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Williams LM, Carpenter WT, Carretta C, Papanastasiou E, Vaidyanathan U. Precision psychiatry and Research Domain Criteria: Implications for clinical trials and future practice. CNS Spectr 2024; 29:26-39. [PMID: 37675453 DOI: 10.1017/s1092852923002420] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Psychiatric disorders are associated with significant social and economic burdens, many of which are related to issues with current diagnosis and treatments. The coronavirus (COVID-19) pandemic is estimated to have increased the prevalence and burden of major depressive and anxiety disorders, indicating an urgent need to strengthen mental health systems globally. To date, current approaches adopted in drug discovery and development for psychiatric disorders have been relatively unsuccessful. Precision psychiatry aims to tailor healthcare more closely to the needs of individual patients and, when informed by neuroscience, can offer the opportunity to improve the accuracy of disease classification, treatment decisions, and prevention efforts. In this review, we highlight the growing global interest in precision psychiatry and the potential for the National Institute of Health-devised Research Domain Criteria (RDoC) to facilitate the implementation of transdiagnostic and improved treatment approaches. The need for current psychiatric nosology to evolve with recent scientific advancements and increase awareness in emerging investigators/clinicians of the value of this approach is essential. Finally, we examine current challenges and future opportunities of adopting the RDoC-associated translational and transdiagnostic approaches in clinical studies, acknowledging that the strength of RDoC is that they form a dynamic framework of guiding principles that is intended to evolve continuously with scientific developments into the future. A collaborative approach that recruits expertise from multiple disciplines, while also considering the patient perspective, is needed to pave the way for precision psychiatry that can improve the prognosis and quality of life of psychiatric patients.
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Affiliation(s)
- Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Evangelos Papanastasiou
- Boehringer Ingelheim Pharma GmbH & Co, Ingelheim am Rhein, Rhineland-Palatinate, Germany
- HMNC Holding GmbH, Wilhelm-Wagenfeld-Strasse 20, 80807Munich, Bavaria, Germany
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Shi Y, Sprooten E, Mulders P, Vrijsen J, Bralten J, Demontis D, Børglum AD, Walters GB, Stefansson K, van Eijndhoven P, Tendolkar I, Franke B, Mota NR. Multi-polygenic scores in psychiatry: From disorder specific to transdiagnostic perspectives. Am J Med Genet B Neuropsychiatr Genet 2024; 195:e32951. [PMID: 37334623 PMCID: PMC10803201 DOI: 10.1002/ajmg.b.32951] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/31/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
The dense co-occurrence of psychiatric disorders questions the categorical classification tradition and motivates efforts to establish dimensional constructs with neurobiological foundations that transcend diagnostic boundaries. In this study, we examined the genetic liability for eight major psychiatric disorder phenotypes under both a disorder-specific and a transdiagnostic framework. The study sample (n = 513) was deeply phenotyped, consisting of 452 patients from tertiary care with mood disorders, anxiety disorders (ANX), attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, and/or substance use disorders (SUD) and 61 unaffected comparison individuals. We computed subject-specific polygenic risk score (PRS) profiles and assessed their associations with psychiatric diagnoses, comorbidity status, as well as cross-disorder behavioral dimensions derived from a rich battery of psychopathology assessments. High PRSs for depression were unselectively associated with the diagnosis of SUD, ADHD, ANX, and mood disorders (p < 1e-4). In the dimensional approach, four distinct functional domains were uncovered, namely the negative valence, social, cognitive, and regulatory systems, closely matching the major functional domains proposed by the Research Domain Criteria (RDoC) framework. Critically, the genetic predisposition for depression was selectively reflected in the functional aspect of negative valence systems (R2 = 0.041, p = 5e-4) but not others. This study adds evidence to the ongoing discussion about the misalignment between current psychiatric nosology and the underlying psychiatric genetic etiology and underscores the effectiveness of the dimensional approach in both the functional characterization of psychiatric patients and the delineation of the genetic liability for psychiatric disorders.
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Affiliation(s)
- Yingjie Shi
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Emma Sprooten
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Mulders
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janna Vrijsen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Pro Persona Mental Health Care, Depression Expertise Centre, Nijmegen, The Netherlands
| | - Janita Bralten
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Ditte Demontis
- Department of Biomedicine/Human Genetics, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
- Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Anders D. Børglum
- Department of Biomedicine/Human Genetics, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
- Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - G. Bragi Walters
- deCODE Genetics, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Kari Stefansson
- deCODE Genetics, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Philip van Eijndhoven
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Barbara Franke
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nina Roth Mota
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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Kleszczewska-Albińska A. Potential applications of Schema Therapy in the treatment of adolescents with anorexia nervosa: a theoretical analysis. Postep Psychiatr Neurol 2023; 32:215-233. [PMID: 38559610 PMCID: PMC10976625 DOI: 10.5114/ppn.2023.135530] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 12/19/2023] [Indexed: 04/04/2024]
Abstract
Purpose The main purpose of the article is to present basic theoretical assumptions on Schema Therapy and its hypothetical application among adolescents suffering with anorexia nervosa. Views Anorexia nervosa is a very deadly mental disease, more frequently suffered by females than males, with the mean age of onset at approximately 14-15. Studies underline the relatively poor effectiveness of currently applied treatment methods and the need for new approaches that could be recommended for adolescent patients suffering with this disease. The results of studies conducted to date lead to the conclusion that Schema Therapy is a promising approach for this group. It is a transdiagnostic method of work that compiles elements known in other therapeutic approaches, aiming at an increase in the individual's awareness of their feelings and emotional needs, applied both in adolescent and adult groups of patients. Since the symptoms of eating disorders observed in adolescents are strongly connected with family systems it seems reasonable to use treatment techniques that rigorously address the unmet needs and rejected emotions of the individual. Conclusions Based on the data published so far it might be hypothesized that the techniques characteristic for Schema Therapy (e.g. imagery rescripting, chairwork, limited reparenting) could be eligible for use with adolescent patients with anorexia nervosa.They address unmet needs, rejected emotions, and early maladaptive schemas that are very frequent in patients with AN. Since the analysis presented provides only hypotheses and the discussion of theoretical aspects, empirical research in this area is needed.
