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Wang W, Cui Y, Hu Q, Wei Y, Xu L, Tang X, Hu Y, Liu H, Wang Z, Chen T, Wang R, An C, Wang J, Zhang T. Childhood maltreatment and personality disorders in adolescents and adults with psychotic or non-psychotic disorders. Front Psychiatry 2024; 15:1336118. [PMID: 38577403 PMCID: PMC10991748 DOI: 10.3389/fpsyt.2024.1336118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction While the attention to personality disorders (PD) and childhood maltreatment (CM) has grown in recent years, there remains limited understanding of the prevalence and distinctions of PD and CM in clinical populations of Chinese adolescents in comparison to adults. Methods A total of 1,417 participants were consecutively sampled from patients diagnosed with either psychotic or non-psychotic disorders in the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. The participants were categorized into two groups based on their age: adolescents (aged 15-21 years) and adults (aged 22-35 years). PDs were evaluated using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were assessed using the Chinese version of the Child Trauma Questionnaire Short Form. Results When comparing self-reported PD traits and CM between adolescents and adults, differences emerge. Adolescents, particularly in the psychotic disorder group, exhibit more pronounced schizotypal PD traits (p=0.029), and this pattern extends to non-psychotic disorders (p<0.001). Adolescents in the non-psychotic disorder group also report higher levels of emotional abuse (p=0.014), with a notable trend in physical abuse experiences compared to adults (p=0.057). Furthermore, the most prevalent PDs in the clinical sample are avoidant, borderline, and obsessive-compulsive PDs. Among patients with psychotic disorders, adolescents exhibit higher rates of schizoid, schizotypal, and obsessive-compulsive PDs compared to adults. Logistic regression analyses highlight distinct predictors for psychotic and non-psychotic disorders in adolescents and adults. Discussion The findings emphasize distinct differences in PDs and CMs between adolescent and adult groups, shedding light on their potential roles in psychotic and non-psychotic disorders.
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Affiliation(s)
- WenZheng Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yin Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Qiang Hu
- Department of Psychiatry, ZhenJiang Mental Health Center, Zhenjiang, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, China
| | - ZiXuan Wang
- Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Waterloo, ON, Canada
- Labor and Worklife Program, Harvard University, Cambridge, MA, United States
| | - Ran Wang
- Department of Psychiatry, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - CuiXia An
- Hebei Technical Innovation Center, Mental Health Assessment and Intervention, Shijiazhuang, Hebei, China
- Hebei Clinical Research Center of Mental Disorders, Institute of Mental Health, Shijiazhuang, Hebei, China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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2
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Chen S, Jing L, Li C, Wang H. Exploring the Nexus between Moderate-to-Vigorous Physical Activity, Self-Disclosure, Social Anxiety, and Adolescent Social Avoidance: Insights from a Cross-Sectional Study in Central China. CHILDREN (BASEL, SWITZERLAND) 2023; 11:56. [PMID: 38255369 PMCID: PMC10814873 DOI: 10.3390/children11010056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
Objectives: Psychological issues among adolescents represent a prevalent challenge in today's society. The purpose of this study is to explore the associations among moderate-to-vigorous physical activity, self-disclosure, social anxiety, and social avoidance in adolescents. Methods: This study collected cross-sectional data from 427 students in eight provincial key junior and senior high schools in the central China region of three provinces using snowball sampling and convenience sampling from July to August 2023. A structural equation model was employed to investigate the relationship between moderate-to-vigorous physical activity and social avoidance among adolescents. Results: The findings indicate that moderate-to-vigorous physical activity is negatively correlated with social anxiety (standardized coefficient = -0.219, p < 0.001) and positively correlated with self-disclosure (standardized coefficient = 0.454, p < 0.001). Social anxiety is negatively correlated with self-disclosure (standardized coefficient = -0.220, p < 0.001). Social avoidance is positively correlated with social anxiety (standardized coefficient = 0.461, p < 0.001) and negatively correlated with self-disclosure (standardized coefficient = -0.331, p < 0.001). Conclusions: The chain-mediated dual-path model between moderate-to-vigorous physical activity and social avoidance is facilitated by social anxiety and self-disclosure. In other words, adolescents who engage in more moderate to high-intensity physical activities exhibit lower levels of social anxiety, and those who have a stronger inclination for self-disclosure tend to demonstrate lower levels of social avoidance. In light of these findings, it is recommended that the government, society, schools, and families collaborate synergistically to promote the holistic well-being of adolescents and advance the development of a healthier China.
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Affiliation(s)
- Shuyin Chen
- School of Physical Education, Hunan University of Science and Technology, Xiangtan 411201, China
| | - Longjun Jing
- School of Physical Education, Hunan University of Science and Technology, Xiangtan 411201, China
- China Athletics College, Beijing Sport University, Beijing 100061, China
| | - Chuchu Li
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh EH8 8AQ, UK
| | - Huilin Wang
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh EH8 8AQ, UK
- School of Business, Hunan University of Science and Technology, Xiangtan 411201, China
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3
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Amendola S, Cerutti R, von Wyl A. Estimating the prevalence and characteristics of people in severe social isolation in 29 European countries: A secondary analysis of data from the European Social Survey round 9 (2018-2020). PLoS One 2023; 18:e0291341. [PMID: 37699030 PMCID: PMC10497126 DOI: 10.1371/journal.pone.0291341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/27/2023] [Indexed: 09/14/2023] Open
Abstract
The main aim of the present study was to estimate the prevalence of people in severe social isolation as a proxy for high risk of hikikomori using data from 29 European countries. The relationship between the presence/absence of severe social isolation and demographic and psychosocial variables was also investigated. Publicly available data from the European Social Survey (ESS) round 9 collected between August 2018 and January 2020 were used. Data from the ESS round 1 (September 2002 -December 2003) and round 10 (September 2020 -May 2022) were also examined to investigate changes in the prevalence of severe social isolation over time. Analyses were restricted to the working-age population (15-64 years). A complex sampling design to obtain weighted prevalence and results was used. The study protocol was preregistered online on the Open Science Framework (https://osf.io/6a7br/). The weighted prevalence of severe social isolation was 2.01% for the sample from the ESS 1, 1.77% for the sample from the ESS 9, and 1.71% for the sample from the ESS 10, indicating a decrease over time, mainly in males. Logistic regression models showed that different sociodemographic factors (e.g., being retired, being permanently sick or disabled, doing housework, living in Central and Eastern Europe, living uncomfortably on household income, having no income) were associated with severe social isolation. Further, feeling unsafe when walking alone in the neighbourhood after dark, low social trust, and support, decreased happiness and lack of future planning correlated with severe social isolation after adjustment for the effect of sociodemographic factors was made. In this study, the prevalence of severe social isolation as a proxy for hikikomori in European countries is in line with that found by previous representative studies conducted in Asian countries. The novelty of the findings as well as implications for hikikomori research are discussed according to recent scientific literature.
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Affiliation(s)
- Simone Amendola
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Rita Cerutti
- Department of Dynamic and Clinical Psychology, Health Studies, Sapienza–University of Rome, Rome, Italy
| | - Agnes von Wyl
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
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4
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Hovmand OR, Reinholt N, Dichmann K, Borisov R, Arnfred S. Social phobia and evasiveness: trial protocol for a randomized controlled feasibility and superiority trial of the effect of Modified Collaborative Assessment vs. standard assessment on patients' readiness for psychotherapy (CO-ASSM-RCT). Pilot Feasibility Stud 2023; 9:102. [PMID: 37340450 DOI: 10.1186/s40814-023-01332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Evasive personality disorder (AvPD) and social phobia (SP) have substantial costs for patients and their families and great economic costs to the society. While psychotherapy can be an efficacious treatment, many patients drop out during treatment. Increased knowledge on how to decrease dropout from psychotherapy is warranted, including how to increase a patient's readiness for psychotherapy. METHODS We describe a randomized controlled feasibility and superiority trial of 42 individuals with a clinical diagnosis of either SP or AvPD, who are to initiate psychotherapeutic treatment in Danish outpatient mental health services. They will be randomized in a 1:1 ratio to either assessment-as-usual and receive no further assessment or to a Modified Collaborative Assessment (MCA) provided as a pre-treatment intervention before psychotherapy initiation. MCA will include a battery of psychological tests designed to thoroughly assess the patients' psychopathology. The tests are administered in collaboration with the patient, including detailed oral and written feedback. We hypothesize that the intervention is feasible regarding patient's acceptance and adherence. We further hypothesize that patients randomized to MCA will reach higher levels of readiness for psychotherapy as assessed with the University of Rhode Island Change Assessment Scale (URICA). DISCUSSION This protocol assesses the feasibility, efficacy, acceptability, and safety of an intervention aimed at changing the readiness for participation in psychotherapy of patients with SP and AvPD. Results from this feasibility study could guide the development of future large-scale trials of MCA and procedures for MCA treatment fidelity assessment. TRIAL REGISTRATION NCT2021001.
