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Health Technology Assessment... Sep 2020People with a history of complex traumatic events typically experience trauma and stressor disorders and additional mental comorbidities. It is not known if existing...
BACKGROUND
People with a history of complex traumatic events typically experience trauma and stressor disorders and additional mental comorbidities. It is not known if existing evidence-based treatments are effective and acceptable for this group of people.
OBJECTIVE
To identify candidate psychological and non-pharmacological treatments for future research.
DESIGN
Mixed-methods systematic review.
PARTICIPANTS
Adults aged ≥ 18 years with a history of complex traumatic events.
INTERVENTIONS
Psychological interventions versus control or active control; pharmacological interventions versus placebo.
MAIN OUTCOME MEASURES
Post-traumatic stress disorder symptoms, common mental health problems and attrition.
DATA SOURCES
Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 onwards); Cochrane Central Register of Controlled Trials (CENTRAL) (from inception); EMBASE (1974 to 2017 week 16); International Pharmaceutical Abstracts (1970 onwards); MEDLINE and MEDLINE Epub Ahead of Print and In-Process & Other Non-Indexed Citations (1946 to present); Published International Literature on Traumatic Stress (PILOTS) (1987 onwards); PsycINFO (1806 to April week 2 2017); and Science Citation Index (1900 onwards). Searches were conducted between April and August 2017.
REVIEW METHODS
Eligible studies were singly screened and disagreements were resolved at consensus meetings. The risk of bias was assessed using the Cochrane risk-of-bias tool and a bespoke version of a quality appraisal checklist used by the National Institute for Health and Care Excellence. A meta-analysis was conducted across all populations for each intervention category and for population subgroups. Moderators of effectiveness were assessed using metaregression and a component network meta-analysis. A qualitative synthesis was undertaken to summarise the acceptability of interventions with the relevance of findings assessed by the GRADE-CERQual checklist.
RESULTS
One hundred and four randomised controlled trials and nine non-randomised controlled trials were included. For the qualitative acceptability review, 4324 records were identified and nine studies were included. The population subgroups were veterans, childhood sexual abuse victims, war affected, refugees and domestic violence victims. Psychological interventions were superior to the control post treatment for reducing post-traumatic stress disorder symptoms (standardised mean difference -0.90, 95% confidence interval -1.14 to -0.66; number of trials = 39) and also for associated symptoms of depression, but not anxiety. Trauma-focused therapies were the most effective interventions across all populations for post-traumatic stress disorder and depression. Multicomponent and trauma-focused interventions were effective for negative self-concept. Phase-based approaches were also superior to the control for post-traumatic stress disorder and depression and showed the most benefit for managing emotional dysregulation and interpersonal problems. Only antipsychotic medication was effective for reducing post-traumatic stress disorder symptoms; medications were not effective for mental comorbidities. Eight qualitative studies were included. Interventions were more acceptable if service users could identify benefits and if they were delivered in ways that accommodated their personal and social needs.
LIMITATIONS
Assessments about long-term effectiveness of interventions were not possible. Studies that included outcomes related to comorbid psychiatric states, such as borderline personality disorder, and populations from prisons and humanitarian crises were under-represented.
CONCLUSIONS
Evidence-based psychological interventions are effective and acceptable post treatment for reducing post-traumatic stress disorder symptoms and depression and anxiety in people with complex trauma. These interventions were less effective in veterans and had less of an impact on symptoms associated with complex post-traumatic stress disorder.
FUTURE WORK
Definitive trials of phase-based versus non-phase-based interventions with long-term follow-up for post-traumatic stress disorder and associated mental comorbidities.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42017055523.
FUNDING
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 24, No. 43. See the NIHR Journals Library website for further project information.
Topics: Adult; Cognitive Behavioral Therapy; Comorbidity; Evidence-Based Medicine; Female; Humans; Male; Middle Aged; Non-Randomized Controlled Trials as Topic; Psychotherapy; Psychotropic Drugs; Randomized Controlled Trials as Topic; Stress Disorders, Post-Traumatic
PubMed: 32924926
DOI: 10.3310/hta24430 -
Health Psychology : Official Journal of... Mar 2017Too much sitting is associated with an increased risk of chronic disease and premature death. This investigation aimed to systematically review the evidence for... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Too much sitting is associated with an increased risk of chronic disease and premature death. This investigation aimed to systematically review the evidence for personality as a correlate of time spent in sedentary pursuits.
METHOD
Electronic databases (PubMed; Science Direct; PsycINFO, PsycARTICLES, and SPORTDiscus via EBSCO; Web of Science; MEDLINE via Ovid; Scopus; ProQuest) were searched in December 2015 for studies reporting an association between at least 1 personality trait and time spent in at least 1 sedentary behavior. Pooled mean effect sizes were computed using inverse-variance weighted random effects meta-analysis.