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Raposo CF, Pascoal PM, Faustino B, Nobre PJ. The effect of emotional regulation difficulties on sexual and psychological distress using repetitive negative thinking as a mediator. J Sex Med 2023; 20:1466-1469. [PMID: 37846102 DOI: 10.1093/jsxmed/qdad136] [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] [Received: 07/14/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Sexual distress, a determinant factor in diagnosing sexual dysfunction, plays a significant role in individuals' sexual well-being, yet it has been overlooked in research. AIM This exploratory study adopted a transdiagnostic approach to sexual distress and sought to examine the association between emotional regulation difficulties and sexual and psychological distress, with repetitive negative thinking as a potential mediator. METHODS We used a quantitative cross-sectional design with a sample of 509 partnered individuals. OUTCOMES The survey included a sociodemographic questionnaire, the Difficulties in Emotion Regulation Scale-Short Form, the Kessler Psychological Distress Scale, the Persistent and Intrusive Negative Thoughts Scale, and the Female Sexual Distress Scale-Revised. RESULTS Correlational analysis revealed significant associations among emotional regulation difficulties, repetitive negative thinking, psychological distress, and sexual distress. Furthermore, a mediation model demonstrated that repetitive negative thinking significantly mediated emotion dysregulation and psychological and sexual distress. CLINICAL IMPLICATIONS These findings underscore the importance of considering emotion regulation difficulties and repetitive negative thinking as a maladaptive coping strategy when evaluating sexual distress and suggest that therapeutic interventions targeting such difficulties and thoughts may yield beneficial outcomes. STRENGTHS AND LIMITATIONS These findings reinforce the importance of considering the role of emotional regulation difficulties and, consequently, repetitive negative thinking as a dysfunctional coping strategy, when studying and intervening in sexual distress. Future research with clinical samples should be developed to establish better the significance of considering these two dimensions in assessment and therapeutic intervention. CONCLUSION Future research should corroborate and expand upon these findings to advance our understanding of sexual distress and optimize interventions in this domain.
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Affiliation(s)
- Catarina F Raposo
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences, University of Porto, Rua Alfredo Allen, s/n, 4200-135, Porto, Portugal
| | - Patrícia M Pascoal
- HEI-Lab: Digital Human-Environment Interaction Lab, Lusófona University, Campo Grande 376, Lisbon 1749-024, Portugal
| | - Bruno Faustino
- HEI-Lab: Digital Human-Environment Interaction Lab, Lusófona University, Campo Grande 376, Lisbon 1749-024, Portugal
| | - Pedro J Nobre
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences, University of Porto, Rua Alfredo Allen, s/n, 4200-135, Porto, Portugal
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An Z, Kwag KH, Kim M, Yang JW, Shin HJ, Treasure J, Kim YR. Effect of modifying negative interpretation bias toward ambiguous social stimuli across eating and personality disorders. Int J Eat Disord 2023. [PMID: 36951187 DOI: 10.1002/eat.23936] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/14/2023] [Accepted: 03/05/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Heightened sensitivity toward social rejection has been implicated in eating disorders (ED) and personality disorder (PD). This study examined the effect of a cognitive bias modification training (CBM-I) targeting the interpretation of ambiguous social situations in individuals with comorbid ED and PD. METHOD A total of 128 participants [33 with ED and PD, 22 with ED-only, 22 with PD-only, and 51 healthy controls (HC)] were recruited from a hospital and university settings, and included in the final analyses. The participants were randomly assigned to a CBM-I task with benign resolutions or a control task with neutral resolutions in a counterbalanced order in two sessions using a within-subject design. Interpretation bias toward social stimuli was measured using the ambiguous sentence completion task before and after completing the assigned task. RESULTS The CBM-I task increased benign and decreased negative interpretations with large effect sizes in the diagnostic groups, and with a moderate effect size in the HC group. Participants' anxiety levels were also reduced after the task. The size of the change in negative interpretation was positively associated with baseline negative affect, and negatively associated with baseline positive affect. DISCUSSION The results suggest that modifying interpretation bias has the potential as a transdiagnostic target of treatment for ED and PD, and a fully powered clinical trial with consecutive sessions would be warranted. PUBLIC SIGNIFICANCE Participants with eating disorders and/or personality disorder, and healthy controls completed a single session of a cognitive training intervention targeting rejection sensitivity. The training produced a large decrease in negative interpretation in the diagnostic groups, and a moderate effect in healthy controls. The findings indicate that training for positive processing of social information may be of value to augment treatment in conditions such as eating disorders and personality disorder, in which there are high levels of rejection sensitivity.