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Affiliation(s)
- Oliver Rumle Hovmand
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark.
| | - Nina Reinholt
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
| | - Kirstine Dichmann
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Research Unit for Psychotherapy and Psychopathology, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
- Department of Forensic Psychiatry, Region Zealand Mental Health Service, Slagelse, Denmark
| | - Radoslav Borisov
- Psychiatry South, Region Zealand Mental Health Service, Ramsherred 1, 1. Sal, 4700, Naestved, Denmark
| | - Sidse Arnfred
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
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5
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Wolke D, Baumann N, Jaekel J, Pyhälä R, Heinonen K, Räikkönen K, Sorg C, Bilgin A. The association of early regulatory problems with behavioral problems and cognitive functioning in adulthood: two cohorts in two countries. J Child Psychol Psychiatry 2023; 64:876-885. [PMID: 36601777 DOI: 10.1111/jcpp.13742] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Regulatory problems (RPs; excessive crying, sleeping, or feeding difficulties) that co-occur (i.e., multiple) or are persistent have been associated with cognitive and behavioral problems in childhood. However, it remains unknown if multiple or persistent RPs are associated with cognitive and behavioral problems in adulthood. METHODS This large prospective longitudinal study (N = 759) was conducted in two cohorts in Germany (N = 342) and Finland (N = 417). RPs were assessed at 5, 20, and 56 months via the same standardized parental interviews and neurological examinations. In young adulthood, questionnaires were used to assess behavioral problems. Cognitive functioning was assessed with IQ tests. We examined the effects of multiple or persistent RPs on the outcomes via analysis of covariance tests and logistic regression controlled for the influence of cohort. RESULTS Of 163 participants with RPs, 89 had multiple and 77 had persistent RPs. Adults who had early multiple or persistent RPs (N = 151) reported more internalizing (p = .001), externalizing (p = .020), and total behavioral problems (p = .001), and, specifically, more depressive (p = .012), somatic (p = .005), avoidant personality (p < .001), and antisocial personality problems (p = .006) than those who never had RPs (N = 596). Participants with multiple or persistent RPs were more likely to receive any ADHD diagnoses (p = .017), particularly of hyperactive/impulsive subtype (p = .032). In contrast, there were no associations between multiple or persistent RPs and IQ scores in young adulthood. CONCLUSIONS The results indicate long-lasting associations between multiple or persistent RPs and behavioral problems. Thus, screening for early RPs could help to identify children who are at risk for later behavioral problems.
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Affiliation(s)
- Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Nicole Baumann
- Department of Health Sciences, University of Leicester, Leicester, UK.,Turner Institute for Brain and Mental Health, School of Psychology Sciences, Monash University, Melbourne, Victoria, Australia
| | - Julia Jaekel
- Department of Psychology, University of Warwick, Coventry, UK.,Psychology, University of Oulu, Oulu, Finland
| | - Riikka Pyhälä
- Maternity and Child Health Clinics, City of Helsinki, Helsinki, Finland
| | - Kati Heinonen
- Psychology/Welfare Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Christian Sorg
- Department of Neuroradiology and Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Psychiatry, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.,TUM-NIC Neuroimaging Center Technische Universität München, Munich, Germany
| | - Ayten Bilgin
- Department of Psychology, University of Warwick, Coventry, UK.,School of Psychology, University of Kent, Canterbury, UK
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6
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van Sprang ED, Maciejewski DF, Milaneschi Y, Elzinga BM, Beekman ATF, Hartman CA, van Hemert AM, Penninx BWJH. Familial risk for depressive and anxiety disorders: associations with genetic, clinical, and psychosocial vulnerabilities. Psychol Med 2022; 52:696-706. [PMID: 32624018 PMCID: PMC8961330 DOI: 10.1017/s0033291720002299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/21/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In research and clinical practice, familial risk for depression and anxiety is often constructed as a simple Yes/No dichotomous family history (FH) indicator. However, this measure may not fully capture the liability to these conditions. This study investigated whether a continuous familial loading score (FLS), incorporating family- and disorder-specific characteristics (e.g. family size, prevalence of depression/anxiety), (i) is associated with a polygenic risk score (PRS) for major depression and with clinical/psychosocial vulnerabilities and (ii) still captures variation in clinical/psychosocial vulnerabilities after information on FH has been taken into account. METHODS Data came from 1425 participants with lifetime depression and/or anxiety from the Netherlands Study of Depression and Anxiety. The Family Tree Inventory was used to determine FLS/FH indicators for depression and/or anxiety. RESULTS Persons with higher FLS had higher PRS for major depression, more severe depression and anxiety symptoms, higher disease burden, younger age of onset, and more neuroticism, rumination, and childhood trauma. Among these variables, FH was not associated with PRS, severity of symptoms, and neuroticism. After regression out the effect of FH from the FLS, the resulting residualized measure of FLS was still associated with severity of symptoms of depression and anxiety, rumination, and childhood trauma. CONCLUSIONS Familial risk for depression and anxiety deserves clinical attention due to its associated genetic vulnerability and more unfavorable disease profile, and seems to be better captured by a continuous score that incorporates family- and disorder-specific characteristics than by a dichotomous FH measure.
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Affiliation(s)
- Eleonore D. van Sprang
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dominique F. Maciejewski
- Department of Developmental Psychopathology, Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Yuri Milaneschi
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Bernet M. Elzinga
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Aartjan T. F. Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Catharina A. Hartman
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, Groningen, The Netherlands
| | - Albert M. van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Brenda W. J. H. Penninx
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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7
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Reich J, Schatzberg A. Prevalence, Factor Structure, and Heritability of Avoidant Personality Disorder. J Nerv Ment Dis 2021; 209:764-772. [PMID: 34582403 DOI: 10.1097/nmd.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT To review the community prevalence, factor structure, and heritability of avoidant personality disorder (AVPD), we reviewed the literature of empirical studies reported between years 1980 and 2020. Community point prevalence rates ranged from 0.8% to 5%, with one study of women older than 25 years finding a lifetime rate of 9.3%. A weighted point prevalence for studies involving both men and women was 3.3%. All factor analytic studies indicated a one factor solution. The themes were social inadequacy, feeling inferior, and fears of social rejection. Family studies of heritability for AVPD ranged from 0.18 to 0.56. Twin studies ranged from 0.28 to 0.71. The weighted average for heritability was 0.55. AVPD is an important clinical issue because it is prevalent in the community and has high morbidity and high heritability. Its single factor seems to suggest evaluation and treatment should be straightforward, but despite this, it tends to be underdiagnosed and undertreated.
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Affiliation(s)
| | - Alan Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford
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8
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Bas-Hoogendam JM, van Steenbergen H, Cohen Kadosh K, Westenberg PM, van der Wee NJA. Intrinsic functional connectivity in families genetically enriched for social anxiety disorder - an endophenotype study. EBioMedicine 2021; 69:103445. [PMID: 34161885 PMCID: PMC8237289 DOI: 10.1016/j.ebiom.2021.103445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/18/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is a serious psychiatric condition with a high prevalence, and a typical onset during childhood/adolescence. The condition runs in families, but it is largely unknown which neurobiological characteristics transfer this genetic vulnerability ('endophenotypes'). Using data from the Leiden Family Lab study on SAD, including two generations of families genetically enriched for SAD, we investigated whether social anxiety (SA) co-segregated with changes in intrinsic functional connectivity (iFC), and examined heritability. METHODS Functional MRI data were acquired during resting-state in 109 individuals (56 males; mean age: 31·5, range 9·2-61·5 years). FSL's tool MELODIC was used to perform independent component analysis. Six networks of interest (default mode, dorsal attention, executive control, frontoparietal, limbic and salience) were identified at the group-level and used to generate subject-specific spatial maps. Voxel-wise regression models, with SA-level as predictor and voxel-wise iFC as candidate endophenotypes, were performed to investigate the association with SA, within masks of the networks of interest. Subsequently, heritability was estimated. FINDINGS SA co-segregated with iFC within the dorsal attention network (positive association in left middle frontal gyrus and right postcentral gyrus) and frontoparietal network (positive association within left middle temporal gyrus) (cluster-forming-threshold z>2·3, cluster-corrected extent-threshold p<0·05). Furthermore, iFC of multiple voxels within these clusters was at least moderately heritable. INTERPRETATION These findings provide initial evidence for increased iFC as candidate endophenotype of SAD, particularly within networks involved in attention. These changes might underlie attentional biases commonly present in SAD. FUNDING Leiden University Research Profile 'Health, Prevention and the Human Lifecycle'.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333, AK, Leiden, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
| | - Henk van Steenbergen
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333, AK, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
| | | | - P Michiel Westenberg
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333, AK, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
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9
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Abstract
The purpose of the current article is to explore familial factors that influence the development of social anxiety disorder (SAD) in children and adolescents, including parenting, sibling relationships, and family environment. A multitude of interrelated genetic and familial factors have been found to cause and maintain SAD in children and adolescents. There are many challenges in diagnosing and treating the disorder. Knowledge and awareness of familial factors provide insight on targeted treatments that prevent or ameliorate SAD. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 23-34.].
