Comorbid Axis Research Articles

PARAPHILIA AND MAJOR DEPRESSIVE DISORDERS: PREVALENCE AND PATHOGENESIS

Introduction - Paraphilia disorders are defined as an abnormal intense sexual deviant followed by behaviors to fulfill fierce sexual erotic activities. Major depressive disorder (MDD) is a mood disorder marked by the appearance of a depressed mood, decreased interest, poor cognitive function, and vegetative symptoms including sleep or eating disorders. There is a study about the prevalence of paraphilia in the US, 15,9%. Meanwhile, there is about 6,1% of the prevalence of depressive disorders in Indonesia. According to DSM-5, Paraphilias, and paraphilia-related disorders, depressive disorders are the most frequent comorbid axis I diagnoses with a lifetime prevalence of life by 56%. Based on these case numbers, this study aims to discuss the correlation between these two events. Methods - Researchers used several journals and textbooks discussing the prevalence and pathogenesis of paraphilia and major depressive disorders; and the correlation between these two disorders. Results - Paraphilias are rarely diagnosed in clinical settings because many cases of paraphilia are related to illegal and criminal acts (such as sexual harassment), and reporting methods are unreliable, meanwhile depression is ubiquitous in both high and low-income countries. This shows that any government needs to be aware of the effects of depressive disorders. Those who have not sought treatment are still high, amounting to 87 to 91% of depressive disorders that have not sought treatment. Discuss - There is a significant correlation between paraphilia and major depressive disorder, MDD is one of the paraphilia-related disorders comorbid axis I diagnosis with a lifespan prevalence of 56%. From the pathogenesis, monoamine neurotransmitters dopamine, norepinephrine, and serotonin serve a modulatory role in human sexual motivation, appetitive, and consummatory behavior. Conclusion - In pathogenesis, there's a degradation in function, amount, and production of neurotransmitter monoamine, dopamine, norepinephrine, and serotonin that cause the person with paraphilia usually show symptoms such as mood changes, decreased interest, depression, decreased cognitive function, and the appearance of vegetative-related symptoms such as impaired appetite or sleep activity. Keywords: paraphilias, depression, pathogenesis.

Mentalizing deficits in borderline personality disorder related to axis I comorbidity: Clinical relevance.

Deficits in mentalization have been described in several mental disorders, but information is still scarce and ambiguous about the types of mentalization errors in each disorder and their specificity and severity in borderline personality disorder (BPD). Due to the high comorbidity between this disorder and axis I disorders, the aim of this work is to study differences in mentalization responses in BPD considering the different comorbidity profiles with other disorders. A total of 141 BPD patients were evaluated using The Mini-International Neuropsychiatric Interview (MINI), to identify comorbid axis I disorders. Mentalizing ability was assessed by the Movie for the Assessment of Social Cognition (MASC). Statistical associations were analysed into the different variables. Patients with comorbid BPD and anorexia nervosa (AN), suicidal behaviour disorder or post-traumatic stress disorder (PTSD) respectively presented higher overmentalization, undermentalization and absence of mentalization errors, compared with patients with BPD without comorbidity. Results show that BPD comorbidity with AN, suicidal behaviour disorder and PTSD affect to the types and severity of mentalizing deficits observed in these patients. This study highlights the importance of the assessment and treatment of axis I comorbid disorders in borderline personality disorder, with the objective of shaping personalized treatment for every patient.

Diagnostic stability of 346 patients with borderline personality disorder based on retrospective clinical records

