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Baljé AE, Greeven A, Deen M, van Giezen AE, Arntz A, Spinhoven P. Group schema therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: A randomized controlled trial. J Anxiety Disord 2024; 104:102860. [PMID: 38714138 DOI: 10.1016/j.janxdis.2024.102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/15/2024] [Accepted: 03/31/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Patients with social anxiety (SAD) and comorbid avoidant personality disorder (AVPD) are severely impaired. Group cognitive behavioral therapy (GCBT) is considered an effective treatment for SAD. More knowledge on treatment of SAD with comorbid AVPD is needed. Schema therapy, developed for personality and chronic mental disorders, may be a promising treatment. METHODS We conducted a randomized controlled trial in an outpatient population (n = 154) with both SAD and AVPD. Group Schema Therapy (GST) and GCBT were compared on SAD symptoms (Liebowitz Social Anxiety Scale) and manifestations of AVPD (Avoidant Personality Disorder Severity Index). RESULTS Intention-to-treat analysis showed no significant differences between treatments at 3 months post-treatment and one-year follow-up. Both modalities led to significant and substantial improvements. No significant between-differences were found in depressive symptoms (Inventory of Depressive Symptoms) and quality of life (World Health Organization Quality of Life-BREF). Per-protocol analysis showed similar outcomes and no significant differences in recovery from SAD and AVPD. Significantly more patients completed GST. CONCLUSION GST and GCBT are valuable treatments for SAD with comorbid AVPD. The higher treatment retention in ST indicates ST is more acceptable than GCBT. Future studies should focus on enhancing treatment effects and improving retention to GCBT.
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Affiliation(s)
- Astrid E Baljé
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Anja Greeven
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Mathijs Deen
- Institute of Psychology/Leiden University, Leiden, the Netherlands; Parnassia Group Academy/Parnassia Psychiatric Institute, The Hague, the Netherlands.
| | - Anne E van Giezen
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychology/University of Amsterdam, Amsterdam, the Netherlands.
| | - Philip Spinhoven
- Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands.
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Belli GM, Law C, Obisie-Orlu IC, Eisen JL, Rasmussen SA, Boisseau CL. Course and clinical correlates of obsessive-compulsive disorder with or without comorbid personality disorder. J Affect Disord 2024; 348:218-223. [PMID: 38145841 PMCID: PMC10939496 DOI: 10.1016/j.jad.2023.12.041] [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: 08/21/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Personality disorders (PDs) are often comorbid with obsessive-compulsive disorder (OCD) which may influence symptom presentation and course. This investigation sought to examine the impact of comorbid PDs on clinical presentation and symptom chronicity in a large, prospective longitudinal OCD study. METHODS Participants (n = 263) were treatment-seeking adults with a primary diagnosis of OCD separated into two groups: individuals with and without a co-occurring PD. We conducted two-tailed t-tests to compare symptom severity, functioning, and quality of life between the OCD + PD group (n = 117) and the OCD w/o PD group (n = 146). Chronicity analyses were conducted to compare the amount of time in-episode for OCD and major depressive disorder (MDD) between the two groups. RESULTS The OCD + PD group reported greater OCD and depression severity, lower levels of psychosocial functioning and worse quality of life than the OCD w/o PD group. The OCD + PD group exhibited greater OCD and MDD symptom chronicity; over 5 years the OCD + PD group spent 16.2 % weeks longer at full criteria for OCD and three times as many weeks in episode for MDD than the OCD w/o PD group. LIMITATIONS Focusing on PDs as a group limited our ability to make observations about specific PDs. Further, the participants in our sample were predominantly White and all were treatment seeking which limits the generalizability of our findings. CONCLUSIONS Our results suggest that those with OCD and comorbid PDs present with greater overall impairment and may require additional considerations during treatment conceptualization and planning.
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Affiliation(s)
- Gina M Belli
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Clara Law
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Immanuela C Obisie-Orlu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane L Eisen
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Steven A Rasmussen
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, USA
| | - Christina L Boisseau
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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3
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Brooks SK, Greenberg N. Recurrence of post-traumatic stress disorder: systematic review of definitions, prevalence and predictors. BMC Psychiatry 2024; 24:37. [PMID: 38195482 PMCID: PMC10777598 DOI: 10.1186/s12888-023-05460-x] [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: 09/04/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Many people will experience a potentially traumatic event in their lifetime and a minority will go on to develop post-traumatic stress disorder (PTSD). A wealth of literature explores different trajectories of PTSD, focusing mostly on resilient, chronic, recovered and delayed-onset trajectories. Less is known about other potential trajectories such as recurring episodes of PTSD after initial recovery, and to date there has been no estimate of what percentage of those who initially recover from PTSD later go on to experience a recurrence. This systematic review aimed to synthesise existing literature to identify (i) how 'recurrence' of PTSD is defined in the literature; (ii) the prevalence of recurrent episodes of PTSD; and (iii) factors associated with recurrence. METHODS A literature search of five electronic databases identified primary, quantitative studies relevant to the research aims. Reference lists of studies meeting pre-defined inclusion criteria were also hand-searched. Relevant data were extracted systematically from the included studies and results are reported narratively. RESULTS Searches identified 5,398 studies, and 35 were deemed relevant to the aims of the review. Results showed there is little consensus in the terminology or definitions used to refer to recurrence of PTSD. Because recurrence was defined and measured in different ways across the literature, and prevalence rates were reported in numerous different ways, it was not possible to perform meta-analysis to estimate the prevalence of recurrence. We also found no consistent evidence regarding predictors of PTSD recurrence. CONCLUSION A clear and consistent evidence-based definition of recurrence is urgently needed before the prevalence and predictors of recurrence can be truly understood.
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Affiliation(s)
- Samantha K Brooks
- Department of Psychological Medicine, King's College London, Weston Education Centre, SE5 9RJ, London, United Kingdom.
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, Weston Education Centre, SE5 9RJ, London, United Kingdom
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Panagiotopoulos A, Despoti A, Varveri C, Wiegand MCA, Lobbestael J. The Relationship Between Early Maladaptive Schemas and Cluster C Personality Disorder Traits: A Systematic Review and Meta-Analysis. Curr Psychiatry Rep 2023; 25:439-453. [PMID: 37870687 PMCID: PMC10627891 DOI: 10.1007/s11920-023-01439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE OF REVIEW We systematically reviewed and meta-analyzed the literature on the relationship between early maladaptive schemas (EMSs) and Cluster C personality disorders (PDs). Our aim was to clarify which of the 18 EMSs exhibit the strongest associations and are most frequently endorsed in clinical and non-clinical samples with Cluster C PDs and traits. RECENT FINDINGS After initially screening 2622 records, 12 studies were selected with 5310 participants. Meta-analyses of the raw correlation coefficients for each EMS-Cluster C PD link (3-8 studies per meta-analysis) indicated that the 18 EMSs were significantly related to all three Cluster C PDs with r's ranging from .13 to .63. However, when considering endorsement rates among multiple regression studies that controlled for the EMSs intercorrelations and the effects of other PD traits and demographics, specific EMS constellations emerged for each Cluster C PD. Overall, the findings of the current paper suggest that Cluster C PDs might be conceptualized on the basis of a hybrid EMS model, in which all EMSs contribute to global personality dysfunction whereas specific EMS patterns reflect unique personality disorder style expressions. Longitudinal research with appropriate methodology is needed to draw more definite conclusions on the EMSs-Cluster C PDs relationships.
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Affiliation(s)
- Angelos Panagiotopoulos
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
- Institute of Behavioural Research and Therapy, Athens, Greece
| | - Akylina Despoti
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Intensive Care Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Marie C A Wiegand
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, University single 40, 6229 ER, Maastricht, the Netherlands
| | - Jill Lobbestael
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, University single 40, 6229 ER, Maastricht, the Netherlands.
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Rajkumar RP. Editorial: Case reports in anxiety and stress. Front Psychiatry 2023; 14:1291083. [PMID: 37822791 PMCID: PMC10562692 DOI: 10.3389/fpsyt.2023.1291083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Kvarstein EH, Frøyhaug M, Pettersen MS, Carlsen S, Ekberg A, Fjermestad-Noll J, Ulvestad DA, Gikling EL, Hjermann E, Lindberget K, Omvik S, Eikenæs IUM, Hummelen B, Morken KTE, Wilberg T, Pedersen GAF. Improvement of personality functioning among people treated within personality disorder mental health services. A longitudinal, observational study. Front Psychiatry 2023; 14:1163347. [PMID: 37229394 PMCID: PMC10203961 DOI: 10.3389/fpsyt.2023.1163347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Objective Evidence-based personality disorder (PD) treatments are dominated by interventions targeting Borderline PD, although clinical populations characteristically include different PD features and severity. Personality functioning is a new concept intended to capture common features across PDs. This study aimed to investigate longitudinal improvement of personality functioning in a clinical sample assigned to PD treatment. Method An observational, large, longitudinal study of patients in PD treatments on specialist mental health service levels (N = 1,051). DSM-5 PDs were systematically assessed on referral. Personality functioning was repeatedly assessed (LPFS-BF-2.0), supplemented by symptom distress (anxiety: PHQ-GAD-7, depression: PHQ-9), and social/occupational activity (WSAS, work/study activity). Statistics were linear mixed models. Results Thirty per cent had personality difficulties below PD threshold. Among PDs, 31% had Borderline (BPD), 39% Avoidant (AvPD), 15% not otherwise specified, 15% other PDs, and 24% > one PD. More severe initial LPFS-BF was associated with younger age, presence of PD and increasing number of total PD criteria. Across PD conditions, LPFS-BF, PHQ-9 and GAD-7 improved significantly (overall effect size 0.9). Mean duration of PD treatment was 15 (SD 9) months. Drop-out rates were low (12%). LPFS-BF improvement-rates were higher for BPD. Younger age was moderately associated with slower PHQ-9 improvement. Work/study activity was initially poor, poorer levels associated with AvPD and younger age, and improvement was non-significant across PD conditions. AvPD was associated with slower WSAS improvement-rates. Conclusion Personality functioning improved across PD conditions. The results highlight BPD improvements. The study points to challenges concerning AvPD treatment, poor occupational activity and age-related differences.
