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Smagula SF, Krafty RT, Thayer JF, Buysse DJ, Hall MH. Rest-activity rhythm profiles associated with manic-hypomanic and depressive symptoms. J Psychiatr Res 2018; 102:238-244. [PMID: 29705489 PMCID: PMC6005763 DOI: 10.1016/j.jpsychires.2018.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 04/05/2018] [Accepted: 04/18/2018] [Indexed: 11/23/2022]
Abstract
Rest-activity rhythm (RAR) disturbances are associated with mood disorders. But there remains a need to identify the particular RAR profiles associated with psychiatric symptom dimensions. Establishing such profiles would support the development of tools that track the 24-h sleep-wake phenotypes signaling clinical heterogeneity. We used data-driven clustering to identify RAR profiles in 145 adults aged 36-82 years (mean = 60, standard deviation = 9). Then we evaluated psychiatric symptom dimensions (including positive and negative affect, depressive, manic-hypomanic, panic-agoraphobic, and substance use symptoms) associated with these empirically-derived RAR profiles. Clustering identified three sub-groups characterized, on average, by: (1) earlier and more robust RARs ("earlier/robust," n = 55, 38%); (2) later and irregular RARs ("later/irregular," n = 31, 21%); and (3) later RARs and a narrower active period ("later/narrower," n = 59, 41%). Compared with the "earlier/robust" group: the "later/irregular" group had higher levels of lifetime manic-hypomanic symptoms (β (standard error) = 0.80 (0.22) higher standardized symptom units, p = 0.0004) and lifetime depression symptoms (β (standard error) = 0.73 (0.21) higher standardized symptom units, p = 0.0009); the "later/narrower" group had more lifetime depression symptoms (β (standard error) = 0.48 (0.18) higher standardized symptom units, p = 0.0076). These associations persisted after adjustments for sleep continuity and duration, suggesting that RARs are distinct behavioral correlates of clinical heterogeneity. Longitudinal studies are needed to confirm whether RAR characteristics contribute to the risk of manic and/or depressive episodes, and whether they reflect the consequences of psychiatric disturbance (e.g., on quality of life or disability). Opportunities to monitor or intervene on objectively-assessed RARs could facilitate better mental health related outcomes.
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Affiliation(s)
- Stephen F Smagula
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Robert T Krafty
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julian F Thayer
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Biagianti B, Grazzi L, Usai S, Gambini O. Dependency-like behaviors and pain coping styles in subjects with chronic migraine and medication overuse: results from a 1-year follow-up study. BMC Neurol 2014; 14:181. [PMID: 25234249 PMCID: PMC4172841 DOI: 10.1186/s12883-014-0181-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Even after successful detoxification, 20-40% of subjects presenting chronic migraine with symptomatic medication overuse (CMwMO) relapse into medication overuse within one year. In this restrospective analysis on subjects referred to our center for detoxification, we investigated whether personality traits, dependency-like behaviors and pain coping styles predicted those who relapsed into medication overuse within the 12 months following the detoxification and those who did not. Methods 63 patients with CMwMO were assessed for personality traits, mood and anxiety, pain coping styles and dependency-like behaviors prior-to and one year after a detoxification program. Results Of the 42 subjects who attended 1-year follow-up interviews, 11 relapsed into medication overuse despite a temporary benefit from detoxification and did not show clinical or psychological improvement, instead reporting increased anxiety and unmodified perpetuation of severe dependency-like behaviors. In contrast, subjects who did not relapse into medication overuse had clinical improvements that generalized to untreated domains, including decreased depressive symptoms and dependency-like behaviors, although showing unmodified low internal control over pain. Conclusions Subjects who did not fall into medication overuse throughout the 12 months following the detoxification showed improved clinical, affective and dependence-related outcomes, but not pain coping strategies. Conversely, subjects who relapsed within one year into CMwMO continued to experience significant disability, pain intensity, and dependency-like behaviors. We believe that the persistence of maladaptive pain coping strategies and residual symptomatology increase the risk for recurrent relapses, against which pharmacological interventions are only partially effective. Further studies investigating predictors of relapse are needed to inform multi-disciplinary interventions for CMwMO.
