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CNS Drugs Oct 2021Borderline personality disorder (BPD) is a debilitating psychiatric disorder that affects 0.4-3.9% of the population in Western countries. Currently, no medications have... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Borderline personality disorder (BPD) is a debilitating psychiatric disorder that affects 0.4-3.9% of the population in Western countries. Currently, no medications have been approved by regulatory agencies for the treatment of BPD. Nevertheless, up to 96% of patients with BPD receive at least one psychotropic medication.
OBJECTIVES
The objective of this systematic review was to assess the general efficacy and the comparative effectiveness of different pharmacological treatments for BPD patients.
METHODS
We conducted systematic literature searches limited to English language in MEDLINE, EMBASE, the Cochrane Library, and PsycINFO up to April 6, 2021, and searched reference lists of pertinent articles and reviews. Inclusion criteria were (i) patients 13 years or older with a diagnosis of BPD, (ii) treatment with anticonvulsive medications, antidepressants, antipsychotic medications, benzodiazepines, melatonin, opioid agonists or antagonists, or sedative or hypnotic medications for at least 8 weeks, (iii) comparison with placebo or an eligible medication, (iv) assessment of health-relevant outcomes, (v) randomized or non-randomized trials or controlled observational studies. Two investigators independently screened abstracts and full-text articles and graded the certainty of evidence based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. For meta-analyses, we used restricted maximum likelihood random effects models to estimate pooled effects.
RESULTS
Of 12,062 unique records, we included 21 randomized controlled trials (RCTs) with data on 1768 participants. Nineteen RCTs compared pharmacotherapies with placebo; two RCTs assessed active treatments head-to-head. Out of 87 medications in use in clinical practice, we found studies on just nine. Overall, the evidence indicates that the efficacy of pharmacotherapies for the treatment of BPD is limited. Second-generation antipsychotics, anticonvulsants, and antidepressants were not able to consistently reduce the severity of BPD. Low-certainty evidence indicates that anticonvulsants can improve specific symptoms associated with BPD such as anger, aggression, and affective lability but the evidence is mostly limited to single studies. Second-generation antipsychotics had little effect on the severity of specific BPD symptoms, but they improved general psychiatric symptoms in patients with BPD.
CONCLUSIONS
Despite the common use of pharmacotherapies for patients with BPD, the available evidence does not support the efficacy of pharmacotherapies alone to reduce the severity of BPD.
REGISTRATION
PROSPERO registration number, CRD42020194098.
Topics: Anticonvulsants; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Borderline Personality Disorder; Humans; Psychotropic Drugs; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 34495494
DOI: 10.1007/s40263-021-00855-4 -
Nutricion Hospitalaria Aug 2022Background: eating disorders are a group of conditions in which negative beliefs about food, body shape, and body weight together with behaviors such as restricted food...
Background: eating disorders are a group of conditions in which negative beliefs about food, body shape, and body weight together with behaviors such as restricted food intake, binge eating, excessive exercise, self-induced vomiting, and use of laxatives. They can become serious, affect quality of life, and lead to multiple physical and even psychiatric complications with a fatal outcome. The purpose of this chapter is to describe the characteristics, epidemiology, and trends of eating disorders with updated information based on the most recent publications. Methods: we conducted a systematic literature search in Medline, EMBASE, Cochrane, and Web of Science. The search terms were "anorexia nervosa", "bulimia nervosa", "binge eating disorders" and "epidemiology" both in titles and in abstracts. Results and conclusions: EDs generally occur in adolescents and young adults. The best characterized TCAs are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (TA). Prevalence studies indicate wide differences by age group and sex, much higher in young women (NA, 0.1-2 %; BN, 0.37-2.98 %; BED, 0.62-4.45 %). The prevalence of EDs is 2.2 % (0.2-13.1 %) in Europe, 3.5 % (0.6-7.8 %) in Asia, and 4.6 % (2.0-13.5 %) in America. Comorbidity is high with psychiatric problems such as depression, anxiety, attention deficit/hyperactivity disorder, obsessive-compulsive disorder, and personality disorders.
Topics: Adolescent; Anorexia; Binge-Eating Disorder; Bulimia; Bulimia Nervosa; Feeding and Eating Disorders; Female; Humans; Male; Quality of Life; Young Adult
PubMed: 35748385
DOI: 10.20960/nh.04173 -
The British Journal of Psychiatry : the... Sep 2022A recently updated Cochrane review supports the efficacy of psychotherapy for borderline personality disorder (BPD). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A recently updated Cochrane review supports the efficacy of psychotherapy for borderline personality disorder (BPD).
