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Thompson KN. Current Complexities in Establishing Risk Factors for Attention-Deficit/Hyperactivity Disorder in Longitudinal Research. Biol Psychiatry 2024; 95:820-821. [PMID: 38599707 DOI: 10.1016/j.biopsych.2024.02.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Katherine N Thompson
- Department of Sociology, College of Liberal Arts, Purdue University, West Lafayette, Indiana.
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Bryan BT, Thompson KN, Goldman-Mellor S, Moffitt TE, Odgers CL, So SLS, Uddin Rahman M, Wertz J, Matthews T, Arseneault L. The socioeconomic consequences of loneliness: Evidence from a nationally representative longitudinal study of young adults. Soc Sci Med 2024; 345:116697. [PMID: 38490911 DOI: 10.1016/j.socscimed.2024.116697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/24/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024]
Abstract
The negative health consequences of loneliness have led to increasing concern about the economic cost of loneliness in recent years. Loneliness may also incur an economic burden more directly, by impacting socioeconomic position. Much of the research to date has focused on employment status which may not fully capture socioeconomic position and has relied on cross-sectional data, leaving questions around the robustness of the association and reverse causation. The present study used longitudinal data to test prospective associations between loneliness and multiple indicators of social position in young adulthood, specifically, whether participants who were lonelier at age 12 were more likely to be out of employment, education and training (NEET) and lower on employability and subjective social status as young adults. The data were drawn from the Environmental Risk (E-Risk) Longitudinal Twin Study, a birth cohort of 2,232 individuals born in England and Wales during 1994-1995. Loneliness and subjective social status were measured at ages 12, 18 and 26. Employability and NEET status were assessed at age 18. Findings indicate that greater loneliness at age 12 was prospectively associated with reduced employability and lower social status in young adulthood. The association between loneliness and lower social status in young adulthood was robust when controlling for a range of confounders using a sibling-control design. Results also indicate that loneliness is unidirectionally associated with reduced subjective social status across adolescence and young adulthood. Overall, our findings suggest that loneliness may have direct costs to the economy resulting from reduced employability and social position, underlining the importance of addressing loneliness early in life.
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Affiliation(s)
- Bridget T Bryan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Katherine N Thompson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK; Department of Sociology, College of Liberal Arts, Purdue University, 700 Mitch Daniels Blvd, West Lafayette, Indiana 47907-2059, USA
| | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California Merced, 5200 North Lake Road, Merced, 95343, USA
| | - Terrie E Moffitt
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK; Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, 27708, USA
| | - Candice L Odgers
- Department of Psychological Science, University of California Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, 92617, USA
| | - Sincere Long Shin So
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK; Chinese University of Hong Kong, Central Ave, Hong Kong, China
| | - Momtahena Uddin Rahman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Jasmin Wertz
- Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Timothy Matthews
- School of Human Sciences, University of Greenwich, Park Row, London, SE10 9LS, UK
| | - Louise Arseneault
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
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Bryan BT, Andrews G, Thompson KN, Qualter P, Matthews T, Arseneault L. Loneliness in the workplace: a mixed-method systematic review and meta-analysis. Occup Med (Lond) 2023; 73:557-567. [PMID: 38285544 PMCID: PMC10824263 DOI: 10.1093/occmed/kqad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Loneliness is a risk factor for a range of mental and physical health problems and has gained increasing interest from policy-makers and researchers in recent years. However, little attention has been paid to loneliness at work and its implications for workers and employers. AIMS Identify workplace, health and personal factors associated with workplace loneliness. METHODS We searched five databases (PubMed, MEDLINE, EMBASE, PsycINFO and EBSCO Business Source Complete) for relevant articles published from 1 January 2000 to 23 February 2023. Quantitative data were synthesized using narrative synthesis and random-effects meta-analysis of correlation coefficients. Qualitative data were synthesized using thematic synthesis. Evidence quality was appraised using the Mixed-Methods Appraisal Tool. RESULTS We identified 49 articles meeting the inclusion criteria. Pooled results indicate that workplace loneliness was associated with lower job performance (r = -0.35, 95% CI -0.49, -0.21), reduced job satisfaction (r = -0.34, 95% CI -0.44, -0.24), worse worker-manager relationship (r = -0.31, 95% CI -0.38, -0.24) and elevated burnout (r = 0.39, 95% CI 0.25, 0.51). Qualitative results suggest links between loneliness and inadequate workplace social interactions and mental health problems. As most studies used cross-sectional data and few adjusted for potential confounders, the direction and robustness of the associations remain untested. CONCLUSIONS Our results indicate that loneliness is associated with poor occupational functioning and well-being among workers. Results also show that loneliness is associated with modifiable aspects of the work environment, suggesting that the workplace may offer a fruitful avenue for interventions targeting loneliness.
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Affiliation(s)
- B T Bryan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - G Andrews
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- School of Psychology, Cardiff University, Cardiff, UK
| | - K N Thompson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - P Qualter
- Manchester Institute of Education, University of Manchester, Manchester, UK
| | - T Matthews
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- School of Human Sciences, University of Greenwich, London, UK
| | - L Arseneault
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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O’Donoghue B, Michel C, Thompson KN, Cavelti M, Eaton S, Betts JK, Fowler C, Luebbers S, Kaess M, Chanen AM. Neighbourhood characteristics and the treated incidence rate of borderline personality pathology among young people. Aust N Z J Psychiatry 2023; 57:1263-1270. [PMID: 36864694 PMCID: PMC10466981 DOI: 10.1177/00048674231157274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE The impact of the wider social environment, such as neighbourhood characteristics, has not been examined in the development of borderline personality disorder. This study aimed to determine whether the treated incidence rate of full-threshold borderline personality disorder and sub-threshold borderline personality disorder, collectively termed borderline personality pathology, was associated with the specific neighbourhood characteristics of social deprivation and social fragmentation. METHOD This study included young people, aged 15-24 years, who attended Orygen's Helping Young People Early programme, a specialist early intervention service for young people with borderline personality pathology, from 1 August 2000-1 February 2008. Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Personality Disorders, and census data from 2006 were used to determine the at-risk population and to obtain measures of social deprivation and fragmentation. RESULTS The study included 282 young people, of these 78.0% (n = 220) were female and the mean age was 18.3 years (SD = ±2.7). A total of 42.9% (n = 121) met criteria for full-threshold borderline personality disorder, and 57.1% (n = 161) had sub-threshold borderline personality disorder, defined as having three or four of the nine Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) borderline personality disorder criteria. There was more than a sixfold increase in the treated incidence rate of borderline personality pathology in the neighbourhoods of above average deprivation (Quartile 3) (incidence rate ratio = 6.45, 95% confidence interval: [4.62, 8.98], p < 0.001), and this was consistent in the borderline personality disorder sub-groups. This association was also present in the most socially deprived neighbourhood (Quartile 4) (incidence rate ratio = 1.63, 95% confidence interval: [1.10, 2.44]), however, only for those with sub-threshold borderline personality disorder. The treated incidence of borderline personality pathology increased incrementally with the level of social fragmentation (Quartile 3: incidence rate ratio = 1.93, 95% confidence interval: [1.37, 2.72], Quartile 4: incidence rate ratio = 2.38, 95% confidence interval: [1.77, 3.21]). CONCLUSION Borderline personality pathology has a higher treated incidence in the more socially deprived and fragmented neighbourhoods. These findings have implications for funding and location of clinical services for young people with borderline personality pathology. Prospective, longitudinal studies should examine neighbourhood characteristics as potential aetiological factors for borderline personality pathology.
