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Bakken R, Benth JŠ, Fauske H, Lien L, Landheim AS. Individual Trajectories of Specialist Substance Use Disorder and Mental Health Treatment Utilization Among Young Adults With Substance Use Problems: A Cohort Study. J Dual Diagn 2024:1-15. [PMID: 38704859 DOI: 10.1080/15504263.2024.2341092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The aim of the study was to identify groups of young adults with distinct longitudinal patterns of use of treatment for substance use disorders and mental health (MH) problems and to investigate potential explanatory factors for different patterns of treatment use over time, including sociodemographic factors. METHODS The sample consisted of 447 young adults aged 16-29 years who entered long-term residential substance use disorder treatment facilities in Norway from 2011 to 2016. In this study, we obtained data collected by the Norwegian Patient Registry and Statistics Norway. These data were linked with the electronic health record data of the substance use disorder treatment facilities from which the participants were recruited. Growth mixture modeling was performed. The identified groups were further compared using analysis of variance or χ2 test. RESULTS Four groups of participants for total treatment use, substance use disorder treatment use, and MH treatment use were identified. Most participants from the overall sample were classified as members of a group characterized by a low and stable pattern of treatment use over time. A group with a high and stable pattern of treatment use was identified in total and MH treatment use. The proportion of participants with higher levels of substance use disorder treatment use at the end of the study period than at the beginning was larger (35%) than in the case of MH treatment use (14.2%). Younger age was associated with a decreasing pattern of MH treatment use and with an increasing pattern of substance use disorder treatment use over time. There were larger proportions of female participants in groups with a stable high use of MH treatment and in groups with an initially increasing trend of substance use disorder treatment use. Findings revealed that most participants across the identified groups were recipients of welfare benefits, had low educational attainment, and were not working. CONCLUSIONS Results demonstrated significant variation in trajectories of treatment use among young adults with substance use disorder. Differences in treatment use could indicate differences in symptom severity and complexity. In this study, treatment use was associated with socioeconomic factors, sex, and age. Integrative approaches, including interagency and interdisciplinary collaboration, will often be necessary to sufficiently address the multidimensionality of substance use disorder.
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Affiliation(s)
- Regine Bakken
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Jūratė Š Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Halvor Fauske
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne S Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
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Hutsebaut J, Clarke SL, Chanen AM. The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence. Front Psychiatry 2023; 14:1130417. [PMID: 37229381 PMCID: PMC10203159 DOI: 10.3389/fpsyt.2023.1130417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Although national guidelines explicitly state that personality disorder can be diagnosed and treated in young people aged 12 to 18 years (adolescents), most clinicians remain hesitant. This creates a gap between science and practice, which we argue is largely motivated by moral reasons and, therefore, is best challenged by ethical arguments. We provide seven arguments in support of the notion that it is ethically right to diagnose and treat personality disorder when it occurs in adolescents. Central to these arguments is the scientific evidence that features of personality disorder are among the best predictors of a complex cluster of psychopathology leading to impairments in many areas of current and future mental, social and vocational functioning. We argue that intervention during adolescence and young adulthood is not only humane, but also critical for efforts to avert the longstanding psychosocial and health problems that seem refractory to treatment in adults with personality disorder. Moreover, we argue that regular services are often inadequately equipped to meet the needs of young people with personality disorder and that the common 'stepped-care' approach should be replaced by a 'staged-care' approach. Finally, we argue that early detection and intervention might have anti-stigmatizing effects, similar to other areas of healthcare in which stigmatizing labels have changed meaning when the conditions to which they refer have become more amenable to treatment.
