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Ebert T, Hamuda N, City-Elifaz E, Kobo O, Roguin A. Trends in CV mortality among patients with known mental and behavioral disorders in the US between 1999 and 2020. Front Psychiatry 2023; 14:1255323. [PMID: 38025453 PMCID: PMC10646424 DOI: 10.3389/fpsyt.2023.1255323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Patients with mental disorders are at increased risk of cardiovascular events. We aimed to assess the cardiovascular mortality trends over the last two decades among patients with mental and behavioral co-morbidities in the US. Methods We performed a retrospective, observational study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death dataset. We determined national trends in age-standardized mortality rates attributed to cardiovascular diseases in patients with and without mental and behavioral disorders, from 1999 to 2020, stratified by mental and behavioral disorders subtype [ICD10 codes F], age, gender, race, and place of residence. Results Among more than 18.7 million cardiovascular deaths in the United States (US), 13.5% [2.53 million] were patients with a concomitant mental and behavioral disorder. During the study period, among patients with mental and behavioral disorders, the age-adjusted mortality rate increased by 113.9% Vs a 44.8% decline in patients with no mental disorder (both p<0.05). In patients with mental and behavioral disorders, the age-adjusted mortality rate increased more significantly among patients whose mental and behavioral disorder was secondary to substance abuse (+532.6%, p<0.05) than among those with organic mental disorders, such as dementia or delirium (+6.2%, P- nonsignificant). Male patients (+163.6%) and residents of more rural areas (+128-162%) experienced a more prominent increase in age-adjusted cardiovascular mortality. Discussion While there was an overall reduction in cardiovascular mortality in the US in the past two decades, we demonstrated an overall increase in cardiovascular mortality among patients with mental disorders.
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Affiliation(s)
- Tanya Ebert
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Psychiatry, Hillel Yaffe Medical Center, Hadera, Israel
| | - Nashed Hamuda
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Efrat City-Elifaz
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Psychiatry, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofer Kobo
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ariel Roguin
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
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Low A, Stiltner B, Nunez YZ, Adhikari K, Deak JD, Pietrzak RH, Kranzler HR, Gelernter J, Polimanti R. Association Patterns of Antisocial Personality Disorder across Substance Use Disorders. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.15.23295625. [PMID: 37745497 PMCID: PMC10516074 DOI: 10.1101/2023.09.15.23295625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
There is a high prevalence of antisocial personality disorder (ASPD) in individuals affected by substance use disorders (SUD). However, there is limited information on the specific patterns of association of ASPD with SUD severity and specific SUD diagnostic criteria. We investigated the association of alcohol, cannabis, cocaine, opioid, and tobacco use disorders (AUD, CanUD, CocUD, OUD, and TUD, respectively) in 1,660 individuals with ASPD and 6,640 controls matched by sex (24% female), age, and racial/ethnic background in a sample ascertained for addiction-related traits. Generalized linear regressions were used to test the association of ASPD with the five DSM-5 SUD diagnoses, their severity (i.e., mild, moderate, severe), and their individual diagnostic criteria. We found that ASPD is associated with the diagnosis and severity of AUD (Odds Ratio, ORs=1.89 and 1.25), CanUD (ORs=2.13 and 1.32), and TUD (ORs=1.50 and 1.21) ( ps <.003). Of the specific diagnostic criteria, the "hazardous use" criterion showed the strongest association with ASPD across the five SUDs investigated (from OR TUD =1.88 to OR CanUD =1.37). However, when criteria of different SUDs were included in the same model, ASPD was independently associated only with TUD "hazardous use" and CocUD "attempts to quit". Attempting to quit cocaine was inversely related to the presence of ASPD and remained significant (OR=0.57, 95% confidence interval = 0.36-0.89) after controlling for interactive effects with sex. The current work provides novel insights into how different SUDs, their severity, and their diagnostic criteria associate with ASPD, potentially furthering our understanding of the impact of polysubstance addiction on mental health.
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Icick R, Shadrin A, Holen B, Karadag N, Lin A, Hindley G, O'Connell K, Frei O, Bahrami S, Høegh MC, Cheng W, Fan CC, Djurovic S, Dale AM, Lagerberg TV, Smeland OB, Andreassen OA. Genetic overlap between mood instability and alcohol-related phenotypes suggests shared biological underpinnings. Neuropsychopharmacology 2022; 47:1883-1891. [PMID: 35953530 PMCID: PMC9485134 DOI: 10.1038/s41386-022-01401-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/20/2022] [Accepted: 07/16/2022] [Indexed: 11/09/2022]
Abstract
Alcohol use disorder (AUD) is a pervasive and devastating mental illness with high comorbidity rates with other mental disorders. Understanding the genetic architecture of this comorbidity could be improved by focusing on intermediate traits that show positive genetic correlation with the disorders. Thus, we aimed to characterize the shared vs. unique polygenicity of AUD, alcohol consumption (AC) and mood instability (MOOD) -beyond genetic correlation, and boost discovery for jointly-associated loci. Summary statistics for MOOD (a binary measure of the tendency to report frequent mood swings), AC (number of standard drinks over a typical consumption week) and AUD GWASs (Ns > 200,000) were analyzed to characterize the cross-phenotype associations between MOOD and AC, MOOD and AUD and AC and AUD. To do so, we used a newly established pipeline that combines (i) the bivariate causal mixture model (MiXeR) to quantify polygenic overlap and (ii) the conjunctional false discovery rate (conjFDR) to discover specific jointly associated genomic loci, which were mapped to genes and biological functions. MOOD was highly polygenic (10.4k single nucleotide polymorphisms, SNPs, SD = 2k) compared to AC (4.9k SNPs, SD = 0.6k) and AUD (4.3k SNPs, SD = 2k). The polygenic overlap of MOOD and AC was twice that of MOOD and AUD (98% vs. 49%), with opposite genetic correlation (-0.2 vs. 0.23), as confirmed in independent samples. MOOD&AUD associated SNPs were significantly enriched for brain genes, conversely to MOOD&AC. Among 38 jointly associated loci, fifteen were novel for MOOD, AC and AUD. MOOD, AC and AUD were also strongly associated at the phenotypic level. Overall, using multilevel polygenic quantification, joint loci discovery and functional annotation methods, we evidenced that the polygenic overlap between MOOD and AC/AUD implicated partly shared biological underpinnings, yet, clearly distinct functional patterns between MOOD&AC and MOOD&AUD, suggesting new mechanisms for the comorbidity of AUD with mood disorders.
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Affiliation(s)
- Romain Icick
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway.
- Université de Paris Cité, INSERM UMR-S1144, F-75006, Paris, France.
| | - Alexey Shadrin
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Børge Holen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Naz Karadag
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Aihua Lin
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Guy Hindley
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Kevin O'Connell
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Oleksandr Frei
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
- Center for Bioinformatics, Department of Informatics, University of Oslo, PO box 1080, Blindern, 0316, Oslo, Norway
| | - Shahram Bahrami
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Margrethe Collier Høegh
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Weiqiu Cheng
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Chun C Fan
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- NORMENT Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
- KG Jebsen Centre for Neurodevelopmental disorders, University of Oslo, Oslo, Norway
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Trine Vik Lagerberg
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Olav B Smeland
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental disorders, University of Oslo, Oslo, Norway
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Massaal-van der Ree LY, Eikelenboom M, Hoogendoorn AW, Thomaes K, van Marle HJF. Cluster B versus Cluster C Personality Disorders: A Comparison of Comorbidity, Suicidality, Traumatization and Global Functioning. Behav Sci (Basel) 2022; 12:bs12040105. [PMID: 35447677 PMCID: PMC9031793 DOI: 10.3390/bs12040105] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 12/10/2022] Open
Abstract
A general clinical assumption states that cluster B personality disorders (PDs) represent a more severe form of PD than cluster C PDs. Consequently, most PD research is centered on cluster B PDs (especially borderline PD). Yet, prevalence ratings of cluster C PDs exceed those of cluster B PDs. In this explorative, cross-sectional study, we compared cluster B and C PD patients (N = 94) on a wide range of clinically-relevant severity measures, including comorbidity, suicidality, (childhood) traumatization and global functioning. Results showed that, although cluster B PD patients suffered more often from substance use disorders and lifetime suicide attempts, no difference could be established between groups for all other severity measures, including trauma variables. In our study, we additionally included a group of combined cluster B and C PDs, who were largely similar to both other groups. Although our study is insufficiently powered to claim a significant non-difference, these findings emphasize that high rates of comorbidity, suicidality, childhood traumatization and functional impairment apply to both cluster B and C patients. As such, our findings encourage more research into cluster C PDs, ultimately leading to more evidence-based treatments for this prevalent patient group. In addition, the high level of traumatization across groups calls for a routine trauma screening, especially since PD treatment may benefit from concurrent trauma treatment.