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Affiliation(s)
- Brian O’Donoghue
- Department of Psychiatry, University College Dublin, Dublin, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katherine N Thompson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Jennifer K Betts
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | - Stefan Luebbers
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, VIC, Australia
| | - Michael Kaess
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, VIC, Australia
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Andrew M Chanen
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
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Bright SJ, Hübel C, Young KS, Bristow S, Peel AJ, Rayner C, Mundy J, Palmos AB, Purves KL, Kalsi G, Armour C, Jones IR, Hotopf M, McIntosh AM, Smith DJ, Walters JTR, Rogers HC, Thompson KN, Adey BN, Monssen D, Kakar S, Malouf CM, Hirsch C, Glen K, Kelly EJ, Veale D, Eley TC, Breen G, Davies MR. Sociodemographic, mental health, and physical health factors associated with participation within re-contactable mental health cohorts: an investigation of the GLAD Study. BMC Psychiatry 2023; 23:542. [PMID: 37495971 PMCID: PMC10373233 DOI: 10.1186/s12888-023-04890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/19/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The Genetic Links to Anxiety and Depression (GLAD) Study is a large cohort of individuals with lifetime anxiety and/or depression, designed to facilitate re-contact of participants for mental health research. At the start of the pandemic, participants from three cohorts, including the GLAD Study, were invited to join the COVID-19 Psychiatry and Neurological Genetics (COPING) study to monitor mental and neurological health. However, previous research suggests that participation in longitudinal studies follows a systematic, rather than random, process, which can ultimately bias results. Therefore, this study assessed participation biases following the re-contact of GLAD Study participants. METHODS In April 2020, all current GLAD Study participants (N = 36,770) were invited to the COPING study. Using logistic regression, we investigated whether sociodemographic, mental, and physical health characteristics were associated with participation in the COPING baseline survey (aim one). Subsequently, we used a zero-inflated negative binomial regression to examine whether these factors were also related to participation in the COPING follow-up surveys (aim two). RESULTS For aim one, older age, female gender identity, non-binary or self-defined gender identities, having one or more physical health disorders, and providing a saliva kit for the GLAD Study were associated with an increased odds of completing the COPING baseline survey. In contrast, lower educational attainment, Asian or Asian British ethnic identity, Black or Black British ethnic identity, higher alcohol consumption at the GLAD sign-up survey, and current or ex-smoking were associated with a reduced odds. For aim two, older age, female gender, and saliva kit provision were associated with greater COPING follow-up survey completion. Lower educational attainment, higher alcohol consumption at the GLAD Study sign-up, ex-smoking, and self-reported attention deficit hyperactivity disorder had negative relationships. CONCLUSIONS Participation biases surrounding sociodemographic and physical health characteristics were particularly evident when re-contacting the GLAD Study volunteers. Factors associated with participation may vary depending on study design. Researchers should examine the barriers and mechanisms underlying participation bias in order to combat these issues and address recruitment biases in future studies.
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Affiliation(s)
- Steven J Bright
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Christopher Hübel
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
- Department of Economics and Business Economics, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Katherine S Young
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Shannon Bristow
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Alicia J Peel
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Christopher Rayner
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Jessica Mundy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Alish B Palmos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Kirstin L Purves
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Gursharan Kalsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Cherie Armour
- Research Centre for Stress, Trauma & Related Conditions (STARC), School of Psychology, Queen's University Belfast (QUB), Belfast, Northern Ireland, UK
| | - Ian R Jones
- Division of Psychiatry and Clinical Neurosciences, National Centre for Mental Health and MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Matthew Hotopf
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Daniel J Smith
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - James T R Walters
- Division of Psychiatry and Clinical Neurosciences, National Centre for Mental Health and MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Henry C Rogers
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Katherine N Thompson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Brett N Adey
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Dina Monssen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Saakshi Kakar
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Chelsea M Malouf
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Colette Hirsch
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kiran Glen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Emily J Kelly
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - David Veale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Thalia C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK.
| | - Molly R Davies
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
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Thompson KN, Agnew-Blais JC, Allegrini AG, Bryan BT, Danese A, Odgers CL, Matthews T, Arseneault L. Do Children With Attention-Deficit/Hyperactivity Disorder Symptoms Become Socially Isolated? Longitudinal Within-Person Associations in a Nationally Representative Cohort. JAACAP Open 2023; 1:12-23. [PMID: 37312759 PMCID: PMC10259183 DOI: 10.1016/j.jaacop.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 06/15/2023]
Abstract
Objective This study examined longitudinal associations between attention-deficit/hyperactivity disorder (ADHD) symptoms and social isolation across childhood. The study tested the direction of this association across time, while accounting for preexisting characteristics, and assessed whether this association varied by ADHD presentation, informant, sex, and socioeconomic status. Method Participants included 2,232 children from the Environmental Risk (E-Risk) Longitudinal Twin Study. ADHD symptoms and social isolation were measured at ages 5, 7, 10, and 12. Random-intercept cross-lagged panel models were used to assess the directionality of the association across childhood. Results Children with increased ADHD symptoms were consistently at increased risk of becoming socially isolated later in childhood, over and above stable characteristics (β = .05-.08). These longitudinal associations were not bidirectional; isolated children were not at risk of worsening ADHD symptoms later on. Children with hyperactive ADHD presentation were more likely to become isolated, compared with inattentive presentation. This was evident in the school setting, as observed by teachers, but not by mothers at home. Conclusion The study findings highlight the importance of enhancing peer social support and inclusion for children with ADHD, particularly in school settings. This study adds explanatory value beyond traditional longitudinal methods, as the results represent how individual children change over time, relative to their own preexisting characteristics. Diversity & Inclusion Statement We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
| | | | - Andrea G. Allegrini
- King’s College London, London, United Kingdom
- University College London, London, United Kingdom
| | | | - Andrea Danese
- King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Candice L. Odgers
- University of California Irvine, California, and Duke University, Durham, North Carolina
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7
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Rayner C, Coleman JRI, Skelton M, Armour C, Bradley J, Buckman JEJ, Davies MR, Hirsch CR, Hotopf M, Hübel C, Jones IR, Kalsi G, Kingston N, Krebs G, Lin Y, Monssen D, McIntosh AM, Mundy JR, Peel AJ, Rimes KA, Rogers HC, Smith DJ, Ter Kuile AR, Thompson KN, Veale D, Wingrove J, Walters JTR, Breen G, Eley TC. Patient characteristics associated with retrospectively self-reported treatment outcomes following psychological therapy for anxiety or depressive disorders - a cohort of GLAD study participants. BMC Psychiatry 2022; 22:719. [PMID: 36401199 PMCID: PMC9675224 DOI: 10.1186/s12888-022-04275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/21/2021] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Progress towards stratified care for anxiety and depression will require the identification of new predictors. We collected data on retrospectively self-reported therapeutic outcomes in adults who received psychological therapy in the UK in the past ten years. We aimed to replicate factors associated with traditional treatment outcome measures from the literature. METHODS Participants were from the Genetic Links to Anxiety and Depression (GLAD) Study, a UK-based volunteer cohort study. We investigated associations between retrospectively self-reported outcomes following therapy, on a five-point scale (global rating of change; GRC) and a range of sociodemographic, clinical and therapy-related factors, using ordinal logistic regression models (n = 2890). RESULTS Four factors were associated with therapy outcomes (adjusted odds ratios, OR). One sociodemographic factor, having university-level education, was associated with favourable outcomes (OR = 1.37, 95%CI: 1.18, 1.59). Two clinical factors, greater number of reported episodes of illness (OR = 0.95, 95%CI: 0.92, 0.97) and higher levels of personality disorder symptoms (OR = 0.89, 95%CI: 0.87, 0.91), were associated with less favourable outcomes. Finally, reported regular use of additional therapeutic activities was associated with favourable outcomes (OR = 1.39, 95%CI: 1.19, 1.63). There were no statistically significant differences between fully adjusted multivariable and unadjusted univariable odds ratios. CONCLUSION Therapy outcome data can be collected quickly and inexpensively using retrospectively self-reported measures in large observational cohorts. Retrospectively self-reported therapy outcomes were associated with four factors previously reported in the literature. Similar data collected in larger observational cohorts may enable detection of novel associations with therapy outcomes, to generate new hypotheses, which can be followed up in prospective studies.