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Affiliation(s)
- Zhen An
- Institute of Eating Disorders and Mental Health, Inje University, Seoul, Republic of Korea
| | - Kyung Hwa Kwag
- Institute of Eating Disorders and Mental Health, Inje University, Seoul, Republic of Korea
| | - Mirihae Kim
- Department of Psychology, Duksung Women's University, Seoul, Republic of Korea
| | - Jae-Won Yang
- Department of Psychology, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Hui-Ji Shin
- Institute of Eating Disorders and Mental Health, Inje University, Seoul, Republic of Korea
| | - Janet Treasure
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Youl-Ri Kim
- Institute of Eating Disorders and Mental Health, Inje University, Seoul, Republic of Korea
- Department of Psychiatry, Seoul Paik Hospital, Inje University, Seoul, Republic of Korea
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Geoffrion S, Nolet K, Giguère CÉ, Lecomte T, Potvin S, Lupien S, Marin MF. Psychosocial Profiles of Patients Admitted to Psychiatric Emergency Services: Results from the Signature Biobank Project. Can J Psychiatry 2022; 67:380-390. [PMID: 34011181 PMCID: PMC9065491 DOI: 10.1177/07067437211018793] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Patients admitted to psychiatric emergency services (PES) are highly heterogenous. New tools based on a transdiagnosis approach could help attending psychiatrists in their evaluation process and treatment planning. The goals of this study were to: (1) identify profiles of symptoms based on self-reported, dimensional outcomes in psychiatric patients upon their admission to PES, (2) link these profiles to developmental variables, that is, history of childhood abuse (CA) and trajectories of externalizing behaviours (EB), and (3) test whether this link between developmental variables and profiles was moderated by sex. METHODS In total, 402 patients were randomly selected from the Signature Biobank, a database of measures collected from patients admitted to the emergency of a psychiatric hospital. A comparison group of 92 healthy participants was also recruited from the community. Symptoms of anxiety, depression, alcohol and drug abuse, impulsivity, and psychosis as well as CA and EB were assessed using self-reported questionnaires. Symptom profiles were identified using cluster analysis. Prediction of profile membership by sex, CA, and EB was tested using structural equation modelling. RESULTS Among patients, four profiles were identified: (1) low level of symptoms on all outcomes, (2) high psychotic symptoms, (3) high anxio-depressive symptoms, and (4) elevated substance abuse and high levels of symptoms on all scales. An indirect effect of CA was found through EB trajectories: patients who experienced the most severe form of CA were more likely to develop chronic EB from childhood to adulthood, which in turn predicted membership to the most severe psychopathology profile. This indirect effect was not moderated by sex. CONCLUSION Our results suggest that a transdiagnostic approach allows to highlight distinct clinical portraits of patients admitted to PES. Importantly, developmental factors were predictive of specific profiles. Such transdiagnostic approach is a first step towards precision medicine, which could lead to develop targeted interventions.
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Affiliation(s)
- Steve Geoffrion
- School of Psychoeducation, 5622University of Montreal, Quebec, Canada.,Centre de recherche de l'26612Institut universitaire en santé mentale de Montréal, Quebec, Canada
| | - Kévin Nolet
- School of Psychoeducation, 5622University of Montreal, Quebec, Canada.,Centre de recherche de l'26612Institut universitaire en santé mentale de Montréal, Quebec, Canada
| | - Charles-Édouard Giguère
- Centre de recherche de l'26612Institut universitaire en santé mentale de Montréal, Quebec, Canada
| | - Tania Lecomte
- Centre de recherche de l'26612Institut universitaire en santé mentale de Montréal, Quebec, Canada.,Department of Psychology, 5622University of Montreal, Quebec, Canada
| | - Stéphane Potvin
- Centre de recherche de l'26612Institut universitaire en santé mentale de Montréal, Quebec, Canada.,Department of Psychiatry and Addictology, 5622University of Montreal, Quebec, Canada
| | - Sonia Lupien
- Centre de recherche de l'26612Institut universitaire en santé mentale de Montréal, Quebec, Canada.,Department of Psychiatry and Addictology, 5622University of Montreal, Quebec, Canada
| | - Marie-France Marin
- Centre de recherche de l'26612Institut universitaire en santé mentale de Montréal, Quebec, Canada.,Department of Psychiatry and Addictology, 5622University of Montreal, Quebec, Canada.,Department of Psychology, 14845Université du Québec à Montréal, Quebec, Canada
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Auerbach RP. RDoC and the developmental origins of psychiatric disorders: How did we get here and where are we going? J Child Psychol Psychiatry 2022; 63:377-380. [PMID: 35133013 DOI: 10.1111/jcpp.13582] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
About a decade ago, the National Institute of Mental Health (NIMH) proposed an innovative framework, the Research Domain Criteria (RDoC), to classify psychiatric disorders. This complementary approach has been used with existing diagnostic systems to identify transdiagnostic factors that inform early detection of mental health disturbances and critically, provide novel targets for interventions. An additional goal, however, has been to clarify developmental processes and illness trajectories by operationalizing dimensional constructs during sensitive periods of neurofunctional development to capture the early emergence of behavioral alterations and impairment. As developmental factors are inherent to all RDoC systems and the units of analysis therein, NIMH shepherded developmental-oriented research with targeted funding opportunity announcements. This resulting work has highlighted promising phenotypes and biological markers related to psychiatric illness across the lifespan.