AIMS
To evaluate the effects of standalone and add-on psychotherapeutic treatments more concisely.
METHOD
We applied the same methods as the 2020 Cochrane review, but focused on adult samples and comparisons of active treatments and unspecific control conditions. Standalone treatments (i.e. necessarily including individual psychotherapy as either the sole or one of several treatment components) and add-on interventions (i.e. complementing any ongoing individual BPD treatment) were analysed separately. Primary outcomes were BPD severity, self-harm, suicide-related outcomes and psychosocial functioning. Secondary outcomes were remaining BPD diagnostic criteria, depression and attrition.
RESULTS
Thirty-one randomised controlled trials totalling 1870 participants were identified. Among standalone treatments, statistically significant effects of low overall certainty were observed for dialectical behaviour therapy (self-harm: standardised mean difference (SMD) -0.54, = 0.006; psychosocial functioning: SMD -0.51, = 0.01) and mentalisation-based treatment (self-harm: risk ratio 0.51, < 0.0007; suicide-related outcomes: risk ratio 0.10, < 0.0001). For adjunctive interventions, moderate-quality evidence of beneficial effects was observed for DBT skills training (BPD severity: SMD -0.66, = 0.002; psychosocial functioning: SMD -0.45, = 0.002), and statistically significant low-certainty evidence was observed for the emotion regulation group (BPD severity: mean difference -8.49, < 0.00001), manual-assisted cognitive therapy (self-harm: mean difference -3.03, = 0.03; suicide-related outcomes: SMD -0.96, = 0.005) and the systems training for emotional predictability and problem-solving (BPD severity: SMD -0.48, = 0.002).
CONCLUSIONS
There is reasonable evidence to conclude that psychotherapeutic interventions are helpful for individuals with BPD. Replication studies are needed to enhance the certainty of findings.
Topics: Adult; Borderline Personality Disorder; Cognitive Behavioral Therapy; Dialectical Behavior Therapy; Humans; Psychotherapy; Randomized Controlled Trials as Topic; Self-Injurious Behavior
PubMed: 35088687
DOI: 10.1192/bjp.2021.204 -
Journal of Clinical Psychology Apr 2021The Enneagram is a typology that many clients use to understand their personality and interpersonal patterns, despite some concerns about its validity. Thus, the purpose... (Review)
Review
The Enneagram is a typology that many clients use to understand their personality and interpersonal patterns, despite some concerns about its validity. Thus, the purpose of this review is to provide a comprehensive and clinician-friendly review of the extant empirical work on the Enneagram. After reviewing 104 independent samples, we found mixed evidence of reliability and validity. In terms of strengths, some factor analytic work has shown partial alignment with prior theorizing, and subscales show theory-consistent relationships with other constructs such as the Big 5. Also, several studies found the Enneagram was helpful for personal/spiritual growth. However, factor analytic work has typically found fewer than nine factors, and no work has used clustering techniques to derive the nine types. Also, there is little research supporting secondary aspects of Enneagram theory, such as wings and intertype movement. We conclude by highlighting directions for future research and implications for clinical practice.
Topics: Humans; Personality; Personality Disorders; Reproducibility of Results; Spirituality
PubMed: 33332604
DOI: 10.1002/jclp.23097 -
CNS Spectrums Dec 2022A number of recent investigations have focused on the neurobiology of obsessive-compulsive personality disorder (OCPD). However, there have been few reviews of this... (Review)
Review
BACKGROUND
A number of recent investigations have focused on the neurobiology of obsessive-compulsive personality disorder (OCPD). However, there have been few reviews of this literature with no detailed model proposed. We therefore undertook a systematic review of these investigations, aiming to map the available evidence and investigate whether it is possible to formulate a detailed model of the neurobiology of OCPD.
METHODS
OCPD can be considered from both categorical and dimensional perspectives. An electronic search was therefore conducted using terms that would address not only OCPD as a category, but also related constructs, such as perfectionism, that would capture research on neuropsychology, neuroimaging, neurochemistry, and neurogenetics.