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Affiliation(s)
| | - Merijn Eikelenboom
- GGZ in Geest Mental Health Care, 1081 HJ Amsterdam, The Netherlands; (L.Y.M.-v.d.R.); (M.E.); (A.W.H.)
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands;
- Amsterdam Public Health, Mental Health Program, 1007 MB Amsterdam, The Netherlands
| | - Adriaan W. Hoogendoorn
- GGZ in Geest Mental Health Care, 1081 HJ Amsterdam, The Netherlands; (L.Y.M.-v.d.R.); (M.E.); (A.W.H.)
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands;
- Amsterdam Public Health, Mental Health Program, 1007 MB Amsterdam, The Netherlands
| | - Kathleen Thomaes
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands;
- Sinai Centrum, Arkin Institute for Mental Health, 1033 NN Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep Program, 1007 MB Amsterdam, The Netherlands
| | - Hein J. F. van Marle
- GGZ in Geest Mental Health Care, 1081 HJ Amsterdam, The Netherlands; (L.Y.M.-v.d.R.); (M.E.); (A.W.H.)
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands;
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep Program, 1007 MB Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-7885000
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Papamalis FE. Examining the Relationship of Personality Functioning and Treatment Completion in Substance Misuse Treatment. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820951777. [PMID: 33088177 PMCID: PMC7543119 DOI: 10.1177/1178221820951777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/28/2020] [Indexed: 12/30/2022]
Abstract
Background: Treatment retention is a major factor contributing to favourable outcome in
the treatment of substance misuse, but the literature remains very limited.
Despite evidence of the association of personality with drug use
experimentation and relapse, surprisingly little is known about its role in
the treatment process. Clients’ personality functioning as measured by
malleable and context sensitive characteristic adaptations in treatment are
of concern. Aims: This study examines whether, and to what extent, personality functioning
contributes to or hinders treatment completion. This paper examined the
extent to which service users’ characteristic adaptations may be potential
determinants of treatment completion. Methodology: A longitudinal multi-site design was utilised, examining the therapy process
in a naturalistic setting in five inpatient treatment units. The study
examined whether service users’ characteristic adaptations (SIPP-118)
predict completion, while controlling psychosocial, motivational and
treatment engagement indicators involving n = 340 participants from 5
inpatient centres. Multivariate regression analyses were
applied to examine the predictive role of characteristic adaptations on
treatment completion. Results: Findings indicated that certain dysfunctional characteristic adaptations
emerged as strong predictors of treatment completion. Dysfunctional levels
on Self-control and Social concordance were significant predictors of drop
out from treatment. Individuals with low capacity to tolerate, use and
control one’s own emotions and impulses were almost three times more likely
to drop-out compared to those without [OR] = 2.73, Wald = 6.09,
P = .014, 95% CI [1.2, 6.0]. Individuals with
dysfunctional levels on the ability to value someone’s identity, withhold
aggressive impulses towards others and work together with
others were 2.21 more times more likely to complete
treatment [OR] = 2.21, Wald = 4.12, P = .042, 95% CI [1.0,
4.7]. The analysis at the facet level provided additional insight.
Individuals with higher adaptive levels on Effortful Control were 46% more
times likely to complete treatment than the group [OR] = 4.67, Wald =
10.231, P = .001, 95% CI [1.81, 12.04], 47% more likely on
Aggression regulation [OR] = 4.76, Wald = 16.68, P <
.001, 95% CI [2.1, 10.3], and 26% more likely on Stable self-image [OR] =
2.62, Wald = 6.75, P < .009, 95% CI [0.9, 3.0]. Conclusions: These findings extend our knowledge of the predictive role of characteristic
adaptations in treatment completion and highlight the clinical utility of
capturing these individual differences early on. Delineating the role of
characteristic adaptations in treatment may provide the basis for enhancing
treatment effectiveness through individualized interventions that are
scientifically driven and may open new avenues for the scientific enquiry of
personality and treatment.
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Richmond JR, Tull MT, Gratz KL. The Roles of Emotion Regulation Difficulties and Impulsivity in the Associations between Borderline Personality Disorder Symptoms and Frequency of Nonprescription Sedative Use and Prescription Sedative/Opioid Misuse. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 16:62-70. [PMID: 32368442 DOI: 10.1016/j.jcbs.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite evidence of a strong relationship between BPD and substance use problems in general, little research has examined the associations of BPD symptoms with the misuse of sedatives or opioids, and no studies have explored possible factors that may underlie these associations. Thus, this study examined the relationships of BPD symptoms (i.e., the number of BPD criteria with threshold ratings on a diagnostic interview) to nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse among 194 patients with alcohol and/or cocaine dependence in a residential substance use disorder treatment facility, as well as the roles of two theoretically-relevant factors in these relationships: emotion regulation (ER) difficulties and impulsivity facets. We found significant positive associations between BPD symptoms and nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse. We also found significant positive indirect relationships of BPD symptoms to nonprescription sedative use through ER difficulties, ab = .04, 95% CI [.003, .09], and to prescription sedative/opioid misuse through two facets of impulsivity: lack of perseverance, ab = .05, 95% CI [.01, .11], and negative urgency, ab = .03, 95% CI [.002, .07]. Findings highlight the differential relevance of ER difficulties and impulsivity dimensions to the relationships of BPD symptoms to nonprescription sedative use and prescription sedative/opioid misuse, respectively, among patients with alcohol and/or cocaine dependence.
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Affiliation(s)
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
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Arnevik EA, Pedersen G, Walderhaug E, Lien I, Wilberg T, Hummelen B. Measuring Personality Problems in Patients With Substance Use Disorders: A Cross-Sample Validation. J Dual Diagn 2019; 15:324-332. [PMID: 31571533 DOI: 10.1080/15504263.2019.1668583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Co-occurrence of substance use disorder and personality disorder (PD) is associated with greater functional impairment and mutual deterioration of the prognosis. More information is needed about the extent of personality problems in substance use disorder patients and when these problems can be assessed in a reliable way. The aim of this study was to compare the levels and scale reliability of (mal)adaptive personality functioning in four different samples and to discuss the possible clinical implications. Methods: Personality problems were assessed using the self-report Severity Indices of Personality Problems (SIPP) questionnaire in four samples: (a) 136 patients in the detoxification phase, (b) 187 patients with substance use disorder in long-term inpatient treatment, (c) 1,399 patients with PD in day and outpatient treatment, and (d) a community population of 935 respondents. Scale reliability of the SIPP facets was computed for each sample and levels of personality problems were compared among samples. Results: The scale reliability was acceptable for most of the SIPP facets in both substance use disorder samples. The substance use disorder samples had scores on SIPP that reflected greater personality dysfunction compared with the general community population and at a level similar to the PD population. Conclusions: SIPP appears to be a promising instrument for assessing personality pathology in substance use disorder treatment. The finding of high levels of maladaptive personality functioning in substance use disorder populations challenges the clinical management of the substance use disorder patient group and supports the development of integrated treatment approaches.
