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Houwen-van Opstal SL, van der Holst M, Willemsen MA, Niks EH, De Groot IJ, Cup EH. Longitudinal Course of Long Finger Flexor Shortening in Males with Duchenne Muscular Dystrophy: A Retrospective Review1. J Neuromuscul Dis 2024; 11:17-23. [PMID: 37927271 PMCID: PMC10789324 DOI: 10.3233/jnd-221653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Shortening of the long finger flexors (Flexor Digitorum Profundus, FDPs) in Duchenne Muscular Dystrophy (DMD) causes reduced hand function. Until now, longitudinal studies on the natural course of the shortening of the FDPs are lacking, which impedes recommendations on timing and evaluation of preventive measures. OBJECTIVE To investigate the longitudinal course of the FDP length during different disease stages focusing on symmetry, timing, and decline of the FDP length. METHODS A retrospective, longitudinal multicenter study was conducted in the Radboud university medical center and the Leiden university medical center. The FDP outcome was measured using goniometry and gross motor function was assessed using the Brooke score. Longitudinal mixed model analyses were used to describe the course of the FDP outcome, and to investigate symmetry in both hands. RESULTS Data on 534 visits of 197 males (age ranged 4-48 years) showed that in the ambulatory stages the FDP outcome was within a normal range. The mean decline in FDP outcome is 3.5 degrees per year, the biggest decline was seen in Brooke 5 (>15 degrees per year). In Brooke 4, 41% of the FDP outcome was < 40 degrees. No significant differences were found between right and left. CONCLUSIONS This study supports the consideration of preventive measures to delay shortening of the FDPs in DMD patients transitioning to a Brooke scale of 4 or higher. Besides, natural history of FDP outcome has been established, which provides a base to evaluate (preventive) interventions.
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Affiliation(s)
- Saskia L.S. Houwen-van Opstal
- Department of Rehabilitation, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
ORCID: 0000-0002-9221-5679
| | - Menno van der Holst
- Department of Orthopaedics, Rehabilitation and Physiotherapy, Leiden University Medical Center, The Netherlands
ORCID: 0000-0002-0797-5711
| | - Michel A.A.P. Willemsen
- Donders Centre for Neuroscience, Department of Pediatric Neurology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
ORCID: 0000-0001-7860-7791
| | - Erik H. Niks
- Department of Pediatric Neurology, Leiden University Medical Center, The Netherlands
ORCID: 0000-0001-5892-5143
| | - Imelda. J.M. De Groot
- Donders Centre for Neuroscience, Department of Rehabilitation, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
ORCID: 0000-0003-1634-1427
| | - Edith H.C. Cup
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
ORCID: 0000-0003-3452-9650
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Hoyniak CP, Donohue MR, Quiñones-Camacho LE, Vogel AC, Perino MT, Hennefield L, Tillman R, Barch DM, Luby JL. Developmental pathways from preschool temper tantrums to later psychopathology. Dev Psychopathol 2023; 35:1643-1655. [PMID: 35440360 PMCID: PMC10863336 DOI: 10.1017/s0954579422000359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Temper tantrums are sudden, overt negative emotional displays that are disproportionate to the eliciting event. Research supports that severe temper tantrums during the preschool period are associated with preschool psychopathology, but few studies have identified which characteristics of preschool tantrums are predictive of distal psychopathological outcomes in later childhood and adolescence. To examine this question, we used a prospective, longitudinal dataset enriched for early psychopathology. Participants (N = 299) included 3-to 6-year-old children (47.8% female) assessed for tantrums and early childhood psychopathology using diagnostic interviews and then continually assessed using diagnostic interviews over 10 subsequent time points throughout childhood and adolescence. We identified two unique groupings of tantrum behaviors: aggression towards others/objects (e.g., hitting others) and aggression towards self (e.g., hitting self). While both types of tantrum behaviors were associated with early childhood psychopathology severity, tantrum behaviors characterized by aggression towards self were more predictive of later psychopathology. Children displaying high levels of both types of tantrum behaviors had more severe externalizing problems during early childhood and more severe depression and oppositional defiant disorder across childhood and adolescence. Findings suggest that tantrum behaviors characterized by aggression towards self are particularly predictive of later psychopathology.
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Affiliation(s)
- Caroline P Hoyniak
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Meghan R Donohue
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Laura E Quiñones-Camacho
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Alecia C Vogel
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Michael T Perino
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Laura Hennefield
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- The Program in Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Putotto C, Pulvirenti F, Pugnaloni F, Isufi I, Unolt M, Anaclerio S, Caputo V, Bernardini L, Messina E, Moretti C, Tarani L, Marino B, Versacci P. Clinical Risk Factors for Aortic Root Dilation in Patients with 22q11.2 Deletion Syndrome: A Longitudinal Single-Center Study. Genes (Basel) 2022; 13. [PMID: 36553601 DOI: 10.3390/genes13122334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Aortic root dilation (ARD) has been described in 22q11.2DS, even without congenital heart disease (CHD). However, the clinical implications and longitudinal course are unclear. In this study, we evaluated aortic root (AR) dimensions in 22q112.DS adolescents/adults without major intracardiac CHDs, analyzed the progression over time and investigated correlations with extracardiac comorbidities. METHODS AR dimensions were evaluated in 74 patients, measuring the sinus of Valsalva (VS) and proximal ascending aorta (AA), using Z-score to define mild, moderate and severe degrees. Changes in AR dimensions during longitudinal echocardiographic follow-up were investigated. Phenotypic characteristics have been collected. RESULTS Twenty-four patients (32.4%) showed ARD in terms of VS Z-score (2.43; IQR 2.08-3.01), eight (33.3%) of a moderate/severe degree. Thirteen (54.2%) had concomitant AAD (Z-score 2.34; IQR 1.60-2.85). The risk of ARD was significantly directly related to skeletal/connective tissue disorders (OR 12.82, 95% CI 1.43-115.31; p = 0.023) and inversely related to BMI (OR 0.86, 95% CI 0.77-0.97; p = 0.011). A significant increase in AR diameter's absolute value (p = 0.001) over time has been detected. CONCLUSION Isolated ARD is common in 22q11.2DS. Although some clinical risk factors have been identified, pathogenetic mechanisms and risk of complications are undefined. Regular cardiac evaluations should be part of the 22q11.2DS follow-up, and also in non-CHDs patients, to improve long-term outcome.