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Affiliation(s)
- Christopher Rayner
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jonathan R I Coleman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Megan Skelton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Cherie Armour
- Research Centre for Stress Trauma & Related Conditions (STARC), School of Psychology, Queen's University Belfast (QUB), Belfast, Northern Ireland, UK
| | - John Bradley
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, WC1E 7HB, London, UK
- iCope - Camden & Islington Psychological Therapies Services - Camden & Islington NHS Foundation Trust, St Pancras Hospital, NW1 0PE, London, UK
| | - Molly R Davies
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Colette R Hirsch
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, SE5 8AZ, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Christopher Hübel
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Aarhus Business and Social Sciences, National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Ian R Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Gursharan Kalsi
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Nathalie Kingston
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Georgina Krebs
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, SE5 8AZ, London, UK
| | - Yuhao Lin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Dina Monssen
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jessica R Mundy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alicia J Peel
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Henry C Rogers
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Daniel J Smith
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Abigail R Ter Kuile
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Katherine N Thompson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Veale
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, SE5 8AZ, London, UK
| | - Janet Wingrove
- South London and Maudsley NHS Foundation Trust, Denmark Hill, SE5 8AZ, London, UK
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Thalia C Eley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- UK National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
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Holt H, Talaei M, Greenig M, Zenner D, Symons J, Relton C, Young KS, Davies MR, Thompson KN, Ashman J, Rajpoot SS, Kayyale AA, El Rifai S, Lloyd PJ, Jolliffe D, Timmis O, Finer S, Iliodromiti S, Miners A, Hopkinson NS, Alam B, Lloyd-Jones G, Dietrich T, Chapple I, Pfeffer PE, McCoy D, Davies G, Lyons RA, Griffiths C, Kee F, Sheikh A, Breen G, Shaheen SO, Martineau AR. Risk factors for developing COVID-19: a population-based longitudinal study (COVIDENCE UK). Thorax 2022; 77:900-912. [PMID: 34848555 PMCID: PMC8646971 DOI: 10.1136/thoraxjnl-2021-217487] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Risk factors for severe COVID-19 include older age, male sex, obesity, black or Asian ethnicity and underlying medical conditions. Whether these factors also influence susceptibility to developing COVID-19 is uncertain. METHODS We undertook a prospective, population-based cohort study (COVIDENCE UK) from 1 May 2020 to 5 February 2021. Baseline information on potential risk factors was captured by an online questionnaire. Monthly follow-up questionnaires captured incident COVID-19. We used logistic regression models to estimate multivariable-adjusted ORs (aORs) for associations between potential risk factors and odds of COVID-19. RESULTS We recorded 446 incident cases of COVID-19 in 15 227 participants (2.9%). Increased odds of developing COVID-19 were independently associated with Asian/Asian British versus white ethnicity (aOR 2.28, 95% CI 1.33 to 3.91), household overcrowding (aOR per additional 0.5 people/bedroom 1.26, 1.11 to 1.43), any versus no visits to/from other households in previous week (aOR 1.31, 1.06 to 1.62), number of visits to indoor public places (aOR per extra visit per week 1.05, 1.02 to 1.09), frontline occupation excluding health/social care versus no frontline occupation (aOR 1.49, 1.12 to 1.98) and raised body mass index (BMI) (aOR 1.50 (1.19 to 1.89) for BMI 25.0-30.0 kg/m2 and 1.39 (1.06 to 1.84) for BMI >30.0 kg/m2 versus BMI <25.0 kg/m2). Atopic disease was independently associated with decreased odds (aOR 0.75, 0.59 to 0.97). No independent associations were seen for age, sex, other medical conditions, diet or micronutrient supplement use. CONCLUSIONS After rigorous adjustment for factors influencing exposure to SARS-CoV-2, Asian/Asian British ethnicity and raised BMI were associated with increased odds of developing COVID-19, while atopic disease was associated with decreased odds. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04330599).
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Affiliation(s)
- Hayley Holt
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mohammad Talaei
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matthew Greenig
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dominik Zenner
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Clare Relton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Katherine S Young
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Molly R Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katherine N Thompson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jed Ashman
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sultan Saeed Rajpoot
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ahmed Ali Kayyale
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah El Rifai
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Philippa J Lloyd
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David Jolliffe
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Olivia Timmis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah Finer
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stamatina Iliodromiti
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Thomas Dietrich
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Iain Chapple
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Paul E Pfeffer
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David McCoy
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gwyneth Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Christopher Griffiths
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Frank Kee
- Centre for Public Health Research (NI), Queen's University Belfast, Belfast, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Seif O Shaheen
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adrian R Martineau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Thompson KN, Odgers CL, Bryan BT, Danese A, Milne BJ, Strange L, Matthews T, Arseneault L. Trajectories of childhood social isolation in a nationally representative cohort: Associations with antecedents and early adulthood outcomes. JCPP Adv 2022; 2:e12073. [PMID: 37431453 PMCID: PMC10242821 DOI: 10.1002/jcv2.12073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/09/2022] Open
Abstract
Background This study examined early life antecedents of childhood social isolation, whether these factors accounted for poor outcomes of isolated children, and how these associations varied according to patterns of stability and change in childhood isolation. Methods Participants included 2232 children from the Environmental Risk (E-Risk) Longitudinal Twin Study. We conducted growth mixture modelling (GMM) on combined parent and teacher reports of children's social isolation when children were 5, 7, 10 and 12 years, and we assessed associations with age-5 antecedents and age-18 outcomes using regression analyses. Results We identified three linear developmental trajectories of increasing (4.75%), decreasing (5.25%) and low stable (90.00%) social isolation. Age-5 attention deficit hyperactivity disorder (ADHD) symptoms, emotional problems, prosocial behaviours, maternal personality (openness) and size of school were associated with the decreasing trajectory of social isolation. When controlling for these antecedents, increasingly isolated children were still more likely to experience ADHD symptoms, loneliness, lower job optimism and lower physical activity at age 18. Conclusions Isolated children follow distinct patterns of change over childhood and isolation seems most detrimental to health at the time it is experienced. Social isolation can be a valuable indicator of co-occurring problems and provide targets for mental health intervention in young people.
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Affiliation(s)
- Katherine N. Thompson
- Social, Genetic and Developmental Psychiatry CentreInstitute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | - Candice L. Odgers
- Social Science Research InstituteDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychological ScienceUniversity of California IrvineIrvineCaliforniaUSA
| | - Bridget T. Bryan
- Social, Genetic and Developmental Psychiatry CentreInstitute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry CentreInstitute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
- Department of Child & Adolescent PsychiatryInstitute of PsychiatryPsychology & NeuroscienceKing's College LondonLondonUK
- National and Specialist CAMHS Trauma, Anxiety, and Depression ClinicSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Barry J. Milne
- Faculty of ArtsCentre of Methods and Policy Application in the Social SciencesUniversity of AucklandAucklandNew Zealand
- Faculty of ScienceDepartment of StatisticsUniversity of AucklandAucklandNew Zealand
| | - Lily Strange
- Social, Genetic and Developmental Psychiatry CentreInstitute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | - Timothy Matthews
- Social, Genetic and Developmental Psychiatry CentreInstitute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | - Louise Arseneault
- Social, Genetic and Developmental Psychiatry CentreInstitute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
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10
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Jenkins CA, Thompson KN, Nicholas CL, Hartmann JA, Chanen AM. Potential mechanisms underlying sleep disturbance in young people with borderline personality disorder features: an exploratory study. Borderline Personal Disord Emot Dysregul 2022; 9:10. [PMID: 35264240 PMCID: PMC8908552 DOI: 10.1186/s40479-022-00180-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sleep disturbance is common among young people (15-25 years) with features of borderline personality disorder (BPD). However, the mechanisms underlying sleep disturbance in BPD remain unknown. Understanding these underlying processes is essential to guide the development of sleep-improvement interventions and to optimise their efficacy through identifying beneficial treatment targets. This exploratory study aimed to investigate potential underlying mechanisms to inform future hypotheses, research development, and provide insight into potential treatment targets to improve sleep in young people with BPD. This study explored the indirect roles of emotion regulation difficulties, depression, anxiety and stress in the relationship between BPD features and sleep disturbance in young people. METHODS Sleep was measured subjectively (self-report questionnaires) and objectively (10 days wrist actigraphy) in 40 young people with BPD features and 38 healthy young people. Participants also completed the Difficulties in Emotion Regulation Scale and the Depression, Anxiety and Stress Scale. RESULTS Mediation analyses revealed that impulse control difficulties, limited emotion regulation strategies and anxiety indirectly affected the relationship between group (BPD vs. healthy) and subjective sleep disturbance in young people. Lack of emotional awareness and anxiety contributed to associations between group and objectively longer time in bed and bedtime variability, respectively. CONCLUSIONS These preliminary findings suggest that targeting emotional dysregulation (impulse control, strategies, emotional awareness) and anxiety might be beneficial for improving sleep in this population.
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Affiliation(s)
- Claire A Jenkins
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Katherine N Thompson
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | - Jessica A Hartmann
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Andrew M Chanen
- Orygen, Melbourne, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
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11
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Abstract
Sleep disturbance is commonly reported in young people with features of borderline personality disorder (BPD). Examining sleep quality and sleep-wake patterns in young people with features of BPD is essential to inform the development of sleep-improvement interventions. A scoping review was conducted according to the Joanna Briggs Institute methodology. The objectives were to map the literature regarding sleep in young people with features of BPD, highlight areas for further investigation, and provide methodological recommendations for future research. Seven data sets were included in the review. Young people with features of BPD had poorer objective and subjective sleep quality, disturbed sleep architecture (particularly rapid-eye-movement sleep), an increased vulnerability to delayed sleep phase syndrome, and more nightmares and dream anxiety, compared with healthy individuals. Future research should use both objective and subjective sleep measures, include clinical comparison groups, and focus specifically on young people with BPD.