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Affiliation(s)
- Espen Ajo Arnevik
- Department of Addiction Treatment, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Department of Personality Psychiatry, Oslo University Hospital, Oslo, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen Walderhaug
- Department of Addiction Treatment, Oslo University Hospital, Oslo, Norway
| | - Ingebjørg Lien
- Department of Acute Psychiatric Ward, Nordland Hospital, Bodoe, Norway
| | - Theresa Wilberg
- Department of Research and Development, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Benjamin Hummelen
- Department of Research and Development, Oslo University Hospital, Oslo, Norway
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Abstract
PURPOSE OF REVIEW To provide an update of treatment for substance use in patients with co-occurring substance use disorders (SUD) and mental health disorders (dual diagnosis) with a focus on both pharmacological and psychosocial interventions. RECENT FINDINGS A total of 1435 abstracts were identified, of which we selectively reviewed 43 for this narrative review. There is emerging evidence, both clinical and neurobiological, that clozapine is a more efficacious antipsychotic in treatment of individuals with schizophrenia and SUD. The use of depot atypical antipsychotic paliperidone palmitate in this population is also promising. Although valproate remains the treatment of choice in individuals with bipolar disorder and SUD, present evidence suggests that lithium and quetiapine may not be effective in this population. Naltrexone is the most effective anticraving agent in individuals with severe mental illness (SMI) and comorbid alcohol use disorders. The use of opioid substitution therapy in individuals with SMI and comorbid opioid use disorders is also associated with favorable outcomes. Varenicline shows promise in patients with SMI who smoke tobacco. Psychosocial interventions should be instituted early in the course of treatment. They should ideally be high intensity and based on established therapies used for SUD. SUMMARY The paucity of systematic studies in individuals with co-occurring mental health disorders and SUD remains a concern, given the enormous burden that they pose. However, there are a number of studies which have evaluated interventions, both psychosocial and pharmacological, which show promise and can guide clinical practice. VIDEO ABSTRACT: http://links.lww.com/YCO/A49.
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Abstract
Borderline personality disorder (BPD) is often a complicating comorbid factor in alcohol use disorders and substance use disorders. Previous work showed that abstinent alcoholics endorsed lifetime and current symptoms of most of the BPD criteria at much higher rates than controls, with much higher symptom counts for short-term abstinent alcoholic (STAA) women than men, which is consistent with such symptoms negatively affecting female alcoholics' ability to maintain abstinence. Because prior work has also shown that treatment-naïve alcoholics (TNA) are not the same as treated alcoholics observed earlier in their alcohol dependence, but rather are a different population with potentially lower psychiatric comorbidity, in this study we compared BPD symptom criteria between TNA samples of comparable age to the control and STAA samples, including both men and women and individuals dependent on alcohol only or with lifetime dependence on both alcohol and drugs. BPD symptoms were obtained using the SCID-II, and endorsed symptoms were classified as current or lifetime. Logistic regression analyses were used to test for effects of group, sex, presence of a lifetime drug dependence diagnosis, and their interactions for lifetime and current symptom endorsement for each BPD criteria. Groups were compared pairwise (TNA vs. NSAC, and STAA vs. TNA). The effect of a lifetime drug dependence diagnosis was not significant for any BPD symptom variable, consistent with the alcohol groups' BPD symptoms being unaffected by the presence of a comorbid drug dependence. The primary result presented here is that TNA women have borderline symptomatology more similar to that of treated STAA than to NSAC, while TNA men have borderline symptomatology more similar to NSAC than to STAA. A visual examination of co-occurring BPD symptoms showed that while more BPD symptoms are likely to be present in TNA and STAA vs. NSAC, there is no grouping of criteria (i.e., symptom cluster) that is characteristic of TNA or STAA.
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Affiliation(s)
- George Fein
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, Maui, HI 96732, United States; Department of Medicine and Psychology, University of Hawaii, Honolulu, HI 96822, United States.
| | - Mathew Price
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, Maui, HI 96732, United States; Cogency, Cape Town, South Africa.
| | - Valerie A Cardenas
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, Maui, HI 96732, United States.
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Moltisanti AJ, Ennis CR, Chavarria J, Smith CE, Taylor J. Multi-Trait Profiles and their Relation to Substance Use Problems and Cluster B Personality Disorder Features: A Replication Study. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2018. [DOI: 10.1521/jscp.2018.37.4.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Substance use disorders (SUDs) and Cluster B personality disorders (PDs) may have shared risk through profiles of personality and motivational traits. The present study sought to replicate in a national sample of adults past research which found multi-trait profiles that were associated with disinhibitory disorders in a college sample. Another aim was to test whether gender differences in the prevalence of disinhibitory disorders are attributable to underlying differences in personality-based risk. Cluster analysis was used to identify multi-trait profiles from impulsivity, constraint, negative emotionality, behavioral activation system (BAS), and behavioral inhibition system (BIS) scale scores. Analyses yielded similar multi-trait profiles to those found in past research, including a “disinhibited” profile with high impulsivity, high BAS, and low constraint, as well as a “high affectivity/impulsive” profile with high negative emotionality, impulsivity, BAS, and BIS. These profiles were associated with elevated drug problems and Cluster B PD features. Results support the validity these trait profiles and their association with disinhibitory psychopathology. Gender was associated with some, but not all, disinhibitory disorders while controlling for cluster membership, suggesting that multi-trait personality clusters may represent a more proximal risk factor than gender for certain disinhibitory disorders.
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11
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Long E, Aggen S, Neale M, Knudsen G, Krueger R, South S, Czajkowski N, Nesvåg R, Ystrom E, Torvik F, Kendler K, Gillespie N, Reichborn-Kjennerud T. The association between personality disorders with alcohol use and misuse: A population-based twin study. Drug Alcohol Depend 2017; 174:171-180. [PMID: 28334662 PMCID: PMC5497569 DOI: 10.1016/j.drugalcdep.2017.01.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/07/2016] [Accepted: 01/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND A clearer understanding of the etiological overlap between DSM-IV personality disorders (PDs) and alcohol use (AU) and alcohol use disorder (AUD) is needed. To our knowledge, no study has modeled the association between all 10 DSM-IV PDs and lifetime AU and AUD. The aim of the present study is to identify which PDs are most strongly associated with the phenotypic, genetic, and environmental risks of lifetime AU and AUD, and to determine if these associations are stable across time. METHODS Participants were Norwegian twins assessed at two waves. At Wave 1, 2801 twins were assessed for all 10 DSM-IV PD criteria, lifetime AU, and DSM-IV AUD criteria. At Wave 2, six of the 10 PDs were again assessed along with AU and AUD among 2393 twins. Univariate and multiple logistic regressions were run. Significant predictors were further analyzed using bivariate twin Cholesky decompositions. RESULTS Borderline and antisocial PD criteria were the strongest predictors of AU and AUD across the two waves. Despite moderate phenotypic and genetic correlations, genetic variation in these PD criteria explained only 4% and 3% of the risks in AU, and 5% to 10% of the risks in AUD criteria, respectively. At Wave 2, these estimates increased to 8% and 23% for AU, and 17% and 33% for AUD. CONCLUSIONS Among a large Norwegian twin sample, borderline and antisocial PD criteria were the strongest predictors of the phenotypic and genotypic liability to AU and AUD. This effect remained consistent across time.
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Affiliation(s)
- E.C. Long
- Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA,Corresponding author: Elizabeth Long, Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, Box 980126, Richmond, VA 23298-0126 (USA);
| | - S.H. Aggen
- Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - M.C. Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - G.P. Knudsen
- Department of Mental Disorders, Norwegian Institute of Public Health, Norway
| | - R.F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - S.C. South
- Department of Psychological Sciences, Purdue University, IN, USA
| | - N. Czajkowski
- Department of Mental Disorders, Norwegian Institute of Public Health, Norway,Department of Psychology, University of Oslo, Oslo, Norway
| | - R. Nesvåg
- Department of Mental Disorders, Norwegian Institute of Public Health, Norway,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - E. Ystrom
- Department of Mental Disorders, Norwegian Institute of Public Health, Norway,Department of Psychology, University of Oslo, Oslo, Norway,School of Pharmacy, University of Oslo, Oslo, Norway
| | - F.A. Torvik
- Department of Mental Disorders, Norwegian Institute of Public Health, Norway,Department of Psychology, University of Oslo, Oslo, Norway
| | - K.S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - N.A. Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - T. Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Risk of Suicide and Dysfunctional Patterns of Personality among Bereaved Substance Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030316. [PMID: 28335530 PMCID: PMC5369152 DOI: 10.3390/ijerph14030316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/12/2017] [Accepted: 03/15/2017] [Indexed: 12/04/2022]
Abstract
Background: Research has shown that suicide is a phenomenon highly present among the drug dependent population. Different studies have demonstrated an upraised level of comorbidity between personality disorders (PD) and substance use disorders (SUD). This study aimed to describe which PDs are more frequent among those patients with a risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 bereaved patients attended to in a Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide and drug related characteristics were recorded. The risk of suicide was assessed with the Spanish version of “Risk of suicide”. Personality disorders were measured with the Spanish version of Millon Multiaxial Clinical Inventory. Results: The PDs more associated with the presence of risk of suicide were depressive, avoidant, schizotypal and borderline disorders. However, the histrionic, narcissistic and compulsive PDs are inversely associated with risk of suicide even though the narcissistic scale had no statistical correlation. Conclusions: The risk of suicide is a significant factor to take into account related to patients with SUD and especially with the presence of specific PDs. These findings underline the importance of diagnosing and treating rigorously patients with SUD.
