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Blay M, Bouteloup M, Duarte M, Hasler R, Pham E, Nicastro R, Jan M, Debbané M, Perroud N. Association between pathological narcissism and emotion regulation: The role of self-mentalizing? Personal Ment Health 2024. [PMID: 38710596 DOI: 10.1002/pmh.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/27/2023] [Accepted: 02/18/2024] [Indexed: 05/08/2024]
Abstract
Pathological narcissism (PN) is a common psychopathological issue leading to maladaptive strategies to cope with self-esteem threats, including self-enhancement and exploitation (grandiose strategies) or internalized shame, depression, and social withdrawal (vulnerable strategies). Mentalizing is a key process for regulating self and other representations and their associated emotions. Patients with PN further struggle with emotion dysregulation (ED), which during development is intertwined with the growing capacity to mentalize. We seek to contribute to emerging empirical data documenting the associations between PN and ED and between PN and mentalizing, and to provide information on the nature of their mutual relationships. In the present study, we assessed PN, ED, and three mentalizing dimensions (mentalizing self, other, and motivation to mentalize) in 183 patients consulting in our outpatient unit specialized in ED. We found that narcissistic vulnerability was negatively associated with self-mentalizing and positively associated with overall ED, both even after adjustment for borderline and attention deficit hyperactivity disorder (ADHD) symptoms. However, the association with ED was not maintained after further adjustment for self-mentalizing or overall-mentalizing, which suggests that mentalizing may play a mediating role in this relationship. On the other hand, narcissistic grandiosity was positively associated with other-mentalizing and ED and negatively associated with self-mentalizing in bivariate analyses, but these last two associations were not maintained after adjustment for comorbid borderline and/or ADHD symptomatology. This study provides new information on the link between PN and ED and on key mentalizing dimensions meaningfully relating to PN, notably through a potential role of self-mentalizing processes between PN and ED.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Groupe Santé Basque Développement, Lyon, France
- Université Paris-Saclay, UVSQ, INSERM, Centre de recherche en Epidémiologie et Santé des Populations Team "DevPsy", Villejuif, France
| | - Margaux Bouteloup
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Miguel Duarte
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eleonore Pham
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Marlène Jan
- University Department of Child and Adolescent Psychiatry, Versailles Hospital Center, Le Chesnay, France
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Duarte M, Blay M, Hasler R, Pham E, Nicastro R, Jan M, Debbané M, Perroud N. Adult ADHD and pathological narcissism: A retrospective-analysis. J Psychiatr Res 2024; 174:245-253. [PMID: 38670059 DOI: 10.1016/j.jpsychires.2024.04.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
Adult attention deficit hyperactivity disorder (ADHD) is often associated with personality pathology. However, only few studies have been conducted on the link between ADHD and pathological narcissism (PN), with or without a diagnosis of narcissistic personality disorder (NPD). In order to fill this gap, PN and NPD were assessed in 164 subjects suffering from ADHD, with several other measures including ADHD severity, quality of life, depression, anxiety, impulsivity, and emotion dysregulation (ED). We found that a significant proportion of ADHD patients suffered from NPD, and that both narcissistic grandiosity and vulnerability were associated with ADHD hyperactivity and impulsivity symptoms, but not with inattentive symptoms. These two dimensions seemed to be negatively associated with well-being and positively associated with most of the other studied psychiatric dimensions except ED, the latter being only associated with vulnerability, even after adjustment on borderline symptoms. Overall, despite important limitations that limit the generalizability of our findings to the overall ADHD population (notably linked to selection bias), we believe that this exploratory study sheds light on the potential clinical relevance of narcissistic pathology in adult ADHD patients.
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Affiliation(s)
- Miguel Duarte
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Martin Blay
- ADDIPSY, Centre Ambulatoire d'Addictologie et de Psychiatrie, Groupe Santé Basque Développement, Lyon, France; Université Paris-Saclay, UVSQ, INSERM, Centre de recherche en Epidémiologie et Santé des Populations Team "DevPsy", 94807, Villejuif, France.
| | - Roland Hasler
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eleonore Pham
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Marlène Jan
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Le Chesnay, France
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Blay M, Hasler R, Nicastro R, Pham E, Weibel S, Debbané M, Perroud N. Body modifications in borderline personality disorder patients: prevalence rates, link with non-suicidal self-injury, and related psychopathology. Borderline Personal Disord Emot Dysregul 2023; 10:7. [PMID: 36859368 PMCID: PMC9979398 DOI: 10.1186/s40479-023-00213-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/09/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is a potentially severe personality disorder, characterized by difficulties in emotion regulation and control of behaviors. It is often associated with non-suicidal self-injury (NSSI). Borderline personality features have also been linked to body modifications (BMs). However, the prevalence of BMs, the link between BMs and NSSI, and between BMs and several psychopathology dimensions (e.g. borderline severity, emotion regulation, impulsivity …) remains understudied in patients with BPD. This study aims to fill this gap, and to provide further evidence on the link between NSSI and BMs. METHODS We used data from a psychiatric outpatient center located in Switzerland (n = 116), specialized in the assessment and treatment of BPD patients. Patients underwent several semi-structured interviews and self-report psychometric scales at the arrival, and the data were retrospectively analyzed. RESULTS We found that 70.69% of the patients had one piercing or more, and 69.83% were tattooed. The total score of body modifications and the total number of piercings score of piercings were significantly positively associated with NSSI and the SCID BPD total score. The association with the SCID score was mainly driven by the "suicide and self-damaging behaviors" item and the "chronic feeling of emptiness" item. A significant association was found between total number of piercings and emotion dysregulation. On the other hand, the self-reported percentage of body covered by tattoos score was specifically associated with the sensation seeking subscale of the UPPS-P. CONCLUSION This study provides evidence on the prevalence of BMs in BPD patients, and on the link between BMs and NSSI in this population, suggesting a role of emotion regulation in the link between both constructs. These results also suggests that tattoos and piercings may be differentially linked to specific underlying psychological mechanisms. This calls for further considerations of body modifications in the assessment and care of BPD patients.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Santé Basque Développement Group, Lyon, France. .,Claude Bernard University Lyon 1, Lyon, France.
| | - Roland Hasler
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eléonore Pham
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France.,Inserm u1114, Strasbourg, France
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Baggio S, Iglesias K, Duarte M, Nicastro R, Hasler R, Euler S, Debbané M, Starcevic V, Perroud N. Validation of self-report measures of narcissism against a diagnostic interview. PLoS One 2022; 17:e0266540. [PMID: 35385531 PMCID: PMC8986001 DOI: 10.1371/journal.pone.0266540] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
The Pathological Narcissism Inventory (PNI) and the Narcissistic Personality Inventory (NPI) are often used to screen for pathological narcissism but have rarely been validated against a clinician-administered diagnostic interview. Our study evaluated the convergent validity of the PNI and NPI against a diagnostic interview for narcissistic personality disorder (NPD) in a clinical population. We used data from a psychiatric outpatient center located in Switzerland (n = 123). Correlations between PNI/NPI and NPD ranged between .299 and .498 (common variance 9.0–24.8%). The PNI and NPI should be used carefully to screen for NPD. We highlight a need to increase the compatibility between the conceptual underpinnings of the PNI, NPI and NPD.
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Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- * E-mail:
| | - Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | - Miguel Duarte
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
- NCCR Synapsy, Campus Biotech, Geneva, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich, Zurich, Switzerland
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Vladan Starcevic
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Sydney, NSW, Australia
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Quenneville AF, Kalogeropoulou E, Nicastro R, Weibel S, Chanut F, Perroud N. Anxiety disorders in adult ADHD: A frequent comorbidity and a risk factor for externalizing problems. Psychiatry Res 2022; 310:114423. [PMID: 35152068 DOI: 10.1016/j.psychres.2022.114423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 12/22/2020] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION ADHD is a common neurodevelopmental disorder and is highly prevalent in adults. It is associated with several negative outcomes, impacting well-being and global functioning. ADHD is highly associated with comorbidities, anxiety disorders being probably the most frequent. The goal of our study is to assess the prevalence of anxiety disorders and their impact in adults with ADHD. METHOD 353 individuals diagnosed with ADHD were recruited. Severity of ADHD was assessed as well as lifetime anxiety disorders and other psychiatric comorbidities. We performed logistic and linear regressions to test the impact of lifetime anxiety disorders on demographic and clinical variables. RESULTS More than half of the patients had at least one anxiety disorder. The presence of comorbid anxiety disorders was associated with worse clinical presentation (positive history of suicide attempts, higher disposition toward anger, higher rate of hospitalization and psychotic symptoms) and with a lower level of education. CONCLUSION Anxiety disorders are highly prevalent in ADHD and are associated with higher levels of suicidality and disposition towards anger, more severe clinical presentation and lower functioning. Comorbid anxiety needs to be evaluated and treated by clinicians to limit distress, aggression towards self and others and to improve quality of life.