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Stahl K, Adorjan K, Anderson-Schmidt H, Budde M, Comes AL, Gade K, Heilbronner M, Kalman JL, Klöhn-Saghatolislam F, Oraki Kohshour M, Papiol S, Reich-Erkelenz D, Schaupp SK, Schulte EC, Senner F, Vogl T, Wiltfang J, Reininghaus E, Falkai P, Schulze TG, Bickeböller H, Heilbronner U. Stability over time of scores on psychiatric rating scales, questionnaires and cognitive tests in healthy controls. BJPsych Open 2022; 8:e55. [PMID: 35232513 PMCID: PMC8935911 DOI: 10.1192/bjo.2022.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Case-only longitudinal studies are common in psychiatry. Further, it is assumed that psychiatric ratings and questionnaire results of healthy controls stay stable over foreseeable time ranges. For cognitive tests, improvements over time are expected, but data for more than two administrations are scarce. AIMS We comprehensively investigated the longitudinal course for trends over time in cognitive and symptom measurements for severe mental disorders. Assessments included the Trail Making Tests, verbal Digit Span tests, Global Assessment of Functioning, Inventory of Depressive Symptomatology, the Positive and Negative Syndrome Scale, and the Young Mania Rating Scale, among others. METHOD Using the data of control individuals (n = 326) from the PsyCourse study who had up to four assessments over 18 months, we modelled the course using linear mixed models or logistic regression. The slopes or odds ratios were estimated and adjusted for age and gender. We also assessed the robustness of these results using a longitudinal non-parametric test in a sensitivity analysis. RESULTS Small effects were detected for most cognitive tests, indicating a performance improvement over time (P < 0.05). However, for most of the symptom rating scales and questionnaires, no effects were detected, in line with our initial hypothesis. CONCLUSIONS The slightly but consistently improved performance in the cognitive tests speaks of a test-unspecific positive trend, while psychiatric ratings and questionnaire results remain stable over the observed period. These detectable improvements need to be considered when interpreting longitudinal courses. We therefore recommend recruiting control participants if cognitive tests are administered.
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Affiliation(s)
- Katharina Stahl
- Department of Genetic Epidemiology, University Medical Center Göttingen, Germany
| | - Kristina Adorjan
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Heike Anderson-Schmidt
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Monika Budde
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Ashley L Comes
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Katrin Gade
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Maria Heilbronner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; and International Max Planck Research School for Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | | | - Mojtaba Oraki Kohshour
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Immunology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Sabrina K Schaupp
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Fanny Senner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; and Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Thomas Vogl
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany; and German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany; and iBiMED, Medical Sciences Department, University of Aveiro, Aveiro, Portugal
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Austria
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany; Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA; and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heike Bickeböller
- Department of Genetic Epidemiology, University Medical Center Göttingen, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Germany
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5
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Iyer SN, Mustafa SS, Moro L, Jarvis GE, Joober R, Abadi S, Casacalenda N, Margolese HC, Abdel-Baki A, Lepage M, Malla A. Suicidality Over the First 5 Years of Psychosis: Does Extending Early Intervention Have Benefits? Can J Psychiatry 2021; 66:468-476. [PMID: 32986470 PMCID: PMC8107949 DOI: 10.1177/0706743720961714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to investigate whether individuals with first-episode psychosis (FEP) receiving extended early intervention (EI) were less likely to experience suicidal ideation and behaviors than those transferred to regular care after 2 years of EI. Another objective was to examine the 5-year course of suicidality in FEP. METHODS We conducted a secondary analysis of a randomized controlled trial where 220 patients were randomized after 2 years of EI to receive extended EI or regular care for the subsequent 3 years. Suicidality was rated using the Brief Psychiatric Rating Scale. Linear mixed model analysis was used to study time and group effects on suicidality. RESULTS Extended EI and regular care groups did not differ on suicidality. There was a small decrease in suicidality over time, F(7, 1038) = 1.84, P = 0.077, with an immediate sharp decline within a month of treatment, followed by stability over the remaining 5 years. Patients who endorsed suicidality at entry (46.6%) had higher baseline positive, negative, and depressive symptoms. The 5-year course fell in 3 groups: never endorsed suicidality (33.9%), endorsed suicidality at low-risk levels (43.1%), and endorsed high-risk levels (23.0%). The high-risk group had a higher proportion of affective versus nonaffective psychosis diagnosis; higher baseline positive and depressive symptoms; higher 5-year mean depression scores, and fewer weeks of positive symptom remission over the 5-year course. CONCLUSIONS The first month of treatment is a critical period for suicide risk in FEP. Although early reductions in suicidality are often maintained, our findings make the case for sustained monitoring for suicide risk management.