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Affiliation(s)
- Bruno Biagianti
- San Francisco Department of Veterans Affairs Medical Center, Building 16, 4150 Clement Street, San Francisco 94121, CA, USA.
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Carmassi C, Stratta P, Massimetti G, Bertelloni CA, Conversano C, Cremone IM, Miccoli M, Baggiani A, Rossi A, Dell'Osso L. New DSM-5 maladaptive symptoms in PTSD: gender differences and correlations with mood spectrum symptoms in a sample of high school students following survival of an earthquake. Ann Gen Psychiatry 2014; 13:28. [PMID: 25670961 DOI: 10.1186/s12991-014-0028-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/28/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Gender differences in post-traumatic stress disorder (PTSD) rates were confirmed across different DSM editions as well as the role of bipolar disorder (BD) comorbidity on prevalence and course, but little data is available upon new DSM-5 criteria, including maladaptive behaviors. The aim of this study was to investigate gender differences in DSM-5 PTSD in a sample of young adult earthquake survivors and the impact of lifetime mood spectrum comorbidity. METHODS Five hundred twelve young adult survivors from the L'Aquila 2009 earthquake were evaluated by Trauma and Loss Spectrum-Self Report (TALS-SR) and Mood Spectrum-Self Report (MOODS-SR). RESULTS Females showed significantly higher DSM-5 PTSD prevalence rates than men. Similarly, female survivors with DSM-5 PTSD showed significantly higher scores in several of the MOODS-SR and TALS-SR domains with respect to males. Males showed significantly higher scores in the TALS-SR maladaptive coping domain only. A significant positive association between the MOODS-SR manic-hypomanic component and TALS-SR potentially traumatic events and maladaptive coping domains emerged in the whole sample, particularly among men. CONCLUSION This study allows a first glimpse on gender differences in DSM-5 PTSD criteria in a sample of earthquake survivors. Further, possible correlations with subthreshold manic-hypomanic comorbidity are suggested among males, showing a significant trend particularly for lifetime trauma exposure and for the newly introduced maladaptive behaviors.
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Campos-Melady M, Smith JE. Memory associations between negative emotions and alcohol on the lexical decision task predict alcohol use in women. Addict Behav 2012; 37:60-6. [PMID: 21968228 DOI: 10.1016/j.addbeh.2011.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 07/10/2011] [Accepted: 08/31/2011] [Indexed: 10/17/2022]
Abstract
Implicit alcohol expectancies, or beliefs about alcohol which exist in the form of automatic memory associations, are thought to uniquely affect drinking behavior. Research also has indicated that there may be a distinctive relationship between negative reinforcement and alcohol use in women. However, the most common measures used to examine implicit alcohol cognitions may be insufficient to examine associations involving negative reinforcement. The current study utilized the Lexical Decision Task (LDT) to examine the relationship between implicit alcohol cognitions and reported drinking in a sample of college women. Seventy-eight female participants completed a LDT including alcohol- and emotion-words, questionnaire measures of explicit alcohol expectancies, and a measure of drinking behavior at baseline and after two months. Strong associations between negative emotion-words and alcohol-words (as measured by the LDT) were found to predict drinking at follow up, and to account for unique variance in drinking beyond the contribution of explicit measures. In addition, women who reported heavier drinking in response to social conflict on an explicit measure showed stronger priming of alcohol words by negative emotion words, thus implying that the LDT may tap into implicit cognitions related to alcohol use as a method of coping. These findings suggest that the LDT is sensitive to negative-reinforcement associations in a way that other measures are not.
