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Journal of Affective Disorders Jun 2024Bipolar disorder (BD) has a high disease burden and the highest mortality risk in BD comes from suicide. Bipolar disorder type II (BD-II) has been described as a milder... (Review)
Review
BACKGROUND
Bipolar disorder (BD) has a high disease burden and the highest mortality risk in BD comes from suicide. Bipolar disorder type II (BD-II) has been described as a milder form of bipolar disorder; however, extant literature is inconsistent with this description and instead describe illness burden and notably suicidality comparable to persons with bipolar I disorder (BD-I). Towards quantifying the hazard of BD-II, herein we aim via systematic review and meta-analysis to evaluate the rates of completed suicide in BD-I and BD-II.
METHOD
We conducted a literature search on PubMed, OVID (Embase, Medline) and PsychINFO databases from inception to June 30th, 2023, according to PRISMA guidelines. Articles were selected based on the predetermined eligibility criteria. A meta-analysis was performed, comparing the risk of completed suicide between individuals diagnosed with BD-I to BD-II.
RESULTS
Four out of eight studies reported higher suicide completion rates in persons living with BD-II when compared to persons living with BD-I; however, two of the studies reported non-significance. Two studies reported significantly higher suicide completion rates for BD-I than BD-II. The pooled odds ratio of BD-II suicide rates to BD-I was 1.00 [95 % CI = 0.75, 1.34].
LIMITATIONS
The overarching limitation is the small number of studies and heterogeneity of studies that report on suicide completion in BD-I and BD-II.
CONCLUSION
Our study underscores the severity of BD-II, with a risk for suicide not dissimilar from BD-I. The greater propensity to depression, comorbidity and rapid-cycling course reported in BD-II are contributing factors to the significant mortality hazard in BD-II.
PubMed: 38901691
DOI: 10.1016/j.jad.2024.06.045 -
Addictive Behaviors Jun 2024Problematic gaming is particularly prevalent in adolescent and young adult populations. While numerous studies have investigated the psychiatric comorbidities of... (Review)
Review
Problematic gaming is particularly prevalent in adolescent and young adult populations. While numerous studies have investigated the psychiatric comorbidities of Internet Gaming Disorder in young adults, few have focused specifically on adolescents who might be especially at risk because developmental particularities related to this developmental period. Here, we conducted a review of the literature, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in order to highlight the types of psychiatric comorbidities found in adolescents with problematic gaming.. We selected and analyzed 30 cross-sectional and longitudinal studies which correspond to 3683 adolescents (63,27% of boys) worldwide with problematic gaming. Our results highlight the high prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in adolescents with problematic gaming and the links between this addiction and inattention, anxiety, depression, behavioural and emotional problems. These psychiatric comorbidities interact with problematic gaming and predict it throughout the adolescent's development. Moreover, this interaction involves personality profile and environment, including parental education. The complexity of this interaction argues in favor of the multi-level assessment that we are promoting.
PubMed: 38901145
DOI: 10.1016/j.addbeh.2024.108091 -
The New Zealand Medical Journal Jun 2024To compare sodium valproate dispensing in women of childbearing age diagnosed with borderline personality disorder in 2014 and 2019 to discover if prescribing practices...
AIMS
To compare sodium valproate dispensing in women of childbearing age diagnosed with borderline personality disorder in 2014 and 2019 to discover if prescribing practices in Aotearoa New Zealand have changed in response to international recommendations.
METHODS
National dispensing data from the Pharmaceutical Collection were linked with diagnostic data from PRIMHD (the national mental health and addiction database) to identify people diagnosed with borderline personality disorder in Aotearoa New Zealand who were dispensed psychotropic medication. Dispensing of sodium valproate for women of childbearing age was compared between 2014 and 2019. Rates of dispensing were compared between ethnicities.
RESULTS
In 2014, 10% of women of childbearing age diagnosed with borderline personality disorder were dispensed sodium valproate. This reduced to 6% of women in 2019 (p<0.001). In 2014, there was substantial ethnic disparity with 18.1% of Māori women and 15.8% of Pacific women dispensed sodium valproate compared with 7.4% of New Zealand Europeans. This disparity reduced in 2019, with 6.4% of Māori women and 12.5% of Pacific women dispensed sodium valproate compared with 5.6% of New Zealand Europeans.