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Affiliation(s)
- Joost Hutsebaut
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Viersprong Institute for the Study on Personality Disorders, Halsteren, Netherlands
| | - Sharon L. Clarke
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Viersprong Institute for the Study on Personality Disorders, Halsteren, Netherlands
| | - Andrew M. Chanen
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Bizzi F, Locati F, Parolin L, Goetz Yael S, Brusadelli E. Advancement in the child attachment interview and the child and adolescent reflective functioning scale using a PDM-2 framework: case reports. RESEARCH IN PSYCHOTHERAPY: PSYCHOPATHOLOGY, PROCESS AND OUTCOME 2022; 25. [PMID: 35373961 PMCID: PMC9153759 DOI: 10.4081/ripppo.2022.586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
The Child Attachment Interview (CAI) is a well-established semi-structured interview, widely used to identify attachment representations in middle childhood and adolescence. The application of the Child and Adolescent Reflective Functioning Scale (CRFS) to CAI narratives allows for an assessment of child mentalization, considered a strong predictor of attachment security. The 2nd edition of the Psychodynamic Diagnostic Manual (PDM-2) includes CAI and CRFS as valid and reliable assessment measures in order to assess the dominion of the Mental Functioning axis. The aim of the present paper is to investigate the informative power of CAI and CRFS for the overall understanding of mental functioning and personality in a PDM-2 framework. The present report includes the discussion of two clinical cases of school-aged children in applying the Psychodiagnostic Chart-Second Edition (PDC-2) to the CAI transcript. The first case concerns a young male, aged 10, suffering from Oppositional-Provocative Disorder (externalizing disorder), while the second case concerns a young female, aged 15, suffering from Somatic Symptoms Disorder (internalizing disorder). PDC-2 for children and adolescents was used. Data from the scoring of CAI and CRFS were combined with a systematic evaluation of the qualitative contents emerging from CAI transcripts. A detailed analysis suggests that both the CAI and CRFS are useful attachment-oriented measures, able to explore child’s mental states, and together with the application of PDC-2 they provide an essential contribution in the understanding of developmental psychopathology. Implications of this innovative approach for clinical assessment, treatment design, and interventions are further discussed.
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Leal I, Silva SB, Ramos MM, Pedreira M, Ramos VS, Pires P. Assessing Personality Disorders in Adolescence: A Validation Study of the IPOP-A. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676609666181204144136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The need to develop clinical and empirically-based tools for
assessing personality development in adolescence led to the proposal of the IPOP-A
(Ammaniti, Fontana, Kernberg, Clarkin, & Clarkin, 2011), a semi-structured interview for
adolescents that aims to differentiate personality organization processes from characteristics
that may reflect a personality disorder.
Objective and Methods:
This research aimed to evaluate the adaptation of the IPOP-A to the
Portuguese population, attending to its diagnostic properties and its discriminant validity by
comparing a clinical group with a nonclinical one. A total sample of 44 adolescents from 13
to 18 years old has taken part in this study, 22 of whom had a previous personality disorder
diagnosis. The content of the interviews was transcribed and codified according to the
coding manual.
Results:
Acceptable internal consistency values across the dimensions of the IPOP-A are
found and statistically significant differences are revealed between the clinical group and
nonclinical group, with the clinical group revealing values that suggest higher impairment in
the dimensions of the personality functioning in comparison with the nonclinical one.
Conclusion:
Our study supports that the Portuguese version of the IPOP-A can be
considered a valid instrument to identify adolescents with a personality disorder.
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Affiliation(s)
- Isabel Leal
- William James Center for Research, ISPA – Instituto Universitário, Lisboa, Portugal
| | | | - Maria Meireles Ramos
- William James Center for Research, ISPA – Instituto Universitário, Lisboa, Portugal
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Hutsebaut J, Debbané M, Sharp C. Designing a range of mentalizing interventions for young people using a clinical staging approach to borderline pathology. Borderline Personal Disord Emot Dysregul 2020; 7:6. [PMID: 32190330 PMCID: PMC7068993 DOI: 10.1186/s40479-020-0121-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/11/2020] [Indexed: 12/21/2022] Open
Abstract
Borderline personality disorder (BPD) can have a long-lasting impact on social and professional functioning, even when core symptoms of BPD are in remission. Adolescence may be a critical developmental period to change the potential long-term functional outcome of BPD. This paper presents a range of mentalizing interventions to alter the course and outcome of BPD, based upon a model of clinical staging. Mentalizing interventions have in common a focus on strengthening self-regulatory and interpersonal capacities, aiming to improve adaptive social learning. This paper argues that these interventions should be dosed and organized according to the stage of progression of BPD, which is illustrated by discussing different specific formats for mentalization-based interventions, including an early-intervention program for BPD and a standard program for full BPD.