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Bizzarri JV, Rucci P, Casalboni D, Randi S, Girelli M, Pojer F, Sbrana A. Substance use and psychiatric symptoms in subjects referred to the Drug Addiction Services by the Prefecture. ACTA ACUST UNITED AC 2007; 16:73-8. [DOI: 10.1017/s1121189x00004632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hassel S, Almeida JR, Frank E, Versace A, Nau SA, Klein CR, Kupfer DJ, Phillips ML. Prefrontal cortical and striatal activity to happy and fear faces in bipolar disorder is associated with comorbid substance abuse and eating disorder. J Affect Disord 2009; 118:19-27. [PMID: 19243839 PMCID: PMC2745518 DOI: 10.1016/j.jad.2009.01.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 01/14/2009] [Accepted: 01/19/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The spectrum approach was used to examine contributions of comorbid symptom dimensions of substance abuse and eating disorder to abnormal prefrontal-cortical and subcortical-striatal activity to happy and fear faces previously demonstrated in bipolar disorder (BD). METHOD Fourteen remitted BD-type I and sixteen healthy individuals viewed neutral, mild and intense happy and fear faces in two event-related fMRI experiments. All individuals completed Substance-Use and Eating-Disorder Spectrum measures. Region-of-Interest analyses for bilateral prefrontal and subcortical-striatal regions were performed. RESULTS BD individuals scored significantly higher on these spectrum measures than healthy individuals (p<0.05), and were distinguished by activity in prefrontal and subcortical-striatal regions. BD relative to healthy individuals showed reduced dorsal prefrontal-cortical activity to all faces. Only BD individuals showed greater subcortical-striatal activity to happy and neutral faces. In BD individuals, negative correlations were shown between substance use severity and right PFC activity to intense happy faces (p<0.04), and between substance use severity and right caudate nucleus activity to neutral faces (p<0.03). Positive correlations were shown between eating disorder and right ventral putamen activity to intense happy (p<0.02) and neutral faces (p<0.03). Exploratory analyses revealed few significant relationships between illness variables and medication upon neural activity in BD individuals. LIMITATIONS Small sample size of predominantly medicated BD individuals. CONCLUSION This study is the first to report relationships between comorbid symptom dimensions of substance abuse and eating disorder and prefrontal-cortical and subcortical-striatal activity to facial expressions in BD. Our findings suggest that these comorbid features may contribute to observed patterns of functional abnormalities in neural systems underlying mood regulation in BD.
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Affiliation(s)
- Stefanie Hassel
- University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA.
| | - Jorge R. Almeida
- University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA,Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Ellen Frank
- University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Amelia Versace
- University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Sharon A. Nau
- University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Crystal R. Klein
- University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - David J. Kupfer
- University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Mary L. Phillips
- University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA,University of Cardiff, School of Medicine, Department of Psychological Medicine, Cardiff, UK
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Suppiger A, In-Albon T, Hendriksen S, Hermann E, Margraf J, Schneider S. Acceptance of structured diagnostic interviews for mental disorders in clinical practice and research settings. Behav Ther 2009; 40:272-9. [PMID: 19647528 DOI: 10.1016/j.beth.2008.07.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 06/26/2008] [Accepted: 07/23/2008] [Indexed: 11/24/2022]
Abstract
The objective of this study was to investigate the acceptance of structured diagnostic interviews in clinical practice, as well as research, settings. Using the Diagnostisches Interview bei Psychischen Störungen (the modified and extended German version of the Anxiety Disorders Interview Schedule for DSM-IV), 10 certified interviewers conducted 183 structured interviews in different inpatient, outpatient, and research settings in Switzerland and Germany. After each interview, patients and interviewers filled out a questionnaire asking for their evaluation of the interview. Patients' and interviewers' reactions to the interview were highly positive. On a scale measuring overall satisfaction with the interview (0=not at all satisfied, 100=totally satisfied) the mean patient rating was 86.55 (SD=13.18), and the mean interviewer rating was 85.82 (SD=12.84). The procedure used by the interviewer was rated by 142 (78.5%) patients as being helpful, and 176 (96.7%) rated the relationship as being positive. Less than 16% of the interviews were described as exhausting by the patients and interviewers. A majority of the interviewers (92.6%) indicated that during the interview they could respond adequately to the patient. The results of this study indicate that structured diagnostic interviews are highly accepted by interviewers and patients in a variety of settings. These findings, together with the existing evidence of the reliability and validity of structured interviews, should encourage their use in the diagnostic process, in outpatient and inpatient clinical settings as well as in research studies.