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Affiliation(s)
- Elfrida H. Kvarstein
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mathias Frøyhaug
- Groruddalen District Psychiatric Center, Akershus University Hospital, Akershus, Norway
| | | | - Sara Carlsen
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Andreas Ekberg
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
- Department for Adult Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Jane Fjermestad-Noll
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | - Dag A. Ulvestad
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | | | - Eirik Hjermann
- Kronstad District Psychiatric Center, Haukeland University Hospital, Bergen, Norway
| | - Kenneth Lindberget
- Strømme District Psychiatric Center, Sørlandet Hospital, Kristiansand, Norway
| | - Siri Omvik
- Kronstad District Psychiatric Center, Haukeland University Hospital, Bergen, Norway
| | - Ingeborg U-M. Eikenæs
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | - Benjamin Hummelen
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Katharina T. E. Morken
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Theresa Wilberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Geir A. F. Pedersen
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Erickson TM, Lewis JA, Crouch TA, Singh NB, Cummings MH. Interpersonal contrast avoidance as a mechanism for the maintenance of worry. J Anxiety Disord 2023; 94:102678. [PMID: 36773485 DOI: 10.1016/j.janxdis.2023.102678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
Despite consistent links between interpersonal problems and worry, mechanisms explaining this relationship remain unknown. The Contrast Avoidance Model (CAM; Newman & Llera, 2011) posits that individuals at risk for chronic worry and generalized anxiety disorder (GAD) fear sudden negative mood shifts, using worry to perpetuate negative moods and avoid these negative emotional contrasts. We propose interpersonal (IP) contrast avoidance (e.g., acting friendly to prevent others from causing mood shifts) as a novel explanation for interpersonal dysfunction in worriers. This study investigated IP contrast avoidance and worry in two samples. A nonclinical sample ranging in GAD symptoms (Study 1; N = 92) reported IP problems at baseline then IP contrast avoidance and worry over eight weeks (637 diaries). As expected, baseline IP problems prospectively predicted worry indirectly through chronic IP contrast avoidance. Affiliative, submissive, cold, and total IP contrast avoidance strategies predicted same-week and lagged next-week worry increases; affiliative, submissive, and total strategies also predicted maintenance of worry over eight weeks in growth models. Lastly, Study 2 showed the relevance of IP contrast avoidance strategies in a treatment-seeking clinical sample (N = 40), correlating with interpersonal problems and worry. Overall, results provide proof-of-concept for extending the CAM to the interpersonal domain.
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Affiliation(s)
- Thane M Erickson
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA 98119, USA.
| | - Jamie A Lewis
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA 98119, USA
| | - Tara A Crouch
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA 98119, USA
| | - Narayan B Singh
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA 98119, USA
| | - Mackenzie H Cummings
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA 98119, USA
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Law C, Kamarsu S, Obisie-Orlu IC, Belli GM, Mancebo M, Eisen J, Rasmussen S, Boisseau CL. Personality traits as predictors of OCD remission: A longitudinal study. J Affect Disord 2023; 320:196-200. [PMID: 36183822 DOI: 10.1016/j.jad.2022.09.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/19/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Personality traits may confer vulnerability to psychopathology. However, few studies have examined the association between personality traits and obsessive-compulsive disorder (OCD) course. The present study investigates personality traits, OCD symptom severity, and illness duration as a predictor of OCD remission. METHODS 166 treatment-seeking adults with OCD, recruited as part of the Brown Longitudinal Obsessive-Compulsive Study, completed the NEO Five-Factor Inventory 3 (NEO-FFI) and were in episode for OCD at time of NEO-FFI completion. Participants were followed for up to 3 years. RESULTS Results suggest individuals with OCD had a 21 % likelihood of reaching remission over the course of 3 years. Greater OCD symptom severity and longer illness duration were associated with a decreased likelihood of remission. Among the five factors of personality, only low extraversion was associated with a decreased rate of remission. Neuroticism, openness, agreeableness, and conscientiousness were not associated with remission. LIMITATIONS As this was an observational study, treatment was not controlled precluding examination of treatment on course. Further, data collected on age of onset and symptom severity during follow up were retrospective and therefore are also subject to recall bias. CONCLUSIONS Our findings provide preliminary support that personality traits are potential factors impacting course and symptom presentation. Future research is necessary to determine the mechanisms in which personality traits may influence the presentation and course of OCD.
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Affiliation(s)
- Clara Law
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Snigdha Kamarsu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Immanuela C Obisie-Orlu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gina M Belli
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria Mancebo
- Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jane Eisen
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Steven Rasmussen
- Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christina L Boisseau
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Duholm CS, Jensen S, Rask CU, Thomsen PH, Ivarsson T, Skarphedinsson G, Torp NC, Weidle B, Nissen JB, Højgaard DRMA. Specific Contamination Symptoms are Associated with Experiencing a Limited Response of Cognitive-Behavioral Therapy in Pediatric Patients with OCD. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01480-y. [PMID: 36510026 DOI: 10.1007/s10578-022-01480-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
A recent study identified three distinct treatment-response trajectories in pediatric OCD where higher levels of contamination symptoms predicted a limited response to cognitive-behavioral therapy (CBT). This study extends these findings by examining which specific symptoms characterize limited CBT response from baseline to 3-year follow-up, with an emphasis on contamination symptoms. The study sample comprised 269 pediatric patients with OCD, all receiving stepped-care treatment with manualized CBT. Differences in single item-reporting between the three trajectory groups were examined using linear mixed-effect modeling. Limited responders displayed a higher symptom load across all OCD symptom categories at 3-year follow-up, dominated by contamination symptoms. Five of these (obsessions about dirt and germs, about bodily fluids, about the feeling of contamination and compulsions regarding handwashing and showering) showed persistence from baseline to 3-year follow-up. The results indicate that presence of specific contamination symptoms may influence long-term symptom severity trajectories in young patients with OCD.
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Affiliation(s)
- Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark.
| | - Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Nor Christian Torp
- Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
- Akershus University Hospital, Oslo, Norway
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Choi-Kain LW, Sahin Z, Traynor J. Borderline Personality Disorder: Updates in a Postpandemic World. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:337-352. [PMID: 37200886 PMCID: PMC10187392 DOI: 10.1176/appi.focus.20220057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Progress in understanding borderline personality disorder has unfolded in the last decade, landing in a new COVID-19-influenced world. Borderline personality disorder is now firmly established as a valid diagnosis, distinct from its co-occurring mood, anxiety, trauma-related, and behavioral disorders. Further, it is also understood as a reflection of general personality dysfunction, capturing essential features shared among all personality disorders. Neuroimaging research, representing the vast neurobiological advances made in the last decade, illustrates that the disorder shares frontolimbic dysfunction with many psychiatric diagnoses but has a distinct signature of interpersonal and emotional hypersensitivity. This signature is the conceptual basis of the psychotherapies and clinical management approaches proven effective for the disorder. Medications remain adjunctive and are contraindicated by some guidelines internationally. Less invasive brain-based therapeutics show promise. The most significant change in the treatment landscape is a focus on briefer, less intensive formats of generalist management. Shorter variants of therapies, such as dialectical behavior therapy and mentalization-based treatment, are in the process of being shown to be adequately effective. Earlier intervention and greater emphasis on functional improvement are needed to more effectively curb the disabilities and risks of borderline personality disorder for patients and their families. Remote interventions show promise in broadening access to care.
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Affiliation(s)
- Lois W Choi-Kain
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| | - Zeynep Sahin
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| | - Jenna Traynor
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
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11
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Saini B, Bansal PD, Bahetra M, Sharma A, Bansal P, Singh B, Moria K, Kumar R. Relationship Pattern of Personality Disorder Traits in Major Psychiatric Disorders: A Cross-Sectional Study. Indian J Psychol Med 2021; 43:516-524. [PMID: 35210680 PMCID: PMC8826195 DOI: 10.1177/0253717621999537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Normal personality development, gone awry due to genetic or environmental factors, results in personality disorders (PD). These often coexist with other psychiatric disorders, affecting their outcome adversely. Considering the heterogeneity of data, more research is warranted. METHODS This was a cross-sectional study on personality traits in psychiatric patients of a tertiary hospital, over 1 year. Five hundred and twenty-five subjects, aged 18-45 years, with substance, psychotic, mood, or neurotic disorders were selected by convenience sampling. They were evaluated for illness-related variables using psychiatric pro forma; diagnostic confirmation and severity assessment were done using ICD-10 criteria and suitable scales. Personality assessment was done using the International Personality Disorder Examination after achieving remission. RESULTS Prevalence of PD traits and PDs was 56.3% and 4.2%, respectively. While mood disorders were the diagnostic group with the highest prevalence of PD traits, it was neurotic disorders for PDs. Patients with PD traits had a past psychiatric history and upper middle socioeconomic status (SES); patients with PDs were urban and unmarried. Both had a lower age of onset of psychiatric illness. Psychotic patients with PD traits had higher and lower PANSS positive and negative scores, respectively. The severity of personality pathology was highest for mixed cluster and among neurotic patients. Clusterwise prevalence was cluster C > B > mixed > A (47.1%, 25.2%, 16.7%, and 11.4%). Among subtypes, anankastic (18.1%) and mixed (16.7%) had the highest prevalence. Those in the cluster A group were the least educated and with lower SES than others. CONCLUSIONS PD traits were present among 56.3% of the patients, and they had many significant sociodemographic and illness-related differences from those without PD traits. Cluster C had the highest prevalence. Among patients with psychotic disorders, those with PD traits had higher severity of psychotic symptoms.
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Affiliation(s)
- Bhavneesh Saini
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Pir Dutt Bansal
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Mamta Bahetra
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Arvind Sharma
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Priyanka Bansal
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Baltej Singh
- Dept. of Community Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Kavita Moria
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Rakesh Kumar
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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Schopman SME, ten Have M, van Balkom AJ, de Graaf R, Batelaan NM. Course trajectories of anxiety disorders: Results from a 6-year follow-up in a general population study. Aust N Z J Psychiatry 2021; 55:1049-1057. [PMID: 33887978 PMCID: PMC8554495 DOI: 10.1177/00048674211009625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Little is known about the course of anxiety disorders in the general population. This study provides insights into the course of anxiety disorders in the general population taking into account transition to residual symptoms and to other diagnostic categories. METHODS Using data from three waves of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2; n = 6646), subjects with anxiety disorders (T0;n = 243) were divided into three mutually exclusive course trajectories according to their diagnostic status at 3-year (T1) and 6-year (T2) follow-up: remission group (no disorder at T2), intermittent course group (no disorder at T1 and disorder at T2) and chronic course group (disorder at all measurements). Transition to residual symptoms or other psychopathology were studied. In addition, predictors of course trajectories were assessed. RESULTS During 6-year follow-up, 77.8% of subjects achieved remission, 14.0% followed an intermittent course and 8.2% a chronic course. Of those in remission, residual anxiety symptoms remained in 46.6%, while 7.9% developed another disorder between T0 and T2. Compared with the remitting group, a chronic course was predicted by not living with a partner, multiple negative life events, neuroticism, lower mental functioning, severity of anxiety symptoms, use of mental health care and medication use. LIMITATIONS The intermittent and chronic course groups were small, limiting statistical power. As a result, certain predictors may not have reached significance. CONCLUSIONS In the general population at 6-year follow-up, 77.8% of subjects with anxiety disorders achieved remission. Because of transition to residual symptoms or another diagnostic category, only 52.4% of those subjects had a true favourable outcome.
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Affiliation(s)
- Simone ME Schopman
- Department of Psychiatry, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam and Amsterdam UMC, Amsterdam, The Netherlands,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands,Simone M Schopman, Department of Psychiatry, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam and Amsterdam UMC, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands.