RESULTS
A total of 1059 articles were retrieved, with 87 ultimately selected for abstract screening, resulting in a final selection of 49 articles focusing on neurobiological investigations relevant to OCPD. Impaired executive function and cognitive inflexibility are common neuropsychological traits in this condition, and suggest that obsessive-compulsive disorder (OCD) and OCPD may lie on a continuum. However, neuroimaging studies in OCPD indicate the involvement of specific neurocircuitry, including the precuneus and amygdala, and so suggest that OCD and OCPD may have important differences. Although OCPD has a heritable component, we found no well-powered genetic studies of OCPD.
CONCLUSION
Although knowledge in this area has advanced, there are insufficient data on which to base a comprehensive model of the neurobiology of OCPD. Given the clinical importance of OCPD, further work to understand the mechanisms that underpin this condition is warranted.
Topics: Humans; Compulsive Personality Disorder; Obsessive-Compulsive Disorder; Neurobiology
PubMed: 34378500
DOI: 10.1017/S1092852921000754 -
The Lancet. Psychiatry Oct 2019Although many meta-analyses have examined the association between childhood sexual abuse and subsequent outcomes, the scope, validity, and quality of this evidence has...
BACKGROUND
Although many meta-analyses have examined the association between childhood sexual abuse and subsequent outcomes, the scope, validity, and quality of this evidence has not been comprehensively assessed. We aimed to systematically review existing meta-analyses on a wide range of long-term psychiatric, psychosocial, and physical health outcomes of childhood sexual abuse, and evaluate the quality of the literature.
METHODS
In this umbrella review, we searched four databases (PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Global Health) from inception to Dec 31, 2018, to identify meta-analyses of observational studies that examined the association between childhood sexual abuse (before 18 years of age) and long-term consequences (after 18 years). We compared odds ratios (ORs) across different outcomes. We also examined measures of quality, including heterogeneity between studies and evidence for publication bias. This study is registered with PROSPERO, CRD42016049701.
FINDINGS
We identified 19 meta-analyses that included 559 primary studies, covering 28 outcomes in 4 089 547 participants. Childhood sexual abuse was associated with 26 of 28 specific outcomes: specifically, six of eight adult psychiatric diagnoses (ORs ranged from 2·2 [95% CI 1·8-2·8] to 3·3 [2·2-4·8]), all studied negative psychosocial outcomes (ORs ranged from 1·2 [1·1-1·4] to 3·4 [2·3-4·8]), and all physical health conditions (ORs ranged from 1·4 [1·3-1·6] to 1·9 [1·4-2·8]). Strongest psychiatric associations with childhood sexual abuse were reported for conversion disorder (OR 3·3 [95% CI 2·2-4·8]), borderline personality disorder (2·9 [2·5-3·3]), anxiety (2·7 [2·5-2·8]), and depression (2·7 [2·4-3·0]). The systematic reviews for two psychiatric outcomes (post-traumatic stress disorder and schizophrenia) and one psychosocial outcome (substance misuse) met high quality standards. Quality was low for meta-analyses on borderline personality disorder and anxiety, and moderate for conversion disorder. Assuming causality, population attributable risk fractions for outcomes ranged from 1·7% (95% CI 0·7-3·3) for unprotected sexual intercourse to 14·4% (8·8-19·9) for conversion disorder.
INTERPRETATION
Although childhood sexual abuse was associated with a wide range of psychosocial and health outcomes, systematic reviews on only two psychiatric disorders (post-traumatic stress disorder and schizophrenia) and one psychosocial outcome (substance misuse) were of a high quality. Whether services should prioritise interventions that mitigate developing certain psychiatric disorders following childhood abuse requires further review. Higher-quality meta-analyses for specific outcomes and more empirical studies on the developmental pathways from childhood sexual abuse to later outcomes are necessary.
FUNDING
Wellcome Trust.
Topics: Child; Child Abuse, Sexual; Health Status; Humans; Mental Disorders
PubMed: 31519507
DOI: 10.1016/S2215-0366(19)30286-X -
PloS One 2019Maladaptive parenting (including childhood maltreatment, abuse and neglect) has been implicated in the scientific literature exploring the aetiology of personality... (Meta-Analysis)
Meta-Analysis
BACKGROUND/OBJECTIVES
Maladaptive parenting (including childhood maltreatment, abuse and neglect) has been implicated in the scientific literature exploring the aetiology of personality disorder, particularly borderline personality disorder (BPD). Our primary objective was to summarise the evidence on the relationship between parenting and personality disorder, assisting clinical decision-makers to translate this research into clinical policy and practice.
