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Amianto F, Arletti L, Vesco S, Davico C, Vitiello B. Therapeutic outcome and long-term naturalistic follow-up of female adolescent outpatients with AN: clinical, personality and psychopathology evolution, process indicators and outcome predictors. BMC Psychiatry 2023; 23:366. [PMID: 37231436 PMCID: PMC10210459 DOI: 10.1186/s12888-023-04855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious mental illness of growing prevalence in childhood and adolescence. Despite its severity, there are still no completely satisfactory evidence-based treatments. Follow-up studies represent the most effective attempt to enlighten treatment effectiveness, outcome predictors and process indicators. METHODS Seventy-three female participants affected with AN were assessed at intake (T0) and at 6 (T1) and 12 (T2) months of an outpatient multimodal treatment program. Nineteen participants were assessed 15 years after discharge (T3). Changes in diagnostic criteria were compared with the chi-square test. Clinical, personality and psychopathology evolution were tested with ANOVA for repeated measures, using the t-test or Wilcoxon test as post-hoc. T0 features among dropout, stable and healed participants were compared. Healed and unhealed groups at long-term follow-up were compared using Mann-Whitney U test. Treatment changes were correlated to each other and with intake features using multivariate regression. RESULTS The rate of complete remission was 64.4% at T2, and 73.7% at T3. 22% of participants maintained a full diagnosis at T2, and only 15.8% at T3. BMI significantly increased at each time-point. A significant decrease of persistence and increase in self-directedness were evidenced between T0 and T2. Interoceptive awareness, drive to thinness, impulsivity, parent-rated, and adolescent-rated general psychopathology significantly decreased after treatment. Lower reward dependence and lower cooperativeness characterized the dropout group. The healed group displayed lower adolescent-rated aggressive and externalizing symptoms, and lower parent-rated delinquent behaviors. BMI, personality and psychopathology changes were related with each other and with BMI, personality and psychopathology at intake. CONCLUSION A 12-months outpatient multimodal treatment encompassing psychiatric, nutritional and psychological approaches is an effective approach for the treatment of mild to moderate AN in adolescence. Treatment was associated not only with increased BMI but also with positive personality development, and changes in both eating and general psychopathology. Lower relational abilities may be an obstacle to healing. Approaches to treatment resistance should be personalized according to these finding.
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Affiliation(s)
- Federico Amianto
- Department of Neuroscience, Section of Child and Adolescent Neuropsychiatry, University of Turin, Via Cherasco, 15 - 10126, Turin, Italy.
| | - Luca Arletti
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Serena Vesco
- Department of Pathology and Care of the Children, Regina Margherita Hospital, Turin, Italy
| | - Chiara Davico
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
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Choi JY, Gim MS, Lee JY. Predictability of temperaments and negative experiences on higher-order symptom-based subtypes of depression. J Affect Disord 2020; 265:18-25. [PMID: 31957688 DOI: 10.1016/j.jad.2020.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 11/18/2019] [Accepted: 01/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The identification of subtypes of depression based on higher-order symptoms of emotional, thought, and behavioral dysfunction will broaden understanding of the heterogeneity in depression. Furthermore, exploring the ability of temperaments and negative experiences to predict each subtype is an effective way of facilitating treatment decisions. METHODS Participants were 417 patients diagnosed with depressive disorder at the psychiatry department of a major medical hospital in Seoul, Korea. A latent profile analysis was performed based on three higher-order scales of the MMPI-2-RF: Emotional/Internalizing Dysfunction, Thought Dysfunction, and Behavioral/Externalizing Dysfunction. Four temperament dimensions were assessed by the Temperament and Character Inventory-Revised-Short, and negative experiences including recent negative life events, number of lifetime traumatic events, and severity of maltreatment, were used as covariates in a multinomial regression analysis. RESULTS Four classes were obtained from the latent profile analysis: a "severe mood class" (39.8%), a "moderate mood class" (37.4%), a "mild mood class" (11.3%), and a "severe mood/thought class" (11.5%). Among temperament dimensions, high harm avoidance and low persistence significantly predicted more severe mood classes. Low reward dependence, number of lifetime traumatic events, and severity of maltreatment in negative experiences were significant predictors of the severe mood/thought class. LIMITATIONS This study could not explain the more detailed heterogeneity within depression because of over-inclusiveness of the higher-order scales. CONCLUSIONS This study identified three latent classes that differed in emotional severity and one other class with thought problems. The distinct dimensions of temperament and different types of negative experiences predicted the identified subtypes.