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Affiliation(s)
- Joost Hutsebaut
- 1Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands.,Centre of Expertise on Personality Disorders, Utrecht, the Netherlands
| | - Martin Debbané
- 3Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,4Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Carla Sharp
- 5Department of Psychology, University of Houston, Houston, Texas USA.,6University of the Free State, Bloemfontein, South Africa
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Kongerslev MT, Chanen AM, Simonsen E. Personality Disorder in Childhood and Adolescence comes of Age: a Review of the Current Evidence and Prospects for Future Research. Scand J Child Adolesc Psychiatr Psychol 2015. [DOI: 10.21307/sjcapp-2015-004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Fok MLY, Stewart R, Hayes RD, Moran P. The impact of co-morbid personality disorder on use of psychiatric services and involuntary hospitalization in people with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1631-40. [PMID: 24715236 DOI: 10.1007/s00127-014-0874-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine the impact of co-morbid personality disorder (PD), on inpatient and community-based service use and risk of involuntary hospitalization, amongst patients with severe mental illness (SMI). METHODS We identified SMI cases (schizophrenia, schizoaffective and bipolar disorder) with and without co-morbid PD, and PD cases, aged ≥18 years, in a large secondary mental healthcare case register. Using multivariable logistic regression, we examined the association between co-morbid PD and high level of inpatient and community-based service use (defined as the top decile of service use), and involuntary hospitalization, respectively, adjusting for socio-demographics, clinical symptoms and social functioning. RESULTS Severe mental illness patients with co-morbid PD (SMI-PD) (n = 961) had more severe symptoms and social functioning problems compared to SMI patients without PD (n = 10,963) and patients who had PD but no concurrent SMI (n = 2,309). A greater proportion of SMI-PD patients were high inpatient service users (22.4 vs. 10.1 %). This association was attenuated but remained significant, after adjustment (fully adjusted odds ratio, OR 2.31, 95 % CI 1.88-2.84). The association between SMI-PD and high community-based service use was confounded by symptoms and social functioning. Compared to patients with SMI, SMI-PD patients were significantly more likely to experience involuntary hospitalization (fully adjusted OR 1.56, 95 % CI 1.31-1.85). CONCLUSIONS In SMI patients, co-morbidity with PD is robustly associated with both high use of inpatient psychiatric services and an increased likelihood of involuntary hospitalization. Patients with SMI and co-morbid PD are likely to require tailored interventions that target both the underlying personality pathology as well as the Axis I disorder.
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Affiliation(s)
- Marcella Lei-Yee Fok
- Health Services & Population Research Department, Institute of Psychiatry, King's College London, London, UK
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Feenstra DJ, Laurenssen EMP, Timman R, Verheul R, Busschbach JJV, Hutsebaut J. Long-term outcome of inpatient psychotherapy for adolescents (IPA) with personality pathology. J Pers Disord 2014; 28:637-56. [PMID: 24689768 DOI: 10.1521/pedi_2014_28_132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Little is known about the effectiveness of treatment programs for adolescents with personality disorders (PDs). This descriptive study investigated long-term outcomes of inpatient psychotherapy for adolescents (IPA). In addition, predictors of long-term treatment effects were investigated. Seventy adolescents who completed their treatment were followed during and after their stay in IPA. Semistructured interviews were used to assess Axis I and Axis II disorders. Patients completed questionnaires to measure symptom severity and personality styles and functioning. Patients showed improvements (d ranging from .18 to .80). After leaving IPA, a small relapse rate was shown. Higher levels of dependency or more Cluster C PD traits significantly predicted positive long-term treatment outcome. Although IPA might be effective for a particular group of adolescents, mean long-term treatment effects were at best modest. Given the high costs of IPA, developing adjustments to IPA and their guidelines is warranted to ensure cost-effectiveness.