METHODS
We conducted an overview of systematic reviews that assessed individuals with personality disorder pathology for experiences of maladaptive parenting, compared to psychiatric or healthy comparisons/controls, and the impact on psychopathological and relational outcomes. Systematic literature searches were conducted in Scopus, Web of Science, MEDLINE, PsycINFO, and by hand in August 2018. Methodological quality was assessed using the CASP systematic review checklist, and results were qualitatively synthesised. A pre-determined protocol was registered in Prospective Register of Systematic Reviews (PROSPERO 2019:CRD42018096177).
RESULTS
Of the 312 identified records, 293 abstracts were screened, 36 full-text articles were retrieved and eight systematic reviews met pre-determined criteria for qualitative synthesises. The majority of studies reported outcomes related to BPD (n = 7), and study design, methodology and quality varied. Within the eight systematic reviews there were 211 primary studies, of which 140 (66.35%) met eligibility criteria for inclusion in this overview. Eligible primary studies reported on 121,895 adult, child/adolescent and parent-offspring participants, with most studies focused on borderline personality pathology (n = 100, 71.43%). Study design and methodology also varied for these studies. Overall, five systematic reviews overwhelming found that maladaptive parenting was a psychosocial risk factor for the development of borderline personality pathology, and three studies found that borderline personality pathology was associated with maladaptive parenting, and negative offspring and parenting-offspring outcomes.
CONCLUSIONS
In light of these findings, we recommend greater emphasis on parenting in clinical practice and the development of parenting interventions for individuals with personality disorder. However, our understanding is limited by the heterogeneity and varying quality of the evidence, and as such, future research utilising more rigorous research methodology is needed.
Topics: Adolescent; Adult; Borderline Personality Disorder; Child; Child Abuse; Emotions; Female; Humans; Mental Health; Parenting; Personality Disorders; Risk Factors
PubMed: 31574104
DOI: 10.1371/journal.pone.0223038 -
JAMA Psychiatry Apr 2017Borderline personality disorder (BPD) is a debilitating condition, but several psychotherapies are considered effective. (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Borderline personality disorder (BPD) is a debilitating condition, but several psychotherapies are considered effective.
OBJECTIVE
To conduct an updated systematic review and meta-analysis of randomized clinical trials to assess the efficacy of psychotherapies for BPD populations.
DATA SOURCES
Search terms were combined for borderline personality and randomized trials in PubMed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials (from database inception to November 2015), as well as the reference lists of earlier meta-analyses.
STUDY SELECTION
Included were randomized clinical trials of adults with diagnosed BPD randomized to psychotherapy exclusively or to a control intervention. Study selection differentiated stand-alone designs (in which an independent psychotherapy was compared with control interventions) from add-on designs (in which an experimental intervention added to usual treatment was compared with usual treatment alone).
DATA EXTRACTION AND SYNTHESIS
Data extraction coded characteristics of trials, participants, and interventions and assessed risk of bias using 4 domains of the Cochrane Collaboration Risk of Bias tool (independent extraction by 2 assessors). Outcomes were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted.
MAIN OUTCOMES AND MEASURES
Standardized mean differences (Hedges g) were calculated using all outcomes reported in the trials for borderline symptoms, self-harm, suicide, health service use, and general psychopathology at posttest and follow-up. Differential treatment retention at posttest was analyzed, reporting odds ratios.
RESULTS
Thirty-three trials (2256 participants) were included. For borderline-relevant outcomes combined (symptoms, self-harm, and suicide) at posttest, the investigated psychotherapies were moderately more effective than control interventions in stand-alone designs (g = 0.32; 95% CI, 0.14-0.51) and add-on designs (g = 0.40; 95% CI, 0.15-0.65). Results were similar for other outcomes, including stand-alone designs: self-harm (g = 0.32; 95% CI, 0.09-0.54), suicide (g = 0.44; 95% CI, 0.15-0.74), health service use (g = 0.40; 95% CI, 0.22-0.58), and general psychopathology (g = 0.32; 95% CI, 0.09-0.55), with no differences between design types. There were no significant differences in the odds ratios for treatment retention (1.32; 95% CI, 0.87-2.00 for stand-alone designs and 1.01; 95% CI, 0.55-1.87 for add-on designs). Thirteen trials reported borderline-relevant outcomes at follow-up (g = 0.45; 95% CI, 0.15-0.75). Dialectical behavior therapy (g = 0.34; 95% CI, 0.15-0.53) and psychodynamic approaches (g = 0.41; 95% CI, 0.12-0.69) were the only types of psychotherapies more effective than control interventions. Risk of bias was a significant moderator in subgroup and meta-regression analyses (slope β = -0.16; 95% CI, -0.29 to -0.03; P = .02). Publication bias was persistent, particularly for follow-up.