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Affiliation(s)
- Srividya N Iyer
- Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Sally S Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP), 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Laura Moro
- Prevention and Early Intervention Program for Psychosis (PEPP), 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 5622University of Montreal, Montreal, Quebec, Canada
| | - G Eric Jarvis
- Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.,First Episode Psychosis Program (FEPP), 5621Jewish General Hospital, Montreal, Quebec, Canada
| | - Ridha Joober
- Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Sherezad Abadi
- 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Nicola Casacalenda
- Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.,First Episode Psychosis Program (FEPP), 5621Jewish General Hospital, Montreal, Quebec, Canada
| | - Howard C Margolese
- Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP-MUHC), 5620McGill University Health Centre, Montreal, Quebec, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, 5622University of Montreal, Montreal, Quebec, Canada
| | - Martin Lepage
- Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ashok Malla
- Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Birmaher B, Merranko JA, Gill MK, Hafeman D, Goldstein T, Goldstein B, Hower H, Strober M, Axelson D, Ryan N, Yen S, Diler R, Iyengar S, Kattan MW, Weinstock L, Keller M. Predicting Personalized Risk of Mood Recurrences in Youths and Young Adults With Bipolar Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2020; 59:1156-1164. [PMID: 31978620 PMCID: PMC7371512 DOI: 10.1016/j.jaac.2019.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/04/2019] [Accepted: 01/14/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE With each recurrence the prognosis of bipolar disorder (BD) worsens, indicating the need to identify the factors associated with increased recurrence risk. The course of BD is heterogenous and although risk factors for recurrence for the group as a whole have been reported in the literature, identification of risk factors for a specific individual are crucial for developing personalized treatments. METHOD A total of 363 recovered BD youths/young adults from the Course and Outcome of Bipolar Youth (COBY) study were included. Participants were evaluated on average every 7 months for a median of 12.5 years and interviewed with standard instruments. Risk factors of recurrence from the literature were used to build a risk calculator (RC) to predict recurrence risk at different time intervals. RESULTS Approximately 80% of participants had at least one syndromal recurrence and 60% had ≥2 recurrences, particularly depressions. The 6-month and 1-, 2-, 3-, and 5-year RC showed an accuracy between 72% and 82% for predicting any mood recurrences, and up to 80% for depression and 89% for hypo/mania (sensitivity/specificity both 0.74). The most influential recurrence risk factors were shorter recovery lengths, younger age at assessment, earlier mood onset, and more severe prior depression. Although important, other factors associated with recurrence risk, such as interepisodic subsyndromal mood symptoms and comorbidities, did not influence the RC score beyond factors noted above. CONCLUSION The RC provides a useful tool for predicting an individual's recurrence risk of depression and/or hypo/mania in BD youths and for developing personalized interventions and informing research. Replication studies are warranted.
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Affiliation(s)
- Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - John A. Merranko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tina Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benjamin Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, Ontario, Canada
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; Butler Hospital, Providence, Rhode Island
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - David Axelson
- Department of Psychiatry, Nationwide Children’s Hospital and The Ohio State College of Medicine, Columbus, Ohio
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; Butler Hospital, Providence, Rhode Island
| | - Rasim Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, 2717 Cathedral of Learning, Pittsburgh, PA
| | | | - Lauren Weinstock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; Butler Hospital, Providence, Rhode Island
| | - Martin Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; Butler Hospital, Providence, Rhode Island
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Chang WC, Ho RWH, Tang JYM, Wong CSM, Hui CLM, Chan SKW, Lee EMH, Suen YN, Chen EYH. Early-Stage Negative Symptom Trajectories and Relationships With 13-Year Outcomes in First-Episode Nonaffective Psychosis. Schizophr Bull 2019; 45:610-619. [PMID: 30124959 PMCID: PMC6483573 DOI: 10.1093/schbul/sby115] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Negative symptoms are a key treatment target in early psychosis intervention. There is a paucity of research examining longitudinal course of negative symptoms across the initial years of treatment for first-episode psychosis using individual-based trajectory analysis. No study has been conducted investigating differential relationships of early-stage negative symptom trajectories with long-term distal outcomes. This study examined patterns and baseline predictors of negative symptom trajectories over the first 3 years of treatment in 138 patients aged 18-55 years presenting with first-episode nonaffective psychosis, using latent class growth analysis based on symptom ratings measured at 4 different time points (baseline, 1, 2, and 3 years). We further explored prospective relationships of identified trajectory classes with functional and negative symptom outcomes at 13-year follow-up. Our results revealed 3 distinct negative symptom trajectories including minimal-stable (59.6%), mild-stable (29.4%), and high-increasing (11.0%) trajectories. Poorer premorbid adjustment, more severe global cognitive impairment, and depressive symptoms at baseline were found to predict high-increasing trajectory. Among 3 trajectory classes, patients in high-increasing trajectory had the worst functional and negative symptom outcomes at 13-year follow-up, with post hoc analyses demonstrating significant outcome differences between high-increasing and minimal-stable trajectories. Our findings thus affirm a heterogeneous course of negative symptoms in first-episode psychosis and indicate that early-stage negative symptom trajectories are critically associated with long-term outcomes. Patients displaying persistently high negative symptom levels in the initial 3 years of treatment may represent a specific subgroup who necessitates an extended period of early intervention specifically targeting at negative symptoms to promote early functional recovery.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pokfulam, Hong Kong, China,To whom correspondence should be addressed; Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; tel: 852-2255-4486, fax: 852-2855-1345, e-mail:
| | - Ryan Wui Hang Ho
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | | | - Corine Sau Man Wong
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Christy Lai Ming Hui
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Sherry K W Chan
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Edwin M H Lee
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pokfulam, Hong Kong, China
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8
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Mistridis P, Krumm S, Monsch AU, Berres M, Taylor KI. The 12 Years Preceding Mild Cognitive Impairment Due to Alzheimer's Disease: The Temporal Emergence of Cognitive Decline. J Alzheimers Dis 2016; 48:1095-107. [PMID: 26402083 PMCID: PMC4927842 DOI: 10.3233/jad-150137] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: The identification of the type and sequence of cognitive decline in preclinical mild cognitive impairment (MCI) prior to Alzheimer’s disease (AD) is crucial for understanding AD pathogenesis and implementing therapeutic interventions. Objective: To model the longitudinal courses of different neuropsychological functions in MCI due to AD. Methods: We investigated the prodromal phase of MCI over a 12-year period in 27 initially healthy participants with subsequent MCI preceding AD (NC-MCI) and 60 demographically matched healthy individuals (NC-NC). The longitudinal courses of cognitive performance (verbal and visual episodic memory, semantic memory, executive functioning, constructional praxis, psychomotor speed, language, and informant-based reports) were analyzed with linear mixed effects models. Results: The sequence with which different cognitive functions declined in the NC-MCI relative to the NC-NC group began with verbal memory and savings performance approximately eight years, and verbal episodic learning, visual memory, and semantic memory (animal fluency) circa four years prior to the MCI diagnosis. Executive functioning, psychomotor speed, and informant-based reports of the NC-MCI group declined approximately two years preceding the MCI diagnosis. Conclusions: Measurable neuropsychological deterioration occurs up to approximately eight years preceding MCI due to AD.