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Affiliation(s)
- Andréanne Filion Quenneville
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Department of Psychiatry and Addictology, Clinique des troubles relationnels et dépendances, Hôpital en Santé Mentale Albert-Prévost, University of Montreal, CIUSSS Nord-de-l'Ile-de-Montréal, 6555 Boulevard Gouin West, Montreal, QC H4K 1B3, Canada.
| | - Eleni Kalogeropoulou
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rosetta Nicastro
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Sébastien Weibel
- Department of Psychiatry, Strasbourg University Hospital, Strasbourg, France; Inserm U1114, Strasbourg, France
| | - Florence Chanut
- Department of Psychiatry and Addictology, Clinique des troubles relationnels et dépendances, Hôpital en Santé Mentale Albert-Prévost, University of Montreal, CIUSSS Nord-de-l'Ile-de-Montréal, 6555 Boulevard Gouin West, Montreal, QC H4K 1B3, Canada
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Duarte M, Dieben K, Nicastro R, Perroud N. [Adult ADHD - recommendations for clinical management in general practice]. Rev Med Suisse 2021; 17:1606-1610. [PMID: 34550653] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently found in the general population and it negatively impacts the quality of life of those that suffer from this disorder. Although the general practitioner occupies a primordial role in the detection as well as in the management of this disorder, the lack of training as well as the stigma surrounding ADHD make it not always obvious how to approach the patient with or possibly suffering from ADHD. In this article, we propose to present a few lines of good clinical practice applicable in primary medicine for the detection, diagnosis and management of ADHD in adults.
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Affiliation(s)
- Miguel Duarte
- Unité du trouble de la régulation émotionnelle, Service des spécialités psychiatriques, Département de psychiatrie, HUG, 12011 Genève 14
| | - Karen Dieben
- Unité du trouble de la régulation émotionnelle, Service des spécialités psychiatriques, Département de psychiatrie, HUG, 12011 Genève 14
- Psychologues
| | - Rosetta Nicastro
- Unité du trouble de la régulation émotionnelle, Service des spécialités psychiatriques, Département de psychiatrie, HUG, 12011 Genève 14
- Psychologues
| | - Nader Perroud
- Unité du trouble de la régulation émotionnelle, Service des spécialités psychiatriques, Département de psychiatrie, HUG, 12011 Genève 14
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Euler S, Stalujanis E, Lindenmeyer HJ, Nicastro R, Kramer U, Perroud N, Weibel S. Impact of Childhood Maltreatment in Borderline Personality Disorder on Treatment Response to Intensive Dialectical Behavior Therapy. J Pers Disord 2021; 35:428-446. [PMID: 31887100 DOI: 10.1521/pedi_2019_33_461] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Childhood maltreatment (CM), including emotional, physical, and sexual abuse and emotional and physical neglect, is associated with severity of borderline personality disorder (BPD). However, knowledge on the impact of CM on treatment response is scarce. The authors investigated whether self-reported CM or one of its subtypes affected treatment retention, depressive symptoms, and impulsivity throughout short-term intensive dialectical behavior therapy (I-DBT) in 333 patients with BPD. Data were analyzed with linear and logistic regressions and linear mixed models, using a Bayesian approach. Patients who reported childhood emotional abuse had a higher dropout rate, whereas it was lower in patients who reported childhood emotional neglect. Emotional neglect predicted a greater decrease of depressive symptoms, and global CM predicted a greater decrease of impulsivity. The authors concluded that patients with BPD who experienced CM might benefit from I-DBT in specific symptom domains. Nonetheless, the impact of emotional abuse on higher dropout needs to be considered.
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Affiliation(s)
- Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich, Zurich, Switzerland.,Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Esther Stalujanis
- Psychiatric University Hospital, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany
| | - Hannah J Lindenmeyer
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York, and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rosetta Nicastro
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Ueli Kramer
- Lausanne University Hospital and University of Lausanne, Switzerland, and Department of Psychology, University of Windsor, Windsor, Canada
| | - Nader Perroud
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sébastien Weibel
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Strasbourg, France, and INSERM U1114, Strasbourg, France
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Nicastro R, Jermann F, Bluteau Blin S, Waeber C, Perroud N. Mindfulness Training for Adults with Attention-Deficit/Hyperactivity Disorder: Implementation of Mindful Awareness Practices in a French-Speaking Attention-Deficit/Hyperactivity Disorder Unit. J Altern Complement Med 2020; 27:179-183. [PMID: 33305979 DOI: 10.1089/acm.2020.0216] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Mindfulness-based programs are a promising option for patients with attention-deficit/hyperactivity disorder (ADHD), who face attention, hyperactivity, and emotion dysregulation issues in their daily life. Objective: To examine the implementation and impact of specific mindfulness training for adults with ADHD in a French-speaking unit. Methods: Thirty-eight adults with ADHD were included in an 8-week Mindful Awareness Practices (MAPs) program. Patients were assessed for ADHD symptoms, anxiety, depression, and mindfulness skills, before (T1) and after (T2) the eight sessions, and then 2 months later (T3). Results: The patients adhered to the program as the majority of them completed it. A significant decrease in ADHD, depression, and anxiety symptoms was found between T1 and T2. Regarding mindfulness skills, a significant increase was observed between T1 and T2 in Observing, Describing and Nonreactivity to inner experience cores, but not Acting with awareness and Nonjudging of inner experience scores. There was no significant change between T2 and T3. Conclusion: The MAPs program was successfully implemented and showed promising effects on ADHD symptomatology and related symptoms.
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Affiliation(s)
- Rosetta Nicastro
- Department of Psychiatry, Service of Psychiatric Specialties, Geneva University Hospitals, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Françoise Jermann
- Department of Psychiatry, Service of Psychiatric Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Bluteau Blin
- Department of Psychiatry, Service of Psychiatric Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Caroline Waeber
- Department of Psychiatry, Service of Psychiatric Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Service of Psychiatric Specialties, Geneva University Hospitals, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Baggio S, Bayard S, Cabelguen C, Desseilles M, Gachet M, Kraemer C, Richard-Lepouriel H, Nicastro R, Bioulac S, Sauvaget A, Weibel S, Perroud N, Lopez R. Diagnostic Accuracy of the French Version of the Adult Attention Deficit / Hyperactivity Disorder Self-Report Screening Scale for DSM-5 (ASRS-5). J Psychopathol Behav Assess 2020. [DOI: 10.1007/s10862-020-09822-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Stenz L, Prados J, Courtet P, Prada P, Nicastro R, Adouan W, Guillaume S, Olié E, Aubry J, Dayer A, Perroud N. Borderline personality disorder and childhood maltreatment: A genome-wide methylation analysis. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2016.01.400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Early life adversity plays a critical role in the emergence of borderline personality disorder (BPD) and this could occur through epigenetic programming. In this perspective, we aimed to determine whether childhood maltreatment could durably modify epigenetic processes by the means of a whole-genome methylation scan of BPD subjects. Using the Illumina Infinium® Human Methylation 450 Bead Chip, global methylation status of DNA extracted from peripheral blood leucocytes was correlated to the severity of childhood maltreatment in 96 BPD subjects suffering from a high level of child adversity and 93 subjects suffering from major depressive disorder (MDD) and reporting a low rate of child maltreatment. Several CpGs within or near the following genes (IL17RA, miR124-3, KCNQ2, EFNB1, OCA2, MFAP2, RPH3AL, WDR60, CST9L, EP400, A2ML1, NT5DC2, FAM163A and SPSB2) were found to be differently methylated, either in BPD compared with MDD or in relation to the severity of childhood maltreatment. A highly relevant biological result was observed for cg04927004 close to miR124-3 that was significantly associated with BPD and severity of childhood maltreatment. miR124-3 codes for a microRNA (miRNA) targeting several genes previously found to be associated with BPD such as NR3C1. Our results highlight the potentially important role played by miRNAs in the etiology of neuropsychiatric disorders such as BPD and the usefulness of using methylome-wide association studies to uncover such candidate genes. Moreover, they offer new understanding of the impact of maltreatments on biological processes leading to diseases and may ultimately result in the identification of relevant biomarkers.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Quenneville AF, Badoud D, Nicastro R, Jermann F, Favre S, Kung AL, Euler S, Perroud N, Richard-Lepouriel H. Internalized stigmatization in borderline personality disorder and attention deficit hyperactivity disorder in comparison to bipolar disorder. J Affect Disord 2020; 262:317-322. [PMID: 31733922 DOI: 10.1016/j.jad.2019.10.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/10/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Internalized stigma constitutes a major concern in mental health illness. It has numerous repercussions on patients, including poor self-esteem, higher illness severity, poor adherence to care and reduced global functioning. The goal of this study was to compare internalized stigma between three diagnoses frequently seen in psychiatric practice: Borderline personality disorder (BPD), Attention deficit-hyperactivity disorder (ADHD) and Bipolar disorder (BD). METHODS A total of 244 French-speaking patients were recruited in a specialized psychiatric center at University Hospitals of Geneva, Switzerland. 39 patients had a diagnosis of BPD, 136 had ADHD and 69 had BD. Every subjects completed the Internalized Stigma of Mental Illness (ISMI) scale, which is the most widely used scale employed to measure of internalized stigma. One way ANOVA analysis with adjustment on age and gender was done to compare the three groups (BPD, ADHD, BD). RESULTS Participants with BPD reported higher ISMI score than subjects with ADHD and BD. BD experienced more internalized-stigma than ADHD. Higher ISMI score was also associated with higher severity of the respective disorder, poorer quality of life and unemployment. LIMITATIONS Limitations of this research include the small sample, especially in BPD group. A disequilibrium between male and female subjects can also impact our results. Observational nature of our study mean that we can only make correlation between variables and not infer causality. Finally, other confounding factors not taken into account in this study may have had influence on stigma. CONCLUSIONS Our findings are coherent with recent literature on BPD reporting high level of distress and of stigmatization. This has serious consequences on provided care and need to be address by mental health professionals to assure the optimal service to this population.
