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Annals of General Psychiatry May 2024Personality disorders (PD) are described as enduring patterns of markedly deviant and pervasive inner experiences and behaviors, with onset in adolescence, which lead to... (Review)
Review
Personality disorders (PD) are described as enduring patterns of markedly deviant and pervasive inner experiences and behaviors, with onset in adolescence, which lead to severe distress or impairment. Patients suffering from major depressive disorder (MDD) display higher rates of comorbidity with personality disorders, often complicating the treatment, and worsening the outcomes. Borderline personality disorder (BPD) is the most common of PD and is frequently associated with MDD, with which shares several features. The most part of research agrees on the fact that comorbid BPD in MDD patients quite doubles the poor response to treatments. Moreover, no treatment strategy stands out currently to emerge as more effective in these cases, thus urging the call for the need of new approaches. Herein, we revise the current literature on BPD, its neurobiology and comorbidity with MDD, as well as the more recent treatment strategies used. Then, based on its pharmacology, we propose a possible role of trazodone as a valuable tool to approach comorbid BPD-MDD.
PubMed: 38816843
DOI: 10.1186/s12991-024-00507-z -
Journal of Anxiety Disorders Jun 2024Given the growth in research examining the effects of psychotherapy on social anxiety disorder (SAD), an up-to-date comprehensive meta-analysis in this field is needed. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Given the growth in research examining the effects of psychotherapy on social anxiety disorder (SAD), an up-to-date comprehensive meta-analysis in this field is needed.
METHODS
We selected studies from a database of randomized trials (RCTs) on psychotherapies for anxiety disorders (last updated search of PubMed, PsycINFO, Embase, and Cochrane (CENTRAL): 1 January 2024) We included RCTs comparing psychotherapy to a control condition for adults with SAD and conducted random effects meta-analyses to examine the efficacy of psychotherapy compared to control conditions at post-treatment.
RESULTS
Sixty-six RCTs were included with 5560 participants and 98 comparisons between psychotherapy and control groups. Psychotherapy was effective in reducing SAD symptoms, with a large effect size (g = 0.88; 95 % CI: 0.76 to 1.0; I = 74 %; 95 % CI: 69 to 79, NNT = 3.8). Effects remained robust across sensitivity analyses. However, there was evidence for significant risk of bias in the included trials. The multivariable meta-regression indicated significant differences in treatment delivery formats, type of recruitment strategy, target group, and number of sessions.
CONCLUSION
Psychotherapy is an effective treatment for SAD, with moderate to large effect sizes across all treatment types and formats. Future research is needed to determine the long-term effects.
Topics: Humans; Phobia, Social; Psychotherapy; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38815481
DOI: 10.1016/j.janxdis.2024.102881 -
Psychiatrike = Psychiatriki May 2024Esketamine is a non-selective, competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor in the brain. Through NMDA receptor antagonism, esketamine causes a...
Esketamine is a non-selective, competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor in the brain. Through NMDA receptor antagonism, esketamine causes a transient increase in glutamate release, leading to increases in neurotrophic signaling and restoration of synaptic function in brain regions involved in mood regulation and emotional behavior. Several randomized clinical trials have shown its effectiveness in reducing the symptoms of depression in some people, despite its short-term side effects that include mainly disorientation, dizziness, nausea, and increased blood pressure. In 2019, the United States Food and Drug Administration (FDA) as well as the European Medicines Agency approved the use of esketamine nasal spray in combination with an oral antidepressant for treatment-resistant depression in adults. Our study aimed to evaluate the effectiveness of this new therapeutic proposal in a case series of five Greek patients with treatment- resistant depression. Intranasal esketamine was administered under medical supervision in combination with an oral antidepressant. Depressive symptoms were evaluated at three time points (baseline, end of treatment, and one-year post-treatment) using the Montgomery-Åsberg Depression Rating Scale (MADRS), the Patient Health Questionnaire (PHQ-9), the CGI Clinical Global Impression Scale, and the Perceived Deficits Questionnaire for Depression (PDQ-D). Possible side effects were assessed using the Richmond Suppression Agitation Scale (RASS), the Sheehan Disability Scale (SDS), the CADSS Disruptive States Scale, and a predefined list of adverse events (AEs) and serious adverse events (SAEs). Patients followed an individualized treatment plan for seven to twelve months depending on the achievement of an adequate response. Statistical analysis of the results revealed a significant improvement (p<0.05) on all scales used. All participants maintained their level of improvement at follow-up after twelve months. Adverse effects were found to be mild and tolerable. It is worth noting that significant side effects were reported only by the two patients with comorbid personality disorder. The results, despite limited to a small sample, indicate the positive effect of esketamine on the stable reduction of depressive symptoms among patients with resistant depression, even after the completion of treatment.