CONCLUSIONS AND RELEVANCE
Psychotherapies, most notably dialectical behavior therapy and psychodynamic approaches, are effective for borderline symptoms and related problems. Nonetheless, effects are small, inflated by risk of bias and publication bias, and particularly unstable at follow-up.
Topics: Behavior Therapy; Borderline Personality Disorder; Humans; Psychotherapy; Psychotherapy, Psychodynamic; Randomized Controlled Trials as Topic; Self-Injurious Behavior; Suicide; Treatment Outcome; Suicide Prevention
PubMed: 28249086
DOI: 10.1001/jamapsychiatry.2016.4287 -
L'Encephale Feb 2015Acceptance and commitment therapy (ACT) is a third generation of cognitive-behavioral therapies. The point is to help patients to improve their psychological flexibility... (Review)
Review
INTRODUCTION
Acceptance and commitment therapy (ACT) is a third generation of cognitive-behavioral therapies. The point is to help patients to improve their psychological flexibility in order to accept unavoidable private events. Thus, they have the opportunity to invest energy in committed actions rather than struggle against their psychological events.
OBJECTIVES OF THE STUDY
(i) To present the ACT basic concepts and (ii) to propose a systematic review of the literature about effectiveness of this kind of psychotherapy.
METHOD
(i) The core concepts of ACT come from Monestès (2011), Schoendorff (2011), and Harris (2012); (ii) we conducted a systematic review of the literature using the PRISMA's criteria. The research paradigm was « acceptance and commitment therapy AND randomized controlled trial ». The bases of the MEDLINE, Cochrane and Web of science have been checked.
RESULTS
Overall, 61 articles have been found, of which, after reading the abstracts, 40 corresponded to the subject of our study. (I) Psychological flexibility is established through six core ACT processes (cognitive defusion, acceptance, being present, values, committed action, self as context), while the therapist emphasizes on experiential approach. (II) Emerging research shows that ACT is efficacious in the psychological treatment of a wide range of psychiatric problems, including psychosis, depression, obsessive-compulsive disorder, trichotillomania, generalized anxiety disorder, post-traumatic stress disorder, borderline personality disorder, eating disorders. ACT has also shown a utility in other areas of medicine: the management chronic pain, drug-dependence, smoking cessation, the management of epilepsy, diabetic self-management, the management of work stress, the management of tinnitus, and the management of multiple sclerosis. Meta-analysis of controlled outcome studies reported an average effect size (Cohen's d) of 0.66 at post-treatment (n=704) and 0.65 (n=580) at follow-up (on average 19.2 weeks later). In studies involving comparison between ACT and active well-specified treatments, the effect size was 0.48 at post (n=456) and 0.62 at follow-up (n=404). In comparisons with waist list, treatment as usual, or placebo treatment, the effect sizes were 0.99 at post (n=248) and 0.71 at follow-up (n=176). Furthermore, ACT studies pointed out learning specific skills, such as decreasing experiential avoidance, increasing cognitive defusion, acceptance and contact with the present moment. Finally, all ACT studies showed an improved quality of life.
DISCUSSION
The loss of psychological flexibility is the origin of the pain caused by psychiatric disorders and chronic diseases. This is why other studies are needed to investigate ACT's full potential.
Topics: Acceptance and Commitment Therapy; Adaptation, Psychological; Humans; Life Change Events; Mental Disorders; Outcome and Process Assessment, Health Care
PubMed: 24262333
DOI: 10.1016/j.encep.2013.04.017 -
Psychological Medicine May 2021Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical.
METHODS
We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12-19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7.
RESULTS
Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = -0.44; 95% CI -0.81 to -0.07) and suicidal ideation (g = -0.31, 95% CI -0.52 to -0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = -0.98, 95% CI -1.15 to -0.81; suicidal ideation: g = -1.16, 95% CI -1.51 to -0.80; BPD symptoms: g = -0.97, 95% CI -1.31 to -0.63).
CONCLUSIONS
DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.
Topics: Adolescent; Borderline Personality Disorder; Dialectical Behavior Therapy; Female; Humans; Male; Self-Injurious Behavior; Suicidal Ideation; Young Adult
PubMed: 33875025
DOI: 10.1017/S0033291721001355