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Affiliation(s)
- Panagiota Mistridis
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sabine Krumm
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Andreas U Monsch
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Manfred Berres
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Koblenz, Germany
| | - Kirsten I Taylor
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Centre for Speech, Language and the Brain, Department of Experimental Psychology, University of Cambridge, Cambridge, UK
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9
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Kim JW, Yu H, Ryan ND, Axelson DA, Goldstein BI, Goldstein TR, Diler RS, Monk K, Hickey MB, Sakolsky DJ, Merranko JA, Birmaher B. Longitudinal trajectories of ADHD symptomatology in offspring of parents with bipolar disorder and community controls. J Clin Psychiatry 2015; 76:599-606. [PMID: 26035189 PMCID: PMC5445724 DOI: 10.4088/jcp.14m09095] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/23/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare the psychopathology and longitudinal course of attention-deficit/hyperactivity disorder (ADHD) symptomatology and global functioning between the offspring with ADHD of parents with bipolar disorder and the offspring with ADHD of community control parents. METHOD One hundred twenty-two offspring with ADHD of parents with bipolar disorder and 48 offspring with ADHD of control parents from the Pittsburgh Bipolar Offspring Study (BIOS) were included. DSM-IV lifetime psychiatric disorders were ascertained through the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). The outcome measures of ADHD symptoms were ascertained at intake and every other year for a period of 6 years using the ADHD section of the K-SADS-PL and the Disruptive Behavior Disorder rating scale (DBD). Global functioning was assessed using the Children's Global Assessment Scale (CGAS). RESULTS The offspring with ADHD of parents with bipolar disorder showed higher lifetime prevalence of mood and anxiety disorders relative to the offspring with ADHD of control parents (P values ≤ .03). For both groups of offspring with ADHD, the hyperactivity, impulsivity, and total K-SADS-PL ADHD scores decreased over time (P values < .001) without differences between the 2 groups. There were no between- or within-group differences in the inattention scores over time. The DBD ADHD scores decreased with age in both groups (P values < .002) without differences between the 2 groups. For both groups of offspring with ADHD, the global functioning did not improve over time. CONCLUSIONS Offspring with ADHD of parents with bipolar disorder have more psychopathology relative to offspring with ADHD of control parents. However, there were no differences in the developmental courses of ADHD symptomatology between these 2 groups of ADHD youth.
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Affiliation(s)
- Jae-Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-No, Chongno-Gu, Seoul, Republic of Korea
| | - Haifeng Yu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Neal D. Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David A. Axelson
- Department of Psychiatry, Ohio State University, Columbus, OH, USA
| | | | - Tina R. Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rasim S. Diler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly Monk
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Beth Hickey
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dara J. Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John A. Merranko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Karan E, Niesten IJM, Frankenburg FR, Fitzmaurice GM, Zanarini MC. The 16-year course of shame and its risk factors in patients with borderline personality disorder. Personal Ment Health 2014; 8:169-77. [PMID: 24599878 PMCID: PMC4127149 DOI: 10.1002/pmh.1258] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/11/2013] [Accepted: 01/24/2014] [Indexed: 11/09/2022]
Abstract
The current study had two aims. The first was to examine the course of shame over 16 years of prospective follow-up among borderline patients and axis II comparison subjects. The second was to determine risk factors associated with feelings of shame among borderline patients. A total of 290 borderline inpatients and 72 axis II comparison subjects were assessed using a series of semi-structured interviews and self-report measures at baseline, and 87% of surviving patients were reassessed at eight waves of follow-up. Borderline patients reported significantly higher levels (2.6 times) of shame (assessed with one item) across 16 years of follow-up than axis II comparison subjects. However, the severity of shame decreased (78% relative decline) significantly over time for both groups. Regarding risk factors, four lifetime adversity risk factors were found to be significantly associated with feelings of shame. Two of these factors (severity of childhood sexual abuse and severity of childhood neglect) remained significant in multivariate analyses. Taken together, the results of this study suggest that borderline patients struggle with intense but decreasing feelings of shame. They also suggest that childhood adversities are significant risk factors for this dysphoric affective state.
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Affiliation(s)
- Esen Karan
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA, USA; Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Zanarini MC, Laudate CS, Frankenburg FR, Wedig MM, Fitzmaurice G. Reasons for self-mutilation reported by borderline patients over 16 years of prospective follow-up. J Pers Disord 2013; 27:783-94. [PMID: 23795756 PMCID: PMC3876880 DOI: 10.1521/pedi_2013_27_115] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The main objective of this study was to assess the reasons for episodes of self-mutilation engaged in by patients with borderline personality disorder (BPD) over 16 years of prospective follow-up. Two hundred and ninety patients meeting both DIB-R and DSM-III-R criteria for BPD were interviewed every 2 years. The authors divided the borderline patients into two groups: those with a more extensive and those with a less extensive lifetime history of self-mutilation at study entry. These groups were not significantly different than one another on either of the interpersonally directed reasons for self-mutilation studied. However, those in the more extensive group were significantly more likely to report each of the five internally directed reasons studied. The results of this study suggest that borderline patients with a more extensive history of self-mutilation are best distinguished from those with a less extensive history by episodes of self-harm that are motivated, at least in part, by dysphoric inner states.