PubMed: 38814267
DOI: 10.22365/jpsych.2024.006 -
BMC Neurology May 2024Migraine is a disease characterized by headache attacks. The disease is multifactorial in etiology and genetic and environmental factors play role in pathogenesis....
BACKGROUND
Migraine is a disease characterized by headache attacks. The disease is multifactorial in etiology and genetic and environmental factors play role in pathogenesis. Migraine can also be accompanied by psychiatric disorders like neurotism and obsessive compulsive disorder. Stress, hormonal changes and certain food intake can trigger attacks in migraine. Previous studies showed that eating attitudes and disorders are prevalant in patients with migraine. Eating disorders are psychiatric disorders related to abnormal eating habits. Both migraine and eating disorders are common in young women and personality profiles of these patient groups are also similar. A possible relationship which shows that migraine and eating habits are related can lead to a better understanding of disease pathogenesis and subsequently new therapeutic options on both entities. Association of migraine in relation to severity, depression and anxiety and eating habits and disorders were aimed to be investigated in this study.
METHODS
The study was designed as a prospective, multi-center, case control study. Twenty-one centers from Turkey was involved in the study. The gathered data was collected and evaluated at a single designated center. From a pool of 1200 migraine patients and 958 healthy control group, two groups as patient group and study group was created with PS matching method in relation to age, body-mass index, marital status and employment status. Eating Attitudes Test-26 (EAT-26), Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) were applied to both study groups. The data gathered was compared between two groups.
RESULTS
EAT-26 scores and the requirement for referral to a psychiatrist due to symptoms related to eating disorder were both statistically significantly higher in patient group compared to control group (p = 0.034 and p = 0.0001 respectively). Patients with migraine had higher scores in both BDI and BAI compared to control group (p = 0.0001 and p = 0.0001 respectively). Severity of pain or frequency of attacks were not found to be related to eating attitudes (r:0.09, p = 0.055).
CONCLUSIONS
Migraine patients were found to have higher EAT-26, BDI and BAI scores along with a higher rate of referral to a psychiatrist due to symptoms. Results of the study showed that eating habits are altered in migraine patients with higher risk of eating disorders. Depression and anxiety are also found to be common amongst migraine patients.
Topics: Humans; Migraine Disorders; Turkey; Female; Adult; Male; Prospective Studies; Feeding and Eating Disorders; Feeding Behavior; Case-Control Studies; Middle Aged; Young Adult; Anxiety
PubMed: 38811875
DOI: 10.1186/s12883-024-03672-6 -
Journal of Affective Disorders Sep 2024Personality traits have been associated with eating disorders (EDs) and comorbidities. However, it is unclear which personality profiles are premorbid risk rather than...
BACKGROUND
Personality traits have been associated with eating disorders (EDs) and comorbidities. However, it is unclear which personality profiles are premorbid risk rather than diagnostic markers.
METHODS
We explored associations between personality and ED-related mental health symptoms using canonical correlation analyses. We investigated personality risk profiles in a longitudinal sample, associating personality at age 14 with onset of mental health symptoms at ages 16 or 19. Diagnostic markers were identified in a sample of young adults with anorexia nervosa (AN, n = 58) or bulimia nervosa (BN, n = 63) and healthy controls (n = 47).
RESULTS
Two significant premorbid risk profiles were identified, successively explaining 7.93 % and 5.60 % of shared variance (R). The first combined neuroticism (canonical loading, r = 0.68), openness (r = 0.32), impulsivity (r = 0.29), and conscientiousness (r = 0.27), with future onset of anxiety symptoms (r = 0.87) and dieting (r = 0.58). The other, combined lower agreeableness (r = -0.60) and lower anxiety sensitivity (r = -0.47), with future deliberate self-harm (r = 0.76) and purging (r = 0.55). Personality profiles associated with "core psychopathology" in both AN (R = 80.56 %) and BN diagnoses (R = 64.38 %) comprised hopelessness (r = 0.95, 0.87) and neuroticism (r = 0.93, 0.94). For BN, this profile also included impulsivity (r = 0.60). Additionally, extraversion (r = 0.41) was associated with lower depressive risk in BN.
LIMITATIONS
The samples were not ethnically diverse. The clinical cohort included only females. There was non-random attrition in the longitudinal sample.