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13
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Aggressive temperament predicts ethanol self-administration in late adolescent male and female rhesus macaques. Psychopharmacology (Berl) 2016; 233:3965-3976. [PMID: 27627910 PMCID: PMC5341689 DOI: 10.1007/s00213-016-4427-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/01/2016] [Indexed: 12/27/2022]
Abstract
RATIONALE Anxiety and aggression are associated with ethanol self-administration, but these behaviors can serve as either risk factors for or consequences of heavy drinking in rodents and humans. Baseline levels of aggressive-like and anxious-like behavior in non-human primates have not yet been characterized in relation to future or prior ethanol intake. OBJECTIVE The objective of the study was to test the association between temperament at baseline with future ethanol self-administration in late adolescent male (n = 21) and female (n = 11) rhesus monkeys. METHODS Shortly after entering the laboratory and before exposure to ethanol, the Human Intruder Test (HIT) and the Novel Object Test (NOT) were used to determine baseline anxious-like and aggressive-like behavior in age-matched male and female rhesus monkeys (Macaca mulatta). The monkeys were induced to drink ethanol 4 % (w/v) using a schedule-induced polydipsia procedure, followed by "open-access" ethanol self-administration in which the monkeys were allowed a choice of water or 4 % ethanol (w/v) for 22 h/day for 52 weeks. RESULTS Aggressive monkeys self-administered more ethanol and attained higher blood ethanol concentrations (BECs). No significant differences in ethanol intakes or BECs were found between anxious and non-anxious monkeys or between behaviorally inhibited and non-inhibited monkeys. Baseline aggressive behavior positively correlated with ethanol intake and intoxication. CONCLUSIONS Baseline reactive aggression was associated with higher future ethanol intake and intoxication. While significant sex differences in HIT reactivity were observed, the relationship between aggression and ethanol drinking was observed across sex and is not sex-specific.
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14
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Korsgaard HO, Torgersen S, Wentzel-Larsen T, Ulberg R. Substance abuse and personality disorder comorbidity in adolescent outpatients: are girls more severely ill than boys? Child Adolesc Psychiatry Ment Health 2016; 10:8. [PMID: 27069507 PMCID: PMC4827187 DOI: 10.1186/s13034-016-0096-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender. METHODS The sample consisted of 153 adolescents, aged 14-17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality. RESULTS 18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD. CONCLUSIONS We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances. Trial registration The regional committee for medical research ethics for eastern Norway approved the study protocol in October 2004 (REK: 11395). Address correspondence and reprint requests to: Hans Ole Korsgaard, The Nic Waal Institute, Lovisenberg Diakonale Hospital, P.O. Box 2970 Nydalen, N-0440 Oslo, Norway; E-mail hansole.korsgaard@tele5.no.
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Affiliation(s)
- Hans Ole Korsgaard
- Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, Oslo, Norway
| | | | - Tore Wentzel-Larsen
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway ,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Randi Ulberg
- Vestfold Hospital Trust, Tønsberg, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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Lane SP, Carpenter RW, Sher KJ, Trull TJ. Alcohol Craving and Consumption in Borderline Personality Disorder: When, Where, and with Whom. Clin Psychol Sci 2016; 4:775-792. [PMID: 28042520 DOI: 10.1177/2167702615616132] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Substance use is highly prevalent in our society, and substance use disorders are comorbid with most psychiatric disorders, including borderline personality disorder (BPD; Grant et al., 2006, 2008). Craving is a fundamental feature of addiction and disorder, yet the contexts in which craving occurs and is associated with substance use is still under-researched. We examined alcohol craving and consumption in a sample of 56 BPD individuals and a comparison group of community drinkers (COM; n = 60) who carried electronic diaries for approximately 21 days. BPD individuals reported more craving than COM individuals in most contexts. Compared to COM individuals, elevated craving in BPD individuals was paralleled by more drinking when at work, at home, and with romantic partners, coworkers, and children. These findings identify contexts of particular relevance to those with BPD and other mood/anxiety disorders in which craving may lead to risky and maladaptive alcohol use.
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Affiliation(s)
- Sean P Lane
- University of Missouri-Columbia and Alcoholism Research Center, Columbia, MO
| | - Ryan W Carpenter
- University of Missouri-Columbia and Alcoholism Research Center, Columbia, MO
| | - Kenneth J Sher
- University of Missouri-Columbia and Alcoholism Research Center, Columbia, MO
| | - Timothy J Trull
- University of Missouri-Columbia and Alcoholism Research Center, Columbia, MO
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16
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Lana F, Sánchez-Gil C, Adroher ND, Pérez V, Feixas G, Martí-Bonany J, Torrens M. Comparison of treatment outcomes in severe personality disorder patients with or without substance use disorders: a 36-month prospective pragmatic follow-up study. Neuropsychiatr Dis Treat 2016; 12:1477-87. [PMID: 27382290 PMCID: PMC4922780 DOI: 10.2147/ndt.s106270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Concurrent personality disorder (PD) and substance use disorder (SUD) are common in clinical practice. However, SUD is the main criterion for study exclusion in most psychotherapeutic studies of PD. As a result, data on treatment outcomes in patients with concurrent PD/SUD are scarce. METHODS The study sample consisted of 51 patients diagnosed with severe PD and admitted for psychotherapeutic treatment as a part of routine mental health care. All patients were diagnosed with PD according to the Structured Clinical Interview for PD. Patients were further assessed (DSM-IV diagnostic criteria) to check for the presence of concurrent SUD, with 28 patients diagnosed with both disorders (PD-SUD). These 28 cases were then compared to the 23 patients without SUD (PD-nSUD) in terms of psychiatric hospitalizations and psychiatric emergency room (ER) visits before and during the 6-month therapeutic intervention and every 6 months thereafter for a total of 36 months. RESULTS The baseline clinical characteristics correspond to a sample of PD patients (78% met DSM-IV criteria for borderline PD) with poor general functioning and a high prevalence of suicide attempts and self-harm behaviors. Altogether, the five outcome variables - the proportion and the number of psychiatric inpatient admissions, the number of days hospitalized, and the proportion and the number of psychiatric ER visits - improved significantly during the treatment period, and this improvement was maintained throughout the follow-up period. Although PD-SUD patients had more psychiatric hospitalizations and ER visits than PD-nSUD patients during follow-up, the differences between these two groups remained stable over the study period indicating that the treatment was equally effective in both groups. CONCLUSION Specialized psychotherapy for severe PD can be effectively applied in patients with concurrent PD-SUD under usual practice conditions. These findings suggest that exclusion of patients with dual disorders from specialized treatments is unjustified.
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Affiliation(s)
- Fernando Lana
- Institute of Neuropsychiatry and Addictions (INAD), Centre Emili Mira and Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Sánchez-Gil
- Institute of Neuropsychiatry and Addictions (INAD), Centre Emili Mira and Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
| | - Núria D Adroher
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Public Health and Epidemiology Research Networking Center (CIBERESP), Madrid, Spain
| | - Víctor Pérez
- Institute of Neuropsychiatry and Addictions (INAD), Centre Emili Mira and Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Josep Martí-Bonany
- Institute of Neuropsychiatry and Addictions (INAD), Centre Emili Mira and Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
| | - Marta Torrens
- Institute of Neuropsychiatry and Addictions (INAD), Centre Emili Mira and Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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17
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Jones DJ, Anton M, Gonzalez M, Honeycutt A, Khavjou O, Forehand R, Parent J. Incorporating Mobile Phone Technologies to Expand Evidence-Based Care. COGNITIVE AND BEHAVIORAL PRACTICE 2015; 22:281-290. [PMID: 26213458 PMCID: PMC4509600 DOI: 10.1016/j.cbpra.2014.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach.