IntroductionState-of-the-art research highlights that borderline personality disorder have high rates of comorbid Axis I disorders, which imply uncertainty in establishing an accurate diagnosis and can be some of the most challenging patients for clinicians and researchers.ObjectivesThis study seeks to observe the diagnostic stability in borderline personality disorder patients, in order to increase empirical knowledge through a retrospective look at the historical line of diagnoses.MethodsA twenty-year retrospective study at a psychiatric hospital, searching at the electronic clinical records for all patients with borderline personality disorder diagnosis, under the code 301.83 from World Health Organization’s International Classification of Diseases, 9th Revision (WHO ICD9). A 346 patients’ sample was identified aged between 18 and 83 years (Mage=44.14 years, SD=11.18; predominantly female 73.70%; Mschooling=9.31years; Madmissions=4.72times, SD=9.21; 2nd-5th comorbid diagnosis, a 75.72% sample with three diagnosis); excluding organic cerebral syndrome and no comorbidity besides drug abuse, or no comorbidity at all.ResultsAs a general observation, the following diagnoses are indicated: 44.09% major depressive disorder, 33.16% affective disorder, 13.05% schizophrenia, and 9.70% mania. As a spectrums disorders analysis (Figure 1), differential percentage occurrences are identified in patients with borderline personality disorder.Image:ConclusionsBased on clinical diagnoses records of borderline personality disorder patients, some spectrums disorders are highlighted, to be reported in descending order of incidence: depressive, affective, schizoaffective and schizophrenia spectrums.Disclosure of InterestNone Declared

Factor structure of borderline personality disorder and response to Systems Training for Emotional Predictability and Problem Solving

Differential response to the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program was compared in subgroups identified through latent class analysis (LCA). STEPPS is an evidence-based group treatment program for patients with borderline personality disorder (BPD). A reanalysis of data was conducted using data from a 20-week randomized controlled trial and 1-year follow-up. Subjects (n = 164) with DSM-IV BPD were assessed for comorbid Axis I and II disorders and selected clinical variables. Severity was assessed using the Zanarini Rating Scale for BPD (ZAN-BPD) and the Borderline Evaluation of Severity Over Time (BEST). Three- and four-class models were identified with the four-class model having the better fit. The latter included a high severity (HS) class (26%), an affective instability/substance abuse (AISA) class (16%), an empty/dissociation/identity disturbance (EDID) class (27%), and a low severity (LS) class (30%). High impulsiveness predicted membership in the HS class. Improvement was determined using a linear mixed-effects model. Those most likely to benefit were those in the HS group characterized by high symptom severity, Axis I and II comorbidity, problem relationships, abandonment fears, and intense anger. This work should help further efforts to match patients with treatments based on sociodemographic, diagnostic, and other illness characteristics.

Early onset of depression and treatment outcome in patients with major depressive disorder

Major depressive disorder (MDD) is a highly heterogeneous disorder, which may partly explain why treatment outcome using antidepressants is unsatisfactory. We investigated the onset of depression as a possible clinical marker for therapy response prediction in the context of somatic biomarkers blood pressure and plasma electrolyte concentration. 889 MDD patients were divided into early (EO, n = 226), intermediate (IO, n = 493), and late onset (LO, n = 169) patients and were analyzed for differences in socio-demographic and clinical parameters, comorbidities and treatment outcome as well as systolic blood pressure and electrolytes. EO patients more often suffered from a recurrent depression, had more previous depressive episodes, a higher rate of comorbid axis I and II disorders, and more often reported of suicidality (p < 0.001) compared to IO and LO patients. Treatment outcome was not different from IO and LO patients, although LO patients responded faster. EO patients who showed an early non-improvement of depression after 2 weeks of therapy (<20% improvement) had a 4.3-fold higher likelihood to become non-remitter as compared to LO patients with an early improvement. EO patients had significantly lower systolic blood pressure than patients with IO or LO and electrolytes in EO patients were significantly correlated with depression severity. Our results confirm other studies showing an association of an early onset of depression with a slower treatment response. The worse treatment outcome in patients with an additional early non-improvement to antidepressant therapy opens perspectives to develop and test individualized treatment approaches for EO and LO patients in the future, which may be based on differences in autonomic regulation.

What Is the Impact of COVID-19 Pandemic on Patients with Pre-Existing Mood or Anxiety Disorder? An Observational Prospective Study.