CONCLUSIONS
The results suggest neuroticism and impulsivity as risk and diagnostic markers for EDs, with neuroticism and hopelessness as shared diagnostic markers. They may inform the design of more personalised prevention and intervention strategies.
Topics: Humans; Female; Personality; Young Adult; Adolescent; Anorexia Nervosa; Male; Neuroticism; Longitudinal Studies; Feeding and Eating Disorders; Bulimia Nervosa; Adult; Impulsive Behavior; Risk Factors; Anxiety; Comorbidity; Anxiety Disorders
PubMed: 38810783
DOI: 10.1016/j.jad.2024.05.132 -
Revista Brasileira de Psiquiatria (Sao... May 2024To analyse the related influencing factors of adolescent major depressive disorder (MDD) with suicidal and self-injurious behaviour (SSIB).
OBJECTIVE
To analyse the related influencing factors of adolescent major depressive disorder (MDD) with suicidal and self-injurious behaviour (SSIB).
METHODS
A total of 299 adolescents with MDD who were admitted to the psychiatric department of the hospital between February 2022 and July 2023 were selected using the convenience sampling method. The participants were divided into the SSIB group (n = 110) and the non-SSIB group (n = 189) according to whether SSIB was present, and related indicators were collected and compared.
RESULTS
The patients' ages at the time of their first SSIB ranged from 10 to 18 years old, with a mean age of 13.30 ± 1.74 years. The most commonly injured parts were the lower arm and wrist (42.13%), and the most common injury was cutting, accounting for 40.00% of the total patients. The most common type of self-injury differed by sex (X2 = 17.798, P = 0.006); for men, hitting was the most common, and for women, cutting was the most common. In 51.41% of the patients, the period between the initial thought and the actual committing of the SSIB was less than 5 minutes. The scores of the Eysenck Personality Questionnaire, the Barratt Impulsivity Scale, the Buss-Perry Aggression Questionnaire, the Symptom Checklist-90 (all P < 0.001), and the health-risk behaviour scale (67.47 ± 12.59 vs. 41.58 ± 11.36, t = 9.587, P < 0.001) were significantly increased in the SSIB group compared with the non-SSIB group. In addition, the total score of quality of life (QOL) (11.36 ± 4.32 vs. 16.43 ± 5.64, t = 5.496, P < 0.001) was decreased in the SSIB group compared with the non-SSIB group.
CONCLUSION
The SSIB of adolescent patients with MDD is related to various factors, including impulsiveness, aggressiveness, personality traits, QOL, and mental health level.
PubMed: 38810153
DOI: 10.47626/1516-4446-2024-3613 -
Clinical Neuropsychiatry Apr 2024Transference is a psychological process where feelings and attitudes towards a familiar person are unconsciously redirected to another. This phenomenon can be activated...
OBJECTIVE
Transference is a psychological process where feelings and attitudes towards a familiar person are unconsciously redirected to another. This phenomenon can be activated by physical resemblance, including facial features. Despite its potential therapeutic significance, little research has investigated transference processes in individuals with psychiatric conditions. Here, we explored how patients with borderline personality disorder (BPD)-characterized, among other features, by unstable relationships, self-damaging impulsivity, and suicidal ideation-would exhibit transference of negative and positive attributes.
METHOD
We performed an experiment where BPD participants and a control group with no prior psychiatric history completed a face-rating task. The task involved an evaluation of images of strangers who resembled significant others in terms of facial features.
RESULTS
Our results indicated that transference effects were elicited in both groups. Notably, there were significant differences in ratings assigned to significant others, whereby participants with BPD displayed transference of negative attributes more and positive attributes less intensely than healthy controls, which, in part, correlated with attachment anxiety.
CONCLUSIONS
Our findings align with the tendency in BPD to perceive interpersonal relationships and emotions more negatively. They have potential implications for psychotherapeutic approaches in treating patients with BPD and our understanding of underlying pathophysiological mechanisms of BPD itself.
PubMed: 38807980
DOI: 10.36131/cnfioritieditore20240202 -
Frontiers in Health Services 2024During the COVID-19 pandemic individuals with mental illnesses faced challenges accessing psychiatric care. Our study aimed to describe patient characteristics and...
INTRODUCTION
During the COVID-19 pandemic individuals with mental illnesses faced challenges accessing psychiatric care. Our study aimed to describe patient characteristics and compare admissions and length of stay (LOS) for psychiatric-related hospitalizations before and during the COVID-19 pandemic.