CONCLUSIONS
These findings suggest that international recommendations and guidelines have been effective in changing clinical practice and reducing ethnic inequities. Given the significant risk to offspring exposed to sodium valproate, we echo warnings against off-label prescribing of sodium valproate in borderline personality disorder.
Topics: Humans; Borderline Personality Disorder; New Zealand; Female; Valproic Acid; Adult; Young Adult; Adolescent; Native Hawaiian or Other Pacific Islander; Practice Patterns, Physicians'; Middle Aged
PubMed: 38901047
DOI: 10.26635/6965.6544 -
JMIR Rehabilitation and Assistive... Jun 2024Impaired cognitive function is observed in many pathologies, including neurodegenerative diseases such as Alzheimer disease. At present, the pharmaceutical treatments...
BACKGROUND
Impaired cognitive function is observed in many pathologies, including neurodegenerative diseases such as Alzheimer disease. At present, the pharmaceutical treatments available to counter cognitive decline have only modest effects, with significant side effects. A nonpharmacological treatment that has received considerable attention is computerized cognitive training (CCT), which aims to maintain or improve cognitive functioning through repeated practice in standardized exercises. CCT allows for more regular and thorough training of cognitive functions directly at home, which represents a significant opportunity to prevent and fight cognitive decline. However, the presence of assistance during training seems to be an important parameter to improve patients' motivation and adherence to treatment. To compensate for the absence of a therapist during at-home CCT, a relevant option could be to include a virtual assistant to accompany patients throughout their training.
OBJECTIVE
The objective of this exploratory study was to evaluate the interest of including a virtual assistant to accompany patients during CCT. We investigated the relationship between various individual factors (eg, age, psycho-affective functioning, personality, personal motivations, and cognitive skills) and the appreciation and usefulness of a virtual assistant during CCT. This study is part of the THERADIA (Thérapies Digitales Augmentées par l'Intelligence Artificielle) project, which aims to develop an empathetic virtual assistant.
METHODS
A total of 104 participants were recruited, including 52 (50%) young adults (mean age 21.2, range 18 to 27, SD 2.9 years) and 52 (50%) older adults (mean age 67.9, range 60 to 79, SD 5.1 years). All participants were invited to the laboratory to answer several questionnaires and perform 1 CCT session, which consisted of 4 cognitive exercises supervised by a virtual assistant animated by a human pilot via the Wizard of Oz method. The participants evaluated the virtual assistant and CCT at the end of the session.
RESULTS
Analyses were performed using the Bayesian framework. The results suggest that the virtual assistant was appreciated and perceived as useful during CCT in both age groups. However, older adults rated the assistant and CCT more positively overall than young adults. Certain characteristics of users, especially their current affective state (ie, arousal, intrinsic relevance, goal conduciveness, and anxiety state), appeared to be related to their evaluation of the session.
CONCLUSIONS
This study provides, for the first time, insight into how young and older adults perceive a virtual assistant during CCT. The results suggest that such an assistant could have a beneficial influence on users' motivation, provided that it can handle different situations, particularly their emotional state. The next step of our project will be to evaluate our device with patients experiencing mild cognitive impairment and to test its effectiveness in long-term cognitive training.
PubMed: 38901017
DOI: 10.2196/48129 -
Psychology of Addictive Behaviors :... Jun 2024Alcohol use is an important, but understudied, risk factor for nonsuicidal self-injury (NSSI), defined as deliberate physical harm to oneself without intent to die....
Alcohol use prior to episodes of nonsuicidal self-injury in women with borderline personality disorder participating in a randomized clinical trial of dialectical behavior therapy.
OBJECTIVE
Alcohol use is an important, but understudied, risk factor for nonsuicidal self-injury (NSSI), defined as deliberate physical harm to oneself without intent to die. Alcohol use may facilitate engagement in NSSI by increasing impulsivity and physical pain tolerance. Limited data also suggest that people engage in more medically severe NSSI under the influence of alcohol.