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10
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Vilaplana-Pérez A, Isung J, Krig S, Vigerland S, Jolstedt M, Bjureberg J, Högström J, Isomura K, Rautio D, Serlachius E, Rück C, Mataix-Cols D, Fernández de la Cruz L. Validity and reliability of social anxiety disorder diagnoses in the Swedish National Patient Register. BMC Psychiatry 2020; 20:242. [PMID: 32414335 PMCID: PMC7227192 DOI: 10.1186/s12888-020-02644-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/30/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Population-based administrative registers are often used for research purposes. However, their potential usefulness depends on the validity of the registered information. This study assessed the validity of the recorded codes for social anxiety disorder (SAD), also known as social phobia, in the Swedish National Patient Register (NPR). METHODS The personal identification numbers of 300 randomly selected individuals with a diagnosis of SAD recorded in the NPR were obtained from the Swedish National Board of Health and Welfare. The medical files of these individuals were then requested from clinics nationally. A total of 117 files were received and two independent raters reviewed each file to assess the presence or absence of SAD, according to the definition of the International Classification of Diseases, Tenth Edition (ICD-10) and the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). When disagreements between the two raters were found, a third rater reviewed the file to establish a best estimate diagnosis. Positive predictive values (PPV) and agreement between the two initial raters (using Cohen's kappa) were calculated. Additionally, raters completed the Clinical Global Impression - Severity (CGI-S) and the Global Assessment of Functioning (GAF) rating scales for each file. Inter-rater agreement for the CGI-S and the GAF was assessed using intraclass correlation coefficients (ICC). RESULTS After exclusion of files not containing sufficient information, 95 files were included in the analyses. Of these, 77 files (81.05%) were considered to be 'true positive' cases (PPV = 0.81, 95% confidence interval = 0.72-0.88). Inter-rater agreement regarding the presence or absence of SAD was substantial (κ = 0.72). CGI-S and GAF scores indicated that patients were in the moderate range of severity and functional impairment. Inter-rater agreement for the CGI-S and the GAF was moderate to good (ICC = 0.72 and ICC = 0.82, respectively). CONCLUSIONS The ICD-10 codes for SAD in the Swedish NPR are generally valid and reliable, but we recommend sensitivity analyses in future register-based studies to minimise the impact of potential diagnostic misclassification. Most patients were moderately severe and impaired, suggesting that results from register-based studies of SAD may be generalizable.
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Affiliation(s)
- Alba Vilaplana-Pérez
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330, Stockholm, Sweden. .,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden. .,Departament de Personalitat, Avaluació i Tractaments Psicològics, Universitat de València, València, Spain.
| | - Josef Isung
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sonja Krig
- grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sarah Vigerland
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maral Jolstedt
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johan Bjureberg
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Jens Högström
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Daniel Rautio
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Serlachius
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Christian Rück
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22 (Entré B), floor 8, SE-11330 Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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11
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Bas-Hoogendam JM, Westenberg PM. Imaging the socially-anxious brain: recent advances and future prospects. F1000Res 2020; 9:F1000 Faculty Rev-230. [PMID: 32269760 PMCID: PMC7122428 DOI: 10.12688/f1000research.21214.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Social anxiety disorder (SAD) is serious psychiatric condition with a genetic background. Insight into the neurobiological alterations underlying the disorder is essential to develop effective interventions that could relieve SAD-related suffering. In this expert review, we consider recent neuroimaging work on SAD. First, we focus on new results from magnetic resonance imaging studies dedicated to outlining biomarkers of SAD, including encouraging findings with respect to structural and functional brain alterations associated with the disorder. Furthermore, we highlight innovative studies in the field of neuroprediction and studies that established the effects of treatment on brain characteristics. Next, we describe novel work aimed to delineate endophenotypes of SAD, providing insight into the genetic susceptibility to develop the disorder. Finally, we outline outstanding questions and point out directions for future research.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, c/o LUMC, postzone C2-S, P.O.Box 9600, 2300 RC Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - P. Michiel Westenberg
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, c/o LUMC, postzone C2-S, P.O.Box 9600, 2300 RC Leiden, The Netherlands
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12
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Bas-Hoogendam JM, van Steenbergen H, van der Wee NJA, Westenberg PM. Amygdala hyperreactivity to faces conditioned with a social-evaluative meaning- a multiplex, multigenerational fMRI study on social anxiety endophenotypes. NEUROIMAGE-CLINICAL 2020; 26:102247. [PMID: 32247196 PMCID: PMC7125356 DOI: 10.1016/j.nicl.2020.102247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 12/31/2022]
Abstract
Social anxiety disorder (SAD) runs in families, but the neurobiological pathways underlying the genetic susceptibility towards SAD are largely unknown. Here, we employed an endophenotype approach, and tested the hypothesis that amygdala hyperreactivity to faces conditioned with a social-evaluative meaning is a candidate SAD endophenotype. We used data from the multiplex, multigenerational Leiden Family Lab study on Social Anxiety Disorder (eight families, n = 105) and investigated amygdala activation during a social-evaluative conditioning paradigm with high ecological validity in the context of SAD. Three neutral faces were repeatedly presented in combination with socially negative, positive or neutral sentences. We focused on two endophenotype criteria: co-segregation of the candidate endophenotype with the disorder within families, and heritability. Analyses of the fMRI data were restricted to the amygdala as a region of interest, and association analyses revealed that bilateral amygdala hyperreactivity in response to the conditioned faces co-segregated with social anxiety (SA; continuous measure) within the families; we found, however, no relationship between SA and brain activation in response to more specific fMRI contrasts. Furthermore, brain activation in a small subset of voxels within these amygdala clusters was at least moderately heritable. Taken together, these findings show that amygdala engagement in response to conditioned faces with a social-evaluative meaning qualifies as a neurobiological candidate endophenotype of social anxiety. Thereby, these data shed light on the genetic vulnerability to develop SAD.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Henk van Steenbergen
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - P Michiel Westenberg
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
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13
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Bas‐Hoogendam JM, van Steenbergen H, Blackford JU, Tissier RLM, van der Wee NJA, Westenberg PM. Impaired neural habituation to neutral faces in families genetically enriched for social anxiety disorder. Depress Anxiety 2019; 36:1143-1153. [PMID: 31600020 PMCID: PMC6916167 DOI: 10.1002/da.22962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is an incapacitating disorder running in families. Previous work associated social fearfulness with a failure to habituate, but the habituation response to neutral faces has, as of yet, not been investigated in patients with SAD and their family members concurrently. Here, we examined whether impaired habituation to neutral faces is a putative neurobiological endophenotype of SAD by using data from the multiplex and multigenerational Leiden Family Lab study on SAD. METHODS Participants (n = 110; age, 9.2 - 61.5 years) performed a habituation paradigm involving neutral faces, as these are strong social stimuli with an ambiguous meaning. We used functional magnetic resonance imaging data to investigate whether brain activation related to habituation was associated with the level of social anxiety within the families. Furthermore, the heritability of the neural habituation response was estimated. RESULTS Our data revealed a relationship between impaired habituation to neutral faces and social anxiety in the right hippocampus and right amygdala. In addition, our data indicated that this habituation response displayed moderate - to-moderately high heritability in the right hippocampus. CONCLUSION The present results provide support for altered habituation as a candidate SAD endophenotype; impaired neural habitation cosegregrated with the disorder within families and was heritable. These findings shed light on the genetic susceptibility to SAD.