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Dell'Osso L, Carmassi C, Rucci P, Conversano C, Shear MK, Calugi S, Maser JD, Endicott J, Fagiolini A, Cassano GB. A multidimensional spectrum approach to post-traumatic stress disorder: comparison between the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) and the Self-Report instrument (TALS-SR). Compr Psychiatry 2009; 50:485-90. [PMID: 19683620 DOI: 10.1016/j.comppsych.2008.11.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Revised: 10/19/2008] [Accepted: 11/02/2008] [Indexed: 10/21/2022] Open
Abstract
Dimensional approaches to psychiatric disorders have shown an increased relevance in the ongoing debate for the forthcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In line with previously validated instruments for the assessment of different mood, anxiety, eating and psychotic spectra, we tested the validity and reliability of a newly developed Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS). The instrument is based on a multidimensional approach to post-traumatic stress spectrum that includes a range of threatening or frightening experiences, as well as a variety of potentially significant losses, to which an individual can be exposed. Furthermore, it explores the spectrum of the peritraumatic reactions and post-traumatic symptoms that may ensue from either type of life events, targeting soft signs and subthreshold conditions, as well as temperamental and personality traits that may constitute risk factors for the development of the disorder. The aim of the present study is to describe the reliability of the self-report version of the SCI-TALS: the TALS-SR. Thirty patients with PTSD and thirty healthy control subjects were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Half of the patients and controls received the TALS-SR first and the SCI-TALS after 15 days; for the other half of the sample, the order of administration was reversed. Agreement between the self-report and the interview formats was substantial. Intraclass correlation coefficients ranged from 0.934 to 0.994, always exceeding the threshold of 0.90. Our findings provide substantial support for the reliability of the TALS-SR questionnaire.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy
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Bizzarri JV, Rucci P, Sbrana A, Miniati M, Raimondi F, Ravani L, Massei GJ, Milani F, Milianti M, Massei G, Gonnelli C, Cassano GB. Substance use in severe mental illness: self-medication and vulnerability factors. Psychiatry Res 2009; 165:88-95. [PMID: 19054572 DOI: 10.1016/j.psychres.2007.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 10/12/2007] [Accepted: 10/19/2007] [Indexed: 01/16/2023]
Abstract
The aim of this article is to examine the onset and clinical correlates of substance use in patients with psychotic disorders. One hundred and eight inpatients and outpatients with DSM-IV psychotic disorders were evaluated with the SCI-SUBS, an instrument designed to explore the spectrum of substance use and its clinical correlates. Comparisons were made between subjects with (n=47) and without (n=61) a DSM-IV diagnosis of substance use disorder (SUD). In patients with an early onset of psychosis (<17 years), the onset of SUD was subsequent. Patients with SUD had higher substance sensitivity, higher sensation-seeking traits and were more likely to self-medicate than patients without SUD. The reasons for self-medication endorsed by patients with SUD included relieving depression, achieving or maintaining euphoria, improving self-confidence and social abilities. Our results, based on a cross-sectional study, suggest that early onset of psychosis, substance sensitivity and sensation-seeking traits represent vulnerability factors for SUD. The relationships between SUD and psychosis should be examined systematically and clarified in longitudinal studies.
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Laker CJ. A literature review to assess the reliability and validity of measures appropriate for use in research to evaluate the efficacy of a brief harm reduction strategy in reducing cannabis use among people with schizophrenia in acute inpatient settings. J Psychiatr Ment Health Nurs 2008; 15:777-83. [PMID: 18844804 DOI: 10.1111/j.1365-2850.2008.01297.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is a growing body of evidence looking at the effects of cannabis use on those with schizophrenia with concerning results. This has led to the development of a number of interventions that are intended to improve outcomes for this client group. However, the methodological quality of some dual diagnosis research has been questioned in reviews for using outcome measures that are not tested as reliable and valid in the population for which they are intended for use. This literature review assesses the self-report measures that have been reliability and validity tested in populations of people with schizophrenia who use cannabis and reports on their appropriateness for use in further research studies. An overview of the most appropriate biochemical tests for cannabis is also given.
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Affiliation(s)
- C J Laker
- Health Services Research, Institute of Psychiatry, King's College, London, UK.