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Affiliation(s)
- Andréanne Filion Quenneville
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Department of Psychiatry, University of Montreal, Montreal, Canada.
| | - Déborah Badoud
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rosetta Nicastro
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Françoise Jermann
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Favre
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Anne-Lise Kung
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Sebastian Euler
- University Hospital Zurich, Department of Consultation Psychiatry and Psychosomatics, Zurich, Switzerland
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Hélène Richard-Lepouriel
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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12
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Weibel S, Micoulaud-Franchi JA, Brandejsky L, Lopez R, Prada P, Nicastro R, Ardu S, Dayer A, Lançon C, Perroud N. Psychometric Properties and Factor Structure of the Short Form of the Affective Lability Scale in Adult Patients With ADHD. J Atten Disord 2019; 23:1079-1089. [PMID: 28152669 DOI: 10.1177/1087054717690808] [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] [Indexed: 12/16/2022]
Abstract
Objective: Affective lability is an important dimension of adult ADHD, associated with marked impairments and worse outcomes. A valid and quick tool to measure affective lability may therefore be of interest. Method: In 187 adult ADHD patients, we explored psychometric properties of the Affective Lability Scale-Short Form (ALS-18 items). We analyzed the construct validity and the external validity of the scale. Patients were compared with 48 healthy adult controls. Results: The three-factor structure of the ALS-18 presented a good fit and a good internal consistency. The correlations between the ALS-18 and ADHD symptoms and other psychological dimensions were, respectively, low and moderate. ALS-18 scores were higher in patients than in healthy adults. Conclusion: ALS-18 showed good psychometric properties in ADHD adult patients, allowing us to recommend the implementation of ALS-18 in assessing affective lability for clinical and research purposes. Use of ALS-18 should improve the clinical assessment of affective lability in adult ADHD patients.
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Affiliation(s)
| | | | - Laura Brandejsky
- 4 Centre Hospitalier Universitaire de Sainte-Marguerite, Marseille, France
| | - Régis Lopez
- 5 Service de Neurologie, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier, France.,6 Inserm U1061, Montpellier, France
| | - Paco Prada
- 1 University Hospital of Geneva, Switzerland
| | | | | | - Alexandre Dayer
- 1 University Hospital of Geneva, Switzerland.,7 University of Geneva, Switzerland
| | - Christophe Lançon
- 4 Centre Hospitalier Universitaire de Sainte-Marguerite, Marseille, France.,8 Université de la Méditerranée, Marseille, France
| | - Nader Perroud
- 1 University Hospital of Geneva, Switzerland.,7 University of Geneva, Switzerland
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13
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Rüfenacht E, Euler S, Prada P, Nicastro R, Dieben K, Hasler R, Pham E, Perroud N, Weibel S. Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD). Borderline Personal Disord Emot Dysregul 2019; 6:11. [PMID: 31360522 PMCID: PMC6637623 DOI: 10.1186/s40479-019-0108-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/25/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Emotional dysregulation (ED) is now considered as an important symptom of attention deficit hyperactivity disorder (ADHD). It is believed to have a considerable impact on the severity of the disorder, one's global functioning, and the prognosis. Our research aimed to evaluate and compare ED and cognitive emotional regulation strategies between ADHD and borderline personality disorder (BPD) patients. METHODS Four hundred six French-speaking outpatients (N = 279 ADHD, N = 70 BPD, N = 60 BPD + ADHD) were assessed with the Emotion Reactivity Scale (ERS), the Cognitive Emotional Regulation Questionnaire (CERQ), The Basic Empathy Scale (BES-A), the Adult ADHD Self-Report Scale (ARSV-v1.1) and the Beck Depression Inventory II (BDI-II). ADHD, BPD and comorbid patients were compared with each other and with samples of controls extracted from already published data. RESULTS ADHD patients, although having higher ED than samples derived from the general population, had less ED, better control over their emotions with higher use of adaptive cognitive strategies and lesser use of non-adaptive strategies than BPD patients. However, ADHD subjects had similar scores as BPD subjects when looking at difficulties in perceiving self and others. ED generated considerable distress in all groups and was also positively associated with ADHD symptomatology. ADHD patients with comorbid BPD had the highest scores of ED. CONCLUSIONS Our results suggest that there may be similarly inefficient cognitive emotional regulation skills leading to ED in both disorders (ADHD and BPD). However, ADHD patients showed a higher use of adaptive cognitive emotional strategies and a lower level of ED than BPD patients.
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Affiliation(s)
- Eva Rüfenacht
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Paco Prada
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Rosetta Nicastro
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Karen Dieben
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Roland Hasler
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Eléonore Pham
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Nader Perroud
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, Strasbourg, France
- INSERM 1114, Strasbourg, France
- FMTS, University of Strasbourg, Strasbourg, France
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14
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Prada P, Perroud N, Rüfenacht E, Nicastro R. Strategies to Deal With Suicide and Non-suicidal Self-Injury in Borderline Personality Disorder, the Case of DBT. Front Psychol 2018; 9:2595. [PMID: 30619004 PMCID: PMC6304419 DOI: 10.3389/fpsyg.2018.02595] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022] Open
Abstract
One of the most problematic aspects of borderline personality disorder resides in repeated non-suicidal self-injury (NSSI) and suicide attempts. These behaviors constitute the prime therapeutic target and a factor that complicates patient care, namely in terms of therapeutic continuity. It has been demonstrated that Dialectical Behavior Therapy (DBT) is efficient in reducing the symptomatology of this disorder, as well as NSSI and suicide. DBT is a multi-component psychotherapeutic treatment, and the effectiveness of its individual constituents is therefore a relevant question. Studies comparing its various components (individual therapy, group therapy, and standard DBT) have not revealed any marked difference between them, other than a tendency toward improved patient retention rates in the standard version of the treatment. The aim of this study is to review the various components of DBT and their constituent parts, in order to highlight the importance of focusing on self-harm behaviors within the therapy as a whole. Although therapeutic strategies may differ and target directly suicide or NSSI, managing the quality of life, and the persistence of the therapeutic alliance (and of the interpersonal alliance) is equally important in terms of treatment efficacy.
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Affiliation(s)
- Paco Prada
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Nader Perroud
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Eva Rüfenacht
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rosetta Nicastro
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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15
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Badoud D, Prada P, Nicastro R, Germond C, Luyten P, Perroud N, Debbané M. Attachment and Reflective Functioning in Women With Borderline Personality Disorder. J Pers Disord 2018; 32:17-30. [PMID: 28263091 DOI: 10.1521/pedi_2017_31_283] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Insecure attachment and impairments in reflective functioning (RF) are thought to play a critical role in borderline personality disorder (BPD). In particular, the mentalization-based model argues that insecure attachment indirectly accounts for increased BPD features, notably via disruption of RF capacities. Although the mediation relationship between attachment, RF, and BPD is supported by previous evidence, it remains to be directly tested in adults with BPD. In the current study, a sample of 55 female adult BPD patients and 105 female healthy controls completed a battery of self-report measures to investigate the interplay between attachment, RF capacities, and BPD clinical status. Overall, the results showed that BPD patients pre- dominantly reported insecure attachment, characterized by negative internal working models of the self as unlovable and unimportant to others, and decreased RF abilities. Our findings further indicated that actual RF capacities mediated the relationships between adult insecure attachment and BPD clinical status.