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Affiliation(s)
- Janna M. Bas‐Hoogendam
- Developmental and Educational Psychology, Institute of PsychologyLeiden UniversityLeidenThe Netherlands,Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands,Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Henk van Steenbergen
- Leiden Institute for Brain and CognitionLeidenThe Netherlands,Cognitive Psychology Unit, Institute of PsychologyUniversity of LeidenLeidenThe Netherlands
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral SciencesVanderbilt University Medical CenterNashvilleTennessee,Department of Veterans Affairs Medical CenterResearch Service, Research and DevelopmentNashvilleTennessee
| | - Renaud L. M. Tissier
- Developmental and Educational Psychology, Institute of PsychologyLeiden UniversityLeidenThe Netherlands
| | - Nic J. A. van der Wee
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands,Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - P. Michiel Westenberg
- Developmental and Educational Psychology, Institute of PsychologyLeiden UniversityLeidenThe Netherlands,Leiden Institute for Brain and CognitionLeidenThe Netherlands
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14
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Lilienfeld SO, Watts AL, Murphy B, Costello TH, Bowes SM, Smith SF, Latzman RD, Haslam N, Tabb K. Personality Disorders as Emergent Interpersonal Syndromes: Psychopathic Personality as a Case Example. J Pers Disord 2019; 33:577-622. [PMID: 31621543 DOI: 10.1521/pedi.2019.33.5.577] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality disorders have long been bedeviled by a host of conceptual and methodological quandaries. Starting from the assumption that personality disorders are inherently interpersonal conditions that reflect folk concepts of social impairment, the authors contend that a subset of personality disorders, rather than traditional syndromes, are emergent interpersonal syndromes (EISs): interpersonally malignant configurations (statistical interactions) of distinct personality dimensions that may be only modestly, weakly, or even negatively correlated. Preliminary support for this perspective derives from a surprising source, namely, largely forgotten research on the intercorrelations among the subscales of select MMPI/MMPI-2 clinical scales. Using psychopathic personality as a case example, the authors offer provisional evidence for the EIS hypothesis from four lines of research and delineate its implications for personality disorder theory, research, and classification. Conceptualizing some personality disorders as EISs elucidates long-standing quandaries and controversies in the psychopathology literature and affords fruitful avenues for future investigation.
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Affiliation(s)
- Scott O Lilienfeld
- Emory University, Atlanta, Georgia.,University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | | | - Nick Haslam
- University of Melbourne, Melbourne, Australia
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15
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Yoldas C, Dogan B, Kocabas O, Memis CO, Sevincok D, Sevincok L. The importance of avoidant personality in social anxiety disorder with and without attention-deficit/hyperactivity disorder. ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2019; 11:271-278. [PMID: 30767106 DOI: 10.1007/s12402-019-00291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/06/2019] [Indexed: 06/09/2023]
Abstract
In the present study, our primary aim was to compare the generalized social anxiety (GSAD) patients with and without attention-deficit/hyperactivity disorder (ADHD) in terms of avoidant personality disorder (AVPD), and some clinical variables. We also investigated the relationship of AVPD and depression with ADHD and GSAD. We hypothesized that ADHD may be associated with AVPD in patients with GSAD. Seventy-six patients with GSAD were evaluated for depression, AVPD, and childhood and adulthood diagnoses of ADHD. The GSAD patients with (n = 34) and without adulthood ADHD (n = 30) were compared with respect to some sociodemographic and clinical variables. GSAD patients with adulthood ADHD had significantly higher comorbid diagnosis of AVPD, more avoidant personality and depression symptoms than those without ADHD. Pearson's correlation coefficient in total sample (n = 76) showed that the mean number of AVPD criteria was significantly associated with the severity of Beck Depression Inventory, Wender Utah Rating Scale (WURS), and inattention symptoms of ADHD. There were no correlations between the total and subscale scores of Liebowitz Social Anxiety Scale and the mean number of AVPD criteria. The scores of WURS significantly predicted the mean number of AVPD criteria (β = 0.305, p= 0.007). The severity of current depression (β = 0.143, p = 0.30) and inattention symptoms of adulthood ADHD (β = 0.112, p = 0.46) were not associated with the severity of AVPD symptoms. These results might demonstrate that comorbid AVPD in adult SAD patients was related to a childhood ADHD independent from depression, and inattention symptoms of ADHD in adulthood.
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Affiliation(s)
- Caner Yoldas
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - Bilge Dogan
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - Oktay Kocabas
- Psychiatry Service, Turhal State Hospital, Tokat, Turkey
| | | | - Doga Sevincok
- Department of Child and Adolescent Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - Levent Sevincok
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey.
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16
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Dogan B, Yoldas C, Kocabas O, Memis CO, Sevincok D, Sevincok L. The characteristics of the comorbidity between social anxiety and separation anxiety disorders in adult patients. Nord J Psychiatry 2019; 73:380-386. [PMID: 31322453 DOI: 10.1080/08039488.2019.1642381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n = 31) and without childhood and adulthood separation anxiety disorder (SeAD) (n = 50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables. Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation. Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD. Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.
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Affiliation(s)
- Bilge Dogan
- a Medical School, Department of Psychiatry, Adnan Menderes University , Aydin , Turkey
| | - Caner Yoldas
- b Medical School, Department of psychiatry, Ahi Evran University , Kirsehir , Turkey
| | - Oktay Kocabas
- c Department of Psychiatry, Turhal State Hospital , Tokat , Turkey
| | - Cagdas Oyku Memis
- a Medical School, Department of Psychiatry, Adnan Menderes University , Aydin , Turkey
| | - Doga Sevincok
- d Medical School, Department of Child and Adolescence Psychiatry, Adnan Menderes University , Aydin , Turkey
| | - Levent Sevincok
- a Medical School, Department of Psychiatry, Adnan Menderes University , Aydin , Turkey
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17
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Welander-Vatn A, Torvik FA, Czajkowski N, Kendler KS, Reichborn-Kjennerud T, Knudsen GP, Ystrom E. Relationships Among Avoidant Personality Disorder, Social Anxiety Disorder, and Normative Personality Traits: A Twin Study. J Pers Disord 2019; 33:289-309. [PMID: 29505386 DOI: 10.1521/pedi_2018_32_341] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Avoidant personality disorder (AvPD) and social anxiety disorder (SAD) share risk factors to a substantial degree, and both are characterized by the experience of anxiety in social situations. The authors investigated whether these disorders are differentially related to the Big Five personality traits. They also examined the underlying genetic and environmental influences on these associations. A population-based sample of 1,761 female twins was interviewed at baseline, and 1,471 of these were re-interviewed 10 years later. Associations between AvPD, SAD, and personality traits were investigated with multivariate biometric analyses. The authors found that AvPD and SAD are differentially related to several personality traits at the phenotypic, genetic, and environmental level. The genetic and environmental liability to AvPD could be fully accounted for by the genetic and environmental factors influencing SAD and personality. The findings may increase current etiological understanding of these disorders and inform future classification and treatment efforts.