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Affiliation(s)
- Ji Young Choi
- Department of Child Studies, Inha University, Incheon, Republic of Korea
| | - Min Sook Gim
- Department of Psychiatry, Sanggye Baik Hospital, Inje University
| | - Joo Young Lee
- Department of Child Development and Education, Dongduk Women's University, Seoul, Republic of Korea.
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Balestri M, Porcelli S, Souery D, Kasper S, Dikeos D, Ferentinos P, Papadimitriou GN, Rujescu D, Martinotti G, Di Nicola M, Janiri L, Caletti E, Mandolini GM, Pigoni A, Paoli RA, Lazzaretti M, Brambilla P, Sala M, Abbiati V, Bellani M, Perlini C, Rossetti MG, Piccin S, Bonivento C, Fabbro D, Damante G, Ferrari C, Rossi R, Pedrini L, Benedetti F, Montgomery S, Zohar J, Mendlewicz J, Serretti A. Temperament and character influence on depression treatment outcome. J Affect Disord 2019; 252:464-474. [PMID: 31005789 DOI: 10.1016/j.jad.2019.04.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/07/2019] [Accepted: 04/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND personality features have been repeatedly associated with depression treatment outcome in Major Depressive Disorder (MDD), however conclusive results are still lacking. Moreover, as for Bipolar Disorder (BD), results are only few and preliminary. AIM the aim of the present study was to perform an exploratory investigation of the influence of personality traits as assessed by the Temperament and Character Inventory (TCI), on principal depression treatment outcomes (non remission, non response and resistance). METHODS 743 mood disorders patients (455 MDD (61.24%) and 288 BD (38.76%)) were recruited in the context of 6 European studies. Generalized logit models were performed to test the effects of TCI dimensions on treatment outcomes, considering possible confounders such as age, gender and education. Positive results were controlled for comorbidities (anxiety and substance use disorders) as well. RESULTS MDD Non-Remitters showed high Harm Avoidance (HA) and Self Transcendence (ST) (p = 0.0004, d = 0.40; p = 0.007, d = 0.36 respectively) and low Persistence (P) and Self Directedness (SD) (p = 0.05; d = 0.18; p = 0.002, d = 0.40, respectively); MDD Non-Responders showed a slightly different profile with high HA and low Reward Dependence (RD) and SD; finally, MDD Resistants showed low RD, P and Cooperativeness (C). In BD patients, only higher HA in non response was observed. LIMITATIONS the retrospective cross-sectional design, the TCI assessment regardless of the mood state and the small number of bipolar patients represent the main limitations. CONCLUSION specific TCI personality traits are associated with depression treatment outcome in MDD patients. The inclusion of such personality traits, together with other socio-demographic and clinical predictors, could ameliorate the accuracy of the prediction models available to date.
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Affiliation(s)
- Martina Balestri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Stefano Porcelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Daniel Souery
- Laboratoire de Psychologie Médicale, Université Libre de Bruxelles, Centre Européen de Psychologie Médicale-PsyPluriel, Brussels, Belgium
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Dimitris Dikeos
- Department of Psychiatry, Athens University Medical School, Athens, Greece
| | | | | | - Dan Rujescu
- University Clinic for Psychiatry, Psychotherapy and Psychosomatic, Martin-Luther-University Halle-Wittenberg, Germany
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Scienze Cliniche, University "G.d'Annunzio", Chieti, Italy
| | - Marco Di Nicola
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Luigi Janiri
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Elisabetta Caletti
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Gian Mario Mandolini
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Riccardo Augusto Paoli
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Lazzaretti
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Michela Sala
- Department of Mental Health, Azienda Sanitaria Locale Alessandria, Alessandria, Italy
| | - Vera Abbiati
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy; UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy; UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Maria Gloria Rossetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy; UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Sara Piccin
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Carolina Bonivento
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Dora Fabbro
- Department of Laboratory Medicine, Institute of Medical Genetics, University of Udine, Italy
| | - Giuseppe Damante
- Department of Laboratory Medicine, Institute of Medical Genetics, University of Udine, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio FBF, Brescia, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio FBF, Brescia, Italy
| | - Laura Pedrini
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio FBF, Brescia, Italy
| | - Francesco Benedetti
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Joseph Zohar
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy.
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