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Affiliation(s)
- Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA.,Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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Gasol X, Navarro-Haro MV, Fernández-Felipe I, García-Palacios A, Suso-Ribera C, Gasol-Colomina M. Preventing Emotional Dysregulation: Acceptability and Preliminary Effectiveness of a DBT Skills Training Program for Adolescents in the Spanish School System. Int J Environ Res Public Health 2022; 19:ijerph19010494. [PMID: 35010754 PMCID: PMC8744757 DOI: 10.3390/ijerph19010494] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/18/2022]
Abstract
Emotional dysregulation is a key factor in the development and maintenance of multiple disabling mental disorders through a person’s lifespan. Therefore, there is an urgent need to prevent emotional dysregulation as early as possible. The main aim of this study was to evaluate the acceptability and preliminary effectiveness of an adapted Dialectical Behavior Therapy Skills Training program for Emotional Problem Solving in Adolescents (DBT STEPS-A) during secondary school. The sample included 93 adolescents (mean age = 12.78; SD = 0.54; and 53% female) studying in their 2nd year of secondary school in a public center in Catalonia (Spain). Measures of acceptability, difficulties of emotional regulation, mental health problems, and life satisfaction were completed before and after participation in the DBT STEPS-A program during one academic year. The majority of students rated the program as useful (64%) and enjoyed the classes (62%) and 48% of them reported practicing the newly learned skills. Statistically significant improvements were revealed in some emotional regulation-related variables, namely the number of peer problems (p = 0.003; d = 0.52) and prosocial behaviors (p < 0.001; d = −0.82). Although non-significant, the scores in the remaining outcomes indicated a general positive trend in emotional dysregulation, mental health, and life satisfaction. The adapted DBT STEPS-A was very well-accepted and helped overcome some emotional regulation difficulties in Spanish adolescents.
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Affiliation(s)
- Xavier Gasol
- Borderline Personality Disorder Institute Foundation, 08221 Terrassa, Spain; (X.G.); (M.G.-C.)
| | - María Vicenta Navarro-Haro
- Department of Psychology and Sociology, University of Zaragoza, 44003 Teruel, Spain
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain
- Correspondence:
| | - Isabel Fernández-Felipe
- Department of Basic Psychology, Clinical Psychology and Psychobiology, Universitat Jaume I, 12071 Castellón de la Plana, Spain; (I.F.-F.); (A.G.-P.); (C.S.-R.)
| | - Azucena García-Palacios
- Department of Basic Psychology, Clinical Psychology and Psychobiology, Universitat Jaume I, 12071 Castellón de la Plana, Spain; (I.F.-F.); (A.G.-P.); (C.S.-R.)
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII CB06/03/0052 Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Carlos Suso-Ribera
- Department of Basic Psychology, Clinical Psychology and Psychobiology, Universitat Jaume I, 12071 Castellón de la Plana, Spain; (I.F.-F.); (A.G.-P.); (C.S.-R.)
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII CB06/03/0052 Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Miquel Gasol-Colomina
- Borderline Personality Disorder Institute Foundation, 08221 Terrassa, Spain; (X.G.); (M.G.-C.)
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Makhashvili N, Javakhishvili JD, Chikovani I, Bevan-Jones R, Uchaneishvili M, Pilauri K, Shengelia N, Marjanishvili N, Sulaberidze L, Sikharulidze K, Roberts B, Bisson J. A transdiagnostic psychosocial prevention-intervention service for young people in the Republic of Georgia: early results of the effectiveness study. Eur J Psychotraumatol 2022; 13:2060606. [PMID: 35599976 PMCID: PMC9116265 DOI: 10.1080/20008198.2022.2060606] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background The decade between the ages of 14 and 25 is a particularly vulnerable period for the development of mental health problems, especially of common mental disorders. Mental health and psychosocial prevention and support services for young people in the Republic of Georgia have been extremely limited, leaving a wide treatment and care gap. Club Synergy was designed as an innovative, pragmatic solution that is responsive to the needs of young people and incorporates all necessary levels of care required (prevention, early identification & intervention, and treatment) into a single, trauma-informed service that uses a transdiagnostic approach. This paper presents preliminary findings from the pilot phase of establishing and running the service. Aim To examine the characteristics of young people presenting to Club Synergy and the effectiveness of contact with the service. Methods Quantitative evaluation of a consecutive series of young people seen by Club Synergy between November 2019 and July 2020. Demographic information was analysed using descriptive statistics. Pre-post outcomes for anxiety (GAD-7), depression (PHQ-9) and health-related quality of life (EQ-5D-5L) were analysed using the Wilcoxon signed-rank test. Results Hundred and seventy-four young people were included. The majority (68.9%) self-referred, with referral from The Ministry of Justice due to conflict with law (23%) accounting for most of the other young people seen. Emotional disturbance (73.6%), anxiety (60.3%), problems in interpersonal relationships (57.5%) and low mood (49.4%) were the commonest presenting symptoms. Seventy-three per cent reported 4 or more adverse childhood experiences. After engaging in transdiagnostic modules, median baseline scores for depression and anxiety reduced by 40% and 45%, respectively, and self-rated health improved by 14%. Conclusions Preliminary analysis indicates that Club Synergy's trauma-informed model of care, based on a transdiagnostic approach, has the potential to provide an effective service to young people in Georgia at risk of developing and with mental health problems. HIGHLIGHTS This pragmatic study of a newly established mental health service for young people in Georgia suggests that a trauma-informed approach, using transdiagnostic modules, has the potential to effectively prevent and treat common mental health presentations.