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Feenstra DJ, Laurenssen EMP, Hutsebaut J, Verheul R, Busschbach JJV. Predictors of treatment outcome of Inpatient Psychotherapy for Adolescents with personality pathology. Personal Ment Health 2014; 8:102-14. [PMID: 24700734 DOI: 10.1002/pmh.1246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/18/2013] [Accepted: 07/22/2013] [Indexed: 11/11/2022]
Abstract
Little is known about the effectiveness of treatment programmes for personality disordered adolescents. This study investigates the treatment outcome of Inpatient Psychotherapy for Adolescents (IPA), i.e. an intensive programme for treatment refractory adolescents with personality pathology. In addition, this study examines predictors of treatment outcome. One hundred and nine adolescents admitted for treatment of their personality problems were followed up during their stay in IPA. Axis I and Axis II disorders were measured using semi-structured interviews, and the adolescents completed several questionnaires to measure symptom severity (global indices of distress), personality styles and functioning, and quality of life at both start and 12 months after start of treatment. Patients showed improvement in level of symptom severity, personality functioning and quality of life (d ranging from 0.49 to 0.97). As for level of symptom severity, 29% of the adolescents moved into a normative range of symptom severity. Higher levels of self-criticism significantly predicted poorer outcome in terms of symptom severity. Type of personality disorder did not predict treatment outcome. IPA is a potentially effective treatment programme for (a subgroup of) treatment refractory adolescents with personality pathology.
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Affiliation(s)
- Dine J Feenstra
- Viersprong Institute for Studies on Personality Disorders (VISPD), Halsteren, The Netherlands; Department of Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands
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Feenstra DJ, Hutsebaut J, Verheul R, van Limbeek J. Identity: empirical contribution. Changes in the identity integration of adolescents in treatment for personality disorders. J Pers Disord 2014; 28:101-12. [PMID: 24344891 DOI: 10.1521/pedi.2014.28.1.101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A renewed interest in identity as one of the core markers of personality disorders has been introduced by the DSM-5 Level of Personality Functioning Scale. However, little is known about the utility of the construct of identity in children and adolescents. This study aimed to broaden the knowledge of identity integration as a core component of personality functioning in adolescents. The authors investigated levels of identity integration, as measured by the Severity Indices of Personality Problems (SIPP-118; Verheul et al., 2008), in adolescents in both normal (n = 406) and clinical populations (n = 285). Furthermore, changes in levels of identity integration during treatment were investigated in a clinical subsample (n = 76). Levels of identity integration were not associated with age. They were, however, associated with the absence or presence of personality pathology. Most adolescents receiving inpatient psychotherapy gradually changed toward more healthy levels of identity integration; a significant number, however, remained at maladaptive levels of identity functioning after intensive psychotherapy.
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Laurenssen EMP, Hutsebaut J, Feenstra DJ, Van Busschbach JJ, Luyten P. Diagnosis of personality disorders in adolescents: a study among psychologists. Child Adolesc Psychiatry Ment Health 2013; 7:3. [PMID: 23398887 PMCID: PMC3583803 DOI: 10.1186/1753-2000-7-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent guidelines concerning the treatment of personality disorders (PDs) recommend diagnosing PDs in adolescents. However, it remains unclear whether these guidelines influence the current opinions and practices of mental health care professionals. METHODS Five hundred sixty-six psychologists completed an online survey concerning PDs in adolescents, of whom 367 professionals reported working with adolescents. The survey contained demographical questions (age, gender, profession, work setting) and specific questions related to PD in adolescence. RESULTS Although a majority of psychologists working with adolescents acknowledged the existence of PDs in adolescents (57.8%), only a small minority diagnoses PDs in adolescence (8.7%) and offers a treatment specifically aimed at targeting PD pathology (6.5%). Reasons for not diagnosing PDs in adolescence mainly concerned the belief that adolescent personality problems are transient (41.2%) and that the DSM-IV-TR does not allow diagnosing PDs in adolescence (25.9%). CONCLUSIONS Although practice guidelines might have influenced clinicians' opinions about PDs in adolescence, they have had little impact so far on routine clinical practice.