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Anton J van Balkom
- Department of Psychiatry, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam and Amsterdam UMC, Amsterdam, The Netherlands,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Neeltje M Batelaan
- Department of Psychiatry, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam and Amsterdam UMC, Amsterdam, The Netherlands,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
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Górska D. The role of the level of personality organization in emotional processing in Generalized Anxiety Disorder. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.111020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Obsessive-compulsive disorder (OCD) is a chronic and disabling mental disorder characterized by the presence of obsessions and/or compulsions that cause major distress and impair important areas of functioning. About 9 out of 10 patients with OCD have comorbid psychiatric diagnoses. A high proportion of clinically diagnosed OCD patients fulfill diagnostic criteria of a schizophrenia spectrum disorder, to the point that significant evidence in the literature supports the existence and the clinical relevance of a schizo-obsessive spectrum of disorders, including schizotypal personality disorder (SPD) with OCD (schizotypal OCD). In this paper, we provide a brief but comprehensive analysis of the literature on the clinical coexistence between OCD and SPD. The clinical validity of the so-called schizotypal OCD is analyzed through a comprehensive investigation of the relationship between SPD features and obsessive-compulsive phenomena in clinical OCD samples. This review describes the potential connections between OCD and SPD on the epidemiological, sociodemographic, psychopathological, and clinical levels. SPD is commonly observed in OCD patients: about 10% of OCD patients have a full categorical diagnosis of SPD. Early clinical identification of SPD features-and, more generally, of psychotic features and personality disorders-in OCD patients is strongly recommended. In fact, a proper and early diagnosis with early treatment may have benefits for prognosis. However, although schizotypal OCD seems to have clinical and predictive validity, further neurobiological and genetic studies on etiological specificity are warranted.
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Hsu CW, Wang LJ, Lin PY, Hung CF, Yang YH, Chen YM, Kao HY. Differences in Psychiatric Comorbidities and Gender Distribution among Three Clusters of Personality Disorders: A Nationwide Population-Based Study. J Clin Med 2021; 10:jcm10153294. [PMID: 34362081 PMCID: PMC8347782 DOI: 10.3390/jcm10153294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 12/03/2022] Open
Abstract
Personality disorders (PDs) are grouped into clusters A, B, and C. However, whether the three clusters of PDs have differences in comorbid mental disorders or gender distribution is still lacking sufficient evidence. We aim to investigate the distribution pattern across the three clusters of PDs with a population-based cohort study. This study used the Taiwan national database between 1995 and 2013 to examine the data of patients with cluster A PDs, cluster B PDs, or cluster C PDs. We compared the differences of psychiatric comorbidities classified in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition across the three clusters of PDs. Moreover, we formed gender subgroups of the three PDs to observe the discrepancy between male and female. Among the 9845 patients, those with cluster A PDs had the highest proportion of neurodevelopmental disorders, schizophrenia and neurocognitive disorders, those with cluster B PDs demonstrated the largest percentage of bipolar disorders, trauma and stressor disorders, feeding and eating disorders, and substance and addictive disorders, and those with cluster C PDs had the greatest proportion of depressive disorders, anxiety disorders, obsessive–compulsive disorders, somatic symptom disorders, and sleep–wake disorders. The gender subgroups revealed significant male predominance in neurodevelopmental disorders and female predominance in sleep–wake disorders across all three clusters of PDs. Our findings support that some psychiatric comorbidities are more prevalent in specified cluster PDs and that gender differences exist across the three clusters of PDs. These results are an important reference for clinicians who are developing services that target real-world patients with PDs.
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Affiliation(s)
- Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-W.H.); (P.-Y.L.); (C.-F.H.)
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 70101, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-W.H.); (P.-Y.L.); (C.-F.H.)
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-W.H.); (P.-Y.L.); (C.-F.H.)
- College of Humanities and Social Sciences, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County 613016, Taiwan;
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi County 613016, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
| | - Yu-Ming Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-W.H.); (P.-Y.L.); (C.-F.H.)
- Correspondence: (Y.-M.C.); (H.-Y.K.); Tel.: +886-7-7317123 (ext. 8753) (Y.-M.C.); +886-6-2757575 (ext. 62546) (H.-Y.K.); Fax: +886-7-7326817 (Y.-M.C.); +886-6-2747076 (H.-Y.K.)
| | - Hung-Yu Kao
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: (Y.-M.C.); (H.-Y.K.); Tel.: +886-7-7317123 (ext. 8753) (Y.-M.C.); +886-6-2757575 (ext. 62546) (H.-Y.K.); Fax: +886-7-7326817 (Y.-M.C.); +886-6-2747076 (H.-Y.K.)
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Hovenkamp-Hermelink JHM, Jeronimus BF, Myroniuk S, Riese H, Schoevers RA. Predictors of persistence of anxiety disorders across the lifespan: a systematic review. Lancet Psychiatry 2021; 8:428-443. [PMID: 33581052 DOI: 10.1016/s2215-0366(20)30433-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 01/10/2023]
Abstract
Despite the substantial disease burden of anxiety disorders, physicians have a poor understanding of factors that predict their typical persistent course. This systematic review of predictors of persistent anxiety disorders covered 48 studies with 29 690 patients diagnosed with an anxiety disorder that were published in PubMed, PsycINFO, and Web of Science between Jan 1, 1980 (introduction of DSM-III), and Dec 1, 2019. We also compared predictors between children, adolescents, adults, and older adults (ie, ≥55 years). A persistent course was primarily predicted by clinical and psychological characteristics, including having panic attacks, co-occurring personality disorders, treatment seeking, poor clinical status after treatment, higher severity and longer duration of avoidance behaviour, low extraversion, higher anxiety sensitivity, and higher behavioural inhibition. Unlike disorder onset, sociodemographic characteristics did not predict persistence. Our results outline a profile of patients with specific clinical and psychological characteristics who are particularly vulnerable to anxiety disorder persistence. Clinically, these patients probably deserve additional or more intensive treatment to prevent development of chronicity.
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Affiliation(s)
- Johanna H M Hovenkamp-Hermelink
- Interdisciplinary Center Psychopathology and Emotional regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
| | - Bertus F Jeronimus
- Interdisciplinary Center Psychopathology and Emotional regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Department of Developmental Psychology, University of Groningen, Groningen, Netherlands
| | - Solomiia Myroniuk
- Department of Developmental Psychology, University of Groningen, Groningen, Netherlands
| | - Harriëtte Riese
- Interdisciplinary Center Psychopathology and Emotional regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Robert A Schoevers
- Interdisciplinary Center Psychopathology and Emotional regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Perris F, Sampogna G, Giallonardo V, Agnese S, Palummo C, Luciano M, Fabrazzo M, Fiorillo A, Catapano F. Duration of untreated illness predicts 3-year outcome in patients with obsessive-compulsive disorder: A real-world, naturalistic, follow-up study. Psychiatry Res 2021; 299:113872. [PMID: 33770711 DOI: 10.1016/j.psychres.2021.113872] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 11/29/2022]
Abstract
Duration of untreated illness (DUI) is a predictor of outcome in psychotic and affective disorders. The few available data on the effect of DUI in obsessive-compulsive disorder (OCD) suggest an association between longer DUI and poorer response to treatments. This is a real-world, naturalistic, follow-up study evaluating the impact of DUI on long-term clinical outcomes. The sample consists of 83 outpatients with OCD with a mean DUI of 7.3 (5.8) years. Patients with symmetry/ordering cluster symptoms were younger at onset of the disease (20.4 ± 7.9 vs. 27.8 ± 10.6; p<.05, d = 0.79), had a longer duration of the illness (10.1 ± 4.6 vs. 6.8 ± 4.6, p<.05; d = 0.53) and a longer DUI (7.9 ± 6.5 vs. 5.4 ± 3.6, p<.05, d = 0.49) compared to patients not presenting with those symptoms. Fifty-nine patients completed the follow-up, and 33.9% (N = 20) met the criteria for partial remission, scoring <15 at the Y-BOCS for at least eight weeks. Patients in partial remission for more than 40% of the follow-up were defined as "good outcome" and they had a significantly shorter DUI compared to patients with "poor outcome". Access to adequate treatments is highly delayed in patients with OCD. DUI is strongly associated with poor treatment outcomes. Therefore, strategies to ensure an early diagnosis and treatment are needed.
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Affiliation(s)
- Francesco Perris
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Salvatore Agnese
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carmela Palummo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesco Catapano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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18
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Rodriguez de Behrends M. Treating Cognitive Symptoms of Generalized Anxiety Disorder Using EMDR Therapy With Bilateral Alternating Tactile Stimulation. JOURNAL OF EMDR PRACTICE AND RESEARCH 2021. [DOI: 10.1891/emdr-d-20-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reports preliminary evidence for the effectiveness of eye movement desensitization and reprocessing psychotherapy (EMDR) therapy, applying bilateral alternating tactile stimulation in treating cognitive symptoms in patients with generalized anxiety disorder (GAD). A single-case experimental design was used in seven clinical cases. The Penn State Worry Questionnaire, Intolerance of Uncertainty, Cognitive Avoidance Questionnaire, and Negative Problem Orientation Questionnaire were administered at five points during pretreatment (which established the baseline phase serving as each participant's control), at three points during the treatment phase, at the end of it, and at the 3- and 6-month follow-ups. Each participant received 16 treatment sessions. Visual, statistical, and clinical significance analyses were conducted. The cognitive symptoms treated were: excessive worry, intolerance of uncertainty, cognitive avoidance, and negative orientation to problems. All four cognitive symptoms subsided, with large effect sizes in all cases, between pre- and posttreatment, which can be observed in the visual and statistical analysis of each case. Pre- and post-cognitions are specified in each case. According to the clinical significance analysis, all participants evidenced a change towards an improvement. Finally, evidence is given in favor of the usefulness of EMDR therapy for the treatment of cognitive symptoms in participants diagnosed with GAD. However, these results must be considered cautiously when generalizing data.
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19
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Wang Q, Zhang L, Zhang J, Ye Z, Li P, Wang F, Cao Y, Zhang S, Zhou F, Ai Z, Zhao N. Prevalence of Comorbid Personality Disorder in Psychotic and Non-psychotic Disorders. Front Psychiatry 2021; 12:800047. [PMID: 35002814 PMCID: PMC8739447 DOI: 10.3389/fpsyt.2021.800047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The burden of personality disorders (PDs) in China is large and the focus on mental health services is increasing. However, there is a lack of sufficient evidence regarding the prevalence of comorbid PD in psychotic and non-psychotic disorders, and whether PDs have different distributions. We aimed to investigate the PD comorbidity distribution pattern between psychotic and non-psychotic disorders using a clinical population-based study. Materials and Methods: We conducted a cross-sectional study of 1,497 patients in Shanghai. PDs were screened using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). All patients were interviewed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis II (SCID-II). We compared the differences in PD comorbidities classified as the 10 types of PDs in the DSM-IV, in 531 patients with psychosis and 966 patients with non-psychotic disorders. Results: More than one-third (37%) of patients with psychotic disorders met the criteria of at least one PD. Approximately half (46%) of patients with non-psychotic disorders met the criteria of at least one PD. Patients with non-psychotic disorders were more likely to meet the criteria of borderline (χ2 = 20.154, p < 0.001) and obsessive-compulsive PD (χ2 = 21.164, p < 0.001) diagnoses compared to those with psychotic disorders. In contrast, patients with psychotic disorders were more likely to meet the criteria of paranoid (χ2 = 11.144, p = 0.001) and schizotypal PD (χ2 = 14.004, p < 0.001) diagnoses than those with non-psychotic disorders. Discussion: PD comorbidity is common and comorbidity distribution pattern is varied in patients with psychotic and non-psychotic disorders, implicating the development of specific strategies that could screen and assess PDs in psychiatric clinical practice.