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Dell'osso L, Shear MK, Carmassi C, Rucci P, Maser JD, Frank E, Endicott J, Lorettu L, Altamura CA, Carpiniello B, Perris F, Conversano C, Ciapparelli A, Carlini M, Sarno N, Cassano GB. Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS). Clin Pract Epidemiol Ment Health 2008; 4:2. [PMID: 18226228 PMCID: PMC2265706 DOI: 10.1186/1745-0179-4-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 01/28/2008] [Indexed: 11/29/2022]
Abstract
Background DSM-IV identifies three stress response disorders (acute stress (ASD), post-traumatic stress (PTSD) and adjustment disorders (AD)) that derive from specific life events. An additional condition of complicated grief (CG), well described in the literature, is triggered by bereavement. Methods This paper reports on the reliability and validity of the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) developed to assess the spectrum of stress response. The instrument is based on a spectrum model that emphasizes soft signs, low-grade symptoms, subthreshold syndromes, as well as temperamental and personality traits comprising clinical and subsyndromal manifestations. Study participants, enrolled at 6 Italian Departments of Psychiatry, included consecutive patients with PTSD (N = 48), CG (N = 44), and controls (N = 48). Results We showed good reliability and validity of the SCI-TALS. Domain scores were significantly higher in participants with PTSD or CG compared to controls. There were high correlations between specific SCI-TALS domains and corresponding scores on established measures of similar constructs. Participants endorsing grief and loss events reported similar scores on all instruments, except those with CG who scored significantly higher on the domain of grief reactions. Conclusion These results support the existence of a specific grief-related condition and the proposal that different forms of stress response have similar manifestations.
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Affiliation(s)
- Liliana Dell'osso
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Italy.
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Bizzarri JV, Sbrana A, Rucci P, Ravani L, Massei GJ, Gonnelli C, Spagnolli S, Doria MR, Raimondi F, Endicott J, Dell'Osso L, Cassano GB. The spectrum of substance abuse in bipolar disorder: reasons for use, sensation seeking and substance sensitivity. Bipolar Disord 2007; 9:213-20. [PMID: 17430295 DOI: 10.1111/j.1399-5618.2007.00383.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the spectrum of alcohol and substance abuse, including reasons for use, in patients with bipolar I disorder, compared with patients with substance use disorder and healthy controls, with a specific focus on the relationship between substance use, substance sensitivity, other comorbid psychiatric symptoms and traits related to sensation seeking. METHODS This study included 104 patients with bipolar I disorder (BPD I), of whom 57 (54.8%) met DSM-IV criteria for lifetime alcohol or substance use disorder (BPD + SUD), 35 patients with substance use disorder (SUD) and no psychiatric disorder and 50 healthy controls. Assessments included the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) and the Structured Clinical Interview for the Spectrum of Substance Use (SCI-SUBS). RESULTS Patients with BPD + SUD and SUD had significantly higher scores on the SCI-SUBS domains of self-medication, substance sensitivity and sensation seeking compared with patients with BPD and healthy controls. Reasons for substance use did not differ between patients with BPD + SUD and patients with SUD. Those most frequently cited were: improving mood; relieving tension; alleviating boredom; achieving/maintaining euphoria; and increasing energy. CONCLUSIONS Recourse to substances is associated with increased mood and anxiety symptoms, substance sensitivity, and sensation seeking among patients with BPD + SUD and SUD. Substance sensitivity and sensation seeking traits should be investigated in all patients with BPD as possible factors associated with a development of SUD, in order to warn patients of the specific risks related to improper use of medications and substances.