METHODS
We conducted a retrospective analysis using health administrative data comparing individuals with an acute psychiatric admission between two time periods: 1st March 2019 to 31st December 2019 (pre-COVID) and 1st March 2020 to 31st December 2020 (during-COVID). Multivariable negative binomial regression was used to model the association between most responsible diagnosis type and the two-time periods to hospital LOS, reporting the Rate Ratio (RR) as the measure of effect.
RESULTS
The cohort comprised 939 individuals who were predominately male (60.3%) with a severe mental illness (schizophrenia or mood-affective disorder) (72.7%) and a median age of 38 (IQR: 28.0, 52.0) years. In the multivariable analysis, anxiety disorders (RR: 0.63, CI: 0.4, 0.99) and personality disorders (RR: 0.52, CI: 0.32, 0.85) were significantly associated with a shorter LOS when compared to individuals without those disorders. Additionally, when compared to hospital admissions for non-substance related disorders the LOS for patients with substance-related disorders were significantly shorter during the COVID period (RR: 0.45, CI: 0.30, 0.67) and pre-COVID period (RR: 0.31, CI: 0.21, 0.46).
CONCLUSIONS
We observed a significant difference in the type and length of admissions for various psychiatric disorders during the COVID-19 period. These findings can support systems of care in adapting to utilization changes during pandemics or other global health events.
PubMed: 38807747
DOI: 10.3389/frhs.2024.1365785 -
Current Issues in Personality Psychology 2024The psychopathology of personality is currently undergoing a paradigm shift from a categorical to a dimensional approach. This work aimed to study the underlying...
BACKGROUND
The psychopathology of personality is currently undergoing a paradigm shift from a categorical to a dimensional approach. This work aimed to study the underlying structure of pathological personality traits of the DSM-5 Alternative Model for Personality Disorders (AMPD). For this purpose, the internal structure of a version of the Personality Inventory for the DSM-5 (PID-5) was examined by a confirmatory factor analysis. This version assesses the five higher-order pathological personality domains (negative affectivity, detachment, antagonism, disinhibition, and psychoticism) and the 25 lower-order pathological personality facets through a reduced number of items. Four alternative models were compared: five-factor oblique; second-order (five first-order factors and one second-order factor); bifactor (five specific factors and a general factor), and one-factor.
PARTICIPANTS AND PROCEDURE
We worked with an Argentinean sample of = 525 subjects from the general population who answered the Argentine version of the PID-5.
RESULTS
The five-factor model was slightly superior to the second order model, and the bifactor model presented the best fit.
CONCLUSIONS
These findings, while preliminary, suggest that the PID-5 facets could reflect five specific pathological personality traits (which correspond to AMPD domains) but also a general factor (which would reflect a general propensity for psychopathology).
PubMed: 38807698
DOI: 10.5114/cipp/163182 -
Current Issues in Personality Psychology 2024The Inventory of Personality Organization (IPO) is a self-assessment instrument designed to measure the level of personality organization. In the present study, we...
BACKGROUND
The Inventory of Personality Organization (IPO) is a self-assessment instrument designed to measure the level of personality organization. In the present study, we developed and validated a French version (IPO-fr) of this instrument in a population of young adults. Its validity was established on the basis of two studies examining (1) its internal structure, and (2) its convergent validity with the Personality Diagnostic Questionnaire-4+, the Positive and Negative Affect Schedule (PANAS), the Hospital Anxiety and Depression Scale (HADS), and the Aggression Questionnaire (AQ).
PARTICIPANTS AND PROCEDURE
In the first study, we assessed the reliability of the internal structure of the French form of the IPO (IPO-fr) in a nonclinical population. Our sample comprised 602 first- and second-year psychology students, with a mean age of 19.40 years ( = 1.95). The second study assessed the convergent validity of the questionnaire in nonclinical samples, with regard to the three clusters (A, B, and C) of personality disorders, positive and negative affect, and aggression and depressive symptoms. The sample for this second study consisted of 305 first-, second- and third-year psychology students, with a mean age of 19.83 years ( = 2.12).
RESULTS
The French version of the IPO is shorter than the English: 40 items instead of 57. Its internal clarity and its discriminative capacity make it easier to interpret.
CONCLUSIONS
This study has established the relevance of the IPO-fr as a reliable and brief instrument for assessing individual personality. It could make a major contribution to the screening of personality pathology in the French population and to the assessment of treatment programs.
PubMed: 38807697
DOI: 10.5114/cipp/174519