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Affiliation(s)
- Deborah Badoud
- Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Switzerland, and Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine
| | - Paco Prada
- Program TRE, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva
| | - Rosetta Nicastro
- Program TRE, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva
| | - Charlotte Germond
- Program TRE, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva
| | - Patrick Luyten
- Department of Clinical, Educational and Health Psychology, University College London.,Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Nader Perroud
- Program TRE, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva.,Department of Psychiatry, University of Geneva
| | - Martin Debbané
- Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Switzerland, and Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine.,Department of Clinical, Educational and Health Psychology, University College London
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16
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Weibel S, Nicastro R, Prada P, Cole P, Rüfenacht E, Pham E, Dayer A, Perroud N. Screening for attention-deficit/hyperactivity disorder in borderline personality disorder. J Affect Disord 2018; 226:85-91. [PMID: 28964997 DOI: 10.1016/j.jad.2017.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A valid screening instrument is needed to detect attention-deficit/hyperactivity disorder (ADHD) in treatment-seeking borderline personality disorder (BPD) patients. We aimed to test the performance of the widely-used Adult ADHD Self-Report Scale v1.1 screener (ASRS-v1.1). METHODS 317 BPD subjects were systematically assessed for comorbid ADHD and completed the ASRS-v1.1. 79 BPD patients also completed the Wender Utah Rating Scale (WURS-25). RESULTS The prevalence of adult ADHD was of 32.4%. The overall positive predictive value of the ASRS-v1.1 was of 38.5%, the negative predictive value 77.0%, the sensitivity 72.8%, and the specificity 43.9%. Combining WURS-25 and ASRS-v1.1 improved sensitivity to 81.8% and specificity to 59.6%. LIMITATIONS Cross-sectional study on treatment-seeking patients. CONCLUSIONS We found a high prevalence of ADHD using structured interviews. The ASRS-v1.1 was not a sensitive screener for identifying possible ADHD cases in a BPD population, with a high number of false positives. When combined with the WURS-25, it offered improved screening.
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Affiliation(s)
- Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France; Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Cole
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eva Rüfenacht
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eléonore Pham
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Prada P, Zamberg I, Bouillault G, Jimenez N, Zimmermann J, Hasler R, Aubry JM, Nicastro R, Perroud N. EMOTEO: A Smartphone Application for Monitoring and Reducing Aversive Tension in Borderline Personality Disorder Patients, a Pilot Study. Perspect Psychiatr Care 2017; 53:289-298. [PMID: 27439663 DOI: 10.1111/ppc.12178] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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] [Received: 02/15/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We developed a smartphone application (App; EMOTEO: emotion-meteo [weather forecast]) to help borderline personality disorder (BPD) patients to monitor and regulate their inner tension. The App proposes targeted mindfulness-based exercises. DESIGN AND METHODS We assessed the usability and efficiency of this App for monitoring and reduction of aversive tension in 16 BPD participants over a 6-month period. FINDINGS We recorded a mean of 318.1 sessions (SD = 166.7) per participants, with a high level of satisfaction. There was a significant decrease in aversive tension (p < .05) and the App was mainly used around 10 a.m. and 9 p.m. PRACTICE IMPLICATIONS EMOTEO was user-friendly and efficient in reducing aversive tension in BPD patients.
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Affiliation(s)
- Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Ido Zamberg
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Gérald Bouillault
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Naya Jimenez
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Julien Zimmermann
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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18
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Perroud N, Badoud D, Weibel S, Nicastro R, Hasler R, Küng AL, Luyten P, Fonagy P, Dayer A, Aubry JM, Prada P, Debbané M. Mentalization in adults with attention deficit hyperactivity disorder: Comparison with controls and patients with borderline personality disorder. Psychiatry Res 2017; 256:334-341. [PMID: 28675858 DOI: 10.1016/j.psychres.2017.06.087] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 10/17/2016] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 02/06/2023]
Abstract
Emotion dysregulation and interpersonal hardships constitute core features of borderline personality disorder (BPD). Research has established the link between these core dysregulations and fluctuations in the capacity to appreciate the mental states that underlie behavior (mentalizing, operationalized as reflective functioning (RF)). As emotion dysregulation and interpersonal hardships also characterize adults with attention deficit hyperactivity disorder (ADHD), this study sought to examine the potential RF impairments affecting this population. 101 adults with ADHD, 108 with BPD and 236 controls were assessed using the RF questionnaire (RFQ), evaluating how individuals employ information about mental states to better understand their own and others' behaviors. The RFQ comprises two dimensions, certainty (RF_c) and uncertainty (RF_u) about mental states. RF scores helped distinguish ADHD from controls, but also from BPD (F = 48.1(2/441); p < 0.0001 for RF_c and F = 92.5(2/441); p < 0.0001 for RF_u). The ADHD group showed intermediary RF scores compared to the controls (b = -0.70; p < 0.0001 and b = 0.89; p < 0.0001 for RF_c and RF_u) and BPD group (b = 0.44; p = 0.001 and b = -0.56; p = 0.001 for RF_c and RF_u). Lower RF scores correlated with poor anger control and high levels of impulsivity. Higher severity of ADHD (more attentional and hyperactive/impulsive symptoms) was correlated with RF impairments. In conclusion, RF may constitute an important process underlying attentional, hyperactive/impulsive as well as emotional symptoms in ADHD; it should therefore be considered in the assessment of these patients.
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Affiliation(s)
- Nader Perroud
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Deborah Badoud
- Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
| | - Anne-Lise Küng
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Alexandre Dayer
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Paco Prada
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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19
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Weibel S, Jermann F, Weiner L, Nicastro R, Ardu S, Pham E, Hasler R, Dayer A, Prada P, Perroud N. Insomnia in adult attention-deficit/hyperactivity disorder: A comparison with borderline personality disorder population in a clinical setting and control participants. Compr Psychiatry 2017; 76:119-128. [PMID: 28501733 DOI: 10.1016/j.comppsych.2017.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/29/2017] [Accepted: 04/28/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Many adults with attention-deficit/hyperactivity disorder (ADHD) report sleeping difficulties. The relationship between sleep and ADHD is poorly understood, and shows discrepancies between subjective and objective measures. In order to determine the specificity of sleep-associated symptoms in ADHD, subjective sleep assessments among ADHD adult patients were compared with control subjects and with individuals suffering from borderline personality disorder (BPD). METHODS 129 outpatients with ADHD, 70 with BPD (including 17 patients with BPD and ADHD comorbidity), and 65 control participants were assessed for sleep quality, insomnia, and sleepiness, using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). RESULTS ADHD- and BPD-sufferers achieved higher insomnia and lower sleep quality scores than control subjects. Clinical groups did not differ in terms of sleep quality, although insomnia was more severe among BPD patients. Depression scores explained most of sleep symptoms, but even when controlling for depression, ADHD sufferers showed higher sleep latency. Inattentive symptoms were associated with somnolence, while hyperactive/impulsive symptoms were associated with insomnia and lower sleep efficiency. CONCLUSION Sleep-related symptoms associated with ADHD were partly explained by non-specific factors, especially depression symptoms. In a dimensional perspective, hyperactive and inattentive symptoms were associated with specific sleep symptoms.
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Affiliation(s)
- Sébastien Weibel
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland.
| | - Françoise Jermann
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Luisa Weiner
- Department of Psychiatry, Mental Health and Addictology, University Hospital of Strasbourg, Strasbourg, France
| | - Rosetta Nicastro
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Stefano Ardu
- Department of Cariology and Endodontology, Treatment Plan Unit and Division of Operative Dentistry, Dental School, University of Geneva, Geneva, Switzerland
| | - Eleonore Pham
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Paco Prada
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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20
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Nicastro R, Desseilles M, Prada P, Weibel S, Perroud N, Gex-Fabry M. Subjective Distress Associated with Adult ADHD: evaluation of a new self-report. ACTA ACUST UNITED AC 2017; 10:77-86. [PMID: 28601956 DOI: 10.1007/s12402-017-0234-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/05/2016] [Accepted: 06/02/2017] [Indexed: 11/28/2022]
Abstract
The current study aims at documenting the psychometric properties of the Subjective Distress Associated with Adult ADHD-Self-Report (SDAAA-SR), a newly developed instrument for the assessment of psychological suffering in ADHD adults. The SDAAA-SR was administered to 247 students and 142 ADHD adults. Factor structure, internal consistency, test-retest reliability, convergent validity and discriminant validity were assessed. Sensitivity to change was examined in a subsample of 25 ADHD patients who participated in a 1-year therapy. The initial pool of 62 items was reduced to 33 items distributed in a three-component structure. Internal consistency was excellent for the "distress due to inattention/disorganization" subscale and good for the "distress due to hyperactivity/impulsivity" and "distress due to self-esteem deficit" subscales. Test-retest reliability in a subsample of 98 students was substantial for all three subscales. ADHD patients scored significantly higher than students on distress due to "inattention/disorganization" and "hyperactivity/impulsivity," but no difference was observed for "self-esteem deficit." The components "inattention/disorganization" and "hyperactivity/impulsivity" displayed moderate to large correlations with the corresponding dimensions of the Adult Self-Report Scale for ADHD (ASRS-V1.1). Distress due to "inattention/disorganization" and "self-esteem deficit" was significantly associated with lower satisfaction with social behaviors (QFS, social functioning questionnaire) and quality of life (WHOQOL-BREF). Distress due to "inattention/disorganization" and "self-esteem deficit" significantly decreased after a 1-year therapy. The SDAAA-SR represents a reliable and valid measure of adult ADHD-associated distress, an important but often undocumented parameter in the clinical setting. Its use as an outcome variable in psychological interventions deserves further investigation.