RESULTS
Twenty-six studies (28 samples, 110 effect sizes) met inclusion criteria. Higher levels of sedentary behavior were associated with higher levels of neuroticism (r+ = .08, 95% confidence interval [CI: .05, .10]) and lower levels of conscientiousness (r+ = -.08, 95% CI [-.11, -.06]). Nonsignificant associations were observed for extraversion (r+ = .00, 95% CI [-.07, .06]), openness (r+ = -.02, 95% CI [-.05, .02]), and agreeableness (r+ = -.04, 95% CI [-.09, .00]). Effects for neuroticism and extraversion were moderated by measurement of sedentary behavior, and effects for openness and agreeableness were moderated by participant age and gender.
CONCLUSIONS
Findings appear consistent with personality trait associations with other health-related behaviors. More objective measures of sedentary behavior are required to make more definitive conclusions about the contribution of personality to a sedentary lifestyle. (PsycINFO Database Record
Topics: Anxiety Disorders; Female; Health Behavior; Humans; Male; Neuroticism; Personality; Personality Disorders; Sedentary Behavior
PubMed: 27736151
DOI: 10.1037/hea0000429 -
Obesity Reviews : An Official Journal... Aug 2016Studies demonstrate an association between personality traits and obesity as well as their prognostic influence on weight course. In contrast, only few studies have... (Review)
Review
BACKGROUND
Studies demonstrate an association between personality traits and obesity as well as their prognostic influence on weight course. In contrast, only few studies have investigated the association between personality disorders (PDs) and obesity.
OBJECTIVE
The present review summarizes through a comprehensive and critical evaluation the results of 68 studies identified by database research (PubMed and PsycINFO) covering the last 35 years that investigated the association between PDs, overweight and obesity as well as the predictive value of PDs for the development of obesity and the effectiveness of weight reduction treatments.
RESULTS
Adults with any PD have a higher risk of obesity. In the female general population, there is an association between avoidant or antisocial PD and severe obesity. Further, women with paranoid or schizotypal PD have a higher risk of obesity. Clinical studies including foremost female participants showed a higher comorbidity of PDs, especially borderline PD and avoidant PD, in binge-eating disorder. Regarding both genders, patients with PD show less treatment success in conservative weight-loss treatment programmes for obesity than patients without PD.
CONCLUSIONS
In prevention and conservative weight-loss treatment strategies, more care should be taken to address the special needs of patients with comorbid PDs.
Topics: Binge-Eating Disorder; Comorbidity; Humans; Meta-Analysis as Topic; Obesity; Overweight; Personality Disorders; Prevalence; Randomized Controlled Trials as Topic
PubMed: 27230851
DOI: 10.1111/obr.12415 -
Psychopharmacology Oct 2023Clozapine is a unique medication with a potential role in the treatment of severe borderline personality disorder (BPD). (Review)
Review
RATIONALE
Clozapine is a unique medication with a potential role in the treatment of severe borderline personality disorder (BPD).
OBJECTIVES
The review examines the effectiveness of clozapine as a medication for management for severe BPD with high risk of suicide, violence or imprisonment, and aims to help guide clinical practice in managing severe BPD.
METHODS
A database search of the terms "Clozapine" AND "BPD"; "Antipsychotics" AND "BPD"; "Clozapine" AND "Borderline Personality Disorder"; and "Antipsychotics" AND "Borderline Personality Disorder" were performed in CINAHL, Cochrane Library, Embase, Medline, PsychINFO, PubMed, and Web of Science. Full-text articles of clinical clozapine use for BPD were included for review.
RESULTS
A total of 24 articles consisting of 1 randomised control trial, 10 non-controlled trials, and 13 case reports were identified. Most of the studies reported benefits from clozapine when used for severe BPD. Many of the studies focused on clozapine use in BPD patients at high risk of suicide. Results from these non-controlled and case reports support the use of clozapine in patients with severe BPD at high risk of suicide.
CONCLUSION
There may be a role for clozapine in treating severe treatment refractory BPD, especially for those patients at high risk of suicide and frequent hospitalisations.
Topics: Humans; Clozapine; Antipsychotic Agents; Suicide; Borderline Personality Disorder; Randomized Controlled Trials as Topic
PubMed: 37572113
DOI: 10.1007/s00213-023-06431-6 -
The International Journal of Social... Feb 2016Support of personal recovery represents the aim for many modern mental health services. There is a lack of conceptual clarity around the application of the term however... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Support of personal recovery represents the aim for many modern mental health services. There is a lack of conceptual clarity around the application of the term however and this is particularly problematic with regard to the personality disorder diagnoses. This study sought to review the existing qualitative methods literature in relation to the experience of personal recovery in personality disorder.