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Affiliation(s)
- Qiang Wang
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China.,Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Lei Zhang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Jiechun Zhang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Zhihao Ye
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Ping Li
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Feng Wang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Yili Cao
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Shaojun Zhang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Fang Zhou
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Zisheng Ai
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
| | - Nan Zhao
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
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20
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Kart A, Yucens B. Personality Beliefs in Obsessive-Compulsive Disorder: How Are They Related to Symptom Severity? Psychiatry Investig 2020; 17:822-828. [PMID: 32750759 PMCID: PMC7449831 DOI: 10.30773/pi.2020.0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The comorbidity of obsessive-compulsive disorder (OCD) and personality disorders (PDs) is frequent but there are conflicting findings about which PDs are the most common. This study aimed to investigate the personality beliefs that exist on a more pathological level among OCD patients, to explore the association between personality beliefs and OCD severity, and to clarify the mediator effect of depression in this relationship. METHODS 202 OCD patients and 76 healthy controls with similar sociodemographic features were included in the study. The Personality Belief Questionnaire-Short Form was administered to both groups. The Yale-Brown Obsessions and Compulsions Scale, Beck Depression Inventory, and the Beck Anxiety Inventory were administered only to the clinical sample. RESULTS The dependent, histrionic, paranoid, borderline, and avoidant personality subscale scores were significantly higher in the OCD group than in the control group. There was an association only between OCD severity and narcissistic personality beliefs, also depression mediated the relationship between narcissistic personality and OCD severity. CONCLUSION Some personality beliefs at a pathological level are more common among OCD patients. Personality beliefs, as well as depression, should be routinely assessed, as they may affect OCD severity, help-seeking behavior, and response to treatment.
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Affiliation(s)
- Aysegul Kart
- Department of Psychiatry, Bakirkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Bengu Yucens
- Department of Psychiatry, Pamukkale University Faculty of Medicine, Denizli, Turkey
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21
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Childhood maltreatment, anxiety disorders and outcome in borderline personality disorder. Psychiatry Res 2020; 284:112688. [PMID: 31784066 DOI: 10.1016/j.psychres.2019.112688] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Anxiety disorders are a frequent in borderline personality disorder (BPD) and are associated with more severe symptomatology and poorer functional outcomes. Their presence in BPD is also believed to be the consequence of early life adversities. The aim of our study was to examine the relationship between comorbid anxiety disorders, childhood maltreatment and severity of BPD. METHODS 388 BPD outpatients were assessed for lifetime anxiety disorders and history of childhood maltreatment. Severity of BPD was measured by the number of DSM-IV BPD criteria, history of suicide attempts, hospitalizations, psychotic symptoms, comorbid substance use disorder, other comorbid disorders, level of depression, hopelessness, impulsivity and trait anger. We used logistic regressions to test the association between childhood maltreatment and anxiety disorders and the effect of those factors on severity indicators RESULTS: More than half of the participants suffered from two or more anxiety disorders. The most common comorbidity was social phobia. Childhood maltreatment was associated with an increased number of anxiety disorders. Both anxiety disorders and childhood maltreatment had, independently from one another, an effect on severity indicators. Anxiety disorders were significantly associated with the number of DSM-IV BPD criteria, suicide attempts and psychotic symptoms. Anxiety disorders had an impact on the level of depression and hopelessness, whereas childhood maltreatment impacted impulsivity and anger trait. CONCLUSION Our results show the importance of comorbid anxiety disorders in BPD, as well as their impact on severity. Anxiety disorders and childhood maltreatment should be considered by healthcare professionals to ensure optimal care. Furthermore, interventions targeting those issues need to be developed.
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Sunde T, Hummelen B, Himle JA, Walseth LT, Vogel PA, Launes G, Haaland VØ, Haaland ÅT. Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder. BMC Psychiatry 2019; 19:318. [PMID: 31655556 PMCID: PMC6815412 DOI: 10.1186/s12888-019-2285-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/11/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Some studies have previously found that certain elevated early maladaptive schemas (EMSs) are negative predictors for outcome for patients with obsessive-compulsive disorder (OCD) treated with Cognitive-Behavioral Therapy (CBT) or Exposure and Response Prevention (ERP). The current study explores whether EMS were related to reductions in OCD symptom severity at long-term follow-up (Mean = 8 years) after group ERP for patients with OCD. The central hypothesis was that patients with no response to treatment or patients who relapsed during the follow-up period were more likely to have elevated pre-treatment EMSs compared to those who responded to initial treatment and maintained gains over time. We also investigated whether there were any differences in change over time of overall EMS between patients who were recovered versus patients who were not recovered at extended follow-up. METHODS Young Schema Questionnaire -Short Form (YSQ-SF), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) were measured in 40 OCD patients in a general outpatient clinic before and after group ERP, after 12-months and at extended follow-up. To analyze the predictors, a multiple regression analyses was conducted. Changes in overall EMS was analyzed by mixed models procedures. RESULTS The major finding is that patients with high pre-treatment YSQ-SF total scores were less likely to respond to initial treatment or were more likely to relapse between post-treatment and the extended follow-up. The YSQ-SF total score at pre-treatment explained 10.5% of the variance of extended long-term follow-up outcome. The entire sample experienced a significant reduction in overall EMS over time with largest reduction from pre- to post-test. There were no statistically significant differences in total EMS change trajectories between the patients who were recovered at the extended follow-up compared to those who were not. CONCLUSION The results from the present study suggest that patients with higher pre-treatment EMSs score are less likely to recover in the long-term after receiving group ERP for OCD. A combined treatment that also targets early maladaptive schemas may be a more effective approach for OCD patients with elevated EMS who don't respond to standard ERP.
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Affiliation(s)
- Tor Sunde
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
| | - Benjamin Hummelen
- Clinic of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Joseph A. Himle
- School of Social Work and School of Medicine-Psychiatry, University of Michigan, Ann Arbor, USA
| | - Liv Tveit Walseth
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
| | - Patrick A. Vogel
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunvor Launes
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
| | - Vegard Øksendal Haaland
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
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Koyuncu A, İnce E, Ertekin E, Tükel R. Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs Context 2019; 8:212573. [PMID: 30988687 PMCID: PMC6448478 DOI: 10.7573/dic.212573] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/21/2022] Open
Abstract
Comorbid disorders are highly prevalent in patients with social anxiety disorder, occurring in as many as 90% of patients. The presence of comorbidity may affect the course of the disease in several ways such as comorbidity in patients with social anxiety disorder (SAD) is related to earlier treatment-seeking behavior, increased symptom severity, treatment resistance and decreased functioning. Moreover, comorbidities cause significant difficulties in nosology and diagnosis, and may cause treatment challenges. In this review, major psychiatric comorbidities that can be encountered over the course of SAD as well as comorbidity associated diagnostic and therapeutic challenges will be discussed.
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Affiliation(s)
- Ahmet Koyuncu
- Academy Social Phobia Center, Atatürk Mah. İkitelli Cad. No:126 A/Daire:6 Küçükçekmece/Istanbul, Turkey
| | - Ezgi İnce
- Department of Psychiatry, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Erhan Ertekin
- Department of Psychiatry, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Raşit Tükel
- Department of Psychiatry, Istanbul Medical School, Istanbul University, Istanbul, Turkey
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Reich J, Schatzberg A, Delucchi K. Empirical evidence of the effect of personality pathology on the outcome of panic disorder. J Psychiatr Res 2018; 107:42-47. [PMID: 30316085 DOI: 10.1016/j.jpsychires.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/01/2018] [Accepted: 10/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment resistant disorders are a significant clinical problem. Impediments to good outcome need to be identified and addressed. Personality pathology has been hypothesized to be one such factor in panic disorder. There is no consensus as to the effects of personality pathology on the outcome of panic disorder. This study examined empirical evidence. The hypothesis was that personality pathology would cause poorer outcome of panic disorder. METHODS A literature search was conducted that winnowed 2627 articles down to 27 based on 1) longitudinal design; 2) validated measures of personality; 3) validated outcome measures; and 4) the presence of effect size or data to calculate effect size. All effect sizes were translated into odds ratios (ORs) for ease of comparison. RESULTS An overall median OR of 2.7 was found, indicating personality pathology negatively affected outcome. This finding persisted even when adjusted for baseline severity of illness. The effects were found for both clinical outcomes (OR = 2.7) and for social adjustment (OR = 2.9). There was a tendency for more dropouts in the personality pathology group. More highly structured drug therapy regimens and highly structured psychotherapy seemed to partially mitigate this outcome. CONCLUSION The negative effect of personality pathology was confirmed in well-designed longitudinal studies. This was not related to initial clinical severity. Clinical implications are that patients with personality pathology require the therapist to stick more closely to treatment protocols and to mitigate the tendency of these patients to drop out of treatment.
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Affiliation(s)
- James Reich
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA.
| | - Alan Schatzberg
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Kevin Delucchi
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA
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25
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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Aust N Z J Psychiatry 2018. [DOI: 10.1177/0004867418799453] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: To provide practical clinical guidance for the treatment of adults with panic disorder, social anxiety disorder and generalised anxiety disorder in Australia and New Zealand. Method: Relevant systematic reviews and meta-analyses of clinical trials were identified by searching PsycINFO, Medline, Embase and Cochrane databases. Additional relevant studies were identified from reference lists of identified articles, grey literature and literature known to the working group. Evidence-based and consensus-based recommendations were formulated by synthesising the evidence from efficacy studies, considering effectiveness in routine practice, accessibility and availability of treatment options in Australia and New Zealand, fidelity, acceptability to patients, safety and costs. The draft guidelines were reviewed by expert and clinical advisors, key stakeholders, professional bodies, and specialist groups with interest and expertise in anxiety disorders. Results: The guidelines recommend a pragmatic approach beginning with psychoeducation and advice on lifestyle factors, followed by initial treatment selected in collaboration with the patient from evidence-based options, taking into account symptom severity, patient preference, accessibility and cost. Recommended initial treatment options for all three anxiety disorders are cognitive–behavioural therapy (face-to-face or delivered by computer, tablet or smartphone application), pharmacotherapy (a selective serotonin reuptake inhibitor or serotonin and noradrenaline reuptake inhibitor together with advice about graded exposure to anxiety triggers), or the combination of cognitive–behavioural therapy and pharmacotherapy. Conclusion: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder provide up-to-date guidance and advice on the management of these disorders for use by health professionals in Australia and New Zealand.