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Affiliation(s)
- Rosetta Nicastro
- TRE Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20 bis rue de Lausanne, 1201, Geneva, Switzerland.
| | | | - Paco Prada
- TRE Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20 bis rue de Lausanne, 1201, Geneva, Switzerland
| | - Sébastien Weibel
- TRE Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20 bis rue de Lausanne, 1201, Geneva, Switzerland
| | - Nader Perroud
- TRE Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20 bis rue de Lausanne, 1201, Geneva, Switzerland
| | - Marianne Gex-Fabry
- TRE Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20 bis rue de Lausanne, 1201, Geneva, Switzerland
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21
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Pascucci M, Stella E, La Montagna M, Di Sabatino D, Nicastro R, Grandinetti P, Testa R, Parente P, Janiri L, Pozzi G, Ventriglio A, Bellomo A. Correlations between medical students’ specialty choice and different attitudes towards mental illness. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IntroductionDiscrimination and stigmatization cause an important burden for people suffering from psychiatric disorders. The medical doctors, those who should be important reference points for psychiatric patients, are instead one of the categories that contribute to their stigmatization.ObjectivesIt is extremely important to study and to know the attitudes of undergraduate medical students towards psychiatric disorders, since these individuals will be involved in the care of these patients throughout their careers.AimsThe present study analyzes the attitudes of a group of Italian medical students towards mental illness, highlighting the differences between the students who would choose surgical specialties from those who prefer medical ones.MethodsA total of 339 medical students of different medical schools, in Rome and Foggia (Italy), completed a cross-sectional survey. The Italian version of community attitude towards the mentally Ill test (CAMI) was used to evaluate the students’ attitudes.ResultsThe students that would choose medical specialties reported less stigmatizing responses in 11 CAMI items (including five items with P < 0.01), in benevolence and community mental health ideology subscales (P = 0.003) and in the total score (P = 0.003).ConclusionsIt is evident that the students that prefer the surgical specialties have more stigmatizing attitudes towards psychiatric patients. Negative feedbacks on Psychiatry from non-psychiatrist colleagues may have a fundamental role in stigmatizing mental disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Pascucci M, Di Sabatino D, Stella E, La Montagna M, Nicastro R, Grandinetti P, Testa R, Parente P, Pozzi G, Janiri L, Ventriglio A, Bellomo A. Differences in empathy in Italian university students: Are medical students more or less empathetic? Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionEmpathy is the capacity to understand or feel what another person is experiencing. It is an important quality in the medical profession, since it is fundamental in interpersonal relationships with patients. Nevertheless, many studies have found that over time medical students (MS) become less empathic and more detached from patients.Objectives and aimsTo determine MS loss of empathy and to study the differences in empathy between MS and other university students who are not involved in healthcare.MethodsWe enrolled 244 MS (120 of the 1st year and 124 of the last year) and 125 other university students not involved in healthcare, in different universities in Rome and Foggia (Italy). They anonymously and voluntarily completed a socio-demographic questionnaire and Baron Cohen's empathy quotient test (EQ).ResultsWe found no differences regarding EQ total score between MS and other students, however there are few differences considering individual EQ items. In particular, MS really like taking care of others (P = 0.005) and they are sometimes considered to be rude, even if only they are only blunt (P = 0.006). We found no differences in empathy between first year and last year MS.ConclusionsIn our sample of Italian students, we have not found MS to be more or less empathetic than other university students, but there are some peculiar differences in empathy that make them better suited to the chosen course of study. Moreover, we found no differences between the different years of medical school.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Cole P, Weibel S, Nicastro R, Hasler R, Dayer A, Aubry JM, Prada P, Perroud N. CBT/DBT skills training for adults with attention deficit hyperactivity disorder (ADHD). Psychiatr Danub 2016; 28:103-107. [PMID: 27663817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is associated with marked impairments in familial, social, and professional functioning. Although stimulant treatments can be effective in adult ADHD, some patients will respond poorly or not at all to medication. Previous studies demonstrated that cognitive behavioural therapy- (CBT) and dialectical behavior therapy- (DBT) oriented interventions are effective in reducing the burden of the disease, which is mainly marked by depression, interpersonal difficulties, low self-esteem, and low quality of life. In order to determine the effectiveness of this intervention, we assessed the benefits of a CBT/DBT programme to reduce residual symptoms and help patients improve their quality of life. SUBJECTS AND METHODS 49 ADHD-patients, poor responders to medication, were enrolled in a one-year programme where they received individual therapy, associated with weekly sessions of group therapy with different modules: Mindfulness, Emotion Regulation, Interpersonal Effectiveness and Distress Tolerance, Impulsivity/Hyperactivity and Attention. Each subject was assessed at baseline, at months 3 and 6, and at the end of the treatment for ADHD severity (ASRS v1.1), depression severity (BDI-II), hopelessness (BHS), mindfulness skills (KIMS), anger expression and control (STAXI), impulsivity (BIS-11), quality of life (WHOQOL-BREF), and social functioning (QFS). The 49 ADHD patients were compared with 13 ADHD subjects on a waiting list. Linear mixed models were used to measure response to treatment. RESULTS Overall, the psychotherapeutic treatment was associated with significant improvements in almost all dimensions. The most significant changes were observed for BDI-II (b=-0.30; p<0.0001), ASRS total score (b=-0.16; p<0.0001), and KIMS AwA (b=0.21; p<0.0001), with moderate to large effect sizes. Compared with the waiting list controls, ADHD patients showed a better, albeit non-significant, pattern of response. CONCLUSIONS Individual and structured psycho-educational DBT/CBT groups support existing data suggesting that a structured psychotherapeutic approach is useful for patients who respond partially or not at all to drug therapy.
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Affiliation(s)
- Pierre Cole
- TRE Program, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospital of Geneva, 20bis rue de Lausanne, 1201, Geneva, Switzerland,
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Richard-Lepouriel H, Etain B, Hasler R, Bellivier F, Gard S, Kahn JP, Prada P, Nicastro R, Ardu S, Dayer A, Leboyer M, Aubry JM, Perroud N, Henry C. Similarities between emotional dysregulation in adults suffering from ADHD and bipolar patients. J Affect Disord 2016; 198:230-6. [PMID: 27031290 DOI: 10.1016/j.jad.2016.03.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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] [Received: 12/07/2015] [Revised: 02/02/2016] [Accepted: 03/12/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Emotional dysregulation in subjects with attention deficit and hyperactivity disorder (ADHD) is a topic of growing interest among clinicians and researchers. The present study aims at investigating components of emotional dysregulation in adults ADHD compared to subjects suffering from bipolar disorder (BD). METHODS A total of 150 adults ADHD, 335 adults BD subjects and 48 controls were assessed using the Affective Lability Scale (ALS) and the Affect Intensity Measure (AIM), measuring respectively emotion lability and emotion responsiveness. RESULTS ADHD and BD subjects scored significantly higher on the ALS compared to controls (p=0.0001). BD subjects scored above ADHD ones (3.07 (SD=0.66) vs. 2.30 (SD=0.68); p<0.0001). The average total scores achieved on the AIM were significantly different for the three groups (p=0.0001) with significantly higher scores for ADHD subjects compared to BD ones (3.74 (SD=0.59) vs. 3.56 (SD=0.69); p<0.0001). LIMITATIONS Suspected cases of ADHD in the BD and control groups were derived from the Wender Utah Rating Scale (WURS). This study is a retrospective one. CONCLUSION Our study thus highlights the importance of emotional dysregulation in adults suffering from ADHD, showing that they display higher emotional intensity than bipolar disorder subjects and controls. Although the current diagnostic criteria of ADHD do not contain an emotional dimension, a better recognition of the significance of emotional responsiveness in ADHD patients can improve the care afforded to these patients, beyond the inattentive and hyperactive/impulsive components.