METHODS
A systematic literature search was conducted. Identified studies were incorporated through meta-synthesis in order to develop higher order descriptive themes representative of the individual experience described within included studies.
RESULTS
Three studies were identified and incorporated into the meta-synthesis. Three novel higher order themes were developed: Safety and containment as a prerequisite to recovery, social networks and autonomy in the recovery process and identity construction as a process of change.
CONCLUSION
Personal recovery in personality disorder is revealed as a complex process reflecting both personal and social experiences or desires. These findings have important implications for clinical practice - emphasising the need to work closely with individuals and to develop an understanding of both their social experience and networks. Further research, taking greater account of social context in the recovery process, is necessary.
Topics: Adult; Deinstitutionalization; Female; Humans; Male; Middle Aged; Personality Disorders; Qualitative Research
PubMed: 26081467
DOI: 10.1177/0020764015589133 -
Current Psychiatry Reports Oct 2020Identity is one of the key domains that is disturbed in people manifesting personality disorder (PD). Within the field of personality psychology, there is a robust... (Review)
Review
PURPOSE OF REVIEW
Identity is one of the key domains that is disturbed in people manifesting personality disorder (PD). Within the field of personality psychology, there is a robust approach to studying identity focused on narrative identity which has been largely overlooked in studying PD. In this paper, a systematic review was conducted of studies published in the past decade that focused on how individuals manifesting personality pathology craft their narrative identity.
RECENT FINDINGS
This review revealed disturbances related to several motivational/affective themes (e.g., negative valence/valence shifts and thwarted themes of agency and communion), autobiographical reasoning (negative self-inferences), and structural elements (e.g., low coherence and fewer life script events) within the narrative identity of people who manifest PD. Narrative identity is disturbed in people experiencing personality pathology and may have crucial implications for enhancing our conceptual understanding of PD and for PD interventions. This review also points to several research limitations and gaps that we encourage the field to pursue in the future.
Topics: Humans; Motivation; Narration; Personality; Personality Disorders; Self Concept
PubMed: 33034756
DOI: 10.1007/s11920-020-01187-8 -
The Psychiatric Quarterly Dec 2020No treatment has been approved and recognized as effective in borderline personality disorder (BPD). Impulsivity is a key dimension because it is a predictor of... (Review)
Review
No treatment has been approved and recognized as effective in borderline personality disorder (BPD). Impulsivity is a key dimension because it is a predictor of remission but also suicide. The purpose of this review is to establish an inventory on the management of impulsivity in BPD and determine the effective treatments. A systematic review on the PubMed and Ovid databases was conducted up to September 2019 to December 2019 using the PRISMA guidelines. The inclusion criteria were: studies with patients with borderline personality disorder, were published between 1989 and 2019, used English-language and evaluated impulsivity before and after treatment. 41 articles selected were included for pharmacological treatment. 24 articles were found for psychotherapeutic management and one randomized study of transcranial magnetic stimulation. Based on this review, we must focus on psychotherapy in BPD, particularly the schema therapy, dialectical behavioral therapy, psychoeducation, system training of emotional predictability and problem solving and psychotherapy using mentalisation. The use of neuroleptics and mood stabilizers appears to be more effective than antidepressants. Another approach, such as transcranial magnetic stimulation, may prove useful in the near future if this technique is studied further.
Topics: Behavior Therapy; Borderline Personality Disorder; Humans; Impulsive Behavior; Psychotherapy; Suicide; Suicide Prevention
PubMed: 32989635
DOI: 10.1007/s11126-020-09845-z -
Harvard Review of Psychiatry 2016Borderline personality disorder (BPD) is a severe mental disorder with a multifactorial etiology. The development and maintenance of BPD is sustained by diverse... (Review)
Review
Borderline personality disorder (BPD) is a severe mental disorder with a multifactorial etiology. The development and maintenance of BPD is sustained by diverse neurobiological factors that contribute to the disorder's complex clinical phenotype. These factors may be identified using a range of techniques to probe alterations in brain systems that underlie BPD. We systematically searched the scientific literature for empirical studies on the neurobiology of BPD, identifying 146 articles in three broad research areas: neuroendocrinology and biological specimens; structural neuroimaging; and functional neuroimaging. We consolidate the results of these studies and provide an integrative model that attempts to incorporate the heterogeneous findings. The model specifies interactions among endogenous stress hormones, neurometabolism, and brain structures and circuits involved in emotion and cognition. The role of the amygdala in BPD is expanded to consider its functions in coordinating the brain's dynamic evaluation of the relevance of emotional stimuli in the context of an individual's goals and motivations. Future directions for neurobiological research on BPD are discussed, including implications for the Research Domain Criteria framework, accelerating genetics research by incorporating endophenotypes and gene × environment interactions, and exploring novel applications of neuroscience findings to treatment research.
