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Neuroscience and Biobehavioral Reviews Aug 2019The comorbidity between discrete clinical diagnosis occurs in higher levels than prevalence rates, indicating that mental disorders are systematically overcategorized.... (Meta-Analysis)
Meta-Analysis
The comorbidity between discrete clinical diagnosis occurs in higher levels than prevalence rates, indicating that mental disorders are systematically overcategorized. Dimensional models - as the Internalizing-Externalizing Spectrum - claim for a common latent structure of psychopathology. The current meta-analysis aims to evaluate whether the externalizing and internalizing latent factors of the psychopathological spectrum display common and distinctive neurobiological substrates, as unveiled by Error-Related Negativity (ERN) modulation. A systematic search of the literature was conducted and a total of 99 articles (160 studies, N = 8123) were included in the quantitative analysis. A dissociable effect was found: reduced ERN amplitude was observed in externalizing, while increased ERN amplitude was reported in internalizing. Larger effects were documented in all the externalizing dimensions (except for alcohol abuse) and were moderated by frontal electrode sites and tasks requiring inhibition. In internalizing, the overall effect was less robust. Disorder severity and tasks with punishment contingencies moderated the findings, and anxiety and obsessive-compulsive traits were the unique dimensions of internalizing accounting for the ERN increased amplitude. Overall, our findings highlight that ERN reduction interacts with the multiple phenotypic expressions of externalizing at a general level, while more specific factors - such as differences in sensitivity and aversion to errors - may explain increased ERN amplitude in internalizing.
Topics: Behavioral Symptoms; Biomarkers; Cerebral Cortex; Evoked Potentials; Executive Function; Humans; Impulsive Behavior; Mental Disorders
PubMed: 31220503
DOI: 10.1016/j.neubiorev.2019.06.013 -
Neuroscience and Biobehavioral Reviews Aug 2019Startle reflex potentiation versus startle attenuation to unpleasant versus pleasant stimuli likely reflect priming of the defensive versus appetitive motivational...
Startle reflex potentiation versus startle attenuation to unpleasant versus pleasant stimuli likely reflect priming of the defensive versus appetitive motivational systems, respectively. This review summarizes and systemizes the literature on affective startle modulation related to psychopathologies with the aim to reveal underlying mechanisms across psychopathologies. We found evidence for psychopathologies characterized by increased startle potentiation to unpleasant stimuli (anxiety disorders), decreased startle potentiation to unpleasant stimuli (psychopathy), decreased startle attenuation to pleasant stimuli (ADHD), as well as a general hyporeactivity to affective stimuli (depression). Increased versus decreased startle responses to disorder-specific stimuli characterize specific phobia and drug dependence. No psychopathology is characterized by increased startle attenuation to standard pleasant stimuli or a general hyperreactivity to affective stimuli. This review indicates that the defensive and the appetitive systems operate independently mostly in accordance with the motivational priming hypothesis and that affective startle modulation is a highly valuable paradigm to unraveling dysfunctions of the defensive and appetitive systems in psychopathologies as requested by the Research Domain Criteria initiative.
Topics: Affect; Antisocial Personality Disorder; Anxiety Disorders; Appetitive Behavior; Attention Deficit Disorder with Hyperactivity; Avoidance Learning; Depressive Disorder; Humans; Motivation; Reflex, Abnormal; Reflex, Startle
PubMed: 31129237
DOI: 10.1016/j.neubiorev.2019.05.019 -
Frontiers in Psychology 2019The emergence of enduring antisocial personality changes in previously normal individuals, or "acquired sociopathy," has consistently been reported in patients with...
The emergence of enduring antisocial personality changes in previously normal individuals, or "acquired sociopathy," has consistently been reported in patients with bilateral injuries of the ventromedial prefrontal cortex. Over the past three decades, cases of acquired sociopathy with (a) bilateral or (b) unilateral sparing of the ventromedial prefrontal cortex have been reported. These cases indicate that at least in a few individuals (a') neural structures beyond the ventromedial prefrontal cortex are also critical for normal social behavior, and (b') the neural underpinnings of social cognition may be lateralized to one cerebral hemisphere. Moreover, researchers have presented evidence that lesion laterality and gender may interact in the production of acquired sociopathy. In the present review, we carried out a comprehensive literature survey seeking possible interactions between gender and hemispheric asymmetry in acquired sociopathy. We found 85 cases of acquired sociopathy due to bilateral ( = 48) and unilateral ( = 37) hemispheric injuries. A significant association between acquired sociopathy and right hemisphere damage was found in men, whereas lesions were bilateral in most women with acquired sociopathy. The present survey shows that: (i) the number of well-documented single-cases of acquired sociopathy is surprisingly small given the length of the historical record; (ii) acquired sociopathy was significantly more frequent in men after an injury of the right or of both cerebral hemispheres; and (iii) in most women who developed acquired sociopathy the injuries affected both cerebral hemispheres. These findings may be especially valuable to neuroscientists and to functional neurosurgeons in particular for the planning of tumor resections as well as for the choice of the best targets for therapeutic neuromodulation.