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Affiliation(s)
- Claire A Jenkins
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katherine N Thompson
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Andrew M Chanen
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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12
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Davies MR, Buckman JEJ, Adey BN, Armour C, Bradley JR, Curzons SCB, Davies HL, Davis KAS, Goldsmith KA, Hirsch CR, Hotopf M, Hübel C, Jones IR, Kalsi G, Krebs G, Lin Y, Marsh I, McAtarsney-Kovacs M, McIntosh AM, Mundy J, Monssen D, Peel AJ, Rogers HC, Skelton M, Smith DJ, Ter Kuile A, Thompson KN, Veale D, Walters JTR, Zahn R, Breen G, Eley TC. Comparison of symptom-based versus self-reported diagnostic measures of anxiety and depression disorders in the GLAD and COPING cohorts. J Anxiety Disord 2022; 85:102491. [PMID: 34775166 DOI: 10.1016/j.janxdis.2021.102491] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 02/05/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Understanding and improving outcomes for people with anxiety or depression often requires large sample sizes. To increase participation and reduce costs, such research is typically unable to utilise "gold-standard" methods to ascertain diagnoses, instead relying on remote, self-report measures. AIMS Assess the comparability of remote diagnostic methods for anxiety and depression disorders commonly used in research. METHOD Participants from the UK-based GLAD and COPING NBR cohorts (N = 58,400) completed an online questionnaire between 2018 and 2020. Responses to detailed symptom reports were compared to DSM-5 criteria to generate symptom-based diagnoses of major depressive disorder (MDD), generalised anxiety disorder (GAD), specific phobia, social anxiety disorder, panic disorder, and agoraphobia. Participants also self-reported any prior diagnoses from health professionals, termed self-reported diagnoses. "Any anxiety" included participants with at least one anxiety disorder. Agreement was assessed by calculating accuracy, Cohen's kappa, McNemar's chi-squared, sensitivity, and specificity. RESULTS Agreement between diagnoses was moderate for MDD, any anxiety, and GAD, but varied by cohort. Agreement was slight to fair for the phobic disorders. Many participants with self-reported GAD did not receive a symptom-based diagnosis. In contrast, symptom-based diagnoses of the phobic disorders were more common than self-reported diagnoses. CONCLUSIONS Agreement for MDD, any anxiety, and GAD was higher for cases in the case-enriched GLAD cohort and for controls in the general population COPING NBR cohort. For anxiety disorders, self-reported diagnoses classified most participants as having GAD, whereas symptom-based diagnoses distributed participants more evenly across the anxiety disorders. Further validation against gold standard measures is required.
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Affiliation(s)
- Molly R Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 7HB, UK; iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Brett N Adey
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Chérie Armour
- Stress, Trauma & Related Conditions (STARC) research lab, School of Psychology, Queens University Belfast (QUB), Belfast, Northern Ireland, UK
| | - John R Bradley
- NIHR BioResource, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, UK
| | - Susannah C B Curzons
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Helena L Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Katrina A S Davis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Kimberley A Goldsmith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Colette R Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Christopher Hübel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; National Centre for Register-based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Ian R Jones
- National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Gursharan Kalsi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Georgina Krebs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Yuhao Lin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Ian Marsh
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Monika McAtarsney-Kovacs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinurgh, UK
| | - Jessica Mundy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Dina Monssen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Alicia J Peel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - Henry C Rogers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Megan Skelton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Abigail Ter Kuile
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Katherine N Thompson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - David Veale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - James T R Walters
- National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Roland Zahn
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Thalia C Eley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK.
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13
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Peel AJ, Armour C, Buckman JE, Coleman JR, Curzons SC, Davies MR, Hübel C, Jones I, Kalsi G, McAtarsney-Kovacs M, McIntosh AM, Monssen D, Mundy J, Rayner C, Rogers HC, Skelton M, ter Kuile A, Thompson KN, Breen G, Danese A, Eley TC. Comparison of depression and anxiety symptom networks in reporters and non-reporters of lifetime trauma in two samples of differing severity. J Affect Disord Rep 2021; 6:100201. [PMID: 34988540 PMCID: PMC8689407 DOI: 10.1016/j.jadr.2021.100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/24/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Reported trauma is associated with differences in the course and outcomes of depression and anxiety. However, no research has explored the association between reported trauma and patterns of clinically relevant symptoms of both depression and anxiety. METHODS We used network analysis to investigate associations between reported trauma and depression and anxiety symptom interactions in affected individuals from the Genetic Links to Anxiety and Depression (GLAD) Study (n = 17720), and population volunteers from the UK Biobank (n = 11120). Participants with current moderate symptoms of depression or anxiety were grouped into reporters and non-reporters of lifetime trauma. Networks of 16 depression and anxiety symptoms in the two groups were compared using the network comparison test. RESULTS In the GLAD Study, networks of reporters and non-reporters of lifetime trauma did not differ on any metric. In the UK Biobank, the symptom network of reporters had significantly greater density (7.80) than the network of non-reporters (7.05). LIMITATIONS The data collected in the GLAD Study and the UK Biobank are self-reported with validated or semi-validated questionnaires. CONCLUSIONS Reported lifetime trauma was associated with stronger interactions between symptoms of depression and anxiety in population volunteers. Differences between reporters and non-reporters may not be observed in individuals with severe depression and/or anxiety due to limited variance in the presentation of disorder.
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Affiliation(s)
- Alicia J. Peel
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
| | - Chérie Armour
- School of Psychology, Queens University Belfast, Belfast BT7 1NN, Northern Ireland
| | - Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 7HB, UK
- iCope – Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, 4 St Pancras Way, London NW1 0PE, UK
| | - Jonathan R.I. Coleman
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Susannah C.B. Curzons
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Molly R. Davies
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Christopher Hübel
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ian Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK
| | - Gursharan Kalsi
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Monika McAtarsney-Kovacs
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | | | - Dina Monssen
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Jessica Mundy
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Christopher Rayner
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
| | - Henry C. Rogers
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Megan Skelton
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Abigail ter Kuile
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Katherine N. Thompson
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- National and Specialist CAMHS Trauma, Anxiety, and Depression Clinic, South London and Maudsley NHS Foundation Trust, London SE5 8AF, UK
| | - Thalia C. Eley
- Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; King's College London, London SE5 8AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
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14
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Thompson KN, Hübel C, Cheesman R, Adey BN, Armour C, Davies MR, Hotopf M, Jones IR, Kalsi G, McIntosh AM, Monssen D, Peel AJ, Rogers HC, Skelton M, Smith DJ, Walters JTR, Breen G, Eley TC. Age and sex-related variability in the presentation of generalized anxiety and depression symptoms. Depress Anxiety 2021; 38:1054-1065. [PMID: 34496112 DOI: 10.1002/da.23213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/12/2021] [Revised: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Generalized anxiety and depression are extremely prevalent and debilitating. There is evidence for age and sex variability in symptoms of depression, but despite comorbidity it is unclear whether this extends to anxiety symptomatology. Studies using questionnaire sum scores typically fail to address this phenotypic complexity. METHOD We conducted exploratory and confirmatory factor analyses on Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) items to identify latent factors of anxiety and depression in participants from the Genetic Links to Anxiety and Depression Study (N = 35,637; 16-93 years). We assessed age- and sex-related variability in latent factors and individual symptoms using multiple logistic regression. RESULTS Four factors of mood, worry, motor, and somatic symptoms were identified (comparative fit index [CFI] = 0.99, Tucker-Lewis Index [TLI] = 0.99, root mean square error of approximation [RMSEA] = 0.07, standardized root mean square residuals [SRMR] = 0.04). Symptoms of irritability (odds ratio [OR] = 0.81) were most strongly associated with younger age, and sleep change (OR = 1.14) with older age. Males were more likely to report mood and motor symptoms (p < .001) and females to report somatic symptoms (p < .001). CONCLUSION Significant age and sex variability suggest that classic diagnostic criteria reflect the presentation most commonly seen in younger males. This study provides avenues for diagnostic adaptation and factor-specific interventions.