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26
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Nel C, Augustyn L, Bartman N, Koen M, Liebenberg M, Naudé J, Joubert G. Anxiety disorders: Psychiatric comorbidities and psychosocial stressors among adult outpatients. S Afr J Psychiatr 2018; 24:1138. [PMID: 30263217 PMCID: PMC6138177 DOI: 10.4102/sajpsychiatry.v24i0.1138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 04/20/2018] [Indexed: 12/03/2022] Open
Abstract
Background Anxiety disorders are the most prevalent class of lifetime mental disorders according to South African research. However, little is known about the prevalence of factors that might complicate treatment among adults in a psychiatric outpatient setting. Aim To explore the psychiatric comorbidities and psychosocial stressors among a population of adults treated for anxiety disorders at the outpatient unit of a tertiary psychiatric facility in Bloemfontein. Methods In this retrospective cross-sectional study, clinical files of all mental healthcare users receiving treatment were reviewed to identify those with a current or previous diagnosis of one or more of the following anxiety disorders: generalised anxiety disorder (GAD), panic disorder, social anxiety disorder (SAD) and agoraphobia. Results Of the 650 available records, 103 (15.8%) included at least one anxiety disorder. Of those, 65.1% had GAD, 34.0% had panic disorder and 29.1% had SAD. Agoraphobia was diagnosed in 14.6% of patients almost exclusively as comorbid with panic disorder. Additional psychiatric disorders were present for 98.1% of patients and 36.9% had multiple anxiety disorders. The patients had a history of relational problems (64.1%), educational and occupational stressors (55.3%), abuse and neglect (28.2%), other problems related to the social environment (24.3%) and self-harm (23.3%). Conclusion Clinical practice should take the high rates of comorbidity into account and the importance of integrated substance-related interventions in mental healthcare settings is clear. Diagnostic practices regarding agoraphobia without panic, and the comorbidity of anxiety and personality disorders should receive further attention. Clinicians should be aware of the potential impact of the frequently reported psychosocial stressors.
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Affiliation(s)
- Carla Nel
- Department of Psychiatry, University of the Free State, South Africa
| | - Linda Augustyn
- School of Medicine, University of the Free State, South Africa
| | - Nandie Bartman
- School of Medicine, University of the Free State, South Africa
| | - Marizél Koen
- School of Medicine, University of the Free State, South Africa
| | | | - Jurgens Naudé
- School of Medicine, University of the Free State, South Africa
| | - Gina Joubert
- Department of Biostatistics, University of the Free State, South Africa
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27
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Doering S, Blüml V, Parth K, Feichtinger K, Gruber M, Aigner M, Rössler-Schülein H, Freidl M, Wininger A. Personality functioning in anxiety disorders. BMC Psychiatry 2018; 18:294. [PMID: 30223818 PMCID: PMC6142416 DOI: 10.1186/s12888-018-1870-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/30/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Alternative DSM-5 Model for Personality Disorders as well as the upcoming IDC-11 have established a new focus on diagnosing personality disorders (PD): personality functioning. An impairment of self and interpersonal functioning in these models represents a general diagnostic criterion for a personality disorder. Little is known so far about the impairment of personality functioning in patients with other mental disorders than PD. This study aims to assess personality functioning in patients with anxiety disorders. METHODS Ninety-seven patients with the diagnosis of generalized anxiety disorder, panic disorder, or phobia, and 16 healthy control persons were diagnosed using the Structured Clinical Interview for DSM-IV (SCID-I and -II) and were assessed by means of the Structured Interview for Personality Organization (STIPO) to determine the level of personality functioning. RESULTS While all three patient groups showed significant impairment in personality functioning compared to the control group, no significant differences were observed between the different patient groups. In all three groups of anxiety disorders patients with comorbid PD showed significantly worse personality functioning than patients without. Patients without comorbid PD also yielded a significant impairment in their personality functioning when compared to the control group. CONCLUSIONS Anxiety disorders are associated with a significant impairment in personality functioning, which is significantly increased by comorbid PD. There are no differences in terms of personality functioning between patients with different anxiety disorders.
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Affiliation(s)
- Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
| | - Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
| | - Karoline Parth
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
- Department of Psychology, Webster Vienna Private University, Wien, Austria
| | - Karin Feichtinger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
| | - Maria Gruber
- Department of Social Psychiatry, Medical University of Vienna, Wien, Austria
| | - Martin Aigner
- Department of Psychiatry, University Hospital Tulln, Tulln, Austria
| | | | - Marion Freidl
- Department of Social Psychiatry, Medical University of Vienna, Wien, Austria
| | - Antonia Wininger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
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28
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Kasteenpohja T, Marttunen M, Aalto-Setälä T, Perälä J, Saarni SI, Suvisaari J. Outcome of depressive and anxiety disorders among young adults: Results from the Longitudinal Finnish Health 2011 Study. Nord J Psychiatry 2018; 72:205-213. [PMID: 29276896 DOI: 10.1080/08039488.2017.1418429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF THE STUDY We investigated the outcomes and outcome predictors of depressive and anxiety disorders in a general population sample of young adults with a lifetime history of these disorders. MATERIALS AND METHODS The study sample was derived from a nationally representative two-stage cluster sample of Finns aged 19-34 years. The original study was carried out in 2003-2005, and the follow-up in 2011. We investigated participants diagnosed with a depressive or anxiety disorder based on a SCID interview (excluding those with only a single specific phobia) (DAX-group, N = 181). The control group included those with no DSM-IV- diagnosis (N = 290). They were followed up with the M-CIDI interview assessing 12-month depressive and anxiety disorders in 2011. RESULTS In 2011, 22.8% of the DAX-group was diagnosed with a depressive or anxiety disorder compared to 9.8% of the control group. Education was lower and quality of life worse in the DAX-group than in the control group. Those participants of the DAX-group who received a diagnosis in 2011 had poorer quality of life than those in remission, which emphasizes the influence of a current disorder on the quality of life. Higher score in the Mood Disorder Questionnaire (MDQ) at baseline predicted poorer quality of life in 2011. CONCLUSIONS Thus, depressive and anxiety disorders were persistent/recurrent in one quarter of participants, significantly affecting education and quality of life. Young adults with these disorders need support to achieve their academic goals.
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Affiliation(s)
- Teija Kasteenpohja
- a Department of Public Health Solutions, Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,b Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - Mauri Marttunen
- a Department of Public Health Solutions, Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,c Department of Adolescent Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | | | - Jonna Perälä
- a Department of Public Health Solutions, Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,e Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Samuli I Saarni
- b Faculty of Medicine , University of Helsinki , Helsinki , Finland.,f Turku University Hospital, University of Turku , Turku , Finland
| | - Jaana Suvisaari
- a Department of Public Health Solutions, Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland
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29
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Keefe JR, Milrod BL, Gallop R, Barber JP, Chambless DL. What is the effect on comorbid personality disorder of brief panic-focused psychotherapy in patients with panic disorder? Depress Anxiety 2018; 35:239-247. [PMID: 29212135 PMCID: PMC5842115 DOI: 10.1002/da.22708] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/04/2017] [Accepted: 11/10/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND No studies of psychotherapies for panic disorder (PD) have examined effects on comorbid personality disorders (PersD), yet half such patients have a PersD. METHODS In a randomized trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), PersD was assessed pre-to-post treatment with the Structured Clinical Interview for the Diagnosis of Axis-II Disorders (SCID-II). For patients completing therapy (n = 118, 54 with PersD), covariance between panic and SCID-II criteria improvements was analyzed. SCID-II diagnostic remission and recovery were evaluated. Comparative efficacy of PFPP versus CBT for improving PersD was analyzed both for the average patient, and as a function of PersD severity. RESULTS 37 and 17% of PersD patients experienced diagnostic PersD remission and recovery, respectively. Larger reductions in PersD were related to more panic improvement, with a modest effect size (r = 0.28). Although there was no difference between treatments in their ability to improve PersD for the average patient (d = 0.01), patients meeting more PersD criteria did better in PFPP compared to CBT (P = .007), with PFPP being significantly superior at 11 criteria and above (d = 0.66; 3 more criteria lost). CONCLUSIONS PersD presenting in the context of primary PD rarely resolves during psychotherapies focused on PD, and change in PersD only moderately tracks panic improvements, indicating non-overlap of the constructs. Patients receiving panic-focused psychotherapies may require additional treatment for their PersD. PFPP may be superior at improving severe PersD, but replication of this finding is required.
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Affiliation(s)
- John R Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara L Milrod
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
| | - Jacques P Barber
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA
| | - Dianne L Chambless
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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30
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Keefe JR, Derubeis RJ. Changing character: A narrative review of personality change in psychotherapies for personality disorder. Psychother Res 2018; 29:752-769. [DOI: 10.1080/10503307.2018.1425930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- John R. Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert J. Derubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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31
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Newton-Howes G, Foulds J. Personality Disorder and Alcohol Use Disorder: An Overview. Psychopathology 2018; 51:130-136. [PMID: 29466805 DOI: 10.1159/000486602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/26/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinically, personality disorder (PD) commonly coexists with alcohol use disorder (AUD), although within mainstream mental health services both of these mental disorders are routinely overlooked. Despite a rich literature examining the interactions between AUD and personality functioning, personality traits, and PD, there remains conflicting evidence as to the degree of association and impact of one on the other. METHODS A narrative review and a synthesis of the literature were done. RESULTS The lifetime prevalence of AUD approaches 50% in some PD populations. The rates of PD in AUD populations are less clear but likely similar. Personality influences outcomes in AUD regardless of whether a categorical personality diagnosis or dimensional trait domain approach is taken. There are, however, no good data to inform clinicians on the impact of AUD on the outcomes of PD. Understanding the extent of this impact is complicated by the multiple tools used for diagnosis (of both PD and AUD) and the statistical methods used. Overall, caution is required in interpreting the data due to the quality of the current literature; however, comorbidity between the two disorders is likely significant and the impact of PD on AUD outcomes is sufficient to require consideration. CONCLUSIONS From a research perspective, better agreement on both diagnoses and outcomes is urgently needed to improve the overall quality of the evidence. Clinically, despite the limitations in the literature, it is unacceptable for PD services to ignore AUD and for AUD services not to screen for PD. Both are likely to have an impact on health and functioning and should be considered in routine reviews. A better conceptualization of the putative mechanisms of this interaction, as well as an understanding of the neurobiology and reasons for the impact on treatment outcomes, will help to move the field forward.
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Affiliation(s)
- Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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32
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Schneibel R, Wilbertz G, Scholz C, Becker M, Bschor T, Schmoll D. Reply. Acta Psychiatr Scand 2017; 136:434-435. [PMID: 28846815 DOI: 10.1111/acps.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Schneibel
- Department of Psychiatry, Schlosspark-Hospital, Berlin, Germany
| | - G Wilbertz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Scholz
- Department of Psychiatry, Schlosspark-Hospital, Berlin, Germany.,Psychologische Hochschule Berlin, Berlin, Germany
| | - M Becker
- Psychologische Hochschule Berlin, Berlin, Germany
| | - T Bschor
- Department of Psychiatry, Schlosspark-Hospital, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - D Schmoll
- Department of Psychiatry, Schlosspark-Hospital, Berlin, Germany
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A 6-Year Posttreatment Follow-up of Panic Disorder Patients: Treatment With Clonazepam Predicts Lower Recurrence Than Treatment With Paroxetine. J Clin Psychopharmacol 2017; 37:429-434. [PMID: 28609307 DOI: 10.1097/jcp.0000000000000740] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The aim of this study was to identify factors associated with relapse in panic disorder (PD). METHODS This was an observational study conducted in the outpatient clinic of a psychiatric hospital in Rio de Janeiro, Brazil. In a previous study, 120 patients diagnosed as having PD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were randomized to receive clonazepam or paroxetine. After 3 years, treatment was discontinued in patients who had achieved remission. These subjects were included in the current study and were followed up for 6 years. The follow-up assessments were made at 1, 2, 3, 5, and 6 years after treatment discontinuation. Assessment included the number of panic attacks per month, Clinical Global Impression-Severity, and other measures. Patients who had initiated psychotherapy or pharmacological treatment because of PD symptoms or who had Clinical Global Impression-Severity scores greater than 1 or panic attacks in the month preceding the assessment were considered relapse cases. Data were collected from January 2003 to August 2012. RESULTS Eighty-five patients completed the follow-up. Cumulative relapse rates were 50% (n = 33) at 1 year and 89.4% (n = 76) at 6 years. One-year relapse rates were lower in patients previously treated with clonazepam (P = 0.001) compared with those treated with paroxetine. Low 6-year relapse rates were associated with high Hamilton Anxiety Rating Scale scores before treatment (P = 0.016) and previous treatment with clonazepam. CONCLUSIONS Relapse is a frequent problem in PD, and long-term treatment does not protect these patients in the long run. Treatment with clonazepam predicts lower relapse when compared with paroxetine.