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Affiliation(s)
- Nino Makhashvili
- Mental Health Resource Centre, Ilia State University, Tbilisi, Georgia
- Global Initiative in Psychiatry, Tbilisi, Georgia
- Nino Makhashvili Mental Health Resource Centre, Ilia State University, Cholokashvili Av. 3/5. E 122, Tbilisi, GeorgiaGlobal Initiative in Psychiatry, Tbilisi, Georgia
| | - Jana Darejan Javakhishvili
- Mental Health Resource Centre, Ilia State University, Tbilisi, Georgia
- Global Initiative in Psychiatry, Tbilisi, Georgia
| | | | | | | | - Ketevan Pilauri
- Mental Health Resource Centre, Ilia State University, Tbilisi, Georgia
| | | | | | | | | | - Bayard Roberts
- London School of Hygiene and Tropical Medicines, London, UK
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Németh G, Csehi R. Editorial: Novel antipsychotics within and beyond clinical trials: The treatment of overlapping psychiatric disorders with D3-D2 partial agonists. Front Psychiatry 2022; 13:1038627. [PMID: 36245871 PMCID: PMC9555016 DOI: 10.3389/fpsyt.2022.1038627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- György Németh
- Gedeon Richter Plc, Budapest, Hungary.,Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Réka Csehi
- Gedeon Richter Plc, Budapest, Hungary.,Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
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11
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Kresznerits S, Rózsa S, Perczel-Forintos D. A transdiagnostic model of low self-esteem: pathway analysis in a heterogeneous clinical sample. Behav Cogn Psychother 2021;:1-16. [PMID: 34852861 DOI: 10.1017/S1352465821000485] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Low self-esteem (LSE) has been associated with several psychiatric disorders, and is presumably influenced by transdiagnostic factors. Our study was based both on investigations of the relationship between depression and LSE (vulnerability, scar, reciprocal models) and on theories of cognitive factors contributing to the development and maintenance of LSE, such as Melanie Fennell's model, the catalyst model and the Self-Regulatory Executive Function model. AIMS Based on the theories above, in our cross-sectional study we aimed at understanding more specifically the transdiagnostic factors that can maintain LSE in a heterogeneous clinical sample. METHOD Six hundred and eleven out-patients were assessed by SCID-I and self-report questionnaires. The model was tested by structural equation modelling. RESULTS Based on the fit indices, the hypothesis model did not fit the data; therefore, a modified transdiagnostic model was emerged. This model made a good fit to the data [χ2 (12, n=611)=76.471, p<.001; RMSEA=.080, CFI=.950, TLI=.913] with a strong explanatory power (adj R2=.636). Severe stressful life events and depressive symptoms lead to LSE indirectly. Self-blame, perfectionism, seeking love and hopelessness have been identified as mediating factors in the relationship between depressive symptoms and LSE. Although there was a significant correlation between state-anxiety and LSE, as well as LSE and rumination, these two factors did not fit into the model. CONCLUSIONS The new transdiagnostic model of LSE has great potential in the treatment of various mental conditions and may serve as a guide to developing more focused and more effective therapeutic interventions.
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Zoccante L, Ciceri ML, Chamitava L, Di Gennaro G, Cazzoletti L, Zanolin ME, Darra F, Colizzi M. Postural Control in Childhood: Investigating the Neurodevelopmental Gradient Hypothesis. Int J Environ Res Public Health 2021; 18:ijerph18041693. [PMID: 33578752 PMCID: PMC7916459 DOI: 10.3390/ijerph18041693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 01/26/2023]
Abstract
Neurodevelopmental disorders (NDDs) have been suggested to lie on a gradient continuum, all resulting from common brain disturbances, but with different degrees of impairment severity. This case-control study aimed to assess postural stability against such hypothesis in 104 children/adolescents aged 5–17, of whom 81 had NDDs and 23 were healthy controls. Compared to healthy controls, Autism Spectrum Disorder (ASD) resulted in the most severely impaired neurodevelopmental condition, followed by Attention Deficit Hyperactive Disorder (ADHD) and Tourette Syndrome (TS). In particular, while ASD children/adolescents performed worse than healthy controls in a number of sensory conditions across all parameters, ADHD children/adolescents performed worse than healthy controls only in the sway area for the most complex sensory conditions, when their vision and somatosensory functions were both compromised, and performance in Tourette Syndrome (TS) was roughly indistinguishable from that of healthy controls. Finally, differences were also observed between clinical groups, with ASD children/adolescents, and to a much lesser extent ADHD children/adolescents, performing worse than TS children/adolescents, especially when sensory systems were not operationally accurate. Evidence from this study indicates that poor postural control may be a useful biomarker for risk assessment during neurodevelopment, in line with predictions from the gradient hypothesis.