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Affiliation(s)
- Katherine N Thompson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - Christopher Hübel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rosa Cheesman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Brett N Adey
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - Chérie Armour
- Stress, Trauma & Related Conditions (STARC) Research Lab, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Molly R Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Ian R Jones
- National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Gursharan Kalsi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Dina Monssen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
| | - Alicia J Peel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - Henry C Rogers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
| | - Megan Skelton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James T R Walters
- National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
| | - Thalia C Eley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
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15
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Jenkins CA, Thompson KN, Chanen AM, Hartmann JA, Nicol K, Nicholas CL. Subjective and objective sleep in young people with borderline personality disorder features. J Sleep Res 2021; 31:e13463. [PMID: 34409668 DOI: 10.1111/jsr.13463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 01/02/2023]
Abstract
Characterising sleep in young people (aged 15-25 years) with borderline personality disorder (BPD) features is crucial given the association between BPD features and sleep disturbance, negative consequences of poor sleep, and normative developmental sleep changes that occur in this age group. The present study aimed to characterise the sleep profile of young people with BPD to determine whether this profile is non-normative and specific to BPD. Participants were 96 young people (40 with BPD features, 38 healthy individuals, and 18 young people seeking help for mental health difficulties without BPD). Sleep was measured subjectively (self-report questionnaires) and objectively (10 days of actigraphy). Young people with BPD features reported poorer subjective sleep quality, greater insomnia symptoms and later chronotype than same-age healthy and clinical comparison groups. Young people with BPD features also displayed irregular sleep timing, later rise times, greater time in bed and longer sleep durations than healthy young people. Those with BPD features had superior sleep quality (greater sleep efficiency, less wake after sleep onset) and longer sleep durations than the clinical comparison group. Sleep profiles were similar across young people with BPD features with and without co-occurring depression. Overall, the findings revealed a subjective-objective sleep discrepancy and suggest that sleep-improvement interventions might be beneficial to improve subjective sleep in young people with BPD features.
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Affiliation(s)
- Claire A Jenkins
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Orygen, Parkville, Victoria., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katherine N Thompson
- Orygen, Parkville, Victoria., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, Parkville, Victoria., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica A Hartmann
- Orygen, Parkville, Victoria., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie Nicol
- Orygen, Parkville, Victoria., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
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16
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Thompson KN, Jackson H, Cavelti M, Betts J, McCutcheon L, Jovev M, Chanen AM. Number of Borderline Personality Disorder Criteria and Depression Predict Poor Functioning and Quality of Life in Outpatient Youth. J Pers Disord 2020; 34:785-798. [PMID: 30689518 DOI: 10.1521/pedi_2019_33_411] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate which factors contribute to poor functioning and poor quality of life in youth (aged 15-25 years) with borderline personality disorder (BPD), and whether the number of BPD criteria might be an independent predictor of these outcomes. A sample of 499 help-seeking outpatient youth, aged 15-25 years, was assessed. Stepwise multiple regression analyses showed that the number of BPD criteria was the best predictor of poor functioning, followed by number of mental health visits in the past month, female sex, and a current diagnosis of depression. Current depression was the best predictor of Assessment of Quality of Life utility score, followed by the number of BPD criteria. These findings underscore the clinical significance of DSM-IV BPD features (even when subthreshold for a categorical diagnosis) in youth and their effects upon social and occupational functioning and quality of life early in the course of BPD.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Henry Jackson
- School of Psychological Sciences, The University of Melbourne, Australia
| | - Marialuisa Cavelti
- Centre for Youth Mental Health, The University of Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Australia.,University Hospital of Psychiatry and Psychotherapy Bern, Switzerland
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | | | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia.,Orygen Youth Health, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia.,Orygen Youth Health, Australia
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17
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Chanen AM, Nicol K, Betts JK, Bond GR, Mihalopoulos C, Jackson HJ, Thompson KN, Jovev M, Yuen HP, Chinnery G, Ring J, Allott K, McCutcheon L, Salmon AP, Killackey E. INdividual Vocational and Educational Support Trial (INVEST) for young people with borderline personality disorder: study protocol for a randomised controlled trial. Trials 2020; 21:583. [PMID: 32591007 PMCID: PMC7320570 DOI: 10.1186/s13063-020-04471-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background The clinical onset of borderline personality disorder (BPD) usually occurs in young people (aged 12–25 years) and commonly leads to difficulty achieving and maintaining vocational (education and/or employment) engagement. While current psychosocial interventions lead to improvements in psychopathology, they have little effect upon functioning. Individual Placement and Support (IPS) is a client-driven model that assists individuals with severe mental illness to engage with education and/or employment appropriate to their personal goals, and that provides ongoing support to maintain this engagement. The objective of the INdividual Vocational and Educational Support Trial (INVEST) is to evaluate the effectiveness of adding IPS to an evidence-based early intervention programme for BPD, with the aim of improving vocational outcomes. Methods/design INVEST is a single-blind, parallel-groups, randomised controlled trial (RCT). The randomisation is stratified by gender and age and uses random permuted blocks. The interventions are 39 weeks of either IPS, or ‘usual vocational services’ (UVS). Participants will comprise 108 help-seeking young people (aged 15–25 years) with three or more DSM-5 BPD features and a desire to study or work, recruited from the Helping Young People Early (HYPE) early intervention programme for BPD at Orygen, in Melbourne, Australia. All participants will receive the HYPE intervention. After baseline assessment, staff who are blind to the intervention group allocation will conduct assessments at 13, 26, 39 and 52 weeks. At the 52-week primary endpoint, the primary outcome is the number of days in mainstream education/employment since baseline. Secondary outcomes include the cost-effectiveness of the intervention, quality of life, and BPD severity. Discussion Current treatments for BPD have little impact on vocational outcomes and enduring functional impairment is prevalent among this patient group. IPS is a targeted functional intervention, which has proven effective in improving vocational outcomes for adults and young people with psychotic disorders. This trial will investigate whether IPS is effective for improving vocational (employment and educational) outcomes among young people with subthreshold or full-syndrome BPD. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12619001220156. 13 September 2019.
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Affiliation(s)
- Andrew M Chanen
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.
| | - Katie Nicol
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Jennifer K Betts
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Gary R Bond
- IPS Employment Center, Rockville Institute and Westat Inc., 85 Mechanic Street, Suite C3-1, Box 4A, Lebanon, NH, 03766, USA
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, VIC, 3220, Australia
| | - Henry J Jackson
- Melbourne School of Psychological Sciences, Redmond Barry Building, The University of Melbourne, Parkville, Melbourne, VIC, 3010, Australia
| | - Katherine N Thompson
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Martina Jovev
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Hok Pan Yuen
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Gina Chinnery
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Judith Ring
- Travancore School, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Kelly Allott
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Louise McCutcheon
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Ashleigh P Salmon
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Eoin Killackey
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
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18
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Cavelti M, Thompson KN, Hulbert C, Betts J, Jackson H, Francey S, Homan P, Chanen AM. Exploratory comparison of auditory verbal hallucinations and other psychotic symptoms among youth with borderline personality disorder or schizophrenia spectrum disorder. Early Interv Psychiatry 2019; 13:1252-1262. [PMID: 30485670 DOI: 10.1111/eip.12763] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/31/2018] [Revised: 08/13/2018] [Accepted: 11/04/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study explored phenomenological aspects of auditory verbal hallucinations (AVH) and other psychotic symptoms among youth with borderline personality disorder (BPD). METHODS Sixty-eight outpatients, aged 15 to 25 years, were categorized into three groups according to their primary Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis and AVH symptom profile; BPD + AVH (n = 23), schizophrenia spectrum disorder (SZ) + AVH (n = 22) and BPD with no AVH (n = 23). RESULTS No differences in AVH were found between BPD + AVH and SZ + AVH. Compared with SZ + AVH, BPD + AVH scored lower on delusions and difficulty in abstract thinking and higher on hostility. BPD + AVH reported more severe self-harm, paranoid ideation, dissociation, anxiety and stress than BPD no AVH. CONCLUSIONS This study replicates, in a sample of youth, the finding from studies of adults that AVH in BPD are indistinguishable from those in SZ, when assessed with the Psychotic Symptom Rating Scales (PSYRATS). Clinicians should specifically enquire about AVH among youth with BPD. When present, AVH appear to be an indicator of a more severe form of BPD.