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34
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Treatment outcomes for inpatients with obsessive-compulsive personality disorder: An open comparison trial. J Affect Disord 2017; 209:273-278. [PMID: 27988411 DOI: 10.1016/j.jad.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/22/2016] [Accepted: 12/04/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The current case-control study compared rates of clinically significant and reliable change in psychopathology and global functioning, prevalence of clinical deterioration, and rates of symptom remission among adult patients with obsessive compulsive personality disorder OCPD (n=52) and well-matched inpatients with any other personality disorder (n=56) and no personality disorder (n=53). METHODS Propensity score matching (PSM) was utilized to select patients matched on specific criteria present in the OCPD group. Multivariate analysis of variance models measured differences in admission functioning and RCI change across depression and anxiety severity, emotion dysregulation and suicidal ideation. RESULTS Patients diagnosed with OCPD admit to treatment with higher rates of depression, anxiety, difficulty with emotion regulation and non-acceptance of emotional experience than inpatient controls. Furthermore, OCPD patients respond to treatment at a similar rate to inpatient controls, but experience lower rates of anxiety remission upon discharge. Post-hoc analyses indicate individuals meeting stubbornness and rigidity (OCPD Criteria 8) were nine times more likely to report moderate to severe anxiety at point of discharge. LIMITATIONS Limitations include a predominantly Caucasian, inpatient sample, use of self-report measures and a non-manualized treatment approach. CONCLUSIONS Overall, OCPD inpatients benefit from an intensive multimodal psychiatric treatment, but experience more anxiety than non-PD patients upon discharge.
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35
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Hudson C, Spry E, Borschmann R, Becker D, Moran P, Olsson C, Coffey C, Romaniuk H, Bayer JK, Patton GC. Preconception personality disorder and antenatal maternal mental health: A population-based cohort study. J Affect Disord 2017; 209:169-176. [PMID: 27923193 DOI: 10.1016/j.jad.2016.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/26/2016] [Accepted: 11/15/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prior anxiety and depression have been identified as risk factors for maternal perinatal mental health problems, but other preconception mental disorders have not been prospectively examined. This study investigated prospectively whether women with preconception personality disorder have increased rates of antenatal anxiety and/or depressive symptoms. METHODS 244 women in a population cohort were assessed for personality disorder at age 24 using the Standardised Assessment of Personality. Five to twelve years later, women were screened with the Clinical Interview Schedule, Revised Anxiety Subscale and the Edinburgh Postnatal Depression Scale during the third trimester of 328 pregnancies. RESULTS Preconception personality disorder was associated with a three-fold increase in the odds of antenatal anxiety symptoms, which remained with adjustment for preconception background factors and preconception common mental disorder (adjusted OR 2.84, 95% CI 1.31-6.15). Preconception personality disorder was associated with doubled odds of antenatal depressive symptoms, however this was attenuated with adjustment for preconception background factors and preconception common mental disorder (adjusted OR 1.98, 95% CI 0.81-4.81). LIMITATIONS Our findings are restricted to pregnant women aged 29-35 years. Anxiety and depression may have been under-identified because they were assessed at a single antenatal time point. Residual confounding of the associations by preconception common mental disorder at other time points may have occurred. CONCLUSIONS Women with personality disorder are at heightened risk of anxiety symptoms in pregnancy, over and above risks associated with prior common mental disorder. This raises a possibility that pregnancy brings particular emotional challenges for women with personality disorders.
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Affiliation(s)
- Charlotte Hudson
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Elizabeth Spry
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Rohan Borschmann
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Denise Becker
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia
| | - Paul Moran
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Craig Olsson
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Carolyn Coffey
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia
| | - Helena Romaniuk
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Clinical Epidemiology & Biostatistics Unit, Royal Children's Hospital, Parkville, VIC, Australia
| | - Jordana K Bayer
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - George C Patton
- Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia.
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Lohman MC, Whiteman KL, Yeomans FE, Cherico SA, Christ WR. Qualitative Analysis of Resources and Barriers Related to Treatment of Borderline Personality Disorder in the United States. Psychiatr Serv 2017; 68:167-172. [PMID: 27691382 PMCID: PMC5288272 DOI: 10.1176/appi.ps.201600108] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Resources and treatment for individuals with borderline personality disorder (BPD) are limited and often difficult to obtain. This article aimed to identify key resources for and barriers to obtaining supportive and treatment services for BPD from the perspective of individuals seeking information or services related to BPD ("BPD care seekers"). METHODS Data came from transcripts of resource requests to the Borderline Personality Disorder Resource Center from January 2008 to December 2015 (N=6,253). Basic statistics, including the type of service requested, demographic information for the BPD care seeker, and national distribution of requests, were generated for all eligible transcripts. Qualitative analysis of a random subset of 500 transcripts was used to identify themes, challenges, and common experiences reported by BPD care seekers. RESULTS The greatest number of requests for primary services or resources among the random subset of transcripts was for outpatient services (51%), informational materials (13%), and day programs (9%). Family services, crisis intervention, and mental health literacy were identified as areas where available resources did not meet current demand and that could be improved or expanded. Factors identified as potential barriers to finding and obtaining appropriate treatment for BPD included stigmatization and marginalization within mental health care systems, financial concerns, and comorbidity with psychiatric or medical disorders. CONCLUSIONS BPD care seekers face numerous barriers to obtaining appropriate care. Expanded services and resources to connect individuals with treatment are needed to meet the current demands and preferences of those seeking care.
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Affiliation(s)
- Matthew C Lohman
- Dr. Lohman and Dr. Whiteman are with the Dartmouth Centers for Health and Aging, Lebanon, New Hampshire (e-mail: ). Dr. Yeomans is with the Department of Psychiatry, Weill Medical College of Cornell University, New York. Ms. Cherico is with the Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, White Plains, New York. Dr. Christ is with the Westchester Psychiatric Group, Tarrytown, New York
| | - Karen L Whiteman
- Dr. Lohman and Dr. Whiteman are with the Dartmouth Centers for Health and Aging, Lebanon, New Hampshire (e-mail: ). Dr. Yeomans is with the Department of Psychiatry, Weill Medical College of Cornell University, New York. Ms. Cherico is with the Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, White Plains, New York. Dr. Christ is with the Westchester Psychiatric Group, Tarrytown, New York
| | - Frank E Yeomans
- Dr. Lohman and Dr. Whiteman are with the Dartmouth Centers for Health and Aging, Lebanon, New Hampshire (e-mail: ). Dr. Yeomans is with the Department of Psychiatry, Weill Medical College of Cornell University, New York. Ms. Cherico is with the Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, White Plains, New York. Dr. Christ is with the Westchester Psychiatric Group, Tarrytown, New York
| | - Sheila A Cherico
- Dr. Lohman and Dr. Whiteman are with the Dartmouth Centers for Health and Aging, Lebanon, New Hampshire (e-mail: ). Dr. Yeomans is with the Department of Psychiatry, Weill Medical College of Cornell University, New York. Ms. Cherico is with the Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, White Plains, New York. Dr. Christ is with the Westchester Psychiatric Group, Tarrytown, New York
| | - Winifred R Christ
- Dr. Lohman and Dr. Whiteman are with the Dartmouth Centers for Health and Aging, Lebanon, New Hampshire (e-mail: ). Dr. Yeomans is with the Department of Psychiatry, Weill Medical College of Cornell University, New York. Ms. Cherico is with the Borderline Personality Disorder Resource Center, New York Presbyterian Hospital, White Plains, New York. Dr. Christ is with the Westchester Psychiatric Group, Tarrytown, New York
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Torvik FA, Reichborn-Kjennerud T, Gjerde LC, Knudsen GP, Ystrom E, Tambs K, Røysamb E, Østby K, Ørstavik R. Mood, anxiety, and alcohol use disorders and later cause-specific sick leave in young adult employees. BMC Public Health 2016; 15:702. [PMID: 27488425 PMCID: PMC4972995 DOI: 10.1186/s12889-016-3427-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders strongly influence work capability in young adults, but it is not clear which disorders that are most strongly associated with sick leave, and which diagnoses that are stated on the sick leave certificates. Better knowledge of the impairments associated with different mental disorders is needed for optimal planning of interventions and prioritization of health services. In the current study, we investigate the prospective associations between eight mood, anxiety, and alcohol use disorders, and later sick leave granted for mental, somatic, or any disorder. METHODS Lifetime mental disorders were assessed by structured diagnostic interviews in 2,178 young adults followed for eight years with registry data on sick leave. Relative risk ratios were estimated for the associations between each mental disorder and the different forms of sick leave. RESULTS All included diagnoses were associated with later sick leave. In adjusted analyses, major depressive disorder and generalized anxiety disorder were the strongest predictors of sick leave granted for mental disorders, whereas social anxiety disorder and specific phobia were the strongest predictors of sick leave granted for somatic disorders. Specific phobia and major depressive disorder had the highest attributable fractions for all-cause sick leave. CONCLUSIONS Mood and anxiety disorders constituted independent risk factors for all cause sick leave, whereas alcohol use disorders seemed to be of less importance in young adulthood. Disorders characterised by distress were most strongly associated with sick leave granted for mental disorders, whereas disorders characterised by fear primarily predicted sick leave granted for somatic conditions. A large part of all sick leave is related to specific phobia, due to the high prevalence of this disorder. The impairment associated with this common disorder may be under-acknowledged, and it could decrease work capacity among individuals with somatic disorders. This disorder has good treatment response and may be overlooked as a target for interventions aimed at prevention of sick leave.