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13
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Bizzarri JV, Rucci P, Sbrana A, Gonnelli C, Massei GJ, Ravani L, Girelli M, Dell'osso L, Cassano GB. Reasons for substance use and vulnerability factors in patients with substance use disorder and anxiety or mood disorders. Addict Behav 2007; 32:384-91. [PMID: 16797139 DOI: 10.1016/j.addbeh.2006.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 04/07/2006] [Accepted: 04/18/2006] [Indexed: 11/23/2022]
Abstract
This cross-sectional study examined the reasons for substance use and the presence of vulnerability factors such as substance sensitivity, sensation seeking, and symptoms related to the attention deficit hyperactivity disorder (ADHD) in patients with substance use disorder (SUD) and comorbid mood and anxiety disorders by using the Structured Clinical Interview for the Spectrum of Substance Use (SCI-SUBS), a novel instrument designed to explore the spectrum of substance use and its clinical correlates. Study participants included 61 patients with SUD and mood or anxiety disorder, and two comparison groups including 35 patients with SUD only and 50 controls not in treatment for mental disorders or SUD. We found that patients with co-morbid mood or anxiety disorder had significantly higher scores on the SCI-SUBS domains 'substance sensitivity' and 'self-medication' as compared to those with SUD only. Scores on 'sensation seeking' and 'ADHD' domains were similar between both groups of patients and higher than in controls. Patients with comorbid mood or anxiety disorders showed a higher sensitivity to substances and were more prone to self-medication than those with SUD only. These characteristics should be taken into account in the diagnostic assessment and in long-term treatment to decrease the risk of relapse.
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Affiliation(s)
- Jacopo V Bizzarri
- Drug Addiction Service of Bolzano, Ser.T., Servizio per le Dipendenze, Via del Ronco 3, 39100 Bolzano, Italy.
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Abstract
OBJECTIVE No clear consensus exists regarding the effect of sustained, heavy drinking on hippocampal volume. Our prior work hypothesized significantly lowered total hippocampus volumes in heavy chronically drinking alcohol-dependent (AD) subjects compared with light-drinking nondependent control subjects matched for age and gender. METHOD Using a series of applicable exclusion criteria culled from previous published studies, we measured hippocampal volumes from MRI scan data acquired on a 3T scanner and subjected those data to automated volume analysis blind to the drinking history. RESULTS Comparison with AD test (n=8) and non-AD control (n=8) subjects found significant lessening in total (p=0.020) and left (p=0.010) hippocampal volumes with a near-significant difference on the right (p=0.051). Linear regression demonstrated that neither total brain volume nor intracranial volume affected the hippocampus measures. CONCLUSIONS These data support the view that heavy drinking exerts a unique and selectively injurious effect on the hippocampus. Further study in larger samples must verify this in a search for possible mechanisms of injury.
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Affiliation(s)
- Thomas P Beresford
- Mental Health Service, Department of Veterans Affairs Medical Center, University of Colorado School of Medicine, 1055 Clermont Street, Denver, CO 80220, USA.
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Sbrana A, Bizzarri JV, Rucci P, Gonnelli C, Doria MR, Spagnolli S, Ravani L, Raimondi F, Dell'Osso L, Cassano GB. The spectrum of substance use in mood and anxiety disorders. Compr Psychiatry 2005; 46:6-13. [PMID: 15714188 DOI: 10.1016/j.comppsych.2004.07.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study evaluates the prevalence of threshold and subthreshold use of substances among patients with psychiatric disorders and 2 comparison groups. Participants were outpatients and inpatients with mood and anxiety disorders, subjects with opiate dependence, and a comparison group of individuals not undergoing treatment for psychiatric disorders. Assessments included the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , Axis I Disorders, an interview exploring the spectrum of substance use (Structured Clinical Interview for the Spectrum of Substance Use), and a self-report instrument exploring the spectrum of 5 psychiatric disorders (General 5-Spectrum Measure). The overall frequency of substance use disorder (SUD) and that of subthreshold use were 46% and 8% in patients with bipolar disorder, 4% and 26% in those with panic disorder, 8% and 26% in those with obsessive-compulsive disorder, and 6% and 10% in the control group, respectively ( Idouble dagger 2 = 51.6, P < .001). Inspection of standardized residuals indicated that alcohol use disorder and SUD were significantly ( P < .05) more frequent in subjects with bipolar disorder than among those with obsessive-compulsive disorder or panic disorder. The latter showed a significantly higher subthreshold use of substances than control subjects. The pattern of motivations for use varied according to the psychiatric disorder. Our results suggest that the well-established relationship between SUDs and psychiatric disorders might be the end point of a process that starts from increased proneness to substance use, which first leads to self-medication and then may eventually develop into substance abuse or dependence, among subjects with psychiatric symptoms.
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Affiliation(s)
- Alfredo Sbrana
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, 56127 Pisa, Italy.
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