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Affiliation(s)
- Marialuisa Cavelti
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,University Hospital for Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shona Francey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Philipp Homan
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA.,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA.,Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
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19
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Thompson KN, Cavelti M, Chanen AM. Psychotic symptoms in adolescents with borderline personality disorder features. Eur Child Adolesc Psychiatry 2019; 28:985-992. [PMID: 30511234 DOI: 10.1007/s00787-018-1257-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/23/2018] [Accepted: 11/14/2018] [Indexed: 02/08/2023]
Abstract
Psychotic symptoms have been found to be relatively common among adults with borderline personality disorder (BPD), and to be a marker of BPD severity, but are not recognised in daily clinical practice in these patients. This study is the first to examine the prevalence of psychotic symptoms in 15-18-year olds with BPD features. It was hypothesised that adolescents with full-threshold BPD would have significantly more psychotic symptoms than adolescents with sub-threshold BPD features, and that both these groups would have significantly more psychotic symptoms than adolescents with no BPD features. A total of 171 psychiatric outpatients, aged 15-18 years, were assessed using a structured interview for DSM-IV personality disorder and categorised into three groups: no BPD features (n = 48), sub-threshold BPD features (n = 80), and full-threshold BPD (n = 43). The groups were compared on measures of psychopathology and functioning (e.g. Youth Self Report, Symptom Check List-90-R, SOFAS). Adolescents with full-threshold BPD reported more psychotic symptoms than the sub-threshold BPD group (p < .001), and both these groups reported more psychotic symptoms than those with no BPD features (p < .001). Adolescents with full-threshold BPD reported more confusion (p < .01), paranoia (p < .001), visual hallucinations (p < .001) and strange thoughts (p < .01), than the other two groups. Psychotic symptoms predicted group membership, determined by BPD severity, after adjusting for other psychopathology and functional impairment (p < .01). Assessment of unusual perceptual experiences, paranoia or odd thoughts is highly clinically relevant in adolescents with BPD features, as these symptoms are associated with a more severe clinical presentation of BPD.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Marialuisa Cavelti
- Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC, 3052, Australia. .,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia. .,Orygen Youth Health, Melbourne, Australia.
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20
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Thompson KN, Betts J, Jovev M, Nyathi Y, McDougall E, Chanen AM. Sexuality and sexual health among female youth with borderline personality disorder pathology. Early Interv Psychiatry 2019; 13:502-508. [PMID: 29076247 DOI: 10.1111/eip.12510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/24/2017] [Revised: 06/12/2017] [Accepted: 08/20/2017] [Indexed: 11/26/2022]
Abstract
AIM Borderline personality disorder (BPD) is a severe mental disorder that is characterized by unstable relationships, impulsive behaviours and identity disturbance. BPD usually has its onset between puberty and young adulthood and presents disproportionately among females in clinical settings. Taken together, this makes young women with BPD a particularly vulnerable group with regard to healthy psychosexual development. It was hypothesized that female youth with BPD pathology would be more likely to score worse on measures of sexual health and safety, and to show greater uncertainty in sexual identity formation. METHODS Fifty 15 to 24 yr-old females with 3 or more Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) BPD criteria were compared with 204 females from a nationally representative sample. Both groups were interviewed using a comprehensive interview for sexual health and relationships. The patient group completed a structured diagnostic interview. RESULTS Young women with borderline personality pathology engaged in sexual relationships at a younger age, with more sexual partners in the previous year, in more casual relationships. They were more likely to practice unsafe sex for their first sexual experience, to be coerced into unwanted sexual activity, to be unclear about their sexual identity or their sexual attraction, and to report worse overall health status. CONCLUSIONS BPD pathology in youth is associated with poor sexual health and safety, and uncertainty in sexual identity formation. These findings support the need for assessment of the sexuality and sexual health of youth with BPD, along with the need for routine screening in sexual health services for BPD features among high-risk youth.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Yolanda Nyathi
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Emma McDougall
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
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Thompson KN, Jackson H, Cavelti M, Betts J, McCutcheon L, Jovev M, Chanen AM. The Clinical Significance of Subthreshold Borderline Personality Disorder Features in Outpatient Youth. J Pers Disord 2019; 33:71-81. [PMID: 30036169 DOI: 10.1521/pedi_2018_32_330] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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] [Indexed: 11/20/2022]
Abstract
Studies among adult patients have found that subthreshold borderline personality disorder (BPD) features are associated with elevated psychosocial morbidity compared with patients with no BPD features. However, the clinical significance of subthreshold features of BPD has not been investigated among real-world patients during the clinical emergence of the disorder, which is usually between puberty and emerging adulthood. This study aimed to replicate and extend previous research by comparing outpatient youth aged 15-25 years with subthreshold BPD features with youth with no BPD features. The sample included 499 potential participants, of whom 111 had no DSM-IV BPD features at all, and 155 had between one and four features. Results indicated that the group with subthreshold BPD features had more severe mental illness and poorer social and occupational functioning. These findings suggest that subthreshold BPD features are clinically important and should be a focus of clinical intervention to reduce continuing disability and improve outcome.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Henry Jackson
- School of Psychological Sciences, The University of Melbourne
| | - Marialuisa Cavelti
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | | | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen Youth Health, Melbourne, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen Youth Health, Melbourne, Australia
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Abstract
Accurate diagnosis is fundamental to effective management of borderline personality disorder, but many patients remain undetected. The first-line management for borderline personality disorder is psychosocial treatment, not drugs. There are major prescribing hazards including polypharmacy, overdose and misuse. Drug treatment might be warranted for patients who have a co-occurring mental disorder such as major depression. If a drug is prescribed for borderline personality disorder, it should only be as an adjunct to psychosocial treatment. There should be clear and collaborative goals that are regularly reviewed with the patient. Use single drugs prescribed in limited quantities for a limited time. Stop drugs that are ineffective.
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Affiliation(s)
| | - Katherine N Thompson
- Orygen - The National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne
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Thompson KN, Phillips LJ, Komesaroff P, Yuen HP, Wood SJ, Pantelis C, Velakoulis D, Yung AR, McGorry PD. Stress and HPA-axis functioning in young people at ultra high risk for psychosis. J Psychiatr Res 2007; 41:561-9. [PMID: 16831447 DOI: 10.1016/j.jpsychires.2006.05.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [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] [Received: 03/13/2006] [Revised: 05/25/2006] [Accepted: 05/30/2006] [Indexed: 11/26/2022]
Abstract
It is thought that hypothalamic-pituitary-adrenal (HPA) axis functioning mediates between the experience of stress and development of psychotic symptoms. This study aimed to evaluate this model in a cohort of young people at ultra high risk (UHR) of psychosis. Information about the experience of psychological symptoms and recent stressful experiences was obtained from 23 young people who met UHR criteria. Plasma samples were taken to assess cortisol and glucocorticoid receptor numbers, and an MRI scan was also performed. Plasma cortisol levels were significantly and positively correlated with the experience of 'hassles' but not with the experience of stressful life events. Significant positive associations were also found between plasma cortisol levels and level of depression and anxiety. No significant relationships were found between plasma cortisol level and global psychopathology, psychotic symptomatology, functioning or pituitary and hippocampal volumes. These results suggest that the number of hassles experienced by young people at UHR of psychosis could be an important factor in raising their cortisol levels, which might, in turn, affect the severity of depressive and anxiety symptoms. No other relationships were found between plasma cortisol levels and the experience of psychotic symptoms, functioning or hippocampal and pituitary volumes. These results indicate possible impairment in HPA-axis functioning in the early stages of psychotic illness, but further investigation of the relationships between these parameters is required.
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Affiliation(s)
- K N Thompson
- PACE Clinic/Orygen Research Centre, Locked Bag 10, Parkville 3052, Australia
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Thompson KN, Berger G, Phillips LJ, Komesaroff P, Purcell R, McGorry PD. HPA axis functioning associated with transition to psychosis: combined DEX/CRH test. J Psychiatr Res 2007; 41:446-50. [PMID: 16403528 DOI: 10.1016/j.jpsychires.2005.11.010] [Citation(s) in RCA: 36] [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] [Received: 09/06/2005] [Revised: 11/23/2005] [Accepted: 11/24/2005] [Indexed: 11/20/2022]
Abstract
We investigated functioning of the hypothalamic-pituitary-adrenal (HPA) axis in 12 young people at ultra high risk for developing psychosis, using the combined dexamethasone corticotrophin releasing hormone (DEX/CRH) test. Over a two year period, three of the 12 participants developed an acute psychosis. Descriptive analysis of the data indicated that contrary to expectations, participants who did not make the transition to psychosis had on average higher cortisol levels at the latter stages of the test, as well as a greater severity of depression and anxiety symptoms, than participants who subsequently developed psychosis. These preliminary results suggest that dysregulated HPA-axis functioning in individuals at high risk for psychosis may be associated more with comorbid depression symptoms than factors specifically related to the process of emerging psychosis illness.