PubMed: 30941065
DOI: 10.3389/fpsyg.2019.00346 -
Journal of Substance Abuse Treatment May 2019Contingency Management is an evidence-based treatment for substance use disorders with strong potential for measurement-based customization. Previous work has examined...
Contingency Management is an evidence-based treatment for substance use disorders with strong potential for measurement-based customization. Previous work has examined individual difference factors in Contingency Management treatment response of potential relevance to treatment targeting and adaptive implementation; however, a systematic review of such factors has not yet been conducted. Here, we summarize and evaluate the existing literature on patient-level predictors, mediators, and moderators of Contingency Management treatment response in stimulant and/or opioid using outpatients - clinical populations most frequently targeted in Contingency Management research and clinical practice. Our search strategy identified 648 unique, peer-reviewed publications, of which 39 met full inclusion criteria for the current review. These publications considered a variety of individual difference factors, including (1) motivation to change and substance use before and during treatment (8/39 publications), (2) substance use comorbidity and chronicity (8/39 publications), (3) psychiatric comorbidity and severity (8/39 publications), (4) medical, legal, and sociodemographic considerations (15/39 publications), and (5) cognitive-behavioral variables (1/39 publications). Contingency Management was generally associated with improved treatment outcomes (e.g., longer periods of continuous abstinence, better retention), regardless of individual difference factors; however, specific patient-level characteristics were associated with either an enhanced (e.g., more previous treatment attempts, history of sexual abuse, diagnosis of antisocial personality disorder) or diminished (e.g., complex post-traumatic stress symptoms, pretreatment benzodiazepine use) response to Contingency Management. Overall, the current literature is limited but existing evidence generally supports greater benefits of Contingency Management in patients who would otherwise have a poorer prognosis in standard outpatient care. It was also identified that the majority of previous work represents a posteriori analysis of pre-existing clinical samples and has therefore rarely considered pre-specified, hypothesis-driven individual difference factors. We therefore additionally highlight patient-level factors that are currently understudied, as well as promising future directions for measurement-based treatment adaptations that may directly respond to patient traits and states to improve Contingency Management effectiveness across individuals and over time.
Topics: Behavior Therapy; Evidence-Based Practice; Humans; Individuality; Motivation; Outcome Assessment, Health Care; Reward; Substance-Related Disorders
PubMed: 30898330
DOI: 10.1016/j.jsat.2019.03.001 -
Frontiers in Psychiatry 2019Antisocial personality disorder is an enduring mental disorder associated with significant disease burden and treatment difficulties. This is apparent within forensic...
Antisocial personality disorder is an enduring mental disorder associated with significant disease burden and treatment difficulties. This is apparent within forensic populations. There is growing evidence to suggest that treatment with oxytocin could have some benefit in treating a range of psychiatric disorders. There are no reviews studying the use of oxytocin for patients with ASPD. We aim to present the first literature review on the use of oxytocin in patients with ASPD. We searched relevant databases for original research on effect of oxytocin upon persons with a diagnosis of ASPD or healthy participants with symptoms seen in ASPD. Studies were included if they included healthy participants that evaluated the effect of oxytocin on symptoms relevant to ASPD, including empathy, inhibitory control, compliance, conformity, aggression, violence, and moral responsibility. Thirty-six studies were included. There were a range of study designs, including randomized controlled trials, double blinded, single blinded, and unblinded controlled trials. The sample sizes in studies ranged from 20 to 259 participants. Studies looked at participants with a diagnosis of ASPD and participants with symptoms relevant to ASPD, including empathy, inhibitory control, compliance, conformity, aggression, violence, and moral responsibility. Oxytocin was found to demonstrate diversified effects, in most cases being associated with socially positive or non-criminogenic behaviors. However, some studies found opposite, and non-desirable, effects, e.g., an increase in violent inclinations to partners. The two studies looking at participants with ASPD had a number of limitations and had conflicting results on the impact that OT has on aggression in ASPD. This is the first systematic literature review exploring the potential use of oxytocin in managing ASPD and the symptoms of ASPD. It is apparent that there is a body of evidence addressing related symptoms in healthy individuals. There were diversified effects with oxytocin showing some benefits in promoting positive effects on symptoms of ASPD, but there were also studies showing non-desirable effects. It is difficult to draw any direct inferences from healthy control studies. Further high quality large sample studies are required to explore the effects of oxytocin in those with ASPD.