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Findling RL, Jo B, Frazier TW, Youngstrom EA, Demeter CA, Fristad MA, Birmaher B, Kowatch RA, Arnold E, Axelson DA, Ryan N, Hauser JC, Brace DJ, Marsh LE, Gill MK, Depew J, Rowles BM, Horwitz SM. The 24-month course of manic symptoms in children. Bipolar Disord 2013; 15:669-79. [PMID: 23799945 PMCID: PMC3762908 DOI: 10.1111/bdi.12100] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 03/28/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The Longitudinal Assessment of Manic Symptoms (LAMS) study was designed to investigate phenomenology and establish predictors of functional outcomes in children with elevated manic symptoms. The purpose of this series of analyses was to determine whether the participants demonstrated different trajectories of parent-reported manic and biphasic symptoms over the first 24 months of follow-up and to describe the clinical characteristics of the trajectories. METHODS The 707 participants were initially aged 6-12 years and ascertained from outpatient clinics associated with the four university-affiliated LAMS sites. There were 621 children whose parents/guardians' ratings scored ≥ 12 on the Parent General Behavior Inventory-10-item Mania Form (PGBI-10M) and a matched random sample of 86 children whose parents/guardians' ratings scored ≤ 11 on the PGBI-10M. Participants were seen every six months after the baseline and their parents completed the PGBI-10M at each visit. RESULTS For the whole sample, manic symptoms decreased over 24 months (linear effect B = -1.15, standard error = 0.32, t = -3.66, p < 0.001). Growth mixture modeling revealed four unique trajectories of manic symptoms. Approximately 85% of the cohort belonged to two classes in which manic symptoms decreased. The remaining ~15% formed two classes (high and rising and unstable) characterized by the highest rates of diagnostic conversion to a bipolar disorder (all p-values < 0.001). CONCLUSIONS Outcomes are not uniform among children with symptoms of mania or at high risk for mania. A substantial minority of clinically referred children shows unstable or steadily increasing manic symptoms, and these patterns have distinct clinical correlates.
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Affiliation(s)
- Robert L Findling
- Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, CA
| | - Thomas W Frazier
- Center for Autism, Pediatric Institute, Cleveland Clinic, Cleveland, OH
| | - Eric A Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Mary A Fristad
- Department of Psychiatry, The Ohio State University, Columbus, OH
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert A Kowatch
- Department of Psychiatry, Ohio State Medical Center, Columbus, OH
| | - Eugene Arnold
- Department of Psychiatry, The Ohio State University, Columbus, OH
| | - David A Axelson
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Neal Ryan
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jessica C Hauser
- Department of Psychiatry, The Ohio State University, Columbus, OH
| | - Daniel J Brace
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Linda E Marsh
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Mary Kay Gill
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Judith Depew
- Division of Psychiatry Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Brieana M Rowles
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
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Abstract
STUDY OBJECTIVES We aimed to explore the incidence and persistence of insomnia, the associated risk factors, and the potential bidirectional association of insomnia with depression, anxiety, and sleepiness in rural Chinese adolescents. DESIGN School-based prospective study. SETTING Five high schools in rural China. PARTICIPANTS There were 2,787 adolescents studied. INTERVENTIONS N/A. MEASURES AND RESULTS Insomnia was defined as having a score of equal to or higher than nine in the Insomnia Severity Index as validated in Chinese adolescents. Depression, anxiety, and sleepiness were determined by the Beck Depression Inventory (BDI), Zung Self-Rating Anxiety Scale (SAS), and Epworth Sleepiness Scale (ESS), respectively. The incidence and persistence rates of insomnia were 16.0% and 41.0%, respectively. Multivariate analyses in logistic regression models revealed that new incidence of insomnia was significantly associated with age, living in a rural area, habitual daytime napping, high life events, anxiety, and depression at baseline (range adjusted odds ratio = 1.12-1.61), whereas the persistence of insomnia was positively associated with age, female sex, high life events, and depression at baseline (range adjusted odds ratio = 1.26-1.55) but negatively associated with living in a rural area (odds ratio = 0.59). Insomnia at baseline could predict new onsets of both depression (odds ratio = 1.45) and anxiety (odds ratio = 1.98) but not sleepiness at follow-up after adjustment for age, sex, and baseline symptoms. The results in cross-lagged analyses further supported these observations in the bidirectional associations of insomnia with depression, anxiety, and sleepiness. CONCLUSIONS Insomnia has considerable incidence and persistence rates in Chinese adolescents. We have identified several risk factors for the incidence and persistence of insomnia. There are bidirectional associations of insomnia with depression and anxiety but not sleepiness. CITATION Luo C; Zhang J; Pan J. One-year course and effects of insomnia in rural Chinese adolescents. SLEEP 2013;36(3):377-384.
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Affiliation(s)
- Chunliu Luo
- Department of Psychiatry, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
- Department of Nursing, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Jihui Zhang
- Department of Psychiatry, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jiyang Pan
- Department of Psychiatry, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
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Abstract
OBJECTIVE To examine 3-year quality-of-life (QOL) outcomes among United States adults with Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) antisocial personality disorder (ASPD), syndromal adult antisocial behavior without conduct disorder (CD) before age 15 [adulthood antisocial behavioral syndrome (AABS), not a DSM-IV diagnosis], or no antisocial behavioral syndrome at baseline. METHOD Face-to-face interviews (n = 34 653). Psychiatric disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV Version. Health-related QOL was assessed using the Short-Form 12-Item Health Survey, version 2 (SF-12v2). Other outcomes included past-year Perceived Stress Scale-4 (PSS-4) scores, employment, receipt of Supplemental Security Income (SSI), welfare, and food stamps, and participation in social relationships. RESULTS Antisocial personality disorder and AABS predicted poorer employment, financial dependency, social relationship, and physical health outcomes. Relationships of antisociality to SSI and food stamp receipt and physical health scales were modified by baseline age. Both antisocial syndromes predicted higher PSS-4, AABS predicted lower SF-12v2 Vitality, and ASPD predicted lower SF-12v2 Social Functioning scores in women. CONCLUSION Similar prediction of QOL by ASPD and AABS suggests limited utility of requiring CD before age 15 to diagnose ASPD. Findings underscore the need to improve prevention and treatment of antisocial syndromes.