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Affiliation(s)
- Audun Welander-Vatn
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Fartein Ask Torvik
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Nikolai Czajkowski
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Ted Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Adult Psychiatry Unit, Institute of Clinical Medicine, University of Oslo
| | - Gun Peggy Knudsen
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Eivind Ystrom
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo
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18
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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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19
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Bas-Hoogendam JM, van Steenbergen H, Tissier RLM, van der Wee NJA, Westenberg PM. Altered Neurobiological Processing of Unintentional Social Norm Violations: A Multiplex, Multigenerational Functional Magnetic Resonance Imaging Study on Social Anxiety Endophenotypes. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:981-990. [PMID: 31031203 DOI: 10.1016/j.bpsc.2019.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/21/2019] [Accepted: 03/04/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with social anxiety disorder (SAD) fear negative evaluation in social situations. Specifically, previous work indicated that social anxiety is associated with increased medial prefrontal cortex activation in response to unintentional social norm (SN) transgressions, accompanied by increased embarrassment ratings for such SN violations. Here, we used data from the multiplex, multigenerational LFLSAD (Leiden Family Lab study on Social Anxiety Disorder), which involved two generations of families genetically enriched for SAD, and investigated whether these neurobiological and behavioral correlates of unintentional SN processing are SAD endophenotypes. Of four endophenotype criteria, we examined two: first, the cosegregation of these characteristics with social anxiety (SA) within families of SAD probands (criterion 4), and second, the heritability of the candidate endophenotypes (criterion 3). METHODS Participants (n = 110, age range 9.0-61.5 years, eight families) performed the revised Social Norm Processing Task; functional magnetic resonance imaging data and behavioral ratings related to this paradigm were used to examine whether brain activation in response to processing unintentional SN violations and ratings of embarrassment were associated with SA levels. Next, heritability of these measurements was estimated. RESULTS As expected, voxelwise functional magnetic resonance imaging analyses revealed positive associations between SA levels and brain activation in the medial prefrontal cortex and medial temporal gyrus, superior temporal gyrus, and superior temporal sulcus, and these brain activation levels displayed moderate to moderately high heritability. Furthermore, although SA levels correlated positively with behavioral ratings of embarrassment for SN transgressions, these behavioral characteristics were not heritable. CONCLUSIONS These results show, for the first time, that brain responses in the medial prefrontal cortex and medial temporal gyrus, superior temporal gyrus, and superior temporal sulcus, related to processing unintentional SN violations, provide a neurobiological candidate endophenotype of SAD.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Institute of Psychology, Leiden University, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Henk van Steenbergen
- Institute of Psychology, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | | | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - P Michiel Westenberg
- Institute of Psychology, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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20
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Bas-Hoogendam JM, van Steenbergen H, Tissier RLM, Houwing-Duistermaat JJ, Westenberg PM, van der Wee NJA. Subcortical brain volumes, cortical thickness and cortical surface area in families genetically enriched for social anxiety disorder - A multiplex multigenerational neuroimaging study. EBioMedicine 2018; 36:410-428. [PMID: 30266294 PMCID: PMC6197574 DOI: 10.1016/j.ebiom.2018.08.048] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is a disabling psychiatric condition with a genetic background. Brain alterations in gray matter (GM) related to SAD have been previously reported, but it remains to be elucidated whether GM measures are candidate endophenotypes of SAD. Endophenotypes are measurable characteristics on the causal pathway from genotype to phenotype, providing insight in genetically-based disease mechanisms. Based on a review of existing evidence, we examined whether GM characteristics meet two endophenotype criteria, using data from a unique sample of SAD-patients and their family-members of two generations. First, we investigated whether GM characteristics co-segregate with social anxiety within families genetically enriched for SAD. Secondly, heritability of the GM characteristics was estimated. METHODS Families with a genetic predisposition for SAD participated in the Leiden Family Lab study on SAD; T1-weighted MRI brain scans were acquired (n = 110, 8 families). Subcortical volumes, cortical thickness and cortical surface area were determined for a-priori determined regions of interest (ROIs). Next, associations with social anxiety and heritabilities were estimated. FINDINGS Several subcortical and cortical GM characteristics, derived from frontal, parietal and temporal ROIs, co-segregated with social anxiety within families (uncorrected p-level) and showed moderate to high heritability. INTERPRETATION These findings provide preliminary evidence that GM characteristics of multiple ROIs, which are distributed over the brain, are candidate endophenotypes of SAD. Thereby, they shed light on the genetic vulnerability for SAD. Future research is needed to confirm these results and to link them to functional brain alterations and to genetic variations underlying these GM changes. FUND: Leiden University Research Profile 'Health, Prevention and the Human Life Cycle'.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Henk van Steenbergen
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Renaud L M Tissier
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
| | | | - P Michiel Westenberg
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
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21
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Harrewijn A, Van der Molen MJW, Verkuil B, Sweijen SW, Houwing-Duistermaat JJ, Westenberg PM. Heart rate variability as candidate endophenotype of social anxiety: A two-generation family study. J Affect Disord 2018; 237:47-55. [PMID: 29763849 DOI: 10.1016/j.jad.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/09/2018] [Accepted: 05/07/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is the extreme fear and avoidance of one or more social situations. The goal of the current study was to investigate whether heart rate variability (HRV) during resting state and a social performance task (SPT) is a candidate endophenotype of SAD. METHODS In this two-generation family study, patients with SAD with their partner and children, and their siblings with partner and children took part in a SPT (total n = 121, 9 families, 3-30 persons per family, age range: 8-61 years, 17 patients with SAD). In this task, participants had to watch and evaluate the speech of a female peer, and had to give a similar speech. HRV was measured during two resting state phases, and during anticipation, speech and recovery phases of the SPT. We tested two criteria for endophenotypes: co-segregation with SAD within families and heritability. RESULTS HRV did not co-segregate with SAD within families. Root mean square of successive differences during the first resting phase and recovery, and high frequency power during all phases of the task were heritable. LIMITATIONS It should be noted that few participants were diagnosed with SAD. Results during the speech should be interpreted with caution, because the duration was short and there was a lot of movement. CONCLUSIONS HRV during resting state and the SPT is a possible endophenotype, but not of SAD. As other studies have shown that HRV is related to different internalizing disorders, HRV might reflect a transdiagnostic genetic vulnerability for internalizing disorders. Future research should investigate which factors influence the development of psychopathology in persons with decreased HRV.
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Affiliation(s)
- A Harrewijn
- Developmental and educational psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands.
| | - M J W Van der Molen
- Developmental and educational psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
| | - B Verkuil
- Leiden Institute for Brain and Cognition, Leiden University, The Netherlands; Clinical psychology, Leiden University, The Netherlands
| | - S W Sweijen
- Developmental and educational psychology, Leiden University, The Netherlands
| | - J J Houwing-Duistermaat
- Department of Medical Statistics and BioInformatics, Leiden University Medical Center, The Netherlands; Department of Statistics, University of Leeds, United Kingdom
| | - P M Westenberg
- Developmental and educational psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
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22
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Abstract
PURPOSE OF REVIEW We review the existing literature on gene-environment interactions (G×E) and epigenetic changes primarily in borderline personality disorder (BPD) but also in antisocial, schizotypal, and avoidant personality disorders. RECENT FINDINGS Research supports that susceptibility genes to BPD or its underlying traits may be expressed under certain environmental conditions such as physical or childhood sexual abuse. Epigenetic modifications of neurodevelopment- and stress-related genes are suggested to underlie the relationship between early life adversary and borderline personality disorder. Only limited studies have investigated the role of gene-environment interactions and epigenetic changes in the genesis of antisocial, schizotypal, and avoidant personality disorders. Considering the lack of pharmacological treatment for most personality disorders, the emerging evidence on the critical role of G×E and epigenetic changes in the genesis of personality disorders could help develop more biologically oriented therapeutic approaches. Future studies should explore the potential of this new therapeutic dimension.
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23
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Bas-Hoogendam JM, Harrewijn A, Tissier RLM, van der Molen MJW, van Steenbergen H, van Vliet IM, Reichart CG, Houwing-Duistermaat JJ, Slagboom PE, van der Wee NJA, Westenberg PM. The Leiden Family Lab study on Social Anxiety Disorder: A multiplex, multigenerational family study on neurocognitive endophenotypes. Int J Methods Psychiatr Res 2018; 27:e1616. [PMID: 29700902 PMCID: PMC6001802 DOI: 10.1002/mpr.1616] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Social anxiety disorder (SAD) is a serious and prevalent psychiatric condition, with a heritable component. However, little is known about the characteristics that are associated with the genetic component of SAD, the so-called "endophenotypes". These endophenotypes could advance our insight in the genetic susceptibility to SAD, as they are on the pathway from genotype to phenotype. The Leiden Family Lab study on Social Anxiety Disorder (LFLSAD) is the first multiplex, multigenerational study aimed to identify neurocognitive endophenotypes of social anxiety. METHODS The LFLSAD is characterized by a multidisciplinary approach and encompasses a variety of measurements, including a clinical interview, functional and structural magnetic resonance imaging and an electroencephalography experiment. Participants are family members from 2 generations, from families genetically enriched for SAD. RESULTS The sample (n = 132 participants, from 9 families) was characterized by a high prevalence of SAD, in both generations (prevalence (sub)clinical SAD: 38.3%). Furthermore, (sub)clinical SAD was positively related to self-reported social anxiety, fear of negative evaluation, trait anxiety, behavioral inhibition, negative affect, and the level of depressive symptoms. CONCLUSIONS By the multidimensional character of the measurements and thorough characterization of the sample, the LFLSAD offers unique opportunities to investigate candidate neurocognitive endophenotypes of SAD.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Anita Harrewijn
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Renaud L M Tissier
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Melle J W van der Molen
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Henk van Steenbergen
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands.,Cognitive Psychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Irene M van Vliet
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - P Eline Slagboom
- Section of Molecular Epidemiology, Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - P Michiel Westenberg
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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24
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Harrewijn A, van der Molen MJW, van Vliet IM, Houwing-Duistermaat JJ, Westenberg PM. Delta-beta correlation as a candidate endophenotype of social anxiety: A two-generation family study. J Affect Disord 2018; 227:398-405. [PMID: 29154156 DOI: 10.1016/j.jad.2017.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/01/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by an extreme and intense fear and avoidance of social situations. In this two-generation family study we examined delta-beta correlation during a social performance task as candidate endophenotype of SAD. METHODS Nine families with a target participant (diagnosed with SAD), their spouse and children, as well as target's siblings with spouse and children performed a social performance task in which they gave a speech in front of a camera. EEG was measured during resting state, anticipation, and recovery. Our analyses focused on two criteria for endophenotypes: co-segregation within families and heritability. RESULTS Co-segregation analyses revealed increased negative delta-low beta correlation during anticipation in participants with (sub)clinical SAD compared to participants without (sub)clinical SAD. Heritability analyses revealed that delta-low beta and delta-high beta correlation during anticipation were heritable. Delta-beta correlation did not differ between participants with and without (sub)clinical SAD during resting state or recovery, nor between participants with and without SAD during all phases of the task. LIMITATIONS It should be noted that participants were seen only once, they all performed the EEG tasks in the same order, and some participants were too anxious to give a speech. CONCLUSIONS Delta-low beta correlation during anticipation of giving a speech might be a candidate endophenotype of SAD, possibly reflecting increased crosstalk between cortical and subcortical regions. If validated as endophenotype, delta-beta correlation during anticipation could be useful in studying the genetic basis, as well as improving treatment and early detection of persons at risk for developing SAD.