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18
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Leasure JL, Neighbors C, Henderson CE, Young CM. Exercise and Alcohol Consumption: What We Know, What We Need to Know, and Why it is Important. Front Psychiatry 2015; 6:156. [PMID: 26578988 PMCID: PMC4629692 DOI: 10.3389/fpsyt.2015.00156] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/16/2015] [Indexed: 12/29/2022] Open
Abstract
Exercise provides a wealth of benefits to brain and body, and is regarded as a protective factor against disease. Protective factors tend to cluster together - that is, people who engage in one healthy behavior, such as exercise, also engage in other healthy behaviors, such as maintaining a nutritious diet and getting sufficient sleep. In contrast to exercise, alcohol consumption is not typically regarded as a health-promoting behavior, although moderate intake has been associated with a lower risk of cardiovascular disease. Surprisingly, several large, population-based studies have shown a positive association between physical activity and alcohol intake. The present review focuses on what is known about this relationship, including potential neural bases as well as moderating factors, and discusses important directions for further study, such as a more thorough characterization of people who both drink and exercise. We focus on ramifications for intervening with people who have alcohol use disorders, as exercise has been assessed as both a treatment and preventive measure, with mixed results. We believe that, in order for such interventions to be effective, clinical trials must distinguish treatment-seeking populations from non-treatment-seeking ones, as well as ensure that the use of exercise as a tool to decrease alcohol consumption is made explicit. We posit that a better understanding of the relationship between physical activity and alcohol intake will maximize intervention efforts by informing the design of clinical trials and research-driven prevention strategies, as well as enable individuals to make educated decisions about their health behaviors.
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Affiliation(s)
- J Leigh Leasure
- Department of Psychology, University of Houston , Houston, TX , USA
| | | | - Craig E Henderson
- Department of Psychology, Sam Houston State University , Huntsville, TX , USA
| | - Chelsie M Young
- Department of Psychology, University of Houston , Houston, TX , USA
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19
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Elliott JC, Stohl M, Wall MM, Keyes KM, Goodwin RD, Skodol AE, Krueger RF, Grant BF, Hasin D. The risk for persistent adult alcohol and nicotine dependence: the role of childhood maltreatment. Addiction 2014; 109:842-50. [PMID: 24401044 PMCID: PMC3984602 DOI: 10.1111/add.12477] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/19/2013] [Accepted: 12/31/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Alcohol and nicotine dependence are associated with considerable morbidity and mortality, especially when cases are persistent. The risk for alcohol and nicotine dependence is increased by childhood maltreatment. However, the influence of childhood maltreatment on dependence course is unknown, and is evaluated in the current study. DESIGN Physical, sexual and emotional abuse, and physical and emotional neglect, were evaluated as predictors of persistent alcohol and nicotine dependence over 3 years of follow-up, with and without control for other childhood adversities. SETTING National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). PARTICIPANTS NESARC participants completing baseline and follow-up who met criteria at baseline for past-year alcohol dependence (n = 1172) and nicotine dependence (n = 4017). MEASUREMENTS Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS) measures of alcohol/nicotine dependence, childhood maltreatment and other adverse childhood experiences (e.g. parental divorce). FINDINGS Controlling for demographics only, physical, sexual and emotional abuse and physical neglect predicted 3-year persistence of alcohol dependence [adjusted odds ratio (AOR) = 1.50-2.99; 95% CI = 1.04-4.68] and nicotine dependence (AOR = 1.37-1.74; 95% CI = 1.13-2.11). With other childhood adversities also controlled, maltreatment types remained predictive for alcohol persistence (AOR = 1.53-3.02; 95% CI = 1.07-4.71) and nicotine persistence (AOR = 1.35-1.72; 95% CI = 1.11-2.09). Further, a greater number of maltreatment types incrementally influenced persistence risk (AOR = 1.19-1.36; 95% CI = 1.11-1.56). CONCLUSIONS A history of childhood maltreatment predicts persistent adult alcohol and nicotine dependence. This association, robust to control for other childhood adversities, suggests that maltreatment (rather than a generally difficult childhood) affects the course of dependence.
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Affiliation(s)
- Jennifer C. Elliott
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Malka Stohl
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Melanie M. Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, New York, USA
| | - Andrew E. Skodol
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA,Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Robert F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, National Institute of Alcohol Abuse and Alcoholism, Rockville, Maryland, USA
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
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20
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Vergés A, Kushner MG, Jackson KM, Bucholz KK, Trull TJ, Lane SP, Sher KJ. Personality disorders and the persistence of anxiety disorders: evidence of a time-of-measurement effect in NESARC. J Anxiety Disord 2014; 28:178-86. [PMID: 24211148 PMCID: PMC3943573 DOI: 10.1016/j.janxdis.2013.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/28/2013] [Accepted: 09/24/2013] [Indexed: 11/26/2022]
Abstract
Recent studies using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) have found that some personality disorders (PDs) increase the persistence of several Axis I disorders. However, these effects are potentially confounded with the data collection wave in which PDs were assessed. Our aim was to extend published analyses to the case of anxiety disorders and to determine the robustness of the associations to analyses examining time-of-measurement effects. Persistence of anxiety disorders was defined either as follow-up diagnosis among participants diagnosed at baseline ("prediction") or baseline diagnosis among participants diagnosed at follow-up ("post-diction"). Results revealed a robust pattern of higher odds ratios for post-diction among PDs assessed at baseline, and lower odds ratios for post-diction among PDs assessed at follow-up, suggesting a time of measurement artifact. Although only 4% of associations were robust to both predictive and post-dictive analyses, these were consistent with previous research.
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Affiliation(s)
- Alvaro Vergés
- University of Missouri-Columbia and the Midwest Alcoholism Research Center, Columbia, MO, USA.
| | | | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Kathleen K Bucholz
- Washington University School of Medicine and the Midwest Alcoholism Research Center, St. Louis, MO, USA
| | - Timothy J Trull
- University of Missouri-Columbia and the Midwest Alcoholism Research Center, Columbia, MO, USA
| | - Sean P Lane
- University of Missouri-Columbia and the Midwest Alcoholism Research Center, Columbia, MO, USA
| | - Kenneth J Sher
- University of Missouri-Columbia and the Midwest Alcoholism Research Center, Columbia, MO, USA
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21
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Lawton EM, Oltmanns TF. Personality pathology and mental health treatment seeking in a community sample of older adults. Personal Ment Health 2013; 7:203-12. [PMID: 24343963 PMCID: PMC3876292 DOI: 10.1002/pmh.1198] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 02/19/2012] [Accepted: 03/09/2012] [Indexed: 11/12/2022]
Abstract
Sampling issues are extremely important in studies of psychopathology, especially with regard to the investigation of personality disorders (PDs). Many studies rely on clinical samples whereas others have focused on representative samples of community residents. Do people who qualify for a PD diagnosis seek and receive mental health services with greater (or possibly reduced) frequency compared with others in the community? Do community-based studies of PDs include people who have been treated? Analyses presented here examine connections between personality pathology and various aspects of treatment seeking in a representative sample of 1 630 middle-aged adults who completed a semi-structured diagnostic interview (Structured Interview for DSM-IV Personality). Results demonstrate a disorder-specific effect. Antisocial, borderline, avoidant and dependent PDs are associated with increased levels of seeking treatment. Four PDs are associated with greater length of treatment. After accounting for lifetime presence of major depression and alcohol dependence, borderline, avoidant and dependent pathology remained associated with increased treatment seeking. These findings point to several conclusions, including (1) community samples do include a substantial proportion of people who have received various kinds of mental health services; (2) the association between personality pathology and mental health treatment seeking is not fully explained by comorbid depression and alcohol dependence.
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Affiliation(s)
- Erin M Lawton
- Department of Psychology, Washington University in St. Louis, 1 Brookings Dr., Campus Box 1125, St. Louis, MO, 63130, USA
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22
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Langås AM, Malt UF, Opjordsmoen S. In-depth study of personality disorders in first-admission patients with substance use disorders. BMC Psychiatry 2012; 12:180. [PMID: 23107025 PMCID: PMC3514215 DOI: 10.1186/1471-244x-12-180] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 10/10/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Assessment of comorbid personality disorders (PDs) in patients with substance use disorders (SUDs) is challenging due to symptom overlap, additional mental and physical disorders, and limitations of the assessment methods. Our in-depth study applied methods to overcome these difficulties. METHOD A complete catchment area sample of 61 consecutively admitted patients with SUDs, with no previous history of specialized treatment (addiction clinics, psychiatry) were studied, addressing PDs and associated clinical and demographic variables. The thorough assessments included the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. RESULTS Forty-six percent of the SUD patients had at least one PD (16% antisocial [males only]; 13% borderline; and 8% paranoid, avoidant, and obsessive-compulsive, respectively). Cluster C disorders were as prevalent as Cluster B disorders. SUD patients with PDs were younger at the onset of their first SUD and at admission; used more illicit drugs; had more anxiety disorders, particularly social phobia; had more severe depressive symptoms; were more distressed; and less often attended work or school. CONCLUSION The psychiatric comorbidity and symptom load of SUD patients with PDs differed from those of SUD patients without PDs, suggesting different treatment needs, and stressing the value of the assessment of PDs in SUD patients.