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Affiliation(s)
- Risë B. Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Deborah A. Dawson
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA,Kelly Government Services Contractor
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
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15
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Abstract
OBJECTIVE The first objective is to detail the prevalence of post-traumatic stress disorder (PTSD) over a decade of follow-up for those in both study groups. The second is to determine time-to-remission, recurrence, and new onset of PTSD, and the third is to assess the relationship between sexual adversity and the likelihood of remission and recurrence of PTSD. METHOD The SCID I was administered to 290 borderline in-patients and 72 axis II comparison subjects during their index admission and re-administered at five contiguous 2-year follow-up periods. RESULTS The prevalence of PTSD declined significantly over time for patients with borderline personality (BPD) (61%). Over 85% of borderline patients meeting criteria for PTSD at baseline experienced a remission by the time of the 10-year follow-up. Recurrences (40%) and new onsets (27%) were less common. A childhood history of sexual abuse significantly decreased the likelihood of remission from PTSD, and an adult history of sexual assault significantly increased the likelihood of a recurrence of PTSD. CONCLUSION Taken together, the results of this study suggest that PTSD is not a chronic disorder for the majority of borderline patients. They also suggest a strong relationship between sexual adversity and the course of PTSD among patients with BPD.
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Affiliation(s)
- Mary C. Zanarini
- McLean Hospital, Belmont, MA, USA,Dept. of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Susanne Hörz
- Dept. of Psychology, Ludwig-Maximilians-Universität München, Germany
| | | | | | - D. Bradford Reich
- McLean Hospital, Belmont, MA, USA,Dept. of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Garrett Fitzmaurice
- McLean Hospital, Belmont, MA, USA,Dept. of Psychiatry, Harvard Medical School, Boston, MA, USA
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Biskin RS, Paris J, Renaud J, Raz A, Zelkowitz P. Outcomes in women diagnosed with borderline personality disorder in adolescence. J Can Acad Child Adolesc Psychiatry 2011; 20:168-74. [PMID: 21804844 PMCID: PMC3143691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 05/07/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study examined the outcomes of patients diagnosed with borderline personality disorder (BPD) prior to age 18. METHOD In a group of 47 adolescent girls assessed over a 10 year period, 31 had a past diagnosis of BPD while 16 had not met criteria. Subjects were assessed with the SCID-I, the Diagnostic Interview for Borderlines (DIB), the SCL-90-R, the Social Adjustment Scale (SAS-SR), the Affective Lability Scale (ALS), the Barratt Impulsivity Scale (BIS), the Continuous Performance Test (CPT), the Wisconsin Card Sorting Test (WCST), and the Attention Network Task (ANT). RESULTS 4.3 years after initial presentation (mean age=19.6), only 11 index patients still met criteria for BPD and no new cases developed. Those who did not remit were significantly more likely to have a current episode of major depressive disorder, lifetime substance use disorder, and self-reported childhood sexual abuse. Those who still met BPD criteria also scored higher on the ALS and the total severity scale as well as several subscales of the SCL-90, but not on other measures. CONCLUSIONS These findings support the validity of an adolescent diagnosis of BPD and show that the majority of cases that develop in early adolescence can be expected to remit within 4 years.
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Affiliation(s)
- Robert S Biskin
- Department of Psychiatry, McGill University, Montreal, Quebec
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Montreal, Quebec
| | - Johanne Renaud
- Douglas Mental Health University Institute, Montreal, Quebec
| | - Amir Raz
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Montreal, Quebec
| | - Phyllis Zelkowitz
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Montreal, Quebec
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Zanarini MC, Laudate CS, Frankenburg FR, Reich DB, Fitzmaurice G. Predictors of self-mutilation in patients with borderline personality disorder: A 10-year follow-up study. J Psychiatr Res 2011; 45:823-8. [PMID: 21129758 PMCID: PMC3203731 DOI: 10.1016/j.jpsychires.2010.10.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/21/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Self-mutilation is a common and serious problem in patients with borderline personality disorder (BPD). The purpose of this study was to determine the most clinically relevant baseline and time-varying predictors of self-mutilation over 10 years of prospective follow-up among patients with BPD. METHOD Four semistructured interviews assessing axis I disorders, childhood adversity, adult experiences of abuse, and experiences of self-mutilation were administered at baseline to 290 patients meeting DIB-R and DSM-III-R criteria for BPD. Three of these interviews (all except for the childhood adversity interview) and two self-report measures pertaining to dysphoric affects and cognitions were administered at each of five contiguous two-year follow-up periods. RESULTS Eleven variables were found to be significant bivariate predictors of self-mutilation over the five follow-up periods. Six of these predictors remained significant in multivariate analyses: female gender, severity of dysphoric cognitions (mostly overvalued ideas), severity of dissociative symptoms, major depression, history of childhood sexual abuse, and sexual assaults as an adult. CONCLUSIONS Taken together, the results of this study suggest that factors pertaining to traumatic experiences throughout the lifespan are significant risk factors for self-mutilation over time. These results also suggest that major depressive episodes and cognitive symptoms, particularly overvalued ideas and dissociation, significantly heighten the risk of self-injurious behaviors tracked for a decade.
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Affiliation(s)
- Mary C Zanarini
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States.