METHOD
This secondary analysis study examined the use of alcohol prior to NSSI in a sample of 79 female patients with borderline personality disorder who were enrolled in a randomized clinical trial of dialectical behavior therapy. We used multilevel modeling (MLM) to examine preregistered hypotheses that alcohol use prior to NSSI would be related to the impulsivity of NSSI, physical pain experienced during NSSI, and the medical severity of injuries from NSSI.
RESULTS
Participants endorsed alcohol use prior to 21.96% (47/221) of NSSI episodes, and roughly one third of participants ( = 27) reported at least one episode of NSSI preceded by alcohol use. For NSSI episodes preceded by alcohol use, more than half (52.38%) of participants reported using alcohol up to the moment of initiating NSSI. Alcohol use was significantly associated with higher impulsivity of NSSI episodes ( = 1.16, = .041), but not physical pain from NSSI or medical severity of NSSI.
CONCLUSIONS
Findings need to be replicated but indicate that alcohol use occurs frequently prior to NSSI and could be a target for reducing impulsive episodes of NSSI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
PubMed: 38900501
DOI: 10.1037/adb0001016 -
Cureus May 2024Dissociative identity disorder (DID), previously recognized as multiple personality disorder, impacts approximately 1.5% of the population. The Diagnostic and...
Dissociative identity disorder (DID), previously recognized as multiple personality disorder, impacts approximately 1.5% of the population. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), outlines various dissociative disorders (DDs), including depersonalization/derealization disorder, dissociative amnesia, DID, unspecified DD, and other specified DDs. Among these, DID stands out as the most severe, characterized by persistent depersonalization/derealization and dissociative amnesia. This case report explores the symptomatology of DID, available treatments, and the role of trauma.
PubMed: 38899275
DOI: 10.7759/cureus.60676 -
Trials Jun 2024Borderline personality disorder (BPD) is considered a disorder of emotion regulation resulting from the expression of a biologically determined emotional vulnerability...
Transcutaneous auricular vagus nerve stimulation to acutely reduce emotional vulnerability and improve emotional regulation in borderline personality disorder (tVNS-BPD): study protocol for a randomized, single-blind, sham-controlled trial.
BACKGROUND
Borderline personality disorder (BPD) is considered a disorder of emotion regulation resulting from the expression of a biologically determined emotional vulnerability (that is, heightened sensitivity to emotion, increased emotional intensity/reactivity, and a slow return to emotional baseline) combined with exposure to invalidating environments. Vagal tone has been associated with activity in cortical regions involved in emotion regulation and a lower resting state of vagal tone has been observed in BPD patients relative to healthy controls. Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) has been shown to reduce temper outbursts in adults with Prader-Willi Syndrome, to enhance recognition of emotions in healthy students, and to improve depressive and anxiety symptoms. Furthermore, a single session of taVNS has been shown to acutely alter the recognition of facial expressions of negative valence in adolescents with MDD and increase emotion recognition in controls. However, the effect of taVNS on emotional vulnerability and regulation in individuals diagnosed with BPD has not been investigated. Our aims are to determine if taVNS is effective in acutely reducing emotional vulnerability and improve emotional regulation in BPD patients.
METHODS
Forty-two patients will be randomized to a single session of taVNS or sham-taVNS while going through an affect induction procedure. It will consist of the presentation of one neutral and three negative affect-evoking 4-min-long videos in sequence, each of which is followed by a 4-min post-induction period during which participants will rate the quality and intensity of their current self-reported emotions (post-induction ratings) and the perceived effectiveness in managing their emotions during the video presentation. The rating of the current self-reported emotions will be repeated after every post-induction period (recovery ratings). Mixed models with individuals as random effect will be used to investigate the ratings at each stage of the study, taking into account the repeated measures of the same individuals at baseline, pre-induction, post-induction, and recovery.