PubMed: 30873049
DOI: 10.3389/fpsyt.2019.00076 -
Neuroscience and Biobehavioral Reviews Jan 2019According to the dual-hormone hypothesis, the relationship between testosterone and status-relevant behavior is moderated by cortisol, suggesting this relationship only... (Meta-Analysis)
Meta-Analysis
A meta-analytical evaluation of the dual-hormone hypothesis: Does cortisol moderate the relationship between testosterone and status, dominance, risk taking, aggression, and psychopathy?
According to the dual-hormone hypothesis, the relationship between testosterone and status-relevant behavior is moderated by cortisol, suggesting this relationship only exists when cortisol is low. In the current study, a meta-analysis (including 30 papers with 33 studies, 49 effect sizes, n = 8538) on the interaction effect of testosterone and cortisol on status-relevant behavior (i.e. status, dominance, risk taking, aggression, and psychopathy) was performed. There was only marginal support for the dual-hormone hypothesis: The effect size of the interaction between testosterone and cortisol on status-relevant behavior was significant but very small (r = -.061, p = .026), which was corroborated by follow-up meta-analyses on simple slopes on low and high cortisol. Effect sizes were largest for direct status measures, although not significantly different from other outcome measures. Similarly, effect sizes seemed larger for men than for women. However, robustness analyses indicated signs of publication bias, enhanced significance due to potential flexibility in data-analysis, and a lack of power of individual studies, emphasizing the need for a large, pre-registered study.
Topics: Aggression; Animals; Antisocial Personality Disorder; Humans; Hydrocortisone; Models, Biological; Risk-Taking; Social Dominance; Testosterone
PubMed: 30529754
DOI: 10.1016/j.neubiorev.2018.12.004 -
The British Journal of Psychiatry : the... Dec 2018Personality disorder is a severe health issue. However, the epidemiology of personality disorders is insufficiently described and surveys report very heterogeneous... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Personality disorder is a severe health issue. However, the epidemiology of personality disorders is insufficiently described and surveys report very heterogeneous rates.AimsWe aimed to conduct a meta-analysis on the prevalence of personality disorders in adult populations and examine potential moderators that affect heterogeneity.
METHOD
We searched PsycINFO, PSYNDEX and Medline for studies that used standardised diagnostics (DSM-IV/-5, ICD-10) to report prevalence rates of personality disorders in community populations in Western countries. Prevalence rates were extracted and aggregated by random-effects models. Meta-regression and sensitivity analyses were performed and publication bias was assessed.
RESULTS
The final sample comprised ten studies, with a total of 113 998 individuals. Prevalence rates were fairly high for any personality disorder (12.16%; 95% CI, 8.01-17.02%) and similarly high for DSM Clusters A, B and C, between 5.53 (95% CI, 3.20-8.43%) and 7.23% (95% CI, 2.37-14.42%). Prevalence was highest for obsessive-compulsive personality disorder (4.32%; 95% CI, 2.16-7.16%) and lowest for dependent personality disorder (0.78%; 95% CI, 0.37-1.32%). A low prevalence was significantly associated with expert-rated assessment (versus self-rated) and reporting of descriptive statistics for antisocial personality disorder.
CONCLUSIONS
Epidemiological studies on personality disorders in community samples are rare, whereas prevalence rates are fairly high and vary substantially depending on samples and methods. Future studies investigating the epidemiology of personality disorders based on the DSM-5 and ICD-11 and models of personality functioning and traits are needed, and efficient treatment should be a priority for healthcare systems to reduce disease burden.Declaration of interestNone.