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18
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Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. The 10-year course of psychosocial functioning among patients with borderline personality disorder and axis II comparison subjects. Acta Psychiatr Scand 2010; 122:103-9. [PMID: 20199493 PMCID: PMC3876887 DOI: 10.1111/j.1600-0447.2010.01543.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the 10-year course of the psychosocial functioning of patients with borderline personality disorder (BPD). METHOD The social and vocational functioning of 290 inpatients meeting both the Revised Diagnostic Interview for Borderlines (DIB-R) and DSM-III-R criteria for BPD and 72 axis II comparison subjects were carefully assessed during their index admission. Psychosocial functioning was reassessed using similar methods at five contiguous 2-year time periods. RESULTS Borderline patients without good psychosocial functioning at baseline reported difficulty attaining it for the first time. Those who had such functioning at baseline reported difficulty retaining and then regaining it. In addition, over 90% of their poor psychosocial functioning was due to poor vocational but not social performance. CONCLUSION Good psychosocial functioning that involves both social and vocational competence is difficult for borderline patients to achieve and maintain over time. In addition, their vocational functioning is substantially more compromised than their social functioning.
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Zanarini MC, Reichman CA, Frankenburg FR, Reich DB, Fitzmaurice G. The course of eating disorders in patients with borderline personality disorder: a 10-year follow-up study. Int J Eat Disord 2010; 43:226-32. [PMID: 19343799 PMCID: PMC2839025 DOI: 10.1002/eat.20689] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the longitudinal course of eating disorders in patients with borderline personality disorder. METHOD The SCID I was administered to 290 borderline inpatients and 72 participants with other axis II disorders during their index admission and at five contiguous 2-year follow-up periods. RESULTS The prevalence of anorexia, bulimia, and eating disorder not otherwise specified (EDNOS) declined significantly over time for those in both study groups but the prevalence of EDNOS remained significantly higher among borderline patients. While over 90% of borderline patients meeting criteria for anorexia, bulimia, or EDNOS at baseline experienced a stable remission by the time of the 10-year follow-up, diagnostic migration was common, particularly for those with anorexia or bulimia. In addition, both recurrences (52%) and new onsets (43%) of EDNOS were more common among borderline patients than recurrences and new onsets of anorexia (28% and 4%) and bulimia (29% and 11%). DISCUSSION The results of this study suggest that the prognosis for both anorexia and bulimia in borderline patients is complicated, with remissions being stable but migrations to other eating disorders being common. The results also suggest that EDNOS may be the most prevalent and enduring of the eating disorders in these patients.
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Affiliation(s)
- Mary C. Zanarini
- McLean Hospital, Belmont, MA, Harvard Medical School, Boston, MA
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Mitelman SA, Nikiforova YK, Canfield EL, Hazlett EA, Brickman AM, Shihabuddin L, Buchsbaum MS. A longitudinal study of the corpus callosum in chronic schizophrenia. Schizophr Res 2009; 114:144-53. [PMID: 19713080 PMCID: PMC2763416 DOI: 10.1016/j.schres.2009.07.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/25/2009] [Accepted: 07/27/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Decreased callosal size and anisotropy have been described in schizophrenia patients but their longitudinal progression remains poorly understood. METHODS We performed diffusion-tensor and structural magnetic resonance imaging at baseline and at follow-up four years later in 49 chronic schizophrenia patients and 16 healthy comparison subjects. Schizophrenia patients were subdivided into good-outcome (n=23) and poor-outcome (n=26) groups. Baseline-to-follow-up changes in size, shape, position and fractional anisotropy of the corpus callosum, divided into five sagittal sections and five rostro-caudal segments, were assessed. RESULTS At baseline scan and in comparison to healthy subjects, schizophrenia patients displayed 1) smaller callosal size, 2) lower average anisotropy in all sagittal sections except the midline, and 3) more dorsal average coordinate position. During the four years after the baseline scan, patients with schizophrenia exhibited a more pronounced decline in absolute size of the corpus callosum than healthy comparison subjects. As compared with the good-outcome group, the corpus callosum in poor-outcome patients at baseline was of smaller size and lower average anisotropy, more elongated and posteriorly positioned. During the follow-up interval, poor-outcome patients displayed a more pronounced decline in size but less pronounced decline in anisotropy of the corpus callosum than patients with good outcomes. CONCLUSIONS Differences in callosal size between schizophrenia patients and healthy subjects seen at baseline continue to widen in the chronic phase of the illness, especially in patients with poor functional outcome. Baseline differences in callosal anisotropy among patients with different outcomes, however, diminish over time.
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Affiliation(s)
- Serge A. Mitelman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA,Corresponding author. Mount Sinai Medical Center, Department of Psychiatry, Box 1505, Neuroscience Positron Emission Tomography Laboratory, One Gustave L. Levy Place, New York, New York 10029, USA. Tel.: 1 (212) 241-5294. Fax: 1 (212) 423-0819.
| | | | - Emily L. Canfield
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
| | - Erin A. Hazlett
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
| | - Adam M. Brickman
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, USA
| | - Lina Shihabuddin
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
| | - Monte S. Buchsbaum
- Departments of Psychiatry and Radiology, University of California San Diego, USA
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Tracie Shea M, Edelen MO, Pinto A, Yen S, Gunderson JG, Skodol AE, Markowitz J, Sanislow CA, Grilo CM, Ansell E, Daversa MT, Zanarini MC, McGlashan TH, Morey LC. Improvement in borderline personality disorder in relationship to age. Acta Psychiatr Scand 2009; 119:143-8. [PMID: 18851719 PMCID: PMC2629076 DOI: 10.1111/j.1600-0447.2008.01274.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE It is commonly believed that some features of borderline personality disorder (BPD) improve as individuals reach their late 30s and 40s. This study examined age-related change in borderline criteria and functional impairment, testing the hypothesis that older age would be associated with relatively more improvement than younger age. METHOD A total of 216 male and female participants with BPD were followed prospectively with yearly assessments over 6 years. RESULTS Participants showed similar rates of improvement in borderline features regardless of age. A significant age by study year interaction showed functioning in older subjects to reverse direction and begin to decline in the latter part of the follow-up, in contrast to younger subjects who maintained or continued improvement over the 6 years. Despite the decline, functioning for the older subjects was comparable with or slightly better at year 6 than at year 1. CONCLUSION Improvement in borderline features is not specific to the late 30s and 40s. There may be a reversal of improvement in functioning in some borderline patients in this older-age range.
