkens
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany.
| | - Elisabeth Schramm
- Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hautzinger
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| |
Collapse
|
40
|
Keefe JR, Derubeis RJ. Changing character: A narrative review of personality change in psychotherapies for personality disorder. Psychother Res 2018; 29:752-769. [DOI: 10.1080/10503307.2018.1425930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- John R. Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert J. Derubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
41
|
van Bronswijk SC, Lemmens LHJM, Viechtbauer W, Huibers MJH, Arntz A, Peeters FPML. The impact of personality disorder pathology on the effectiveness of Cognitive Therapy and Interpersonal Psychotherapy for Major Depressive Disorder. J Affect Disord 2018; 225:530-538. [PMID: 28866297 DOI: 10.1016/j.jad.2017.08.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/26/2017] [Accepted: 08/14/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite extensive research, there is no consensus how Personality Disorders (PD) and PD features affect outcome for Major Depressive Disorder (MDD). The present study evaluated the effects of PD (features) on treatment continuation and effectiveness in Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD. METHODS Depressed outpatients were randomized to CT (n=72) and IPT (n=74). Primary outcome was depression severity measured repeatedly with the Beck Depression Inventory-II (BDI-II) at baseline, three months, at the start of each therapy session, at post-treatment and monthly during five months follow-up. RESULTS Comorbid PD and PD features did not affect dropout. Multilevel and Cox regression models indicated no negative effect of PD on BDI-II change and remission rates during treatment and follow-up, irrespective of the treatment received. For both therapies, higher dependent PD features predicted overall lower BDI-II scores during treatment, however this effect did not sustain through follow-up. Cluster A PD features moderated treatment outcome during treatment and follow-up: individuals with high cluster A PD features had greater BDI-II reductions over time in CT as compared to IPT. LIMITATIONS Not all therapists and participants were blind to the assessment of PD (features), and assessments were performed by one rater. Further research must investigate the state and trait dependent changes of PD and MDD over time. CONCLUSIONS We found no negative impact of PD on the effectiveness and treatment retention of CT and IPT for MDD during treatment and follow-up. If replicated, cluster A PD features can be used to optimize treatment selection.
Collapse
Affiliation(s)
- Suzanne C van Bronswijk
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Lotte H J M Lemmens
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Marcus J H Huibers
- Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104-6241, USA
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Psychology, University of Amsterdam, PO Box 19268, 1000 GG Amsterdam, The Netherlands
| | - Frenk P M L Peeters
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| |
Collapse
|
42
|
Hudson C, Spry E, Borschmann R, Becker D, Moran P, Olsson C, Coffey C, Romaniuk H, Bayer JK, Patton GC. Preconception personality disorder and antenatal maternal mental health: A population-based cohort study. J Affect Disord 2017; 209:169-176. [PMID: 27923193 DOI: 10.1016/j.jad.2016.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/26/2016] [Accepted: 11/15/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prior anxiety and depression have been identified as risk factors for maternal perinatal mental health problems, but other preconception mental disorders have not been prospectively examined. This study investigated prospectively whether women with preconception personality disorder have increased rates of antenatal anxiety and/or depressive symptoms. METHODS 244 women in a population cohort were assessed for personality disorder at age 24 using the Standardised Assessment of Personality. Five to twelve years later, women were screened with the Clinical Interview Schedule, Revised Anxiety Subscale and the Edinburgh Postnatal Depression Scale during the third trimester of 328 pregnancies. RESULTS Preconception personality disorder was associated with a three-fold increase in the odds of antenatal anxiety symptoms, which remained with adjustment for preconception background factors and preconception common mental disorder (adjusted OR 2.84, 95% CI 1.31-6.15). Preconception personality disorder was associated with doubled odds of antenatal depressive symptoms, however this was attenuated with adjustment for preconception background factors and preconception common mental disorder (adjusted OR 1.98, 95% CI 0.81-4.81). LIMITATIONS Our findings are restricted to pregnant women aged 29-35 years. Anxiety and depression may have been under-identified because they were assessed at a single antenatal time point. Residual confounding of the associations by preconception common mental disorder at other time points may have occurred. CONCLUSIONS Women with personality disorder are at heightened risk of anxiety symptoms in pregnancy, over and above risks associated with prior common mental disorder. This raises a possibility that pregnancy brings particular emotional challenges for women with personality disorders.