Topics: Adult; Comorbidity; Developed Countries; Humans; Personality Disorders; Prevalence
PubMed: 30261937
DOI: 10.1192/bjp.2018.202 -
Personality Disorders Nov 2018Antisocial Behavior (AB) has a tremendous societal cost, motivating investigation of the mechanisms that cause individuals to engage and persist in AB. Recent theories...
Antisocial Behavior (AB) has a tremendous societal cost, motivating investigation of the mechanisms that cause individuals to engage and persist in AB. Recent theories of AB emphasize the role of reward-related neural processes in the etiology of severe and chronic forms of AB, including antisocial personality disorder and psychopathy. However, no systematic reviews have evaluated the hypothesis that reward-related neural dysfunction is an etiologic factor in AB in adult samples. Moreover, it is unclear whether AB is linked to a hyper- or hyposensitive reward system and whether AB is related to neural sensitivity to losses. Thus, the current systematic review examined whether AB (including antisocial personality disorder) and psychopathic traits are related to neural reactivity during reward processing, loss processing, or both. Our review identified seven task-based functional MRI or functional connectivity studies that examined associations between neural response to reward and loss, and dimensional and categorical measures of adult AB and/or psychopathy. Across studies, there was evidence that AB is associated with variability in neural functioning during both reward and loss processing. In particular, impulsive-antisocial traits appeared to be specifically associated with hypersensitivity in the ventral striatum during the anticipation, but not the receipt, of rewards. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Topics: Antisocial Personality Disorder; Brain; Functional Neuroimaging; Humans; Impulsive Behavior; Magnetic Resonance Imaging; Reward
PubMed: 30080060
DOI: 10.1037/per0000308 -
Tijdschrift Voor Psychiatrie 2018Death threats are common in the therapist's office. Many therapists don't know how to handle these.
AIM: To provide background information and tools for the... (Review)Review
Death threats are common in the therapist's office. Many therapists don't know how to handle these.
AIM: To provide background information and tools for the practitioner who receives a homicidal threat from a patient.
METHOD: A systematic literature review of the epidemiology, diagnostics, risk assessment and treatment of homicidal threats.
RESULTS: During consultation, a death threat is not equatable with the announcement of murder. There are far more instances where the patient does not follow through with their threat. A psychotic disorder, an antisocial personality disorder, alcohol abuse, (bipolar) depression, long-existing (severe) domestic violence, possession of a weapon or a previous conviction for a death threat are important risk increasing factors. The risk assessment evaluates the motives and the proclivity to act. emdr and aggression regulation therapy appear to be effective treatments for underlying trauma and anger. However, psycho-dynamic aspects and feelings of countertransference should also be taken into account during therapy. Three Dutch guidelines about professional secrecy are important when making an assessment about whether or not one should break the rules of confidentiality.
CONCLUSION: Any practitioner who may be faced with a homicidal patient should have ready access to the relevant guidelines. Mental health institutions are encouraged to actively support this process.Topics: Aggression; Dangerous Behavior; Homicide; Humans; Practice Guidelines as Topic; Psychiatry; Psychotic Disorders; Violence
PubMed: 29638238
DOI: No ID Found -
Personality and Mental Health Aug 2018Comorbid personality disorder (PD) worsens outcome in mental state disorders; however, the proportion of people with PD who have an alcohol use disorder (AUD) is poorly...
Comorbid personality disorder (PD) worsens outcome in mental state disorders; however, the proportion of people with PD who have an alcohol use disorder (AUD) is poorly described. A systematic review of the literature for studies reporting on AUD in those with PD was completed. Lifetime prevalence figures were meta-analysed using multilevel models, accounting for type of PD and population examined. Sixteen unique studies contributed data to the analysis. PD type accounted for most of the heterogeneity in lifetime AUD prevalence. People with antisocial PD had the highest lifetime AUD prevalence, at 76.7%, followed by those with borderline PD at 52.2%, while those with other forms of PD, or undifferentiated PD, had a prevalence of 38.9%. Lifetime AUD prevalence was not significantly higher in clinical compared with population samples. The majority of people with PD experience an AUD at some time in the life course. This has clinical screening and management implications. Copyright © 2018 John Wiley & Sons, Ltd.
Topics: Adult; Alcoholism; Comorbidity; Diagnosis, Dual (Psychiatry); Female; Humans; Male; Personality; Personality Disorders; Prevalence
PubMed: 29611335
DOI: 10.1002/pmh.1415