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Affiliation(s)
- Anne-Marit Langås
- Vestre Viken Hospital Trust, Division of Mental Health and Addiction, Department of Mental Health Research and Development, P,O, Box 135, Lier, NO-3401, Norway.
| | - Ulrik Fredrik Malt
- Norwegian Research Network on Mood Disorders (NORMOOD), Oslo, Norway,University of Oslo, Institute of Clinical Medicine, Oslo, Norway,Division of Surgery and Clinical Neuroscience, Dept of Neuropsychiatry and Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway,Division of Mental Health and Addiction, Dept of Research and Development, Oslo University Hospital, Oslo, Norway
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Pulay AJ, Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Saha TD, Smith SM, Pickering RP, Ruan WJ, Hasin DS, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV schizotypal personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 11:53-67. [PMID: 19617934 DOI: 10.4088/pcc.08m00679] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 08/25/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To present nationally representative findings on the prevalence, correlates, and comorbidity of and disability associated with DSM-IV schizotypal personality disorder (SPD). METHOD This study used the 2004-2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, which targeted a nationally representative sample of the adult civilian population of the United States aged 18 years and older and residing in households and group quarters. In Wave 2, attempts were made to conduct face-to-face reinterviews with all respondents to the Wave 1 interview. RESULTS Lifetime prevalence of SPD was 3.9%, with significantly greater rates among men (4.2%) than women (3.7%) (p < .01). Odds for SPD were significantly greater among black women, individuals with lower incomes, and those who were separated, divorced, or widowed; odds were significantly lower among Asian men (all p < .01). Schizotypal personality disorder was associated with substantial mental disability in both sexes. Co-occurrence rates of Axis I and other Axis II disorders among respondents with SPD were much higher than rates of co-occurrence of SPD among respondents with other disorders. After adjustment for sociodemographic characteristics and additional comorbidity, associations remained significant in both sexes between SPD and 12-month and lifetime bipolar I disorder, social and specific phobias, and posttraumatic stress disorder, as well as 12-month bipolar II disorder, lifetime generalized anxiety disorder, and borderline and narcissistic personality disorders (all p < .01). CONCLUSIONS Common and unique factors may underlie associations of SPD with narcissistic and borderline personality disorders, whereas much of the comorbidity between SPD and most mood and anxiety disorders appears to reflect factors common to these disorders. Some of the associations with SPD were sex specific. Schizotypal personality disorder and dependent, avoidant, and borderline personality disorders were associated with the occurrence of schizophrenia or psychotic episode. Schizotypal personality disorder is a prevalent, fairly stable, highly disabling disorder in the general population. Sex differences in associations of SPD with other specific Axis I and II disorders can inform more focused, hypothesis-driven investigations of factors underlying the comorbid relationships. Schizotypal as well as borderline, dependent, and avoidant personality disorders may be components of the schizophrenia spectrum.
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Affiliation(s)
- Attila J Pulay
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
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24
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Wang L, Ross CA, Zhang T, Dai Y, Zhang H, Tao M, Qin J, Chen J, He Y, Zhang M, Xiao Z. Frequency of borderline personality disorder among psychiatric outpatients in Shanghai. J Pers Disord 2012; 26:393-401. [PMID: 22686227 PMCID: PMC4191971 DOI: 10.1521/pedi.2012.26.3.393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The objective of this study was to investigate the frequency, clinical characteristics, and comorbidity of borderline personality disorder (BPD) among psychiatric outpatients in two clinics at Shanghai Mental Health Center. A cross-sectional investigation was conducted. From 3,075 outpatients screened using the Personality Diagnostic Questionnaire-IV+, 2,284 patients positive for a personality disorder were assessed using the Structured Clinical Interview for DSM-IV Personality Disorders. The frequency of BPD among the psychiatric outpatients was 5.8%, with a frequency of 3.5% among males and 7.5% among females (p < .01). BPD was found to have extensive comorbidity with Axis I and II disorders. This study proves that BPD does occur in China. The detected frequency among outpatients is lower than that reported in North America.
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Affiliation(s)
- Lanlan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, China
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25
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Fein G, Nip V. Borderline personality symptoms in short-term and long-term abstinent alcohol dependence. Alcohol Clin Exp Res 2012; 36:1188-95. [PMID: 22309234 DOI: 10.1111/j.1530-0277.2011.01730.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/08/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Comorbidity of borderline personality disorder (BPD) and substance and alcohol use disorders (SUDs and AUDs) is very high. The literature suggests a negative synergy between BPD and SUDs, which may impact an individual's ability to achieve and maintain remission of either disorder in the face of the other. METHODS We examined lifetime and current (past year) BPD symptom counts in 3 gender- and age-comparable groups: short-term abstinent alcoholics (STA, 6 to 15 weeks abstinent), long-term abstinent alcoholics (LTA, more than 18 months abstinent), and nonsubstance-abusing controls (NSAC). Abstinent individuals were recruited primarily from mutual-help recovery networks and about half had comorbid drug dependence. BPD symptoms were obtained using the Structured Clinical Interview for DSM-IV-TR Axis II Personality Disorders, followed up with questions regarding currency, but did not require that BPD symptoms represent persistent or pervasive behavior such as would meet criteria for BPD diagnosis. Thus, our study dealt only with BPD symptoms, not BPD diagnoses. RESULTS Alcoholics had more lifetime and current symptoms for most all BPD criteria than NSAC. In general, STA and LTA did not differ in BPD symptoms, except for a group-by-gender effect for both lifetime and current anger-associated symptoms and for lifetime abandonment avoidance symptoms. For these cases, there were much higher symptom counts for STA women versus men, with comparable symptom counts for LTA women versus men. CONCLUSIONS Our results suggest for the most part that BPD symptoms do not prevent the maintenance of recovery in AUD and SUD individuals who have established at least 6 weeks abstinence within the mutual-help recovery network-in fact the presence of BPD symptoms is the norm. However, we did find difficulty in establishing longer-term abstinence in women with anger-associated symptoms and abandonment avoidance symptoms.
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Affiliation(s)
- George Fein
- Neurobehavioral Research, Inc., Honolulu, HI 96814, USA.
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26
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Hasin D, Fenton MC, Skodol A, Krueger R, Keyes K, Geier T, Greenstein E, Blanco C, Grant B. Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders. ACTA ACUST UNITED AC 2011; 68:1158-67. [PMID: 22065531 DOI: 10.1001/archgenpsychiatry.2011.136] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD) and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions. OBJECTIVE To determine the association between the 10 DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample. DESIGN Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (n = 1172), cannabis use disorder (n = 454), or nicotine dependence (n = 4017) at baseline and who were reinterviewed 3 years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration. Main Outcome Measure Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period. RESULTS Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis, and nicotine use disorders (adjusted odds ratios, 2.46-3.51), as was borderline personality disorder (adjusted odds ratios, 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios, 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence. CONCLUSIONS The consistent findings on the association of antisocial, borderline, and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional representations of personality disorders and the role of specific components of these disorders, biological and environmental contributors to these relationships, and potential applications of these findings to treatment development.
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Affiliation(s)
- Deborah Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY 10032, USA.
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27
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Jahng S, Trull TJ, Wood PK, Tragesser SL, Tomko R, Grant JD, Bucholz KK, Sher KJ. Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity. JOURNAL OF ABNORMAL PSYCHOLOGY 2011; 120:656-69. [PMID: 21604829 DOI: 10.1037/a0023539] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities.