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Affiliation(s)
- Hélène Richard-Lepouriel
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
| | - Bruno Etain
- Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil 94000, France; Université Paris Est, Faculté de Médecine, Créteil 94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil 94000, France; Fondation Fondamental, Créteil 94000, France
| | - Roland Hasler
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Frank Bellivier
- Fondation Fondamental, Créteil 94000, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, 75010 Paris, France; Université Paris Diderot, UMR-S 1144, 75006 Paris, France
| | - Sébastien Gard
- Fondation Fondamental, Créteil 94000, France; Hôpital Charles Perrens, Service de psychiatrie adulte, Pôle 3-4-7, 33000 Bordeaux, France
| | - Jean-Pierre Kahn
- Fondation Fondamental, Créteil 94000, France; Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les Nancy 54500, France
| | - Paco Prada
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Stefano Ardu
- Department of Cardiology and Endodontology, Treatment Plan Unit and Division of Operative Dentistry, Dental School, University of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Marion Leboyer
- Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil 94000, France; Université Paris Est, Faculté de Médecine, Créteil 94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil 94000, France; Fondation Fondamental, Créteil 94000, France
| | - Jean-Michel Aubry
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Chantal Henry
- Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil 94000, France; Université Paris Est, Faculté de Médecine, Créteil 94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil 94000, France; Institut Pasteur, Unité Perception et Mémoire, 75015 Paris, France
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Perroud N, Hasler R, Golay N, Zimmermann J, Prada P, Nicastro R, Aubry JM, Ardu S, Herrmann FR, Giannakopoulos P, Baud P. Personality profiles in adults with attention deficit hyperactivity disorder (ADHD). BMC Psychiatry 2016; 16:199. [PMID: 27301261 PMCID: PMC4908674 DOI: 10.1186/s12888-016-0906-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/15/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous studies suggested that the presence of ADHD in children and young adolescents may affect the development of personality. Whether or not the persistence of ADHD in adult life is associated with distinct personality patterns is still matter for debate. To address this issue, we compared the profiles of the Temperament and Character Inventory (TCI) that assesses personality dimensions in 119 adults ADHD and 403 controls. METHODS ANCOVA were used to examine group differences (controls vs. ADHD and ADHD inattentive type vs. ADHD combined + hyperactive/impulsive types) in Temperaments and Characters. Partial correlation coefficients were used to assess correlation between TCI and expression and severity of symptoms of ADHD. RESULTS High novelty seeking (NS), harm avoidance (HA) and self-transcendence (ST) scores as well as low self-directedness (SD) and cooperativeness (C) scores were associated with ADHD diagnosis. Low SD was the strongest personality trait associated with adult ADHD. Cases with the ADHD inattentive type showed higher HA and lower SD scores compared to the combined and hyperactive/impulsive types. High HA scores correlated with inattention symptoms whereas high NS and ST scores were related to hyperactive symptoms. Finally low SD and high NS were associated with increased ADHD severity. CONCLUSIONS Distinct temperaments were associated with inattentive versus hyperactive/impulsive symptoms supporting the heterogeneous nature of the disorder.
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Affiliation(s)
- Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland. .,Department of Psychiatry, University of Geneva, Geneva, Switzerland.
| | - Roland Hasler
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicolas Golay
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Julien Zimmermann
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland ,Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Stefano Ardu
- Section of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - François R Herrmann
- Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland ,Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Patrick Baud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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Nicastro R, Prada P, Kung AL, Salamin V, Dayer A, Aubry JM, Guenot F, Perroud N. Psychometric properties of the French borderline symptom list, short form (BSL-23). Borderline Personal Disord Emot Dysregul 2016; 3:4. [PMID: 27293768 PMCID: PMC4901495 DOI: 10.1186/s40479-016-0038-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 03/14/2016] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The short form of the Borderline Symptom List (BSL-23) is a self-rating instrument used to assess specific symptoms of borderline personality disorder (BPD). The original German version has shown good psychometric proprieties. The BSL-23 can also be used to measure the effects of therapy on patients with BPD. The aim of this study was to assess the psychometric properties of the French version of the BSL-23. METHODS The French version of the BSL-23 was given to 265 subjects with BPD. Factor structure, reliability, test-retest stability, convergent validity, divergent validity, and sensitivity to change were analysed. Forty-five subjects suffering from attention-deficit hyperactivity disorder (ADHD) were used as controls to evaluate the specificity of BSL-23. RESULTS A one-factor structure was obtained in the French version of the BSL-23, showing high internal consistency (Cronbach's alpha = .94) and test-retest reliability (r = .841). The French version of the BSL-23 was highly correlated with depression severity, hopelessness, anger, motor impulsiveness, and BPD diagnosis. It was an efficient tool to discriminate between BPD patients and ADHD patients, and showed good sensitivity to change in a group of BPD patients who took part in a one-month DBT intervention. CONCLUSIONS The French version of the BSL-23 shows similar psychometric properties as the original German version. This study therefore provides clinicians and researchers with a French instrument to measure BPD symptomatology.
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Affiliation(s)
- Rosetta Nicastro
- Service of Psychiatric Specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, 1201 Geneva, Switzerland
| | - Paco Prada
- Service of Psychiatric Specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, 1201 Geneva, Switzerland
| | - Anne-Lise Kung
- Service of Psychiatric Specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, 1201 Geneva, Switzerland
| | | | - Alexandre Dayer
- Service of Psychiatric Specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, 1201 Geneva, Switzerland ; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- Service of Psychiatric Specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, 1201 Geneva, Switzerland ; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | | | - Nader Perroud
- Service of Psychiatric Specialties, Department of mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, 1201 Geneva, Switzerland ; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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27
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Perroud N, Zewdie S, Stenz L, Adouan W, Bavamian S, Prada P, Nicastro R, Hasler R, Nallet A, Piguet C, Paoloni-Giacobino A, Aubry JM, Dayer A. METHYLATION OF SEROTONIN RECEPTOR 3A IN ADHD, BORDERLINE PERSONALITY, AND BIPOLAR DISORDERS: LINK WITH SEVERITY OF THE DISORDERS AND CHILDHOOD MALTREATMENT. Depress Anxiety 2016; 33:45-55. [PMID: 26350166 DOI: 10.1002/da.22406] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [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: 04/07/2015] [Revised: 07/28/2015] [Accepted: 08/02/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Serotonin 3A receptor (5-HT3A R) is associated at the genetic and epigenetic levels with a variety of psychiatric disorders and interacts with early-life stress such as childhood maltreatment. We studied the impact of childhood maltreatment on the methylation status of the 5-HT3A R and its association with clinical severity outcomes in relation with a functional genetic polymorphism. METHODS Clinical severity indexes of 346 bipolar, borderline personality, and adult attention deficit hyperactivity disorders patients were tested for association with the DNA methylation status of eight 5-HT3A R gene CpGs. Relationship between the functional variant rs1062613 (C > T) and methylation status on severity of the disorders were also assessed. RESULTS Childhood maltreatment was associated with higher severity of the disease (higher number of mood episodes, history of suicide attempts, hospitalization, and younger age at onset) across disorders and within each individual disorder. This effect was mediated by two 5-HT3A R CpGs. Compared to T allele carriers, CC carriers had higher methylation status at one CpG located 1 bp upstream of this variant. CONCLUSIONS This study shows that epigenetic modification of the 5-HT3A R is involved in the mechanism underlying the relationship between maltreatment in childhood and the severity of several psychiatric disorders in adulthood.