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Affiliation(s)
- Anita Harrewijn
- Developmental and Educational Psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands.
| | - Melle J W van der Molen
- Developmental and Educational Psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
| | - Irene M van Vliet
- Department of Psychiatry, Leiden University Medical Center, The Netherlands
| | - Jeanine J Houwing-Duistermaat
- Department of Medical Statistics and BioInformatics, Leiden University Medical Center, The Netherlands; Department of Statistics, University of Leeds, United Kingdom
| | - P Michiel Westenberg
- Developmental and Educational Psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
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25
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Hoertel N, Blanco C, Oquendo MA, Wall MM, Olfson M, Falissard B, Franco S, Peyre H, Lemogne C, Limosin F. A comprehensive model of predictors of persistence and recurrence in adults with major depression: Results from a national 3-year prospective study. J Psychiatr Res 2017; 95:19-27. [PMID: 28759845 PMCID: PMC5653405 DOI: 10.1016/j.jpsychires.2017.07.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
Identifying predictors of persistence and recurrence of depression in individuals with a major depressive episode (MDE) poses a critical challenge for clinicians and researchers. We develop using a nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34,653), a comprehensive model of the 3-year risk of persistence and recurrence in individuals with MDE at baseline. We used structural equation modeling to examine simultaneously the effects of four broad groups of clinical factors on the risk of MDE persistence and recurrence: 1) severity of depressive illness, 2) severity of mental and physical comorbidity, 3) sociodemographic characteristics and 4) treatment-seeking behavior. Approximately 16% and 21% of the 2587 participants with an MDE at baseline had a persistent MDE and a new MDE during the 3-year follow-up period, respectively. Most independent predictors were common for both persistence and recurrence and included markers for the severity of the depressive illness at baseline (as measured by higher levels on the general depressive symptom dimension, lower mental component summary scores, prior suicide attempts, younger age at onset of depression and greater number of MDEs), the severity of comorbidities (as measured by higher levels on dimensions of psychopathology and lower physical component summary scores) and a failure to seek treatment for MDE at baseline. This population-based model highlights strategies that may improve the course of MDE, including the need to develop interventions that target multiple psychiatric disorders and promotion of treatment seeking to increase access to timely mental health care.
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Affiliation(s)
- Nicolas Hoertel
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France.
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Maria A Oquendo
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Bruno Falissard
- Centre de Recherche en Epidemiologie et Santé des Populations (CESP), Paris-Saclay University, Paris-Sud University, UVSQ, INSERM, APHP, Paris, France
| | - Silvia Franco
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Hugo Peyre
- Assistance Publique-Hôpitaux de Paris (APHP), Robert-Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - Cédric Lemogne
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
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26
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Harrewijn A, van der Molen MJW, van Vliet IM, Tissier RLM, Westenberg PM. Behavioral and EEG responses to social evaluation: A two-generation family study on social anxiety. Neuroimage Clin 2017; 17:549-562. [PMID: 29527481 PMCID: PMC5842666 DOI: 10.1016/j.nicl.2017.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 02/07/2023]
Abstract
Social anxiety disorder is an invalidating psychiatric disorder characterized by extreme fear and avoidance of one or more social situations in which patients might experience scrutiny by others. The goal of this two-generation family study was to delineate behavioral and electrocortical endophenotypes of social anxiety disorder related to social evaluation. Nine families of patients with social anxiety disorder (their spouse and children, and siblings of these patients with spouse and children) performed a social judgment paradigm in which they believed to be evaluated by peers. For each peer, participants indicated their expectation about the evaluative outcome, after which they received social acceptance or rejection feedback. Task behavior, as well as the feedback-related EEG brain potentials (N1, FRN, P3) and theta power were tested as candidate endophenotypes based on two criteria: co-segregation with social anxiety disorder within families and heritability. Results indicated that reaction time for indicating acceptance-expectations might be a candidate behavioral endophenotype of social anxiety disorder, possibly reflecting increased uncertainty or self-focused attention and vigilance during the social judgment paradigm. N1 in response to expected rejection feedback and P3 in response to acceptance feedback might be candidate electrocortical endophenotypes of social anxiety disorder, although the heritability analyses did not remain significant after correcting for multiple tests. Increased N1 possibly reflects hypervigilance to socially threatening stimuli, and increased P3 might reflect that positive feedback is more important for, and/or less expected by, participants with social anxiety disorder. Finally, increased feedback-related negativity and theta power in response to unexpected rejection feedback compared to the other conditions co-segregated with social anxiety disorder, but these EEG measures were not heritable. The candidate endophenotypes might play a new and promising role in future research on genetic mechanisms, early detection and/or prevention of social anxiety disorder.
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Affiliation(s)
- Anita Harrewijn
- Developmental and Educational Psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands.
| | - Melle J W van der Molen
- Developmental and Educational Psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
| | - Irene M van Vliet
- Department of Psychiatry, Leiden University Medical Center, The Netherlands
| | - Renaud L M Tissier
- Developmental and Educational Psychology, Leiden University, The Netherlands
| | - P Michiel Westenberg
- Developmental and Educational Psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
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27
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Electrocortical measures of information processing biases in social anxiety disorder: A review. Biol Psychol 2017; 129:324-348. [DOI: 10.1016/j.biopsycho.2017.09.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 01/06/2023]
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28
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Bas-Hoogendam JM, van Steenbergen H, Nienke Pannekoek J, Fouche JP, Lochner C, Hattingh CJ, Cremers HR, Furmark T, Månsson KN, Frick A, Engman J, Boraxbekk CJ, Carlbring P, Andersson G, Fredrikson M, Straube T, Peterburs J, Klumpp H, Phan KL, Roelofs K, Veltman DJ, van Tol MJ, Stein DJ, van der Wee NJ. Voxel-based morphometry multi-center mega-analysis of brain structure in social anxiety disorder. NEUROIMAGE-CLINICAL 2017; 16:678-688. [PMID: 30140607 PMCID: PMC6103329 DOI: 10.1016/j.nicl.2017.08.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/01/2017] [Indexed: 01/04/2023]
Abstract
Social anxiety disorder (SAD) is a prevalent and disabling mental disorder, associated with significant psychiatric co-morbidity. Previous research on structural brain alterations associated with SAD has yielded inconsistent results concerning the direction of the changes in gray matter (GM) in various brain regions, as well as on the relationship between brain structure and SAD-symptomatology. These heterogeneous findings are possibly due to limited sample sizes. Multi-site imaging offers new opportunities to investigate SAD-related alterations in brain structure in larger samples. An international multi-center mega-analysis on the largest database of SAD structural T1-weighted 3T MRI scans to date was performed to compare GM volume of SAD-patients (n = 174) and healthy control (HC)-participants (n = 213) using voxel-based morphometry. A hypothesis-driven region of interest (ROI) approach was used, focusing on the basal ganglia, the amygdala-hippocampal complex, the prefrontal cortex, and the parietal cortex. SAD-patients had larger GM volume in the dorsal striatum when compared to HC-participants. This increase correlated positively with the severity of self-reported social anxiety symptoms. No SAD-related differences in GM volume were present in the other ROIs. Thereby, the results of this mega-analysis suggest a role for the dorsal striatum in SAD, but previously reported SAD-related changes in GM in the amygdala, hippocampus, precuneus, prefrontal cortex and parietal regions were not replicated. Our findings emphasize the importance of large sample imaging studies and the need for meta-analyses like those performed by the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium. Multi-center mega-analysis on gray matter (GM) in social anxiety disorder (SAD) Largest sample available for analysis to date: 174 SAD-patients vs 213 controls Larger GM volume in the right putamen in SAD-patients No SAD-related alterations in amygdala-hippocampal, prefrontal or parietal regions Results stress need for larger samples and meta-analyses - cf. ENIGMA Consortium