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Affiliation(s)
- Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
| | - Marco Luigi Ciceri
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
| | - Liliya Chamitava
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (L.C.); (M.E.Z.)
| | - Gianfranco Di Gennaro
- Department of Pathology and Diagnostics, Integrated University Hospital of Verona, 37126 Verona, Italy;
| | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (L.C.); (M.E.Z.)
| | - Maria Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (L.C.); (M.E.Z.)
| | - Francesca Darra
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
| | - Marco Colizzi
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- Correspondence: ; Tel.: +39-045-812-6832
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13
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van Everdingen C, Peerenboom PB, van der Velden K, Delespaul P. Health Patterns Reveal Interdependent Needs of Dutch Homeless Service Users. Front Psychiatry 2021; 12:614526. [PMID: 33841201 PMCID: PMC8027245 DOI: 10.3389/fpsyt.2021.614526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 10/06/2020] [Accepted: 02/24/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Homelessness is an increasing problem in Western European countries. Dutch local authorities initiated cross-sectional reviews to obtain accurate health and needs information on Homeless Service (HS) users. Methods: The Homeless People Treatment and Recovery (HOP-TR) study uses a comprehensive assessment strategy to obtain health data. Using a naturalistic meta-snowball sampling in 2015-2017, 436 Dutch HS users were assessed. The lived experience of HS users was the primary data source and was enriched with professional assessments. The InterRAI Community Mental Health questionnaire and "Homelessness Supplement" provided information in different areas of life. The approach for mental health assessments was transdiagnostic. Raw interview data were recoded to assess health and needs. The positive health framework structured symptomatic, social, and personal health domains relevant to recovery. Results: Most subjects were males, low educated, with a migration background. The majority were long-term or intermittently homeless. Concurrent health problems were present in two domains or more in most (95.0%) subjects. Almost all participants showed mental health problems (98.6%); for a significant share severe (72.5%). Frequent comorbid conditions were addiction (78%), chronic physical conditions (59.2%), and intellectual impairments (39.9%). Conclusion: The HOP-TR study reveals significant concurrent health problems among Dutch HS users. The interdependent character of different needs requires an integrated 3-D public health approach to comprehensively serve symptomatic, social, and personal dimensions, required to facilitate recovery.
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Affiliation(s)
- Coline van Everdingen
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | | | - Koos van der Velden
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands.,Department of Adult Psychiatry, Mondriaan Mental Health Trust, Heerlen, Netherlands
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Colizzi M, Ciceri ML, Di Gennaro G, Morari B, Inglese A, Gandolfi M, Smania N, Zoccante L. Investigating Gait, Movement, and Coordination in Children with Neurodevelopmental Disorders: Is There a Role for Motor Abnormalities in Atypical Neurodevelopment? Brain Sci 2020; 10:E601. [PMID: 32887253 PMCID: PMC7565603 DOI: 10.3390/brainsci10090601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022] Open
Abstract
Motor abnormalities have been suggested to play a role in most neuropsychiatric disorders, as a potential generic neurodevelopmental vulnerability. However, they still represent a neglected area, with a paucity of empirical studies, especially in pediatric populations. This case-control study aimed to comprehensively assess motor functioning in children with atypical neurodevelopment and investigate whether any socio-demographic or clinical characteristics would concur with motor difficulties to distinguish children with neurodevelopmental disorders (NDD) from healthy controls. Socio-demographic (age and gender) and clinical (intelligence quotient, gait, movement, and coordination) data were collected on 114 children aged 5-15 (83 with NDD, 31 healthy controls). Male children were at significantly higher risk for NDD (OR: 13.023, p < 0.001). Furthermore, there was a statistically significant interaction between the total intelligence quotient and overall coordination such that increasing levels of total intelligence quotient appeared to protect against the likelihood of being diagnosed with an NDD, but only in the context of a preserved coordination (OR: 0.964, p = 0.038). Collectively, results may have important public health implications, as they point towards the development of new approaches to establish an early prognosis in neurodevelopment, including assessing motor difficulties and mitigating their impact on children's quality of life.
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Affiliation(s)
- Marco Colizzi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (M.L.C.); (B.M.); (A.I.); (L.Z.)
| | - Marco Luigi Ciceri
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (M.L.C.); (B.M.); (A.I.); (L.Z.)
- Neurorehabilitation Unit, Integrated University Hospital of Verona, 37134 Verona, Italy; (M.G.); (N.S.)
| | - Gianfranco Di Gennaro
- Department of Pathology and Diagnostics, Integrated University Hospital of Verona, 37126 Verona, Italy;
| | - Beatrice Morari
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (M.L.C.); (B.M.); (A.I.); (L.Z.)
| | - Alessandra Inglese
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (M.L.C.); (B.M.); (A.I.); (L.Z.)
| | - Marialuisa Gandolfi
- Neurorehabilitation Unit, Integrated University Hospital of Verona, 37134 Verona, Italy; (M.G.); (N.S.)
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Nicola Smania
- Neurorehabilitation Unit, Integrated University Hospital of Verona, 37134 Verona, Italy; (M.G.); (N.S.)
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (M.L.C.); (B.M.); (A.I.); (L.Z.)