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Affiliation(s)
- Nader Perroud
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | | | - Ludwig Stenz
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Basic Neuroscience, University of Geneva, Switzerland
| | - Wafae Adouan
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Sabine Bavamian
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Basic Neuroscience, University of Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Audrey Nallet
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Camille Piguet
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Ariane Paoloni-Giacobino
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Basic Neuroscience, University of Geneva, Switzerland
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28
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Prados J, Stenz L, Courtet P, Prada P, Nicastro R, Adouan W, Guillaume S, Olié E, Aubry JM, Dayer A, Perroud N. Borderline personality disorder and childhood maltreatment: a genome-wide methylation analysis. Genes Brain Behav 2015; 14:177-88. [PMID: 25612291 DOI: 10.1111/gbb.12197] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 12/30/2022]
Abstract
Early life adversity plays a critical role in the emergence of borderline personality disorder (BPD) and this could occur through epigenetic programming. In this perspective, we aimed to determine whether childhood maltreatment could durably modify epigenetic processes by the means of a whole-genome methylation scan of BPD subjects. Using the Illumina Infinium® HumanMethylation450 BeadChip, global methylation status of DNA extracted from peripheral blood leucocytes was correlated to the severity of childhood maltreatment in 96 BPD subjects suffering from a high level of child adversity and 93 subjects suffering from major depressive disorder (MDD) and reporting a low rate of child maltreatment. Several CpGs within or near the following genes (IL17RA, miR124-3, KCNQ2, EFNB1, OCA2, MFAP2, RPH3AL, WDR60, CST9L, EP400, A2ML1, NT5DC2, FAM163A and SPSB2) were found to be differently methylated, either in BPD compared with MDD or in relation to the severity of childhood maltreatment. A highly relevant biological result was observed for cg04927004 close to miR124-3 that was significantly associated with BPD and severity of childhood maltreatment. miR124-3 codes for a microRNA (miRNA) targeting several genes previously found to be associated with BPD such as NR3C1. Our results highlight the potentially important role played by miRNAs in the etiology of neuropsychiatric disorders such as BPD and the usefulness of using methylome-wide association studies to uncover such candidate genes. Moreover, they offer new understanding of the impact of maltreatments on biological processes leading to diseases and may ultimately result in the identification of relevant biomarkers.
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Affiliation(s)
- J Prados
- Department of Psychiatry, University of Geneva, Switzerland
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Airoldi C, Tripodi F, Guzzi C, Nicastro R, Coccetti P. NMR analysis of budding yeast metabolomics: a rapid method for sample preparation. Mol Biosyst 2014; 11:379-83. [PMID: 25333203 DOI: 10.1039/c4mb00452c] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Here we propose the optimization of a rapid and reproducible protocol for intracellular metabolite extraction from yeast cells and their metabolic profiling by (1)H-NMR spectroscopy. The protocol reliability has been validated through comparison between the metabolome of cells in different phases of growth or with different genetic backgrounds.
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Affiliation(s)
- C Airoldi
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy.
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30
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Prada P, Hasler R, Baud P, Bednarz G, Ardu S, Krejci I, Nicastro R, Aubry JM, Perroud N. Distinguishing borderline personality disorder from adult attention deficit/hyperactivity disorder: a clinical and dimensional perspective. Psychiatry Res 2014; 217:107-14. [PMID: 24656900 DOI: 10.1016/j.psychres.2014.03.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 07/24/2013] [Revised: 02/10/2014] [Accepted: 03/02/2014] [Indexed: 11/25/2022]
Abstract
Adult attention deficit hyperactivity disorder (ADHD) is frequently associated with borderline personality disorder (BPD). As both disorders share some core clinical features they are sometimes difficult to distinguish from one another. The present work aimed to investigate differences in the expression of impulsivity, anger and aggression, quality of life as well as the number and severity of the comorbidities between ADHD, BPD, comorbid BPD-ADHD and control subjects. ADHD and BPD-ADHD patients showed a higher level of impulsivity than BPD and control subjects. BPD-ADHD patients had higher levels of substance abuse/dependence and higher levels of aggression than the other groups. Comorbid BPD-ADHD patients showed high levels of impulsivity and aggression, a characteristic that should draw the attention of clinicians on the necessity of providing an accurate diagnosis. The question also arises as to whether they represent a distinct clinical subgroup with specific clinical characteristics, outcomes and vulnerability factors.
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Affiliation(s)
- Paco Prada
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland
| | - Roland Hasler
- Department of Medical Genetic and Laboratories, Psychiatric Genetic Unit, University Hospitals of Geneva, Switzerland
| | - Patrick Baud
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland
| | - Giovanna Bednarz
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland
| | - Stefano Ardu
- Department of Cardiology and Endodontology, Treatment Plan Unit and Division of Operative Dentistry, Dental School, University of Geneva, Geneva, Switzerland
| | - Ivo Krejci
- Department of Cardiology and Endodontology, Treatment Plan Unit and Division of Operative Dentistry, Dental School, University of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland.
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Perroud N, Nicastro R, Jermann F, Huguelet P. Mindfulness skills in borderline personality disorder patients during dialectical behavior therapy: preliminary results. Int J Psychiatry Clin Pract 2012; 16:189-96. [PMID: 22443984 DOI: 10.3109/13651501.2012.674531] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE One of the components of dialectical behavior therapy (DBT) is the use of mindfulness skills as a core component of treatment for subjects with borderline personality disorder (BPD). In this study, we investigated changes in and correlates of mindfulness skills over a 1-year follow-up including a 4-week session of intensive DBT followed by 10 months of standard DBT. METHODS Fifty-two BPD subjects were assessed several times using the Kentucky Inventory of Mindfulness Skills (KIMS) which describes mindfulness in four discrete dimensions: observing (Obs), describing (Des), acting with awareness (AwA) and accepting without judgment (AwJ). RESULTS AwJ was the only dimension that increased significantly over time after adjustment for potential confounding factors (β = 0.24; P = 0.0002). Increases in AwJ correlated with improvement in BPD symptoms. CONCLUSIONS This study highlights the usefulness of investigating changes in mindfulness dimensions during DBT. AwJ is a possible mechanism for positive change. Encouraging this skill should lead to a more adaptive response to problematic situations and counteract impulsive and problematic behaviors. The lack of specific control groups means that these findings are preliminary and replication is required.
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Affiliation(s)
- Nader Perroud
- Department of Psychiatry and Mental Health, University Hospitals of Geneva, Geneva, Switzerland.
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Perroud N, Dieben K, Nicastro R, Muscionico M, Huguelet P. Functions and timescale of self-cutting in participants suffering from borderline personality disorder. J Pers Disord 2012; 26:267-79. [PMID: 22486455 DOI: 10.1521/pedi.2012.26.2.267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to examine the meanings and timescale of self-cuttings in a cohort of 22 outpatients suffering from borderline personality disorder. Sixty-one events were recorded using the newly developed self-cutting-checklist (SCUC) designed to investigate the severity of self-cuttings, and intent to die, suicidal ideation, inner tension, sense of relief and anesthesia, and consequences associated with this behavior. We found that typical self-cuttings were associated with a decrease in inner tension and suicidal ideation. Moreover self-cuttings associated with a desire to die differentiated from those associated with no desire to die by significantly less reduction in inner tension. Finally, self-cuttings occurred significantly more often during evenings and nights than during daytime. In conclusion, self-cuttings can be reasonably addressed by self-report. Attention to specific issues such as intent to die and the time of the self-cuttings may improve the outcome of these particularly high-risk subjects.
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Affiliation(s)
- Nader Perroud
- Department of Psychiatry, Division of Adult Psychiatry, Rue du 31-Décembre 8, Geneva, Switzerland.
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Abstract
The purpose of this study was to examine the effectiveness, and predictors of response and drop-out during a four-week course of intensive dialectical behavior therapy (I-DBT) in 447 outpatients suffering from borderline personality disorder (BPD), over a 10-year period. Assessments included a diagnostic interview, the International Personality Disorder Examination Screening Questionnaire, the Beck Depression Inventory, and the Beck Hopelessness Scale. Among these participants, 103 started a second course of treatment. In agreement with previous reports, I-DBT was effective in reducing levels of depression and hopelessness with a trend of increasing effectiveness over the study period. High schizoid scores and low narcissistic score predicted poor response. Treatment completion rate was high, and low education predicted dropout. A discussion on the usefulness of a second course of treatment should be held with patients and staff as it was not effective in reducing depression and hopelessness.
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Affiliation(s)
- Nader Perroud
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.
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Nicastro R, Jermann F, Bondolfi G, McQuillan A. Assessment of Mindfulness With the French Version of the Kentucky Inventory of Mindfulness Skills in Community and Borderline Personality Disorder Samples. Assessment 2010; 17:197-205. [DOI: 10.1177/1073191110363551] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores mindfulness skills in community and borderline personality disorder (BPD) samples. Study 1 includes 173 community volunteers and explores the psychometric properties of the French version of the Kentucky Inventory of Mindfulness Skills (KIMS). Study 2 explores the KIMS factor structure in 130 BPD patients and compares KIMS scores of this sample with those of the community sample from Study 1. Study 3 investigates the changes in KIMS scores in a BPD sample ( n = 82) treated with Intensive Dialectical Behavior Therapy (I-DBT). Results suggest that the psychometric properties of the French KIMS are comparable with those of the original version in the community and the BPD samples. Moreover, fewer mindfulness skills were found in BPD patients than in control participants. It was also observed that the ability to describe and to act with awareness increased in BPD patients after I-DBT. The present work makes a French instrument measuring mindfulness in daily activities available for clinical practice and research.