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Affiliation(s)
- M Tracie Shea
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02906, USA.
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Yehuda R, Schmeidler J, Labinsky E, Bell A, Morris A, Zemelman S, Grossman RA. Ten-year follow-up study of PTSD diagnosis, symptom severity and psychosocial indices in aging holocaust survivors. Acta Psychiatr Scand 2009; 119:25-34. [PMID: 18785948 PMCID: PMC2670556 DOI: 10.1111/j.1600-0447.2008.01248.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We performed a longitudinal study of holocaust survivors with and without post-traumatic stress disorder (PTSD) by assessing symptoms and other measures at two intervals, approximately 10 years apart. METHOD The original cohort consisted of 63 community-dwelling subjects, of whom 40 were available for follow-up. RESULTS There was a general diminution in PTSD symptom severity over time. However, in 10% of the subjects (n=4), new instances of delayed onset PTSD developed between time 1 and time 2. Self-report ratings at both assessments revealed a worsening of trauma-related symptoms over time in persons without PTSD at time 1, but an improvement in those with PTSD at time 1. CONCLUSION The findings suggest that a nuanced characterization of PTSD trajectory over time is more reflective of PTSD symptomatology than simple diagnostic status at one time. The possibility of delayed onset trajectory complicates any simplistic overall trajectory summarizing the longitudinal course of PTSD.
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Affiliation(s)
- R Yehuda
- Division of Traumatic Stress Studies, Department of Psychiatry, Mount Sinai School of Medicine, New York, USA.
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Gunderson JG, Stout RL, Sanislow CA, Shea MT, McGlashan TH, Zanarini MC, Daversa MT, Grilo CM, Yen S, Skodol AE. New episodes and new onsets of major depression in borderline and other personality disorders. J Affect Disord 2008; 111:40-5. [PMID: 18358539 PMCID: PMC2829969 DOI: 10.1016/j.jad.2008.01.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 01/30/2008] [Accepted: 01/30/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the context of much literature and conjecture about the relationship of personality disorders (PD) and major depressive disorder (MDD), this paper uses longitudinal data to assess the frequency with which PD patients, and especially those with borderline personality disorder (BPD), have recurrences (for patients with lifetime histories), or new onsets (for patients without lifetime histories) of MDD. METHODS A sample of 478 PD patients received reliable repeated follow-up assessments over a period of 6 years. The rates of new onsets and recurrences of MDD in all PD patients, and in BPD patients compared to OPD patients were analyzed. Whether age, gender, GAF score, or the number and types of BPD criteria predict new onsets or recurrences of MDD was also examined. RESULTS Eighty-five percent of PD subjects had episodes of MDD during the 6 year follow-up; of those with lifetime MDD, 85% had recurrences. Of the PD subjects without lifetime MDD, 44% had new onsets. BPD subjects were significantly more likely (p = .0036) to have recurrences of MDD but were about equally likely to have new onsets compared to OPD subjects. The number and types of BPD criteria were predictive of onsets and recurrences for all PDs, but were not more predictive for the BPD than OPD subsamples. LIMITATIONS Longer term follow ups with a more epidemiologically representative sample of PDs would strengthen the generalizability of this study's findings. CONCLUSIONS Having a comorbid PD confers significant risk for recurrences and for new onsets of MDD and confers a significantly negative effect on the course of MDD. BPD conferred more risk for recurrence than OPD.
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Affiliation(s)
- John G. Gunderson
- Harvard Medical School, United States, McLean Hospital, United States,Corresponding author: (J.G. Gunderson)
| | | | | | - M. Tracie Shea
- Brown University Department of Psychiatry and Human Behavior, United States
| | | | - Mary C. Zanarini
- Harvard Medical School, United States, McLean Hospital, United States
| | - Maria T. Daversa
- Harvard Medical School, United States, McLean Hospital, United States
| | | | - Shirley Yen
- Brown University Department of Psychiatry and Human Behavior, United States
| | - Andrew E. Skodol
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, United States
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Zanarini MC, Frankenburg FR, Jager-Hyman S, Reich DB, Fitzmaurice G. The course of dissociation for patients with borderline personality disorder and axis II comparison subjects: a 10-year follow-up study. Acta Psychiatr Scand 2008; 118:291-6. [PMID: 18759803 PMCID: PMC3876894 DOI: 10.1111/j.1600-0447.2008.01247.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the severity of dissociation reported by borderline patients and axis II comparison subjects over 10 years of prospective follow-up. METHOD The Dissociative Experiences Scale (DES) - a 28-item self-report measure - was administered to 290 borderline in-patients and 72 axis II comparison subjects during their index admission. It was also re-administered at five contiguous 2-year follow-up periods. RESULTS The overall severity of dissociative experiences of those in both study groups decreased significantly over time but was discernibly greater in borderline patients (61% vs. 43%). The same pattern emerged for the subtypes of dissociation that were studied: absorption, depersonalization and amnesia. CONCLUSION The severity of dissociation declines significantly over time for even severely ill borderline patients. However, it remains as a recurring problem for over a third of those with DES scores that initially were in the range associated with trauma-spectrum disorders.
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Affiliation(s)
- M C Zanarini
- Laboratory for Study of Adult Development, McLean Hospital, Belmont, MA 02478, USA.
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