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Affiliation(s)
| | - Joost Hutsebaut
- Viersprong Institute for Studies on Personality Disorders (VISPD), P.O. Box 7, 4660 AA, Halsteren, The Netherlands,MBT Netherlands, Halsteren, The Netherlands
| | - Dine Jerta Feenstra
- Viersprong Institute for Studies on Personality Disorders (VISPD), P.O. Box 7, 4660 AA, Halsteren, The Netherlands,Department of Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan Jurgen Van Busschbach
- Viersprong Institute for Studies on Personality Disorders (VISPD), P.O. Box 7, 4660 AA, Halsteren, The Netherlands,Department of Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, Department of Psychology, University of Leuven, Leuven, Belgium and University College London, London, United Kingdom
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Anglin DM, Corcoran C, Brown A, Chen H, Lighty Q, Brook J, Cohen P. Early cannabis use and schizotypal personality disorder symptoms from adolescence to middle adulthood. Schizophr Res 2012; 137:45-9. [PMID: 22325079 PMCID: PMC3591468 DOI: 10.1016/j.schres.2012.01.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/12/2012] [Accepted: 01/17/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND While increasing evidence suggests that cannabis use may play a role in the development of schizophrenia in some young people, less is known about the strength and specificity of its relationship to latent schizophrenia liability, i.e., schizotypal personality disorder traits. AIMS Determine the predictive value of cannabis use during childhood and early adolescence on schizotypal personality disorder (SPD) symptoms projecting into adulthood, using a community-based longitudinal cohort from upstate New York. METHOD Prospective data from 804 participants was used to determine associations between early cannabis use and later schizotypal symptoms, accounting for important potential confounds (e.g., adolescent schizotypal symptoms). RESULTS Cannabis use with onset prior to age 14 strongly predicted SPD symptoms in adulthood, independent of early adolescent SPD symptoms, major depression, anxiety disorder, other drug use, and cigarette use. There was no interaction effect of early cannabis use and early adolescent SPD symptoms on SPD symptoms into adulthood. CONCLUSIONS Our data provide further support for a strong association of early cannabis use with the development of symptoms characteristic of schizophrenia spectrum disorders. As with studies in schizophrenia, early SPD symptoms could not fully explain the association of early cannabis use with later schizotypal symptoms. The mechanisms that underlie the association of cannabis use and schizotypal symptoms in a developmental context deserve further exploration.
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Affiliation(s)
- Deidre M. Anglin
- The City College and The Graduate Center, City University of New York
| | - Cheryl Corcoran
- Columbia University, College of Physicians and Surgeons, New York State Psychiatric Institute, Department of Psychiatry
| | - Alan Brown
- Columbia University, College of Physicians and Surgeons, New York State Psychiatric Institute, Department of Psychiatry
| | | | - Quenesha Lighty
- The City College and The Graduate Center, City University of New York
| | | | - Patricia Cohen
- Columbia University, College of Physicians and Surgeons, New York State Psychiatric Institute, Department of Psychiatry
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Schöttke H, Lange J, Imholz M, Wiedl KH. Entwicklung eines Screening-Verfahrens zur Diagnostik von Persönlichkeitsstörungen: Das Persönlichkeitsstörungs-Screening – Kurzform (PSS-K). VERHALTENSTHERAPIE 2011. [DOI: 10.1159/000329747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
The evidence is surprisingly strong that even early adolescent personality disorders or elevated personality disorder symptoms have a broad range of negative effects well into adulthood, for the most part comparable to or even larger than those of Axis I disorders. Current evidence suggests that the most severe long-term prognosis is associated with borderline and schizotypal PDs and elevated symptoms. And of course, childhood conduct disorder is in a peculiar status, disappearing in adulthood to be manifest as a very severe disorder-antisocial PD-in a minority of those with the adolescent disorder.
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Affiliation(s)
- Patricia Cohen
- Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
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