Topics: Borderline Personality Disorder; Humans; Models, Neurological
PubMed: 27603741
DOI: 10.1097/HRP.0000000000000123 -
Obesity Reviews : An Official Journal... Jan 2015Based on a bio-social-ecological systems model of the development and maintenance of obesity, there has been in the last few years a growing research interest in the... (Review)
Review
Based on a bio-social-ecological systems model of the development and maintenance of obesity, there has been in the last few years a growing research interest in the association of obesity and personality traits. The aim of the present review was a comprehensive and critical evaluation of the existing literature taking into account the methodological quality of studies to enhance our understanding of personality traits associated with body weight, the development of overweight and obesity as well as the effectiveness of weight loss interventions including bariatric surgery. Personality traits play an important role both as risk as well as protective factors in the development of overweight and obesity. While thus in particular 'neuroticism', 'impulsivity' and 'sensitivity to reward' appear as risk factors, 'conscientiousness' and 'self-control' have been shown to have a protective function in relation to weight gain. Conscientiousness is a measure of regulation of internal urges and self-discipline, and may thus provide a potential source of control over impulsive reward-oriented behaviour. The results of the present review suggest that, within the context of therapeutic weight reduction measures, it is meaningful to identify subgroups of patients for whom specific treatment options need to be developed, such as measures for strengthening self-control skills.
Topics: Anxiety Disorders; Bariatric Surgery; Body Mass Index; Feeding Behavior; Humans; Neuroticism; Obesity; Personality; Personality Disorders; Risk Factors; Weight Loss
PubMed: 25470329
DOI: 10.1111/obr.12235 -
Child Abuse & Neglect Jun 2023Parental pathology may affect parenting capacity and is deemed a risk factor for child maltreatment. Especially parental personality disorder (PD) can significantly... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Parental pathology may affect parenting capacity and is deemed a risk factor for child maltreatment. Especially parental personality disorder (PD) can significantly burden the relationship and interaction between parents and their children.
OBJECTIVE
This meta-analytic review aims to summarize and quantify the influence of parental PD on the occurrence / the risk of child maltreatment.
PARTICIPANTS AND SETTING
Studies had to meet the following inclusion criteria: They had to analyze a sample of parents with a diagnosed PD and the occurrence / risk of maltreating their children. To be included in the narrative synthesis and/or meta-analysis, they had to be case-control, cross-sectional, or longitudinal studies. Literature research was conducted in the databases Web of Science, Psychinfo, and Google Scholar up to January 2023.
METHODS
First, studies were analyzed on a narrative level, and eligible studies for the meta-analysis were identified. Studies were grouped according to the diagnosed PDs. Five different groups were included: borderline PD, antisocial PD, narcissistic PD, nondifferentiated PDs, and Cluster B PDs. Three different random-effects meta-analyses were computed (borderline PD, antisocial PD, Cluster B PDs). Meta-analyses were controlled for publication bias and different covariates (e.g., study quality, sample size).
RESULTS
After screening 41 full texts, 17 studies were included in the narrative synthesis, out of which 14 samples from 11 studies were included in the meta-analysis. Analysis of borderline PD showed an association with the occurrence / risk of child maltreatment (OR = 8.08; 95 % CI [2.51, 25.93]). However, after taking into account possible publication bias, this association was no longer significant. We found a significant and stable association between antisocial PD and the occurrence of / risk of child maltreatment (OR = 4.92; 95 % CI [3.26, 7.43]). Analysis of Cluster B PDs (antisocial, borderline, histrionic, narcissistic) revealed a significant overall association (OR = 4.23; 95 % CI [2.75, 6.5]), indicating that the presence of Cluster B PDs in parents significantly increases the occurrence of / the risk of child maltreatment.
CONCLUSIONS
Analyses indicated a significant association between of Cluster B PDs, and specifically between antisocial and borderline PD, with the occurrence of / the risk of child maltreatment. However, methodological limitations have to be taken into account, because results for borderline PD were no longer significant after controlling for possible publication bias. Moreover, the number of studies included was rather small, and results showed a substantial amount of heterogeneity.
OTHER
This work was not supported by any funding.
Topics: Humans; Child; Cross-Sectional Studies; Personality Disorders; Borderline Personality Disorder; Antisocial Personality Disorder; Child Abuse; Parents
PubMed: 37060689
DOI: 10.1016/j.chiabu.2023.106148