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Affiliation(s)
- K N Thompson
- ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Poplar Road, Locked Bag 10, Parkville, Victoria 3052, Australia
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Phillips LJ, McGorry PD, Garner B, Thompson KN, Pantelis C, Wood SJ, Berger G. Stress, the hippocampus and the hypothalamic-pituitary-adrenal axis: implications for the development of psychotic disorders. Aust N Z J Psychiatry 2006; 40:725-41. [PMID: 16911747 DOI: 10.1080/j.1440-1614.2006.01877.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.8] [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: 01/04/2023]
Abstract
OBJECTIVE The experience of stress is commonly implicated in models of the onset of psychotic disorders. However, prospective studies investigating associations between biological markers of stress and the emergence of psychotic disorders are limited and inconclusive. One biological system proposed as the link between the psychological experience of stress and the development of psychosis is the Hypothalamic-Pituitary-Adrenal (HPA) axis. This paper summarizes and discusses evidence supporting a role for HPA-axis dysfunction in the early phase of schizophrenia and related disorders. METHOD A selective review of psychiatric and psychological research on stress, coping, HPA-axis, the hippocampus and psychotic disorders was performed, with a particular focus on the relationship between HPA-axis dysfunction and the onset of psychotic disorders. RESULTS Individual strands of past research have suggested that the HPA-axis is dysfunctional in at least some individuals with established psychotic disorders; that the hippocampus is an area of the brain that appears to be implicated in the onset and maintenance of psychotic disorders; and that an increase in the experience of stress precedes the onset of a psychotic episode in some individuals. Models of the onset and maintenance of psychotic disorders that link these individual strands of research and strategies for examining these models are proposed in this paper. CONCLUSIONS The current literature provides some evidence that the onset of psychotic disorders may be associated with a higher rate of stress and changes to the hippocampus. It is suggested that future research should investigate whether a relationship exists between psychological stress, HPA-axis functioning and the hippocampus in the onset of these disorders. Longitudinal assessment of these factors in young people at 'ultra' high risk of psychosis and first-episode psychosis cohorts may enhance understanding of the possible interaction between them in the early phases of illness.
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Affiliation(s)
- Lisa J Phillips
- Department of Psychology, University of Melbourne, Parkville, Victoria, Australia.
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Abstract
BACKGROUND The initial prodrome to bipolar disorder has received very little attention to date, with most of the available data only addressing the prodrome to relapse. This study presents several prospective case studies of the initial prodrome to bipolar affective disorder. METHODS Three patients are presented who developed bipolar disorder during their treatment at the Personal Assessment and Crisis Evaluation Clinic (PACE). They were prospectively interviewed over a 12-month period using standard clinical research interviews. RESULTS These patients met the criteria for bipolar disorder by the end of the treatment period. Depressive symptoms were the main reason for their first clinical presentation, with mania developing at a later date. Other comorbidities were observed before they were diagnosed with bipolar disorder. LIMITATIONS The generalisability of our findings was constrained because of the small sample size. Furthermore, our findings are likely to be influenced by the intake criteria used at PACE, a clinic that primarily aims at identifying patients at risk of psychosis rather than bipolar disorder. CONCLUSION Our study provides information about the initial prodrome to bipolar disorder, which has previously been neglected in research studies. We found there were no prodrome features that clearly distinguished between patients who go on to develop bipolar disorder and those who develop schizophrenia. We hope our prospective data will be the starting point for subsequent studies, with the aim of applying these findings to developing suitable preventative interventions for bipolar disorder.
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Affiliation(s)
- Katherine N Thompson
- PACE Clinic, Mental Health Services for Kids and Youth, University of Melbourne, Department of Psychiatry, Parkville, Victoria 3052, Australia
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Abstract
Our study aimed to investigate how recovery styles influence 12-month clinical outcome in first-episode psychosis patients. We hypothesised that patients who use an integrative recovery style would have better outcome than those who seal over. A total of 196 first-episode psychosis patients from the Early Psychosis Intervention Centre (EPPIC) participated in the study. Each patient was interviewed at stabilization of their acute psychotic episode, and then again 12 months later, using an Integration/Sealing-over measure. Our results suggest that recovery style may be a useful predictor of outcome. Integrative patients had better outcome and functioning at 12 months. These results were influenced by diagnosis and, unlike previous studies, recovery style changed over time, suggesting it was not a stable trait. The capacity for recovery style to change challenges the suggestion it is a personality trait and raises the need for psychoeducation and other psychological interventions that could improve outcome.
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Valentine BA, Van Saun RJ, Thompson KN, Hintz HF. Role of dietary carbohydrate and fat in horses with equine polysaccharide storage myopathy. J Am Vet Med Assoc 2001; 219:1537-44. [PMID: 11759989 DOI: 10.2460/javma.2001.219.1537] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- B A Valentine
- Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis 97331, USA
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Abstract
We sought to investigate whether first-episode and multiple-episode patients differ in their awareness of their illness. A total of 312 multiple-episode and 144 first-episode patients participated, the majority of whom had a schizophrenia spectrum disorder (schizophrenia or schizophreniform disorder). Insight was measured using the Scale for the Assessment of Unawareness of Mental Disorder (SUMD). First-episode patients with a schizophrenia spectrum disorder were less aware of having a mental illness than multiple-episode patients. Our findings suggest that in the time following the first episode of psychosis, patients may become less defensive, and possibly more skilled in using medical terms to describe their illness. We suggest a need for skilled psychoeducation that addresses awareness in patients with psychosis, particularly those who are unaware of their illness.
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Affiliation(s)
- K N Thompson
- Mental Health Services for Kids and Youth, Parkville, Victoria, Australia
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Abstract
OBJECTIVE The present study aimed to investigate neuroleptic side-effect severity in women with psychosis, and to investigate their putative association with variations in sex steroids over the menstrual cycle. Based on the oestrogen hypothesis, which postulates a synergistic relationship between oestrogen and neuroleptics, it was hypothesized that oestrogen would exacerbate extrapyramidal symptoms. METHOD Twenty-five psychotic women were assessed using the ESRS and blood hormone analysis. Testing was conducted twice, 2 weeks apart, in a randomized cross-over design. RESULTS Contrary to expectation the results indicated that high levels of oestrogen reduce hyperkinetic symptoms in women with psychosis, and this effect appears to be further potentiated when both oestrogen and progesterone are high. CONCLUSION On the basis of these findings, and receptor studies in animals, it was concluded that oestrogen has different effects on dopamine dynamics in the mesolimbic and mesostriatal pathways.
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Affiliation(s)
- K N Thompson
- Monash University Research Centre for Women's Mental Health, Dandenong Area Mental Health Service, Victoria, Australia
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Abstract
Because exercise fatigue has been associated with the accumulation of lactic acid, factors that influence lactate metabolism during exercise can potentially enhance performance. The objective of this study was to examine the effects of supplemental betaine on eight mature Thoroughbred horses before and after 8 wk of conditioning. The effects of betaine were tested in two cross-over design experiments, allowing each horse to receive both the control and betaine treatments at each fitness level. Ingestion of 80 mg of betaine/kg of BW for 14 d before exercise testing did not alter plasma lactate, glucose, free fatty acids (FFA), or triglyceride concentrations during exercise in the untrained or trained horses. A time x treatment interaction (P < .05) was observed for plasma lactate in untrained horses during recovery from exercise, and plasma lactate concentrations were lower (P < .05) at 60 min after exercise when untrained horses received betaine. Plasma FFA concentrations were lower (P < .05) before exercise and at 720 min after exercise when untrained horses received betaine. These data indicate that betaine may influence lactate metabolism following exercise in untrained horses; however, betaine does not seem beneficial for trained horses.
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Affiliation(s)
- L K Warren
- Department of Animal Sciences, University of Kentucky, Lexington 40546, USA.
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Valentine BA, Hintz HF, Freels KM, Reynolds AJ, Thompson KN. Dietary control of exertional rhabdomyolysis in horses. J Am Vet Med Assoc 1998; 212:1588-93. [PMID: 9604030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether feeding a low-carbohydrate, high-fat diet would decrease severity of exercise-induced muscle injury in horses with exertional rhabdomyolysis. ANIMALS 19 horses with a history of exertional rhabdomyolysis. DESIGN Case series. PROCEDURE Specimens of the semitendinosus or semimembranosus muscle were obtained for histologic examination, and serum creatine kinase (CK) and aspartate transaminase (AST) activities 4 hours after exercise were determined. Horses were then fed a low-carbohydrate, high-fat diet, and serum CK and AST activities 4 hours after exercise were reevaluated at approximately monthly intervals for 3 to 6 months. RESULTS Serum CK and AST activities 4 hours after exercise were high before any change in diet. All 19 horses had evidence of chronic myopathic change and abnormal glycogen accumulation in muscle biopsy specimens; 11 horses also had evidence of complex polysaccharide accumulation. Adaptation to diet change required approximately 3 to 6 months. Sixteen horses did not have any episodes of exertional rhabdomyolysis after 3 to 6 months of diet change, and 3 horses had mild episodes of exertional rhabdomyolysis following either a reduction in dietary fat intake or restriction in exercise. Postexercise serum CK and AST activities 3 to 6 months after the change in diet were significantly less than initial values. CLINICAL IMPLICATIONS Results indicated that exertional rhabdomyolysis may be a result of abnormal carbohydrate metabolism in some horses. Feeding a diet with low carbohydrate and high fat content may reduce severity of exercise-induced injury in some horses with exertional rhabdomyolysis.