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
- Corresponding author at: Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
| | - Henk van Steenbergen
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - J. Nienke Pannekoek
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London, United Kingdom
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa
| | - Christine Lochner
- SU/UCT MRC Unit on Anxiety & Stress Disorders, South Africa
- Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
| | - Coenraad J. Hattingh
- Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa
| | - Henk R. Cremers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kristoffer N.T. Månsson
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Frick
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Engman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Carl-Johan Boraxbekk
- Umeå Centre for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Jutta Peterburs
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - K. Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Karin Roelofs
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Dick J. Veltman
- Department of Psychiatry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Marie-José van Tol
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa
- SU/UCT MRC Unit on Anxiety & Stress Disorders, South Africa
| | - Nic J.A. van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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Mating Strategies and Sexual Functioning in Personality Disorders: A Comprehensive Review of Literature. Sex Med Rev 2017; 5:414-428. [PMID: 28526631 DOI: 10.1016/j.sxmr.2017.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/07/2017] [Accepted: 03/17/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Personality disorders impair several aspects of intrapsychic and interpersonal life. In particular, mating strategies and sexual functioning could manifest in different and/or dysfunctional ways in people with personality disorders. AIM To describe, through a comprehensive review of the literature, the mating strategies and sexual functioning in patients with personality disorders. METHODS We listed and discussed the principal studies on the relation between mating strategies and sexual functioning in personality disorders. The search strategy used search terms in PubMed for the main studies published from January 2000 to December 2016. MAIN OUTCOME MEASURES We considered two main sections for our selection according to the aim of the present review: mating and sexuality. RESULTS Interesting evidence on mating strategies in personality disorders was found. In particular, the major items were found in the dramatic-unpredictable cluster, with borderline personality disorder being the most studied. In contrast, the bizarre-eccentric cluster had fewer items, with the schizoid personality disorder being the least studied. For sexual behavior, borderline personality seems to be the unique disorder sufficiently studied, with evidence of major histories of child sexual abuse, the presence of sexual dysfunctions, and paraphilic interests. CONCLUSION A large spectrum of mating strategies characterizes different personality disorders, although an inconsistent knowledge about the relation between sexual function and personality disorders emerged from our analysis of the literature. Hence, we invite clinicians and researchers to integrate psychodiagnostic and sexual assessments in psychiatric disciplines for people with personality disorders. Collazzoni A, Ciocca G, Limoncin E, et al. Mating Strategies and Sexual Functioning in Personality Disorders: A Comprehensive Review of Literature. Sex Med Rev 2017;5:414-428.
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30
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Wang JY, Hsieh MH, Lin PC, Liu CS, Chen JD. Parallel contagion phenomenon of concordant mental disorders among married couples: a nationwide cohort study. J Epidemiol Community Health 2017; 71:640-647. [PMID: 28219896 PMCID: PMC5485751 DOI: 10.1136/jech-2016-208283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/12/2016] [Accepted: 02/05/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aggregation of mental disorders in couples, as reported by prior research, indicates the effect of familial environments and warrants attention. However, the concordant categories of mental disorders in couples remain unclear. This study investigated spousal concordance for the category of mental disorders among couples throughout Taiwan by using factors associated with such disorders. METHODS 5643 couples in the 2002-2013 Taiwan National Health Insurance Research Database were analysed and compared with propensity-matched 5643 non-couples. Twelve independent variables, including spouse and shared characteristics, and the category of mental disorders were analysed, mainly by using multinomial logistic regression. RESULTS The determined prevalence rates for concordant categories of mental disorder were 0.19% for affective disorders, 6.96% for anxiety disorders, and 3.15% of other mental disorders. Multinomial logistic regression results revealed that two spouses were significantly more likely to be diagnosed with the same category of the aforementioned mental disorders (ORs=2.914, 1.776 and 1.727, respectively). Other associated factors included gender, age, occupation, comorbidity and region. The odds of concordances were significantly higher in couples than in non-couples. CONCLUSIONS A category of mental disorder in one spouse is a determinant of that in the other spouse. This study extended the emotional contagion theory to the phenomenon of parallel contagion to reflect the three concordances, suggesting a direction of family-based mental health intervention, particularly prevention for the same category of mental disorders in couples. Policymakers should strengthen the coping strategies of the caring spouse and external support system to psychiatrically vulnerable families.
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Affiliation(s)
- Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ming-Hong Hsieh
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Pei-Ching Lin
- Tele-Healthcare Center, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Jen-De Chen
- Department of Sports, National Changhua University of Education, Changhua, Taiwan
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31
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Kreifelts B, Brück C, Ethofer T, Ritter J, Weigel L, Erb M, Wildgruber D. Prefrontal mediation of emotion regulation in social anxiety disorder during laughter perception. Neuropsychologia 2017; 96:175-183. [DOI: 10.1016/j.neuropsychologia.2017.01.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/28/2022]
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Bas-Hoogendam JM, Blackford JU, Brühl AB, Blair KS, van der Wee NJ, Westenberg PM. Neurobiological candidate endophenotypes of social anxiety disorder. Neurosci Biobehav Rev 2016; 71:362-378. [DOI: 10.1016/j.neubiorev.2016.08.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/15/2016] [Accepted: 08/31/2016] [Indexed: 02/07/2023]
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Bandelow B, Baldwin D, Abelli M, Altamura C, Dell'Osso B, Domschke K, Fineberg NA, Grünblatt E, Jarema M, Maron E, Nutt D, Pini S, Vaghi MM, Wichniak A, Zai G, Riederer P. Biological markers for anxiety disorders, OCD and PTSD - a consensus statement. Part I: Neuroimaging and genetics. World J Biol Psychiatry 2016; 17:321-65. [PMID: 27403679 DOI: 10.1080/15622975.2016.1181783] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). METHODS Findings in biomarker research were reviewed by a task force of international experts in the field, consisting of members of the World Federation of Societies for Biological Psychiatry Task Force on Biological Markers and of the European College of Neuropsychopharmacology Anxiety Disorders Research Network. RESULTS The present article (Part I) summarises findings on potential biomarkers in neuroimaging studies, including structural brain morphology, functional magnetic resonance imaging and techniques for measuring metabolic changes, including positron emission tomography and others. Furthermore, this review reports on the clinical and molecular genetic findings of family, twin, linkage, association and genome-wide association studies. Part II of the review focuses on neurochemistry, neurophysiology and neurocognition. CONCLUSIONS Although at present, none of the putative biomarkers is sufficient and specific as a diagnostic tool, an abundance of high-quality research has accumulated that will improve our understanding of the neurobiological causes of anxiety disorders, OCD and PTSD.