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Penolazzi B, Del Missier F, Stramaccia DF, Monego AL, Castelli L, Manzan A, Bertoli M, Galfano G. Testing the transdiagnostic hypothesis of inhibitory control deficits in addictions: An experimental study on gambling disorder. J Behav Addict 2020; 9:339-346. [PMID: 32554838 PMCID: PMC8939424 DOI: 10.1556/2006.2020.00021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS Many psychopathologies, including addictions, are characterized by inhibitory control deficits. In this regard, recent studies on substance-related disorders (SRD) have shown an impairment in the ability to inhibit potentially interfering memories, despite preserved motor inhibition. To investigate whether the same dissociation could also characterize gambling disorder (GD) in a transdiagnostic perspective, we tested both cognitive and motor inhibitory processes through dedicated tasks, for the first time in this behavioral addiction. METHODS 30 outpatients with GD and 30 healthy controls performed a go/no-go task addressing the integrity of motor inhibition, and the Retrieval Practice Paradigm, a task addressing the integrity of memory inhibition as indexed by the Retrieval-Induced Forgetting (RIF) effect. Self-report questionnaires assessing impulsivity were also administered. RESULTS Whereas RIF was similar across the two groups, patients showed more commission errors in the go/no-go task, and higher self-rated scores of impulsivity than controls. DISCUSSION The present findings suggest preserved memory inhibition and impaired motor response inhibition in GD, a pattern of inhibitory deficits opposite to that previously reported for SRD. Therefore, although both GD and SRD are characterized by altered inhibitory processing, a more fine-grained analysis revealed a specific inhibitory profile indicating vulnerability in different inhibitory components. CONCLUSION The present study highlights the need to investigate the multifaceted construct of inhibition more thoroughly, using performance measures able to assess its various components. This approach would enable to both better characterize different psychopathologies and orient their treatment.
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Affiliation(s)
- Barbara Penolazzi
- Department of Life Sciences, University of Trieste, Via Weiss, 21, I-34128, Trieste, Italy,Corresponding author. E-mail:
| | - Fabio Del Missier
- Department of Life Sciences, University of Trieste, Via Weiss, 21, I-34128, Trieste, Italy
| | - Davide Francesco Stramaccia
- Department of Developmental and Social Psychology, University of Padova, Via Venezia, 8, I-35131, Padova, Italy
| | - Anna Laura Monego
- Department of Developmental and Social Psychology, University of Padova, Via Venezia, 8, I-35131, Padova, Italy
| | - Luigi Castelli
- Department of Developmental and Social Psychology, University of Padova, Via Venezia, 8, I-35131, Padova, Italy
| | | | - Marco Bertoli
- Azienda per l'Assistenza Sanitaria 2 Bassa Friulana-Isontina, Italy
| | - Giovanni Galfano
- Department of Developmental and Social Psychology, University of Padova, Via Venezia, 8, I-35131, Padova, Italy,Corresponding author. E-mail:
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16
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Villarroel J, Salinas V, Silva H, Herrera L, Montes C, Jerez S, Vöhringer PA, Bustamante ML. Beyond the Categorical Distinction Between Borderline Personality Disorder and Bipolar II Disorder Through the Identification of Personality Traits Profiles. Front Psychiatry 2020; 11:552. [PMID: 32922312 PMCID: PMC7456877 DOI: 10.3389/fpsyt.2020.00552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 01/21/2020] [Accepted: 05/29/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The relationship between borderline personality disorder (BPD) and type-II bipolar disorder (BDII) is not clearly understood. Nevertheless, in clinical practice and research, most efforts focus on establishing a categorical distinction between the two. We propose using personality traits as a more informative strategy to describe them. METHODS Five-Factor Model personality traits were measured in 73 individuals with either BPD or BDII. Latent class cluster analysis was applied to the sample. RESULTS A three-cluster model resulted the best fit to the data, where all clusters had high neuroticism and low extraversion scores but differed widely on the other traits. The clusters' boundaries did not match the categorical diagnosis. CONCLUSIONS Our sample showed significant heterogeneity on personality traits, which can have a relevant effect on the outcome of each disorder and that was not captured by the categorical diagnosis. Thus, we advocate for a multivariate approach as a better way to understand the relationship between BPD and BDII.
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Affiliation(s)
- Juana Villarroel
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Valeria Salinas
- Neurogenetics Outpatient Clinic and Laboratory, University Neurology Center and Neurology Section, J.M. Ramos Mejía Hospital, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina.,Precision Medicine and Clinical Genomics Program, Faculty of Biomedical Sciences, Translational Medicine Research Institute, Universidad Austral-CONICET, Buenos Aires, Argentina
| | - Hernán Silva
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Luisa Herrera
- Human Genetics Program, Faculty of Medicine, Biomedical Sciences Institute, Universidad de Chile, Santiago, Chile
| | - Cristián Montes
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Sonia Jerez
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paul A Vöhringer
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Mood Disorders Program, Tufts Medical Center, Tufts University, Boston, MA, United States
| | - Maria Leonor Bustamante
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Human Genetics Program, Faculty of Medicine, Biomedical Sciences Institute, Universidad de Chile, Santiago, Chile
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17
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Burton CL, Wang K, Pachankis JE. Psychotherapy for the Spectrum of Sexual Minority Stress: Application and Technique of the ESTEEM Treatment Model. Cogn Behav Pract 2019; 26:285-299. [PMID: 31592215 PMCID: PMC6779338 DOI: 10.1016/j.cbpra.2017.05.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Converging evidence points to minority stress as a risk factor that predisposes sexual minority individuals to a variety of negative psychosocial health outcomes, particularly depression and anxiety, substance use, and sexual risk-taking. This paper outlines the techniques and theoretical underpinnings for implementing an emerging empirically supported psychotherapy targeting the transdiagnostic mechanisms linking minority stress with these outcomes for sexual minority clients. We outline the essential therapeutic principles, psychoeducation content, as well as session- and homework-based activities that can be adapted for a variety of presenting problems that originate from and are exacerbated by minority stress via these transdiagnostic minority stress processes. As the development and dissemination of this therapeutic model is still within its early stages, we review the intervention's empirical support thus far and outline potential directions for future development and dissemination via individual, clinic-based, and societal channels.