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Affiliation(s)
- B A Valentine
- Department of Pathology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401, USA
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Abstract
Surface electrodes were used to record electromyographic (EMG) activity of the long digital extensor muscle on the right hindlimb of 8 Thoroughbred horses for 8 s at the walk and 8 s at the trot before (unfatigued) and after (fatigued) an exercise test. The exercise test was performed on a motorised treadmill set on a 10% grade. Each test started at a speed of 6 m/s which was increased by 1 m/s each minute until the horse fatigued as indicated by its inability to keep pace with the treadmill with minimal encouragement. Observations were made on the horses prior to conditioning (untrained state) and after 8 weeks of regular exercise (trained state). The mean root-mean-square (rms) values of EMG bursts collected in each experimental trial were determined for each horse and group means were derived from the mean of independent subjects. Statistical comparisons for differences in rmsEMG were related to gait, fatigue and training. Mean rmsEMG at the trot was consistently higher than at the walk (P<0.05). At the walk, mean fatigued rmsEMG tended to be higher than the mean unfatigued rmsEMG in the untrained state and was significantly higher in the trained state (P<0.05). At the trot, mean fatigued rmsEMG was higher (P<0.05) than mean unfatigued rmsEMG in both the untrained and trained states. Training did not have an effect on mean rmsEMG of unfatigued muscles at the walk or the trot (P>0.05). However, fatigued muscles experienced higher EMG activity in the trained state at the walk (P<0.05). A similar tendency was observed at the trot. Results of this study suggest that surface EMG measurement may be useful for evaluating fatigue in exercising horses.
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Affiliation(s)
- T K Cheung
- Department of Veterinary Science, Maxwell Gluck Equine Research Center, University of Kentucky, Lexington 40546, USA
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Harkins JD, Mundy GD, Stanley S, Woods WE, Rees WA, Thompson KN, Tobin T. Determination of highest no effect dose (HNED) for local anaesthetic responses to procaine, cocaine, bupivacaine and benzocaine. Equine Vet J 1996; 28:30-7. [PMID: 8565951 DOI: 10.1111/j.2042-3306.1996.tb01587.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The highest no effect doses (HNEDs) for the local anaesthetic (LA) effects of procaine, cocaine, bupivacaine and benzocaine were determined using the heat lamp/hoof withdrawal model of Kamerling et al. (1985b) and the abaxial sesamoid block model of local anaesthesia. The heat lamp rapidly (4 or 5 s) increased the temperature of the superficial skin layers of the pastern to about 90 degrees C, at which point the animal sharply withdrew its hoof. Effective LA blockade precluded this response and superficial skin temperatures exceeded 120 degrees C. Thermal stimulus experiments were routinely terminated after 10 s of exposure to prevent undue tissue damage. Following abaxial sesamoid block with bupivacaine, the HNED for that drug was about 0.25 mg/site. Increasing the dose to 2 mg/site apparently produced complete and prolonged LA blockade. Analogous work showed that the HNED for procaine was about 2.5 mg/site. Similarly, the dose response curve for procaine was parallel with that of bupivacaine but was shifted 10-fold to the right. The duration of the LA response following procaine injection was less than for bupivacaine with the statistically significant response following 40 mg/site injection lasting less than 45 min. Cocaine was less potent than procaine, showing a shallower dose response curve. The HNED for cocaine was less than 5 mg/site, although at this dose the duration of action was extremely short (< 7.5 min). Benzocaine had no significant LA action when a dose of 800 mg was applied topically as a 5% preparation. These results show that the HNEDs for bupivacaine and procaine are remarkably low, that cocaine is somewhat less potent as a LA than might be expected, and that 5% topical benzocaine has no significant pharmacology. The small doses of bupivacaine and procaine producing effective local anaesthesia suggests that developing plasma thresholds for these agents is likely to be very challenging.
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Affiliation(s)
- J D Harkins
- Maxwell H. Gluck Equine Research Center, University of Kentucky, Lexington 40506, USA
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Abstract
This study was conducted to determine normal rates of growth of different skeletal segments in the thoroughbred horse. Growth of body weight and eight skeletal segments (wither height, hip height, body length, knee to pastern length, hock to pastern length, shoulder to pastern length, width of chest, depth of girth) were monitored in 106 horses (60 colts, 46 fillies) during the period from 14 to 588 d of age. Body weight gains were slightly higher (30 to 40 kg) than previously reported values. Growth in wither height and hip height were similar to previous reports. During the period measured in this study hip height was consistently 2 or 3 cm larger than wither height. Growth patterns for wither height, body length, and shoulder to pastern lengths were similar to one another. Growth of the knee to pastern and hock to pastern segments reached a plateau at approximately 140 d of age, which coincided with the cessation of longitudinal bone growth. These data define skeletal growth patterns in the thoroughbred horse and are useful in determining the relationship between growth and the occurrence of orthopedic diseases in horses.
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Affiliation(s)
- K N Thompson
- University of Kentucky, Department of Veterinary Science, Lexington 40546-0099, USA
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Abstract
Effects of high dietary levels of energy, protein and Ca and deficient levels of Ca on skeletal growth and development in the equine were studied in two experiments. The weanlings were fed grain-based diets. In Exp. 1, Group 1 (Ctl) received all nutrients at NRC recommended levels for growth; Group 2 (HE) received 150% of their digestible energy (DE) requirement; Group 3 (LC) received 150% of DE and 35% of Ca requirements. In Exp. 2, Group 1 (Ctl) again received all nutrients at NRC recommended levels for growth; Group 2 (HEP) received 150% of DE and 275% of CP requirements; Group 3 (HEPC) received 150% of DE, 275% of CP and 500% of Ca requirements. In addition, all groups had access to pasture. The HE treatment resulted in greater (P less than .10) increases in BW and total cortical width. However, LC weanlings had lower (P less than .10) gains in third metacarpal length and radiographic bone density. Cumulative increases in BW and wither height were greater (P less than .10) for the HEP and HEPC weanlings than for the Ctl weanlings. Increases in third metatarsal length also were greater (P less than .10) for HEP weanlings than for Ctl weanlings. Higher planes of nutrition increased body weight gains and growth rate of several long bones. However, skeletal development (e.g., cortical area) may be compromised by a high rate of growth.
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Abstract
Thirty foals of mixed breeding, from two consecutive years, were used in two 120-d experiments to evaluate the effects of supplemental feeding (creep feed) on growth in nursing foals. At 10 d postpartum, foals were randomly assigned either to a creep-fed group (CF) or an unsupplemented group (NCF). Initial measurements of body weight (BW), height at the withers (WH), third metatarsal length (MtIII) and third metacarpal length (McIII) were made at 10 d of age and at 30-d intervals thereafter. Medial and lateral cortical peak values for radiographic bone density, cortical width and cortical area at the midpoint of the third metacarpal were used to assess bone quality. Creep feed containing National Research Council (NRC, 1978) recommended levels for all nutrients was offered at 1.5% of BW per day. When compared with unsupplemented foals, supplemented foals had greater gains in BW (P less than .05), in WH (P less than .10) and in MtIII (P less than .05). Mean gains during the trial in BW, WH, MtIII and McIII for the CF foals were 133.3 kg, 22.8 cm, 2.1 cm and 1.9 cm and for the NCF foals were 117.6 kg, 21.2 cm, 1.5 cm and 1.9 cm, respectively. The mean value for the lateral cortical peak was slightly lower (P less than .10) for the CF foals. No differences (P greater than .10) were observed for the medial cortical peak, cortical width or cortical area of the third metacarpal. The results of this study indicate that a creep feeding program that supplies NRC-recommended nutrient levels can increase the rate of skeletal growth with little decrease in quality of bone.
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