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Affiliation(s)
- Seungmin Jahng
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
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28
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Chen EY, McCloskey MS, Michelson S, Gordon KH, Coccaro E. Characterizing eating disorders in a personality disorders sample. Psychiatry Res 2011; 185:427-32. [PMID: 20667417 PMCID: PMC2972373 DOI: 10.1016/j.psychres.2010.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 06/28/2010] [Accepted: 07/03/2010] [Indexed: 10/19/2022]
Abstract
The presence of a comorbid eating disorder (ED) and personality disorder (PD) is associated with greater problems and poorer functioning than having an ED alone or PD alone. This pattern is also found for non-ED axis I disorders and PDs. This study aims to examine if an ED, compared to other non-ED axis I disorders, in a PD sample confers greater risks for: number and type of non-ED axis I and axis II disorders, suicide attempts and non-suicidal self-injury, and poorer psychosocial functioning. Standardized interviews were conducted on 166 females and 166 males with PDs. In females with PDs, EDs, as compared to other axis I disorders, were associated with more non-ED axis I and II disorders (particularly borderline and avoidant PD) and poorer global functioning, but not with suicide attempts or non-suicidal self-injury. In males with PDs, EDs were associated with more axis II disorders, particularly borderline PD. Given the small group of males with EDs, these results require replication. Males and females with PDs and EDs may have multiple comorbid disorders, particularly borderline PD and for females, avoidant PD that may warrant targeting in treatment.
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Affiliation(s)
- Eunice Yu Chen
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, IL, USA.
| | | | - Sara Michelson
- Department of Clinical Psychology, Roosevelt University, Chicago, IL, USA
| | | | - Emil Coccaro
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, IL, USA
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29
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Becker DF, Añez LM, Paris M, Grilo CM. Exploratory factor analysis of borderline personality disorder criteria in monolingual Hispanic outpatients with substance use disorders. Psychiatry Res 2010; 178:305-8. [PMID: 20472296 PMCID: PMC2902552 DOI: 10.1016/j.psychres.2009.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 01/16/2009] [Accepted: 03/19/2009] [Indexed: 11/27/2022]
Abstract
This study examined the factor structure of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for borderline personality disorder (BPD) in Hispanic patients. Subjects were 130 monolingual Hispanic adults who had been admitted to a specialty outpatient clinic that provides psychiatric and substance abuse services to Spanish-speaking individuals. All were reliably assessed with the Spanish-Language Version of the Diagnostic Interview for DSM-IV Personality Disorders. After evaluating internal consistency of the BPD criterion set, an exploratory factor analysis was performed using principal axis factoring. Results suggested a unidimensional structure, and were consistent with similar studies of the DSM-IV criteria for BPD in non-Hispanic samples. These findings have implications for understanding borderline psychopathology in this population, and for the overall validity of the DSM-IV BPD construct.
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Affiliation(s)
- Daniel F. Becker
- Department of Psychiatry, University of California, San Francisco, USA,Corresponding author. Mills-Peninsula Medical Center, 1501 Trousdale Dr., Burlingame, CA 94010, USA. Tel.: +1 650 696 5912; fax: +1 650 696 5901. E-mail address: (D.F. Becker)
| | - Luis Miguel Añez
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Manuel Paris
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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30
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Walter M, Gunderson JG, Zanarini MC, Sanislow CA, Grilo CM, McGlashan TH, Morey LC, Yen S, Stout RL, Skodol AE. New onsets of substance use disorders in borderline personality disorder over 7 years of follow-ups: findings from the Collaborative Longitudinal Personality Disorders Study. Addiction 2009; 104:97-103. [PMID: 19133893 PMCID: PMC2743265 DOI: 10.1111/j.1360-0443.2008.02413.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The purpose of this study was to examine whether patients with borderline personality disorder (BPD) have a higher rate of new onsets of substance use disorders (SUD) than do patients with other personality disorders (OPD). DESIGN This study uses data from the Collaborative Longitudinal Personality Disorder Study (CLPS), a prospective naturalistic study with reliable repeated measures over 7 years of follow-up. SETTING Multiple clinical sites in four northeastern US cities. PARTICIPANTS A total of 175 patients with BPD and 396 patients with OPD (mean age 32.5 years) were assessed at baseline and at 6, 12, 24, 36, 48, 60, 72 and 84 months. MEASUREMENTS The Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders were used at baseline, the Follow-Along version of the DIPD-IV and the Longitudinal Interval Follow-up Evaluation at the follow-up evaluations. Kaplan-Meier analyses were calculated to generate the time to new onsets. FINDINGS BPD patients showed a shorter time to new onsets of SUD. Thirteen per cent of BPD patients developed a new alcohol use disorder and 11% developed a new drug use disorder, compared to rates of 6% and 4%, respectively, for OPD. Non-remitted BPD and remitted BPD patients did not differ significantly in rates of new onsets of SUD. CONCLUSIONS BPD patients have a high vulnerability for new onsets of SUDs even when their psychopathology improves. These findings indicate some shared etiological factors between BPD and SUD and underscore the clinical significance of treating SUD when it co-occurs in BPD patients.
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Affiliation(s)
- Marc Walter
- Harvard Medical School, McLean Hospital, Belmont, MA, USA.
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31
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Tragesser SL, Trull TJ, Sher KJ, Park A. Drinking motives as mediators in the relation between personality disorder symptoms and alcohol use disorder. J Pers Disord 2008; 22:525-37. [PMID: 18834299 PMCID: PMC2692480 DOI: 10.1521/pedi.2008.22.5.525] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research shows high comorbidity between Cluster B Personality Disorders (PDs) and Alcohol Use Disorders (AUDs). Studies of personality traits and alcohol use have identified coping and enhancement drinking motives as mediators of the relation among impulsivity, negative affectivity or affectivity instability, and alcohol use. To the extent that certain PDs reflect extreme expression of these traits, drinking motives were hypothesized to mediate the relation between PD symptoms and presence/absence of an alcohol use disorder (AUD). This hypothesis was tested using a series of cross-sectional and prospective path models estimating the extent that coping and enhancement drinking motives mediated the relation between cluster A, B, and C PD symptom counts and AUD diagnosis among a sample of 168 young adults between ages 18 and 21. Enhancement motives mediated the cross-sectional relation between Cluster B symptoms and AUD. Prospectively, enhancement motives partially mediated the relation between Cluster B personality symptoms and AUD through the stability of Year 1 AUD to Year 3 AUD. Results suggest that enhancement motives may be especially important in understanding the relation between Cluster B personality disorders and AUDs.
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Affiliation(s)
- Sarah L Tragesser
- Department of Psychology, Washington State University, 2710 University Drive, Richland, WA 99354, USA.
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Sher L, Stanley BH, Cooper TB, Malone KM, Mann JJ, Oquendo MA. Serotonergic responses in depressed patients with or without a history of alcohol use disorders and healthy controls. Eur Neuropsychopharmacol 2008; 18:692-9. [PMID: 18590952 PMCID: PMC3785085 DOI: 10.1016/j.euroneuro.2008.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 05/13/2008] [Accepted: 05/19/2008] [Indexed: 01/21/2023]
Abstract
Dysfunction of serotonergic neurotransmission has been implicated in the etiopathogenesis of major depression (MDD) and alcohol use disorders (AUD). To compare serotonin function in MDD with co-occurring AUD (MDD/AUD), MDD without co-occurring AUD (MDD only) and healthy controls (HC) we sought to study differences in prolactin responses to fenfluramine administration in patients with MDD/AUD, patients with MDD only and HC. In all, 169 subjects (62 MDD/AUD, 75 MDD only, and 32 HC) were entered into the study. Controlling for gender, prolactin responses were lower in the MDD/AUD group compared to the MDD only or the HC group. Controlling for gender and aggression, prolactin responses in the MDD/AUD group remained significantly lower compared to the HC group but the difference between the MDD/AUD and the MDD only groups disappeared. The difference in prolactin responses between MDD/AUD and MDD only could be attributed to higher aggression scores in the MDD/AUD group compared to the MDD group.
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Affiliation(s)
- Leo Sher
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY 10032, USA.