DISCUSSION
The study has potential to yield new insights into the role of vagal tone in emotion dysregulation in BPD and offer preliminary data on the effectiveness of taVNS as a possible non-invasive brain stimulation to treat a core symptom of BPD.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05892900. Retrospectively registered on Jun 07, 2023.
Topics: Humans; Borderline Personality Disorder; Vagus Nerve Stimulation; Emotional Regulation; Single-Blind Method; Adult; Randomized Controlled Trials as Topic; Emotions; Transcutaneous Electric Nerve Stimulation; Young Adult; Female; Treatment Outcome; Male; Adolescent; Time Factors; Vagus Nerve; Middle Aged
PubMed: 38898522
DOI: 10.1186/s13063-024-08230-6 -
Journal of Affective Disorders Jun 2024Identifying patients at risk for a suicide attempt (SA) is critical in adolescents with mental disorders. The current study aimed to 1) examine whether personality...
BACKGROUND
Identifying patients at risk for a suicide attempt (SA) is critical in adolescents with mental disorders. The current study aimed to 1) examine whether personality dysfunction (PD) is associated with previous SA, 2) explore the incremental utility of PD over psychiatric disorders in modeling previous SA.
METHODS
The sample comprised of n = 498 adolescent patients (mean age = 15.41 years, 79.12 % females, inpatient 48.8 %, outpatient 51.2 %). SA in the past year, PD according to the alternative DSM-5 model for personality disorders, and psychiatric diagnoses were assessed using semi-structured interviews. Logistic regression and principal component analysis examining the associations and specific patterns of PD and SA in the past year were conducted. Hierarchical (stepwise) logistic regression was applied to investigate the incremental utility of PD over that of psychiatric diagnoses to identify individuals with SA in the past year.
RESULTS
Including all facets of PD revealed a significant model with SA in the past year as outcome (χ(12) = 106.65, McFaddens Pseudo-R = 0.17, p < 0.01). Adding PD to the model explained a significant amount of variance in past SA over that of psychiatric diagnoses (Pseudo-R = 0.18, Wald χ = 43.05, p < 0.01).
LIMITATIONS
As we only studied past SA and due to the cross-sectional design, no conclusion regarding the prediction of future SA can be drawn.
DISCUSSION
PD should routinely be assessed in adolescent patients since individuals with PD are more likely to have attempted suicide even when controlling for comorbid psychiatric disorders. PD may represent an important target for intervention in those with suicidal thoughts and behaviors.
PubMed: 38897305
DOI: 10.1016/j.jad.2024.06.038 -
Infant Behavior & Development Jun 2024The aim of this preliminary study was to explore infant-mother attachment quality in a Dutch clinical sample of mothers with severe psychiatric disorder, with or without...
The aim of this preliminary study was to explore infant-mother attachment quality in a Dutch clinical sample of mothers with severe psychiatric disorder, with or without comorbid personality disorder. Thirty-two mothers were recruited through specialized secondary and tertiary outpatient clinics and mental health institutions. Maternal psychiatric and personality diagnoses were verified with structured clinical interviews during pregnancy. Maternal concurrent level of psychiatric symptoms was assessed by self-report and infant-mother attachment quality by observation in the Strange Situation Procedure at 14 months postpartum. In the full sample, almost half of the infants were classified as disorganized. All infants of mothers with a comorbid personality disorder were classified as either insecure or disorganized. Infants of mothers with a comorbid personality disorder had a significantly higher disorganization score than infants of mothers with a psychiatric disorder only. Continuous attachment security scores did not differ significantly between groups. In the full sample, continuous infant attachment security and disorganization score were not significantly correlated with the level of maternal concurrent psychiatric symptoms. Our exploratory findings suggest a specific link between maternal psychiatric and comorbid personality disorder and attachment disorganization. Moreover, chronicity of symptoms appears more relevant for attachment behaviors than the severity of concurrent psychiatric symptoms. Maternal personality disorder may have a strong formative impact on infant attachment security and disorganization, which warrants further research to inform clinical practice, in order to reduce the risk of intergenerational transmission of maternal psychopathology.
PubMed: 38896928
DOI: 10.1016/j.infbeh.2024.101974