Collapse
Affiliation(s)
- Charlotte Hudson
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Elizabeth Spry
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Rohan Borschmann
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Denise Becker
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia
| | - Paul Moran
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Craig Olsson
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Carolyn Coffey
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia
| | - Helena Romaniuk
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Clinical Epidemiology & Biostatistics Unit, Royal Children's Hospital, Parkville, VIC, Australia
| | - Jordana K Bayer
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - George C Patton
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia.
| |
Collapse
|
43
|
Lohman MC, Whiteman KL, Yeomans FE, Cherico SA, Christ WR. Qualitative Analysis of Resources and Barriers Related to Treatment of Borderline Personality Disorder in the United States. Psychiatr Serv 2017; 68:167-172. [PMID: 27691382 PMCID: PMC5288272 DOI: 10.1176/appi.ps.201600108] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Resources and treatment for individuals with borderline personality disorder (BPD) are limited and often difficult to obtain. This article aimed to identify key resources for and barriers to obtaining supportive and treatment services for BPD from the perspective of individuals seeking information or services related to BPD ("BPD care seekers"). METHODS Data came from transcripts of resource requests to the Borderline Personality Disorder Resource Center from January 2008 to December 2015 (N=6,253). Basic statistics, including the type of service requested, demographic information for the BPD care seeker, and national distribution of requests, were generated for all eligible transcripts. Qualitative analysis of a random subset of 500 transcripts was used to identify themes, challenges, and common experiences reported by BPD care seekers. RESULTS The greatest number of requests for primary services or resources among the random subset of transcripts was for outpatient services (51%), informational materials (13%), and day programs (9%). Family services, crisis intervention, and mental health literacy were identified as areas where available resources did not meet current demand and that could be improved or expanded. Factors identified as potential barriers to finding and obtaining appropriate treatment for BPD included stigmatization and marginalization within mental health care systems, financial concerns, and comorbidity with psychiatric or medical disorders. CONCLUSIONS BPD care seekers face numerous barriers to obtaining appropriate care. Expanded services and resources to connect individuals with treatment are needed to meet the current demands and preferences of those seeking care.
Collapse
Affiliation(s)
- Matthew C Lohman
- Dr. Lohman and Dr. Whiteman are with the Dartmouth Centers for Health and Aging, Lebanon, New Hampshire (e-mail: ). Dr. Yeomans is with the Department of Psychiatry, Weill Medical College of Cornell University, New York. Ms. Cherico is with the Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, White Plains, New York. Dr. Christ is with the Westchester Psychiatric Group, Tarrytown, New York
| | - Karen L Whiteman
- Dr. Lohman and Dr. Whiteman are with the Dartmouth Centers for Health and Aging, Lebanon, New Hampshire (e-mail: ). Dr. Yeomans is with the Department of Psychiatry, Weill Medical College of Cornell University, New York. Ms. Cherico is with the Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, White Plains, New York. Dr. Christ is with the Westchester Psychiatric Group, Tarrytown, New York
| | - Frank E Yeomans
- Dr. Lohman and Dr. Whiteman are with the Dartmouth Centers for Health and Aging, Lebanon, New Hampshire (e-mail: ). Dr. Yeomans is with the Department of Psychiatry, Weill Medical College of Cornell University, New York. Ms. Cherico is with the Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, White Plains, New York. Dr. Christ is with the Westchester Psychiatric Group, Tarrytown, New York
| | - Sheila A Cherico
- Dr. Lohman and Dr. Whiteman are with the Dartmouth Centers for Health and Aging, Lebanon, New Hampshire (e-mail: ). Dr. Yeomans is with the Department of Psychiatry, Weill Medical College of Cornell University, New York. Ms. Cherico is with the Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, White Plains, New York. Dr. Christ is with the Westchester Psychiatric Group, Tarrytown, New York
| | - Winifred R Christ
- Dr. Lohman and Dr. Whiteman are with the Dartmouth Centers for Health and Aging, Lebanon, New Hampshire (e-mail: ). Dr. Yeomans is with the Department of Psychiatry, Weill Medical College of Cornell University, New York. Ms. Cherico is with the Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, White Plains, New York. Dr. Christ is with the Westchester Psychiatric Group, Tarrytown, New York
| |
Collapse
|
44
|
Karukivi M, Vahlberg T, Horjamo K, Nevalainen M, Korkeila J. Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders. BMC Psychiatry 2017; 17:16. [PMID: 28088222 PMCID: PMC5237511 DOI: 10.1186/s12888-017-1200-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Current categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance. METHODS The sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder). RESULTS The proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p < 0.05) from the other groups regarding the BDI, 15D, and MHI-5 scores as well as the number of Axis I diagnoses. Patients with complex/severe personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant. CONCLUSIONS An elevated severity level of personality disturbance is associated with an increase in psychiatric morbidity and social dysfunction. Diagnostically sub-threshold personality difficulties are of clinical significance and the degree of impairment corresponds to actual personality disorders. Since these two groups did not significantly differ from each other, our findings also highlight the complexity related to the use of diagnostic thresholds for separate personality disorders.