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Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2008; 69:1033-45. [PMID: 18557663 PMCID: PMC2669224 DOI: 10.4088/jcp.v69n0701] [Citation(s) in RCA: 185] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To present nationally representative findings on prevalence, sociodemographic correlates, disability, and comorbidity of narcissistic personality disorder (NPD) among men and women. METHOD Face-to-face interviews with 34,653 adults participating in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions conducted between 2004 and 2005 in the United States. RESULTS Prevalence of lifetime NPD was 6.2%, with rates greater for men (7.7%) than for women (4.8%). NPD was significantly more prevalent among black men and women and Hispanic women, younger adults, and separated/divorced/widowed and never married adults. NPD was associated with mental disability among men but not women. High co-occurrence rates of substance use, mood, and anxiety disorders and other personality disorders were observed. With additional comorbidity controlled for, associations with bipolar I disorder, post-traumatic stress disorder, and schizotypal and borderline personality disorders remained significant, but weakened, among men and women. Similar associations were observed between NPD and specific phobia, generalized anxiety disorder, and bipolar II disorder among women and between NPD and alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive personality disorders among men. Dysthymic disorder was significantly and negatively associated with NPD. CONCLUSIONS NPD is a prevalent personality disorder in the general U.S. population and is associated with considerable disability among men, whose rates exceed those of women. NPD may not be as stable as previously recognized or described in the DSM-IV. The results highlight the need for further research from numerous perspectives to identify the unique and common genetic and environmental factors underlying the disorder-specific associations with NPD observed in this study.
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Affiliation(s)
- Frederick S. Stinson
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Deborah A. Dawson
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Rise B. Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - S. Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Attila J. Pulay
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Roger P. Pickering
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
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Suliman S, Stein DJ, Williams DR, Seedat S. DSM-IV personality disorders and their axis I correlates in the South African population. Psychopathology 2008; 41:356-64. [PMID: 18765961 PMCID: PMC3949611 DOI: 10.1159/000152377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 01/15/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of personality disorders (PD) in the South African population is largely unknown. Thus, we undertook to estimate prevalence, demographic correlates, co-morbidity and treatment rates of DSM-IV PD among South Africans. SAMPLING AND METHODS A three-stage probability sample design was used. Of the 4,433 interviews obtained, based on quality control criteria, 4,315 interviews were retained for analysis. All participants were screened for PD and axis I disorders with the World Health Organisation Composite International Diagnostic Interview. The multiple imputation method was then used to estimate prevalence. RESULTS The multiple imputation prevalence estimate in the total sample was 6.8%. All three PD clusters were significantly co-morbid with each other and with other axis I disorders. Male gender was the only significant predictor of PD. Of note was the finding that less than one fifth of participants with a possible PD diagnosis had received treatment for a mental health or substance abuse problem in the previous 12 months. CONCLUSION The high co-morbidity of PD with axis I disorders in South Africa is consistent with previous reports elsewhere. However, more research is indicated to determine the reasons for the higher prevalence of cluster A disorders than of cluster B and C disorders in this population.
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Affiliation(s)
- S Suliman
- MRC Anxiety and Stress Disorders Unit, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa.
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35
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Tragesser SL, Sher KJ, Trull TJ, Park A. Personality disorder symptoms, drinking motives, and alcohol use and consequences: cross-sectional and prospective mediation. Exp Clin Psychopharmacol 2007; 15:282-92. [PMID: 17563215 PMCID: PMC2673803 DOI: 10.1037/1064-1297.15.3.282] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Research shows high comorbidity between Cluster B personality disorders (PDs) and alcohol use disorders (AUDs). Studies on personality traits and alcohol use have identified coping and enhancement drinking motives as mediators in the relations among impulsivity, affective instability, and alcohol use. To the extent that PDs reflect extreme expression of these traits, drinking motives should mediate the relation between PD symptoms and alcohol involvement. This was tested using path models estimating the extent to which coping and enhancement drinking motives mediated the relation between Cluster B symptom counts and alcohol use and problems both concurrently and at a 5-year follow-up. Three hundred fifty-two adults participated in a multiwave study of risk for alcoholism (average age = 29 years at Wave 1). Enhancement motives mediated (a) the cross-sectional relation between Cluster B symptoms and drinking quantity/frequency, heavy drinking, total drinking consequences, dependence features, and AUD diagnosis and (b) the prospective relation to AUDs. Although coping motives mediated the relation between Cluster B symptoms and drinking consequences and dependence features cross-sectionally, prospective effects were limited to indirect effects through Time 1.
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Affiliation(s)
- Sarah L Tragesser
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO 65211, USA.
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36
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Cohen P, Chen H, Crawford TN, Brook JS, Gordon K. Personality disorders in early adolescence and the development of later substance use disorders in the general population. Drug Alcohol Depend 2007; 88 Suppl 1:S71-84. [PMID: 17227697 PMCID: PMC2034357 DOI: 10.1016/j.drugalcdep.2006.12.012] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 12/20/2006] [Indexed: 11/20/2022]
Abstract
Assessments of personality disorder (PD) and conduct disorder (CD) in a random community sample at mean age 13 were employed to predict subsequent substance abuse disorder (SUD), trajectories of symptoms of abuse or dependence on alcohol, marijuana, or other illicit substances, and hazard of initiating marijuana use over the subsequent decade. Personality disorders and conduct disorder were associated with diagnoses and symptoms of SUDs in every model and their effects were independent of correlated family risks, participant sex, and other Axis I disorders. Specific elevated PD symptoms in early adolescence were also associated with differential trajectories of already initiated SUD symptoms as well as elevated risk for future onset of SUD symptoms. For several models the greatest of these effects were shown for borderline PD and for conduct disorder, the predecessor of adult antisocial PD. Passive-aggressive PD also showed independent elevation effects on substance use symptoms for alcohol and marijuana. Analyses over 30 years suggest that Cluster B PD (borderline, histrionic, narcissistic) are independent risks for development of SUD and warrant clinical attention.
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Affiliation(s)
- Patricia Cohen
- Department of Epidemiology, New York State Psychiatric Institute, New York, NY 10032, USA.
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Shea MT, Stout RL, Yen S, Pagano ME, Skodol AE, Morey LC, Gunderson JG, McGlashan TH, Grilo CM, Sanislow CA, Bender DS, Zanarini MC. Associations in the course of personality disorders and Axis I disorders over time. JOURNAL OF ABNORMAL PSYCHOLOGY 2004; 113:499-508. [PMID: 15535783 PMCID: PMC3274820 DOI: 10.1037/0021-843x.113.4.499] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this study, the authors examined time-varying associations between schizotypal (STPD), borderline (BPD), avoidant (AVPD), or obsessive-compulsive (OCPD) personality disorders and co-occurring Axis I disorders in 544 adult participants from the Collaborative Longitudinal Personality Disorders Study. The authors tested predictions of specific longitudinal associations derived from a model of crosscutting psychobiological dimensions (L. J. Siever & K. L. Davis, 1991) with participants with the relevant Axis I disorders. The authors assessed participants at baseline and at 6-, 12-, and 24-month follow-up evaluations. BPD showed significant longitudinal associations with major depressive disorder and posttraumatic stress disorder. AVPD was significantly associated with anxiety disorders (specifically social phobia and obsessive-compulsive disorder). Two of the four personality disorders under examination (STPD and OCPD) showed little or no association with Axis I disorders.
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Affiliation(s)
- M Tracie Shea
- Department of Psychiatry and Human Behavior, Brown University Medical School, Duncan Building, 700 Butler Drive, Providence, RI 20906, USA.
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Holmberg N. The girl from Ibiza. A Socratic dialogue with a female substance abuser. NORDIC STUDIES ON ALCOHOL AND DRUGS 2000. [DOI: 10.1177/145507250001700302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cognitive therapy has lately gained a more central role in Finnish treatment of different problem behaviors. Abroad, research has shown the model to be effective in the treatment of, e.g., depression, panic disorder, eating disorders, OCD, and borderline personality disorder. From the early '80s onwards, the model has also been applied in the treatment of substance abuse.Cognitive therapy is more goal-oriented than psychodynamic therapy and is also more structured and task-oriented. Beside the purely cognitive tools, like Socratic dialogue, the therapy also includes a variety of techniques from the behavior therapy tradition. Today the therapy model is in a period of rapid change and can be seen as stressing more complex conceptualizations of the human mind and problem behaviors.The case presented in the article is a 29-year-old female with a 5-year stretch of marijuana and cocaine abuse. The patient sought treatment because of depressive episodes and problems resulting from her drug use. In the treatment process described, the therapist and the patient together analyzed and modified her dysfunctional addictive beliefs and tried to elaborate the personal meaning of her drug use. It was hypothesized that this web of meanings (and the resulting addictive beliefs) had been the key factor in the development and maintenance of the problem behavior. This was also found to be the case as through the use of Socratic dialogue the therapist guided the patient to construct new meanings and targets for her view of herself and her behavior.
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