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Affiliation(s)
- Borwin Bandelow
- a Department of Psychiatry and Psychotherapy , University of Göttingen , Germany
| | - David Baldwin
- b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Marianna Abelli
- c Department of Clinical and Experimental Medicine , Section of Psychiatry, University of Pisa , Italy
| | - Carlo Altamura
- d Department of Psychiatry , University of Milan; Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - Bernardo Dell'Osso
- d Department of Psychiatry , University of Milan; Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - Katharina Domschke
- e Department of Psychiatry, Psychosomatics and Psychotherapy , University of Wuerzburg , Germany
| | - Naomi A Fineberg
- f Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire , Rosanne House, Parkway , Welwyn Garden City , UK
| | - Edna Grünblatt
- e Department of Psychiatry, Psychosomatics and Psychotherapy , University of Wuerzburg , Germany ;,g Neuroscience Center Zurich , University of Zurich and the ETH Zurich , Zürich , Switzerland ;,h Department of Child and Adolescent Psychiatry and Psychotherapy , Psychiatric Hospital, University of Zurich , Zürich , Switzerland ;,i Zurich Center for Integrative Human Physiology , University of Zurich , Switzerland
| | - Marek Jarema
- j Third Department of Psychiatry , Institute of Psychiatry and Neurology , Warszawa , Poland
| | - Eduard Maron
- k North Estonia Medical Centre, Department of Psychiatry , Tallinn , Estonia ;,l Department of Psychiatry , University of Tartu , Estonia ;,m Faculty of Medicine, Department of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences , Imperial College London , UK
| | - David Nutt
- m Faculty of Medicine, Department of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences , Imperial College London , UK
| | - Stefano Pini
- c Department of Clinical and Experimental Medicine , Section of Psychiatry, University of Pisa , Italy
| | - Matilde M Vaghi
- n Department of Psychology and Behavioural and Clinical Neuroscience Institute , University of Cambridge , UK
| | - Adam Wichniak
- j Third Department of Psychiatry , Institute of Psychiatry and Neurology , Warszawa , Poland
| | - Gwyneth Zai
- n Department of Psychology and Behavioural and Clinical Neuroscience Institute , University of Cambridge , UK ;,o Neurogenetics Section, Centre for Addiction & Mental Health , Toronto , Canada ;,p Frederick W. Thompson Anxiety Disorders Centre, Department of Psychiatry, Sunnybrook Health Sciences Centre , Toronto , Canada ;,q Institute of Medical Science and Department of Psychiatry, University of Toronto , Toronto , Canada
| | - Peter Riederer
- e Department of Psychiatry, Psychosomatics and Psychotherapy , University of Wuerzburg , Germany ;,g Neuroscience Center Zurich , University of Zurich and the ETH Zurich , Zürich , Switzerland ;,h Department of Child and Adolescent Psychiatry and Psychotherapy , Psychiatric Hospital, University of Zurich , Zürich , Switzerland
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Nordsletten AE, Larsson H, Crowley JJ, Almqvist C, Lichtenstein P, Mataix-Cols D. Patterns of Nonrandom Mating Within and Across 11 Major Psychiatric Disorders. JAMA Psychiatry 2016; 73:354-61. [PMID: 26913486 PMCID: PMC5082975 DOI: 10.1001/jamapsychiatry.2015.3192] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Psychiatric disorders are heritable, polygenic traits, which often share risk alleles and for which nonrandom mating has been suggested. However, despite the potential etiological implications, the scale of nonrandom mating within and across major psychiatric conditions remains unclear. OBJECTIVE To quantify the nature and extent of nonrandom mating within and across a broad range of psychiatric conditions at the population level. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort using Swedish population registers. Participants were all Swedish residents with a psychiatric diagnosis of interest (attention-deficit/hyperactivity disorder, autism spectrum disorder, schizophrenia, bipolar disorder, major depression, generalized anxiety disorder, agoraphobia, social phobia, obsessive-compulsive disorder, anorexia, or substance abuse), along with their mates. Individuals with select nonpsychiatric disorders (Crohn's disease, type 1 and type 2 diabetes mellitus, multiple sclerosis, or rheumatoid arthritis) were included for comparison. General population samples were also derived and matched 1:5 with each case proband. Inpatient and outpatient diagnostic data were derived from the Swedish National Patient Register (1973-2009), with analyses conducted between June 2014 and May 2015. MAIN OUTCOMES AND MEASURES Correlation in the diagnostic status of mates both within and across disorders. Conditional logistic regression was used to quantify the odds of each diagnosis in the mates of cases relative to matched population controls. RESULTS Across cohorts, data corresponded to 707 263 unique case individuals, with women constituting 45.7% of the full population. Positive correlations in diagnostic status were evident between mates. Within-disorder correlations were marginally higher (range, 0.11-0.48) than cross-disorder correlations (range, 0.01-0.42). Relative to matched populations, the odds of psychiatric case probands having an affected mate were significantly elevated. Differences in the magnitude of observed relationships were apparent by disorder (odds ratio range, 0.8-11.4). The number of comorbidities in a case proband was associated with the proportion of affected mates. These relationships were not apparent or weaker in magnitude among nonpsychiatric conditions (correlation range, -0.03 to 0.17). CONCLUSIONS AND RELEVANCE Nonrandom mating is evident in psychiatric populations both within specific disorders and across the spectrum of psychiatric conditions. This phenomenon may hold important implications for how we understand the familial transmission of these disorders and for psychiatric genetic research.
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Affiliation(s)
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - James J. Crowley
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden3Department of Genetics, University of North Carolina at Chapel Hill
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden4Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Abstract
This review focuses on recent research on diagnostic aspects, etiology, and treatment of avoidant personality disorder (AVPD). Current studies stress the close relation between AVPD and social anxiety disorder, the influence of genetic factors in the development of AVPD, and the relative stability of symptoms. Treatment approaches should target the pervasive patterns of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Empirical evidence for cognitive-behavior and schema therapy is promising. Few other therapeutic approaches have been developed, but until now, these have only been investigated in case studies. We conclude that AVPD qualifies as a neglected disorder and that more research specifically on avoidant personality disorder symptoms and its treatment is needed.
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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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Avoidant personality disorder as a social anxiety phenotype: risk factors, associations and treatment. Curr Opin Psychiatry 2016; 29:64-9. [PMID: 26651009 DOI: 10.1097/yco.0000000000000211] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article identifies research trends and synthesizes information from recent studies of avoidant personality disorder (AVPD). RECENT FINDINGS AVPD and social anxiety disorder (SAD) share genetic vulnerability, but may have distinct environmental risk factors that shape qualitative differences. Negative self-concept, shame proneness, and interpersonal hypersensitivity are characteristic of AVPD and may be predisposed to by heritable traits of high negative affectivity and low positive affectivity, and experiences of neglectful or emotionless parents. The interpersonal difficulties of AVPD may be associated with both anxious and avoidant attachment. Most individuals with AVPD do not also meet criteria for SAD. SUMMARY Integrative treatments incorporating cognitive behavioral strategies effective in SAD but also targeting shame aversion and avoidance may be most helpful for AVPD. Therapy adapted to both anxious attachment, associated with heightened interpersonal sensitivity and distress, and avoidant attachment, associated with experiential avoidance, may be optimal, though this is yet to be tested. Effective treatment of AVPD may enhance the outcome of comorbid conditions. More research is needed which compares three social anxiety groups (SAD alone, AVPD alone, and SAD plus AVPD) to further explore these disorders which are highly related, but which may have differences that are clinically relevant for individuals.
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Meier SM, Petersen L, Mattheisen M, Mors O, Mortensen PB, Laursen TM. Secondary depression in severe anxiety disorders: a population-based cohort study in Denmark. Lancet Psychiatry 2015; 2:515-23. [PMID: 26360447 PMCID: PMC5087327 DOI: 10.1016/s2215-0366(15)00092-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/01/2015] [Accepted: 02/17/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depression and anxiety disorders are highly comorbid conditions and a worldwide disease burden; however, large-scale studies delineating their association are scarce. In this retrospective study, we aimed to assess the effect of severe anxiety disorders on the risk and course of depression. METHODS We did a population-based cohort study with prospectively gathered data in Denmark using data from three Danish population registers: The Danish Civil Registration System, the Danish Psychiatric Central Register, and the Danish National Hospital Registry. We selected the cohort from people born in Denmark between Jan 1, 1955, and Dec 31, 2002, who we followed up from Jan 1, 1994, to Dec 31, 2012. The cohort was restricted to individuals with known parents. First, we investigated the effect of specific anxiety diagnoses on risk of single depressive episodes and recurrent depressive disorder. Second, we investigated the effect of comorbid anxiety on risk of readmission for depression, adjusting for sex, age, calendar year, parental age, place at residence at time of birth, and the interaction of age with sex. FINDINGS We included 3,380,059 individuals in our study cohort. The adjusted incidence rate ratio (IRR) for single depressive episodes was 3·0 (95% CI 2·8-3·1, p<0·0001) and for recurrent depressive disorder was 5·0 (4·8-5·2) in patients with severe anxiety disorders compared with the general population. Compared with control individuals, the offspring of parents with anxiety disorders were more likely to be diagnosed with single depressive episodes (1·9, 1·8-2·0) or recurrent depressive disorder (2·1, 1·9-2·2). Comorbid anxiety increased the readmission rates in both patients with single depressive episodes and patients with recurrent depressive disorder. INTERPRETATION Severe anxiety constitutes a significant risk factor for depression. Focusing on specific anxiety disorders might help to identify individuals at risk of depression, thereby providing new insights for prevention and treatment. FUNDING The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH).
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Affiliation(s)
- Sandra M Meier
- National Centre for Register-Based Research, Aarhus University, Aarhus V, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus C, Denmark.
| | - Liselotte Petersen
- National Centre for Register-Based Research, Aarhus University, Aarhus V, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus C, Denmark
| | - Manuel Mattheisen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus C, Denmark; Department of Biomedicine, Aarhus University, Aarhus C, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus C, Denmark; Research Department P, Aarhus University Hospital, Risskov, Denmark
| | - Preben B Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus V, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus C, Denmark
| | - Thomas M Laursen
- National Centre for Register-Based Research, Aarhus University, Aarhus V, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus C, Denmark
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