Collapse
Affiliation(s)
- Max Karukivi
- Department of Psychiatry, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland. .,Unit of Adolescent Psychiatry, Satakunta Hospital District, Itäpuisto 11, FI-28100, Pori, Finland.
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, Lemminkäisenkatu 1, FI-20520 Turku, Finland
| | - Kalle Horjamo
- Department of Public Health, University of Helsinki, PO Box 20, FI-00014 Helsinki, Finland
| | - Minna Nevalainen
- Unit of Research and Development, Satakunta Hospital District, Sairaalantie 3, FI-28500 Pori, Finland ,Department of General Practice, University of Turku, Lemminkäisenkatu 1, FI-20520 Turku, Finland
| | - Jyrki Korkeila
- Department of Psychiatry, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland ,Psychiatric Care Division, Satakunta Hospital District, Sairaalantie 14, FI-29200 Harjavalta, Finland
| |
Collapse
|
45
|
Abstract
Borderline personality disorder (BPD) has been demonstrated to be a reliable and valid construct in young people (adolescents and young adults). Both borderline- and mood-related psychopathology become clinically apparent from puberty through to young adulthood, frequently co-occur, can reinforce one another, and can be difficult to differentiate clinically. This Gordian knot of overlapping clinical features, common risk factors, and precursors to both BPD and mood disorders complicates clinical assessment, prevention, and treatment. Regardless of whether an individual crosses an arbitrary diagnostic threshold, a considerable proportion of young people with borderline- and mood-related psychopathology will develop significant and persistent functional, vocational, and interpersonal impairment and disability during this critical risk and developmental period. There is a clear need for early intervention, but spurious diagnostic certainty risks stigma, misapplication of diagnostic labels, inappropriate treatment, and unfavorable outcomes. This article aims to integrate early intervention for BPD and mood disorders in the clinical context of developmental and phenomenological change and evolution. "Clinical staging," similar to disease staging in general medicine, is presented as a pragmatic, heuristic, and trans-diagnostic framework to guide prevention and intervention. It acknowledges that the early stages of these disorders cannot be disentangled sufficiently to allow for disorder-specific preventive measures and early interventions. Clinical staging defines an individual's location along the continuum of the evolving temporal course of a disorder. Such staging aids differentiation of early or milder clinical phenomena from those that accompany illness progression and chronicity, and suggests the application of appropriate and proportionate intervention strategies.
Collapse
|
46
|
Pitfalls in the assessment, analysis, and interpretation of routine outcome monitoring (ROM) Data: results from an outpatient clinic for integrative mental health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 41:647-59. [PMID: 23884455 DOI: 10.1007/s10488-013-0511-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There is considerable debate about routine outcome monitoring (ROM) for scientific or benchmarking purposes. We discuss pitfalls associated with the assessment, analysis, and interpretation of ROM data, using data of 376 patients. 206 patients (55 %) completed one or more follow-up measurements. Mixed-model analysis showed significant improvement in symptomatology, quality of life, and autonomy, and differential improvement for different subgroups. Effect sizes were small to large, depending on the outcome measure and subgroup. Subtle variations in analytic strategies influenced effect sizes substantially. We illustrate how problems inherent to design and analysis of ROM data prevent drawing conclusions about (comparative) treatment effectiveness.
Collapse
|
47
|
Komorbide Persönlichkeitsstörungen und Parenting Stress bei postpartal depressiv erkrankten Müttern. Prax Kinderpsychol Kinderpsychiatr 2016; 65:282-6. [DOI: 10.13109/prkk.2016.65.4.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
48
|
Dunlop BW. Evidence-Based Applications of Combination Psychotherapy and Pharmacotherapy for Depression. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2016; 14:156-173. [PMID: 31975799 PMCID: PMC6519650 DOI: 10.1176/appi.focus.20150042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Combination treatment with psychotherapy and antidepressant medication can be provided from the initiation of treatment, sequentially after nonremission with a single-modality treatment or sequentially after remission to buttress the patient's recovery to prevent recurrence. Combination treatment from the initiation of care is best reserved for patients with high depression severity. Sequential addition of treatments, particularly psychotherapy after nonremission to antidepressant medication, is the best supported method of combination, improving remission rates and reducing relapse and recurrence in the long term. However, uncertainty persists around the optimal form of psychotherapy to combine with antidepressant medication for maximizing long-term gains. Better outcomes from combination treatment have been strongest in clinical trials that limited pharmacotherapy to a single antidepressant; benefits of combination treatment have been substantially smaller in trials that allowed flexible use of multiple antidepressant classes. Patients with recurrent major depressive disorder who benefit from combination treatment have better long-term outcomes if an active treatment component is maintained during recovery.