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Affiliation(s)
- Fartein Ask Torvik
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Institute of Clinical Medicine, P.O. Box 1171, Blindern, 0318 Oslo Norway
| | - Line C. Gjerde
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Department of Psychology, Section of Health, Developmental and Personality Psychology, P.O. Box 1094, Blindern, 0317 Oslo Norway
| | - Gun Peggy Knudsen
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Eivind Ystrom
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Department of Psychology, Section of Health, Developmental and Personality Psychology, P.O. Box 1094, Blindern, 0317 Oslo Norway
- University of Oslo, School of Pharmacy, PharmacoEpidemiology and Drug Safety Research Group, P.O. Box 1094, Blindern, 0317 Oslo Norway
| | - Kristian Tambs
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Espen Røysamb
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Department of Psychology, Section of Health, Developmental and Personality Psychology, P.O. Box 1094, Blindern, 0317 Oslo Norway
| | - Kristian Østby
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Ragnhild Ørstavik
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
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Lukat J, Becker ES, Lavallee KL, van der Veld WM, Margraf J. Predictors of Incidence, Remission and Relapse of Axis I Mental Disorders in Young Women: A Transdiagnostic Approach. Clin Psychol Psychother 2016; 24:322-331. [PMID: 27256536 DOI: 10.1002/cpp.2026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/30/2016] [Accepted: 05/01/2016] [Indexed: 11/07/2022]
Abstract
An understanding of etiological and maintaining factors of mental disorders is essential for the treatment of mental disorders, as well as mental health promotion and protection. The present study examines predictors of the incidence, remission and relapse of a wide range of Axis I mental disorders, using data from the Dresden Predictor Study. A sample of 1394 young German women completed questionnaires evaluating psychological factors (positive mental health, self-efficacy, life satisfaction, neuroticism, psychopathology and dysfunctional attitudes) and global assessment of functioning, as well as structured diagnostic interviews assessing incidence and change (remission, relapse) in mental disorders. Predictors were analysed using a multivariate logistic regression model. Significant factors for incidence of mental disorders included neuroticism and global functioning. A remitting course of mental disorders was predicted by positive mental health, self-efficacy and global assessment of functioning. Relapse was significantly predicted by neuroticism and dysfunctional attitudes. Results imply that mental health promotion is particularly important for women with high neuroticism and low functioning, as they tend to be at risk for incidence. Mental disorder treatment may benefit from strengthening positive mental health and functioning, as these factors promote remission. Relapse-prevention may benefit from attention to neuroticism and dysfunctional attitudes in order to reduce the likelihood of relapse. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Incidence of mental disorders in young women was predicted by neuroticism and low global functioning. There seems to be a need for preventive interventions addressing high neuroticism and low global functioning. Remission in young women was predicted by positive mental health. It may be helpful to include resource-based interventions, which can strengthen or support general positive mental health. Relapse in young women was predicted by two negative psychological factors: high neuroticism and reporting many dysfunctional attitudes. Psychotherapy addressing the characteristics and behaviour of neurotic patients might be beneficial. Interventions should also focus on addressing and changing dysfunctional attitudes.
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Affiliation(s)
- Justina Lukat
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Kristen L Lavallee
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany.,Department of Psychology, University of Basel, Switzerland
| | | | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
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Abstract
Emphasis on identifying evidence-based therapies (EBTs) has increased markedly. Lists of EBTs are the rationale for recommendations for how psychotherapy provider training programs should be evaluated, professional competence assessed, and licensure and reimbursement policies structured. There are however methodological concerns that limit the external validity of EBTs. Among the most salient is the circularity inherent in randomized control trials (RCTs) of psychotherapy that constrains the manner in which the psychological problems are defined, psychotherapy can be practiced, and change evaluated. RCT studies favor therapies that focus of specific symptoms and can be described in a manual, administered reliably across patients, completed in relatively few sessions, and involve short-term evaluations of outcome. The epistemological assumptions of a natural science approach to psychotherapy research limit how studies are conducted and assessed in ways that that advantage symptom-focused approaches and disadvantage those approaches that seek to bring broad recovery-based changes. Research methods that are not limited to RCTs and include methodology to minimize the effects of "therapist allegiance" are necessary for valid evaluations of therapeutic approaches that seek to facilitate changes that are broader than symptom reduction. Recent proposals to adopt policies that dictate training, credentialing, and reimbursement based on lists of EBTs unduly limit how psychotherapy can be conceptualized and practiced, and are not in the best interests of the profession or of individuals seeking psychotherapy services.
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Affiliation(s)
- Glenn Shean
- Professor of Psychology, Emeritus, College of William and Mary
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Champagne AL, Brunault P, Huguet G, Suzanne I, Senon JL, Body G, Rusch E, Magnin G, Voyer M, Réveillère C, Camus V. Personality disorders, but not cancer severity or treatment type, are risk factors for later generalised anxiety disorder and major depressive disorder in non metastatic breast cancer patients. Psychiatry Res 2016; 236:64-70. [PMID: 26747215 DOI: 10.1016/j.psychres.2015.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 10/06/2015] [Accepted: 12/25/2015] [Indexed: 01/06/2023]
Abstract
This study aimed to determine whether personality disorders were associated with later Major Depressive Disorder (MDD) or Generalised Anxiety Disorder (GAD) in breast cancer patients. This longitudinal and multicentric study included 120 French non-metastatic breast cancer patients. After cancer diagnosis (T1) and 7 months after diagnosis (T3), we assessed MDD and GAD (Mini International Neuropsychiatric Interview 5.0). We assessed personality disorders 3 months after diagnosis (VKP). We used multiple logistic regression analysis to determine what were the factors associated with GAD and MDD at T3. At T3, prevalence rate was 10.8% for MDD and 19.2% for GAD. GAD at T3 was significantly and independently associated with GAD at T1 and with existence of a personality disorder, no matter the cluster type. MDD at T3 was significantly and independently associated with MDD at T1 and with the existence of a cluster C personality disorder. Initial cancer severity and the type of treatment used were not associated with GAD or MDD at T3. Breast cancer patients with personality disorders are at higher risk for GAD and MDD at the end of treatment. Patients with GAD should be screened for personality disorders. Specific interventions for patients with personality disorders could prevent psychiatric disorders.
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Affiliation(s)
- Anne-Laure Champagne
- CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France
| | - Paul Brunault
- CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France; CHRU de Tours, Équipe de Liaison et de Soins en Addictologie, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France; Université François Rabelais de Tours, Département de Psychologie, EA 2114 « Psychologie des Âges de la Vie », 3 rue des Tanneurs BP 4103, 37041 Tours Cedex 1, France.
| | - Grégoire Huguet
- CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France
| | - Isabelle Suzanne
- CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France
| | - Jean-Louis Senon
- Centre Hospitalier Henri-Laborit, Service de Psychiatrie, 370 Avenue Jacques Cœur, 86021 Poitiers, France
| | - Gilles Body
- CHRU de Tours, Service de Gynécologie Obstétrique, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France
| | - Emmanuel Rusch
- CHRU de Tours, Service d'Information Médicale, Epidémiologie et Economie de la Santé, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France
| | - Guillaume Magnin
- CHU de Poitiers, Service de Gynécologie Obstétrique, 2 rue de la Milétrie, 86021 Poitiers, France
| | - Mélanie Voyer
- Centre Hospitalier Henri-Laborit, Service de Psychiatrie, 370 Avenue Jacques Cœur, 86021 Poitiers, France
| | - Christian Réveillère
- Université François Rabelais de Tours, Département de Psychologie, EA 2114 « Psychologie des Âges de la Vie », 3 rue des Tanneurs BP 4103, 37041 Tours Cedex 1, France
| | - Vincent Camus
- CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France; UMR INSERM U930, 2 boulevard Tonnellé, 37044 Tours Cedex, France; Université François Rabelais de Tours, 3 rue des Tanneurs BP 4103, 37041 Tours Cedex 1, France
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Welander-Vatn A, Ystrom E, Tambs K, Neale MC, Kendler KS, Reichborn-Kjennerud T, Knudsen GP. The relationship between anxiety disorders and dimensional representations of DSM-IV personality disorders: A co-twin control study. J Affect Disord 2016; 190:349-356. [PMID: 26544619 PMCID: PMC4684968 DOI: 10.1016/j.jad.2015.09.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/10/2015] [Accepted: 09/20/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is substantial comorbidity between personality disorders (PDs) and anxiety disorders (ADs). Sharing of familial risk factors possibly explains the co-occurrence, but direct causal relationships between the disorders may also exist. METHODS 2801 persons from 1391 twin pairs from the Norwegian Institute of Public Health Twin Panel were assessed for all DSM-IV PDs and ADs. Bivariate Poisson-regression analyses were performed to assess whether PDs predicted ADs at three different levels: All PDs combined, PDs combined within DSM-IV-clusters and each individual PD separately. Next, bivariate co-twin control analyses were executed within monozygotic (MZ) and dizygotic (DZ) twin pairs. A similar analytic strategy was employed in multivariate models including PDs as independent variables. RESULTS PDs predicted ADs at all levels of analysis in bivariate regression models. Bivariate co-twin control analyses demonstrated an increased risk of ADs in all PDs combined, all PD-clusters and in schizotypal, paranoid, borderline, antisocial, avoidant and dependent PD. In the multivariate regression model, all PD-clusters and schizotypal, borderline, avoidant and obsessive-compulsive PD predicted ADs. Only borderline and avoidant PD predicted ADs in the multivariate co-twin control analysis. LIMITATIONS Over-adjustment may explain the results from the multivariate analyses. The cross-sectional study design hampers causal inference. CONCLUSIONS Comorbidity between ADs and PDs can be largely accounted for by shared familial risk factors. However, the results are also consistent with a direct causal relationship partly explaining the co-occurrence. Our results indicate specific environmental factors for comorbidity of ADs and borderline and avoidant PDs that are not shared with other PDs.
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Affiliation(s)
- A Welander-Vatn
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, N-0403 Oslo, Norway.
| | - E Ystrom
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, N-0403 Oslo, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Norway
| | - K Tambs
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, N-0403 Oslo, Norway
| | - M C Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - K S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - T Reichborn-Kjennerud
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, N-0403 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - G P Knudsen
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, N-0403 Oslo, Norway
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Torvik FA, Welander-Vatn A, Ystrom E, Knudsen GP, Czajkowski N, Kendler KS, Reichborn-Kjennerud T. Longitudinal associations between social anxiety disorder and avoidant personality disorder: A twin study. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:114-124. [PMID: 26569037 PMCID: PMC4701609 DOI: 10.1037/abn0000124] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Social anxiety disorder (SAD) and avoidant personality disorder (AvPD) are frequently co-occurring psychiatric disorders with symptomatology related to fear of social situations. It is uncertain to what degree the 2 disorders reflect the same genetic and environmental risk factors. The current study addresses the stability and co-occurrence of SAD and AvPD, the factor structure of the diagnostic criteria, and genetic and environmental factors underlying the disorders at 2 time points. SAD and AvPD were assessed in 1,761 young adult female twins at baseline and 1,471 of these approximately 10 years later. Biometric models were fitted to dimensional representations of SAD and AvPD. SAD and AvPD were moderately and approximately equally stable from young to middle adulthood, with increasing co-occurrence driven by environmental factors. At the first wave, approximately 1 in 3 individuals with AvPD had SAD, increasing to 1 in 2 at follow-up. The diagnostic criteria for SAD and AvPD had a two-factor structure with low cross-loadings. The relationship between SAD and AvPD was best accounted for by a model with separate, although highly correlated (r = .76), and highly heritable (.66 and .71) risk factors for each disorder. Their genetic and environmental components correlated .84 and .59, respectively. The finding of partially distinct risk factors indicates qualitative differences in the etiology of SAD and AvPD. Genetic factors represented the strongest time-invariant influences, whereas environmental factors were most important at the specific points in time.