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McQuillan A, Nicastro R, Guenot F, Girard M, Lissner C, Ferrero F. Intensive dialectical behavior therapy for outpatients with borderline personality disorder who are in crisis. Psychiatr Serv 2005; 56:193-7. [PMID: 15703347 DOI: 10.1176/appi.ps.56.2.193] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the effectiveness of an intensive version of dialectical behavior therapy for patients in an outpatient setting who met criteria for borderline personality disorder and who were in crisis. METHODS Over the two-year study period, 127 patients (103 women) between the ages of 18 and 52 years were referred to the program; 87 were admitted, and because of a limited number of places, 40 were referred elsewhere. Patients were admitted after recent suicidal or parasuicidal behavior, and the most suicidal patients were given priority. The treatment was a three-week intensive version of dialectical behavior therapy consisting of individual therapy sessions; an emphasis on skills training provided in groups, including mindfulness skills; and team consultation. A diagnostic interview was administered, and patients were screened with the International Personality Disorder Examination Screening Questionnaire, the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS), and the Social Adaptation Self-Evaluation Scale. RESULTS The only significant difference at intake between patients admitted to the program and those referred elsewhere was a slighter higher incidence of antisocial traits in the latter group. Of the 87 patients admitted, 71 (82 percent) completed the program and 16 (18 percent) dropped out. Pre-post analysis showed significant improvement in scores on the BDI and BHS. CONCLUSIONS The three-week, intensive version of dialectical behavior therapy was found to be an effective treatment. Treatment completion was high, and patients showed statistically significant improvements in depression and hopelessness measures. This approach allowed therapists to treat a large number of patients in a short time.
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Affiliation(s)
- Annabel McQuillan
- Hôpitaux Universitiares de Genève, Ch. du Petit-Bel-Air 2, 1225 Chêne-Bourg, Switzerland.
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Huguelet P, Nicastro R, Zanello A. [Influence of attention on an auditory-verbal learning test in schizophrenic patients]. Encephale 2002; 28:291-7. [PMID: 12232538] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Schizophrenic patients are known to feature alterations in their cognitive performances, principally in executive functions, attention and memory. In this last domain, studies have shown a relatively severe and global deficit, which can be assessed in chronic and first episode patients. It seems that the memory dysfunction is independent of age and intellectual level, but does correlate with negative psychopathology and global functioning. In the study of memory dysfunction, attentional capacities, information processing and symptomatology have to be considered as determining factors. It has been shown that patients with schizophrenia perform poorly in selective attention tasks and that this deficit may interfere with learning. In the same way, the slowing of information processing contributes to a superficial and incomplete learning. The impact of symptomatology has also to be considered, as negative and depressive symptoms are linked to mnesic performances. The majority of studies bearing on working memory and schizophrenia show an alteration of performances, but studies on long term memory are more equivocal. Procedural memory seems to be preserved, while declarative memory is impaired. These results support the hypothesis that in schizophrenia, memory processes that are consciously controlled are impaired, contrary to implicit learning which may be intact. Nevertheless, studies bearing on semantic memory and episodic memory show controversial results. Still, many authors argue that schizophrenic patients have difficulties in recalling learned material, specially when a delay or a interfering task are introduced in the test. Besides, the schizophrenic subjects do not use the semantic properties of the words, as well as the control subjects, when they have to learn a words list for example. The main goal of the present study was to examine the auditory-verbal learning capacities of 31 schizophrenic patients (20 men and 11 women, 19-56 years old), compared to 27 healthy subjects (11 men and 16 women, 23-56 years old). All subjects received an evaluation including the Rey Auditory-Verbal Learning Test, used to study the progressive acquisition of 15 disyllabic words which are successively orally presented five times to the subject. About forty-five minutes after the last of the five immediate recalls, the delayed recall is assessed and a percentage of retention is also calculated. Visual reasoning and attention capacities were studied with the Progressive Matrix and the d2 encumbrance test respectively. Global psychiatric symptomatology of the patients group was assessed with the Brief Psychiatric Rating Scale. Considering the literature existing on the verbal learning capacities of schizophrenic patients, it was expected that the patients would perform poorly and learn slower than controls. The initial learning of the material, which is a critical stage for schizophrenic patients, was studied with particular attention as well as the effect of the introduction of a delay upon the recall of the words list. A secondary objective of the study was to investigate the role of visual reasoning and attention upon auditory-verbal learning process. According to published studies, it is expected that schizophrenic patients manifest some impairment in the domains of visual reasoning and attention. The question is to know whether it alters performances in the auditory-verbal learning test or not. Finally, the links between clinical characteristics of the patients, like age and illness duration, and their learning performances were explored. Statistical analysis included first a descriptive analysis of data to examine differences between the two groups. Second, ANCOVAs were used in order to control the respective impact of educational level, attention capacities and verbal reasoning capacities upon learning performances. Third, Spearman's correlations were used to detect links between clinical characteristics of the patients and learning performances. The comparisons between patients and controls confirmed that schizophrenic patients scored less in the attentional and visual reasoning tasks. They also featured a lower educational level compared to the healthy subjects. In the auditory-verbal learning test, the patients showed altered performances in the five recalls, as well as in the delayed recall and for the retention percentage. In order to control the impact of educational level, attentional and visual reasoning capacities, these parameters were introduced in the statistical analyses. Educational level did not influence memory alterations in the schizophrenic group. However, attention and, to a lesser extend, visual reasoning had an impact on the comparison of memory scores: when controlling attention, almost no significant group effect remained. Finally, the exploratory analyses of links between clinical characteristics and memory only revealed the presence of a significant negative correlation between illness duration and learning performances. Thus, the analyze of data showed that schizophrenic subjects featured poor performances in the domains of attention, verbal reasoning and auditory-verbal memory. Further analyses taking into account group differences on attention suggest that the impairment featured by schizophrenic patients in the domain of verbal memory strongly relies on an attentional deficit. These results are discussed according to the existing literature and methodological limitations. Clinical implications are also discussed.
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Affiliation(s)
- Ph Huguelet
- Département de Psychiatrie, Hôpitaux Universitaires de Genève, 8, rue du 31 décembre, 1207 Genève, Suisse
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Huguelet P, Zanello A, Nicastro R. A study of visual and auditory verbal working memory in schizophrenic patients compared to healthy subjects. Eur Arch Psychiatry Clin Neurosci 2000; 250:79-85. [PMID: 10853923 DOI: 10.1007/s004060070039] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [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: 10/27/2022]
Abstract
Impaired working memory (WM) performance is considered as a central feature of schizophrenia. Divided into two components, verbal and spatial, WM has been shown to involve frontal and parietal regions. Verbal WM can be tested either visually or aurally. The present study aimed to test schizophrenic patients in both visual and auditory verbal WM in order to assess a possible distinct pattern of alteration of these two modalities. Twenty-four schizophrenic patients and 24 healthy controls were compared with 2-back continuous visual and auditory verbal WM testing. Both groups were also tested on a neuropsychological battery including Wisconsin Card Sorting Test (WCST). Schizophrenic patients were less efficient in both verbal WM tests. When taking age and educational level as covariates and both WM modalities as dependent variables, there was no differential effect of modalities across groups. In further exploratory analyses, partial correlations brought association between verbal WM and psychosocial adaptation, WCST and length of illness. These results suggest a similar pattern of alteration of both modalities of verbal WM in schizophrenic patients. The implications of this finding are discussed.
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Affiliation(s)
- P Huguelet
- Dpartement de Psychiatrie, Hôpitaux Universitaires de Genève, Chêne-Bourg, Switzerland.
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Abstract
Design aspects and results of experiments that investigated the effects of caffeine on alcohol-induced performance decrements in humans are discussed. Simple conclusions concerning those outcomes are unwarranted because they seem to depend on the tasks used and the dosages of both drugs, with both antagonism and potentiation of alcohol-induced effects having been reported. Results indicate that legally intoxicated individuals cannot antagonize alcohol-induced, driving-related decrements with caffeine prior to driving an automobile, thought to be the major behavior for which caffeine is used in attempts to antagonize alcohol-induced decrements. We offer suggestions for research concerning subjects' habitual use or nonuse of caffeine and typical alcohol consumption levels, the interval between alcohol and caffeine ingestion, and the effects of caffeine and alcohol alone on performance tasks. We also suggest that statistical analyses should allow for a differentiation of results in which caffeine partially offsets an alcohol-induced decrement from more positive results in which caffeine returns functioning to its normal level.
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Affiliation(s)
- R Fudin
- Department of Psychology, Long Island University, Brooklyn, New York 11201
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