Collapse
Affiliation(s)
- Boadie W Dunlop
- Dr. Dunlop is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia (e-mail: )
| |
Collapse
|
49
|
Keefe JR, Webb CA, DeRubeis RJ. In cognitive therapy for depression, early focus on maladaptive beliefs may be especially efficacious for patients with personality disorders. J Consult Clin Psychol 2016; 84:353-64. [PMID: 26727410 PMCID: PMC4936187 DOI: 10.1037/ccp0000071] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Patients with major depressive disorder (MDD) and a comorbid personality disorder (PD) have been found to exhibit relatively poor outcomes in cognitive therapy (CT) and other treatments. Adaptations of CT focusing heavily on patients' core beliefs have yielded promising findings in the treatment of PD. However, there have been no investigations that have specifically tested whether increased focus on maladaptive beliefs contributes to CT's efficacy for these patients. METHOD CT technique use from an early CT session was assessed for 59 patients (33 without PD, 26 with PD-predominantly Cluster C) who participated in a randomized controlled trial for moderate to severe MDD. Scores were calculated for directive CT techniques (CT-Concrete) and a set of belief-focused items (CT-Belief) as rated by the Collaborative Study Process Rating Scale. Robust regressions were conducted to estimate relations between scores on each of these measures and change in depressive and PD symptoms. A PD status by CT-Belief use interaction tested the hypothesis that therapist use of CT-Belief techniques would exhibit a stronger association with symptom change in the PD group relative to the non-PD group. RESULTS As hypothesized, a significant interaction between PD status and use of CT-Belief techniques emerged in the prediction of depressive and PD symptom change. Among PD patients, higher early CT-Belief interventions were found to predict significantly greater improvement. CT-Belief use did not predict greater symptom change among those without PD. CONCLUSIONS Early focus on CT-Belief interventions may facilitate changes in depression and PD symptoms for patients with MDD-PD comorbidity.
Collapse
Affiliation(s)
- John R Keefe
- Department of Psychology, University of Pennsylvania
| | - Christian A Webb
- Department of Psychiatry, McLean Hospital, Harvard Medical School
| | | |
Collapse
|
50
|
Conway CC, Craske MG, Zinbarg RE, Mineka S. PATHOLOGICAL PERSONALITY TRAITS AND THE NATURALISTIC COURSE OF INTERNALIZING DISORDERS AMONG HIGH-RISK YOUNG ADULTS. Depress Anxiety 2016; 33:84-93. [PMID: 26344411 PMCID: PMC4701643 DOI: 10.1002/da.22404] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/18/2015] [Accepted: 07/18/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A personality disorder diagnosis signals a negative prognosis for depressive and anxiety disorders, but the precise abnormal personality traits that determine the temporal course of internalizing psychopathology are unknown. In the present study, we examined prospective associations between abnormal personality traits and the onset and recurrence of internalizing disorders. METHODS A sample of 371 young adults at high risk for internalizing problems completed the Schedule for Nonadaptive and Adaptive Personality-Second Edition--a measure of 12 abnormal personality traits and three temperament dimensions (i.e., Negative Temperament, Positive Temperament, Disinhibition vs. Control)--and underwent annual diagnostic interviews over 4 years of follow-up. RESULTS In multivariate survival analyses, Negative Temperament was a robust predictor of both new onsets and recurrences of internalizing disorder. Further, the Dependency and Self-Harm abnormal personality dimensions emerged as independent predictors of new onsets and recurrences, respectively, of internalizing disorders after statistically adjusting for variation in temperament. CONCLUSIONS Our findings suggest that abnormal personality traits and temperament dimensions have complementary effects on the trajectory of internalizing pathology during young adulthood. In assessment and treatment settings, targeting the abnormal personality and temperament dimensions with the greatest prognostic value stands to improve the early detection of enduring internalizing psychopathology.
Collapse
Affiliation(s)
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA,The Family Institute at Northwestern University, Evanston, IL, USA
| | - Susan Mineka
- Department of Psychology, Northwestern University, Evanston, IL, USA
| |
Collapse
|