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18
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Wichers M, Schreuder MJ, Goekoop R, Groen RN. Can we predict the direction of sudden shifts in symptoms? Transdiagnostic implications from a complex systems perspective on psychopathology. Psychol Med 2019; 49:380-387. [PMID: 30131079 PMCID: PMC6331686 DOI: 10.1017/s0033291718002064] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/27/2018] [Accepted: 07/19/2018] [Indexed: 12/20/2022]
Abstract
Recently, there has been renewed interest in the application of assumptions from complex systems theory in the field of psychopathology. One assumption, with high clinical relevance, is that sudden transitions in symptoms may be anticipated by rising instability in the system, which can be detected with early warning signals (EWS). Empirical studies support the idea that this principle also applies to the field of psychopathology. The current manuscript discusses whether assumptions from complex systems theory can additionally be informative with respect to the specific symptom dimension in which such a transition will occur (e.g. whether a transition towards anxious, depressive or manic symptoms is most likely). From a complex systems perspective, both EWS measured in single symptom dynamics and network symptom dynamics at large are hypothesized to provide clues regarding the direction of the transition. Challenging research designs are needed to provide empirical validation of these hypotheses. These designs should be able to follow sudden transitions 'live' using frequent observations of symptoms within individuals and apply a transdiagnostic approach to psychopathology. If the assumptions proposed are supported by empirical studies then this will signify a large improvement in the possibility for personalized estimations of the course of psychiatric symptoms. Such information can be extremely useful for early intervention strategies aimed at preventing specific psychiatric problems.
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Affiliation(s)
- Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatrie, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - Marieke J. Schreuder
- University of Groningen, University Medical Center Groningen, Department of Psychiatrie, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
| | - Rutger Goekoop
- Department of Mood Disorders, Parnassia Group, PsyQ, The Hague, The Netherlands
| | - Robin N. Groen
- University of Groningen, University Medical Center Groningen, Department of Psychiatrie, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands
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Cauda F, Nani A, Costa T, Palermo S, Tatu K, Manuello J, Duca S, Fox PT, Keller R. The morphometric co-atrophy networking of schizophrenia, autistic and obsessive spectrum disorders. Hum Brain Mapp 2018; 39:1898-1928. [PMID: 29349864 DOI: 10.1002/hbm.23952] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/19/2017] [Accepted: 12/28/2017] [Indexed: 12/13/2022] Open
Abstract
By means of a novel methodology that can statistically derive patterns of co-alterations distribution from voxel-based morphological data, this study analyzes the patterns of brain alterations of three important psychiatric spectra-that is, schizophrenia spectrum disorder (SCZD), autistic spectrum disorder (ASD), and obsessive-compulsive spectrum disorder (OCSD). Our analysis provides five important results. First, in SCZD, ASD, and OCSD brain alterations do not distribute randomly but, rather, follow network-like patterns of co-alteration. Second, the clusters of co-altered areas form a net of alterations that can be defined as morphometric co-alteration network or co-atrophy network (in the case of gray matter decreases). Third, within this network certain cerebral areas can be identified as pathoconnectivity hubs, the alteration of which is supposed to enhance the development of neuronal abnormalities. Fourth, within the morphometric co-atrophy network of SCZD, ASD, and OCSD, a subnetwork composed of eleven highly connected nodes can be distinguished. This subnetwork encompasses the anterior insulae, inferior frontal areas, left superior temporal areas, left parahippocampal regions, left thalamus and right precentral gyri. Fifth, the co-altered areas also exhibit a normal structural covariance pattern which overlaps, for some of these areas (like the insulae), the co-alteration pattern. These findings reveal that, similarly to neurodegenerative diseases, psychiatric disorders are characterized by anatomical alterations that distribute according to connectivity constraints so as to form identifiable morphometric co-atrophy patterns.
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Affiliation(s)
- Franco Cauda
- GCS-FMRI, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy.,Focus Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Andrea Nani
- GCS-FMRI, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy.,Focus Lab, Department of Psychology, University of Turin, Turin, Italy.,Michael Trimble Neuropsychiatry Research Group, University of Birmingham and BSMHFT, Birmingham, UK
| | - Tommaso Costa
- GCS-FMRI, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy.,Focus Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Sara Palermo
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Karina Tatu
- GCS-FMRI, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy.,Focus Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Jordi Manuello
- GCS-FMRI, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy.,Focus Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Sergio Duca
- GCS-FMRI, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center At San Antonio, San Antonio, Texas.,South Texas Veterans Health Care System, San Antonio, Texas
| | - Roberto Keller
- Adult Autism Center, DSM Local Health Unit ASL Citta' Di Torino, Turin, Italy
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Abstract
This commentary considers a recent article on how the proliferating use of atheoretical, confirmatory and diagnosis driven research approaches is resulting in the over-identification of behavioral addictions. In response to the original article, I reflect on the timeliness and value of its observations and expand on a central point it raises: The importance of thinking beyond diagnostic frameworks in developing a comprehensive understanding of addictive behaviors and associated treatments.
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Affiliation(s)
- Marcantonio M. Spada
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK,* Corresponding address: Marcantonio M. Spada; Division of Psychology, School of Applied Sciences, London South Bank University, UK; Phone: +44 (0)20 7815 5760; E-mail:
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