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Affiliation(s)
- Fartein Ask Torvik
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Audun Welander-Vatn
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Eivind Ystrom
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Gun Peggy Knudsen
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Nikolai Czajkowski
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
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Grambal A, Prasko J, Kamaradova D, Latalova K, Holubova M, Sedláčková Z, Hruby R. Quality of life in borderline patients comorbid with anxiety spectrum disorders - a cross-sectional study. Patient Prefer Adherence 2016; 10:1421-33. [PMID: 27536074 PMCID: PMC4975144 DOI: 10.2147/ppa.s108777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Borderline personality disorder (BPD) significantly reduces the quality of life (QoL) in mental, social, and work domains. Patients with BPD often suffer from depressive anxiety symptoms. The purpose of this cross-sectional study was to compare the QoL and demographic and clinical factors of inpatients diagnosed with BPD and comorbid anxiety spectrum disorders, and healthy controls. METHODS Ninety-two hospitalized patients treated in the psychotherapeutic department and 40 healthy controls were included. Subjects were assessed by the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Dissociative Experiences Scale, Beck Depression Inventory (BDI)-II, Beck Anxiety Inventory, Clinical Global Impression, demographic questionnaire, Sheehan Disability Scale (SDS), and Sheehan Anxiety Scale. RESULTS BPD patients suffered from comorbid anxiety disorders, panic disorder (18.5%), social phobia (20.7%), generalized anxiety disorder/mixed anxiety depression disorder (17.4%), adjustment disorder (22.8%), and posttraumatic stress disorder (8.7%); 19.6% patients had two or more anxiety disorder comorbidities. Patients score in Q-LES-Q (general) was 36.24±9.21, which was significantly lower in comparison to controls (57.83±10.21) and similar in all domains (physical health, feelings, work, household, school/study, leisure, social activities). The subjective level of depression measured by BDI and SDS (social life and family subscales) negatively correlated with all Q-LES-Q domains. CONCLUSION Patients suffering from BPD and comorbid anxiety disorders have a lower level of QoL compared to healthy controls in all measured domains. Negative correlations of the Q-LES-Q domains with clinical scales (Dissociative Experiences Scale, BDI, Beck Anxiety Inventory, Sheehan Anxiety Scale, Clinical Global Impression, and SDS) are noticeable.
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Affiliation(s)
- Ales Grambal
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
- Correspondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, IP Pavlova 6, 77520 Olomouc, Czech Republic, Tel +420 603 414 930, Email
| | - Dana Kamaradova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Michaela Holubova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
- Department of Psychiatry, Hospital Liberec, Liberec
| | - Zuzana Sedláčková
- Department of Psychology, Faculty of Arts, Palacky University Olomouc, Olomouc, Czech Republic
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Lampe L. Social anxiety disorders in clinical practice: differentiating social phobia from avoidant personality disorder. Australas Psychiatry 2015; 23:343-6. [PMID: 26129819 DOI: 10.1177/1039856215592319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To outline the problems around overlap between social phobia (SAD) and avoidant personality disorder (AVPD) and provide guidelines that may assist clinicians to differentiate these conditions. CONCLUSIONS A constellation of symptoms can be identified that may distinguish AVPD from SAD, with key features being a strong and pervasively negative self-concept, a view of rejection as equating to a global evaluation of the individual as being of little worth and a sense of not fitting in socially that dates from early childhood. It is important to identify the presence of AVPD in order to anticipate potential problems with engagement and retention in therapy, to target treatment interventions and optimise outcome.
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Affiliation(s)
- Lisa Lampe
- Senior Lecturer Discipline of Psychiatry, Sydney Medical School, University of Sydney, and CADE Clinic, Department of Academic Psychiatry, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, NSW, Australia
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Hitora-Imamura N, Miura Y, Teshirogi C, Ikegaya Y, Matsuki N, Nomura H. Prefrontal dopamine regulates fear reinstatement through the downregulation of extinction circuits. eLife 2015; 4. [PMID: 26226637 PMCID: PMC4547090 DOI: 10.7554/elife.08274] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/29/2015] [Indexed: 12/17/2022] Open
Abstract
Prevention of relapses is a major challenge in treating anxiety disorders. Fear reinstatement can cause relapse in spite of successful fear reduction through extinction-based exposure therapy. By utilising a contextual fear-conditioning task in mice, we found that reinstatement was accompanied by decreased c-Fos expression in the infralimbic cortex (IL) with reduction of synaptic input and enhanced c-Fos expression in the medial subdivision of the central nucleus of the amygdala (CeM). Moreover, we found that IL dopamine plays a key role in reinstatement. A reinstatement-inducing reminder shock induced c-Fos expression in the IL-projecting dopaminergic neurons in the ventral tegmental area, and the blocking of IL D1 signalling prevented reduction of synaptic input, CeM c-Fos expression, and fear reinstatement. These findings demonstrate that a dopamine-dependent inactivation of extinction circuits underlies fear reinstatement and may explain the comorbidity of substance use disorders and anxiety disorders.
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Affiliation(s)
- Natsuko Hitora-Imamura
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - Yuki Miura
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - Chie Teshirogi
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - Yuji Ikegaya
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - Norio Matsuki
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - Hiroshi Nomura
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
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Levy KN, Ehrenthal JC, Yeomans FE, Caligor E. The efficacy of psychotherapy: focus on psychodynamic psychotherapy as an example. Psychodyn Psychiatry 2015; 42:377-421. [PMID: 25211431 DOI: 10.1521/pdps.2014.42.3.377] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The growing number of individuals seeking treatment for mental disorders calls for intelligent and responsible decisions in health care politics. However, the current relative decrease in reimbursement of effective psychotherapy approaches occurring in the context of an increase in prescription of psychotropic medication lacks a scientific base. Using psychodynamic psychotherapy as an example, we review the literature on meta-analyses and recent outcome studies of effective treatment approaches. Psychodynamic psychotherapy is an effective treatment for a wide variety of mental disorders. Adding to the known effectiveness of other shorter treatments, the results indicate lasting change in many cases, especially for complex and difficult to treat patients, ultimately reducing health-care utilization. Research-informed health care decisions that take into account the solid evidence for the effectiveness of psychotherapy, including psychodynamic psychotherapy, have the potential to promote choice, increase mental health, and reduce society's burden of disease in the long run.
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Skodol AE. Comment on Tyrer: Personality dysfunction is the cause of recurrent non-cognitive mental disorder: a testable hypothesis. Personal Ment Health 2015; 9:10-3. [PMID: 25711646 DOI: 10.1002/pmh.1284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Anxiety disorders belong to the most frequent mental disorders and are often characterized by an early onset and a progressive, persistent/chronic, or recurrent course. Several individual, familial, and environmental risk factors for adverse course characteristics of anxiety disorders (including higher persistence, lower probability of remission, and increased risk of recurrence) have been identified, and previous research suggests that clinical features of anxiety (e.g., higher severity, duration, and avoidance) as well as comorbid other mental disorders are particularly useful for predicting an unfavorable course of anxiety disorders. However, additional studies are needed to identify risk factors for individual course trajectories of anxiety disorders in general as well as specific diagnoses. Doing so is essential in order to more precisely identify individuals with anxiety disorders who are at increased risk for adverse long-term outcomes and might thus particularly profit from targeted early interventions.
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Steinert C, Hofmann M, Leichsenring F, Kruse J. The course of PTSD in naturalistic long-term studies: high variability of outcomes. A systematic review. Nord J Psychiatry 2015; 69:483-96. [PMID: 25733025 DOI: 10.3109/08039488.2015.1005023] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND With a lifetime prevalence of 8% posttraumatic stress disorder (PTSD) is one of the most common mental disorders; nevertheless, its longitudinal course is largely unknown. AIMS Our aim was to conduct a systematic review summarizing available findings on the prospective, naturalistic long-term course of PTSD and its predictors. METHODS Databases MEDLINE and PsycINFO were searched. Main selection criteria were: 1) naturalistic cohort study with a follow-up period of at least 3 years, 2) adult participants with observer-rated or probable PTSD at baseline. RESULTS Twenty-four cohorts (25 studies) were retrieved (14 with observer-assessed, 10 with probable PTSD). In total, they comprised about 10,500 participants with PTSD at baseline that were included in the long-term follow-ups. Studies investigating patient populations with observer-assessed PTSD found that between 18% and 50% of patients experienced a stable recovery within 3-7 years; the remaining subjects either facing a recurrent or a more chronic course. Outcomes of community studies and studies investigating probable PTSD varied considerably (remission rates 6-92%). Social factors (e.g. support) as well as comorbid physical or mental health problems seem to be salient predictors of PTSD long-term course and special focus should be laid on these factors in clinical settings. CONCLUSIONS Included studies differed notably with regard to applied methodologies. The resulting large variability of findings is discussed. More standardized systematic follow-up research and more uniformed criteria for remission and chronicity are needed to gain a better insight into the long-term course of PTSD.
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Affiliation(s)
- Christiane Steinert
- a Christiane Steinert, Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen , Germany
| | - Mareike Hofmann
- b Mareike Hofmann, Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen , Germany
| | - Falk Leichsenring
- c Falk Leichsenring, Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen , Germany
| | - Johannes Kruse
- d Johannes Kruse, Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, and Clinic for Psychosomatic Medicine and Psychotherapy, University of Marburg , Germany
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Zanarini MC, Frankenburg FR, Fitzmaurice GM. Severity of anxiety symptoms reported by borderline patients and Axis II comparison subjects: description and prediction over 16 years of prospective follow-up. J Pers Disord 2014; 28:767-77. [PMID: 24932876 PMCID: PMC4250411 DOI: 10.1521/pedi_2014_28_141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The first purpose of this study was to determine the severity of anxiety symptoms reported by borderline patients and Axis II comparison subjects over 16 years of follow-up. The second purpose was to determine the most salient predictors of the severity of anxiety symptoms of borderline patients. Initially, 290 borderline inpatients and 72 comparison subjects were assessed using measures of anxiety, childhood adversity, and normal personality. The severity of anxiety symptoms was reassessed every 2 years. Borderline patients reported approximately twice as severe symptoms of anxiety as comparison subjects. However, these symptoms decreased significantly over time for those in both groups. Among borderline patients, two variables were found to be significant multivariate predictors of severity of overall anxiety: nonsexual childhood abuse and trait neuroticism. The results of this study suggest that anxiety symptoms form a distinct profile for borderline patients-a profile related to both childhood adversity and a vulnerable temperament.
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Affiliation(s)
- Mary C. Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital,Department of Psychiatry, Harvard Medical School
| | - Frances R. Frankenburg
- Laboratory for the Study of Adult Development, McLean Hospital,Department of Psychiatry, Boston University School of Medicine
| | - Garrett M. Fitzmaurice
- Laboratory for the Study of Adult Development, McLean Hospital,Department of Psychiatry, Harvard Medical School,Laboratory for Psychiatric Biostatistics, McLean Hospital
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