Background and Objectives: This observational prospective study aims to examine the psychological and psychopathological impact of the pandemic stress on patients with pre-existing mood, anxiety and obsessive–compulsive disorders. Materials and Methods: The study includes 386 consecutive patients recruited from 10 March to 30 June 2020 among those being treated at the Institute of Psychopathology in Rome (Italy) with an age ≥18 years and meeting DSM-5 criteria for major depressive disorder (MDD) (35.2%), bipolar I (BD-I) (21.5%) or II (BD-II) (28.8%) disorder, obsessive–compulsive disorder (OCD) (7.5%), panic disorder (PD) (7.0%) or social anxiety (SA). A total of 34.2% had lifetime comorbid Axis I disorders and 15.3% had alcohol/drug abuse disorders. Using a semi-structured interview, we investigated if the impact of COVID-19 stress for patients has been similar, higher or lower than that of their family and friends and, for patients with relapse/symptoms worsening, if there was a relationship between the clinical condition worsening and the pandemic stress. Results: Compared with that experienced by their family members and friends, the psychological impact of pandemic stress was similar in 52.1% of the sample, better in 37.1% and worse in 10.8%. In 21 patients (5.4%), the stress triggered a recurrence or worsened the symptoms. Patients with OCD had a higher rate of worsening due to pandemic stress compared to patients with MDD (p = 0.033), although, overall, the χ2 test was not significant among primary diagnoses (χ2 = 8.368; p = 0.057). Conclusions: The psychological and psychopathological consequences of COVID-19 stress in our outpatients were very modest. The continuity of care offered during the lockdown could explain the results.

Effect of assertive case management intervention on suicide attempters with comorbid Axis I and II psychiatric diagnoses: secondary analysis of a randomised controlled trial

BackgroundMost suicide attempters suffer from psychiatric disorders, which are often comorbid with personality disorders. The effects of intervention on patients who have attempted suicide with comorbid Axis I and II diagnoses have not been fully elucidated. We evaluated whether assertive case management can reduce the repetition of suicidal behaviours in patients who had attempted suicide with comorbid Axis I and II diagnoses.MethodsThis study was a secondary analysis of a randomised controlled trial investigating whether assertive case management could reduce the repetition of suicide attempts, compared with enhanced usual care. Subjects were divided into those who had comorbid Axis I and II diagnoses (Axis I + II group), and those who had an Axis I diagnosis without Axis II comorbidity (Axis I group). Outcome measures were compared between patients receiving a case management intervention and patients receiving enhanced usual care, as allocated. The primary outcome measure was the incidence proportion of the first episode of recurrent suicidal behaviour at 6 months after randomisation. We calculated risk ratios (RR) with 95% confidence intervals (CI) at 6 months and 12 months after randomisation of patients in the Axis I and Axis I + II groups.ResultsOf 914 enrolled patients, 120 (13.1%) were in the Axis I + II group, and 794 (86.9%) were in the Axis I group. Assertive case management was significantly effective for the Axis I group on the primary outcome at 6 months (risk ratio [RR] 0.51, 95% confidence intervals [CI] 0.31 to 0.84). The RR of the Axis I + II group was 0.44 (95% CI 0.14 to 1.40).ConclusionsAssertive case management not only had an effect on patients who had attempted suicide with only Axis I disorders but may also have a similar effect on patients with comorbid Axis I and II disorders.

Mediating role of childhood abuse for the relationship between schizotypal traits and obsessive-compulsive disorder

Abstract Background The mediating role of childhood trauma in the relationship between schizotypal symptoms and obsessive-compulsive disorder (OCD) was not sufficiently investigated to date. Objectives In the present study, our major goal was to analyse the mediator role of childhood abuse (emotional, physical, and sexual), and neglect (emotional and physical) on the link between schizotypal symptoms and OCD, after controlling for duration of OCD, the mean number of comorbid Axis I disorders, and current anxiety. Methods One hundred fifteen patients (aged 18-65 years) who had primary diagnosis of OCD and Yale-Brown Obsessive-Compulsive Scale score ≥16 were assessed using the short form of Childhood Trauma Questionnaire questionnaire (CTQ-SF), Schizotypal Personality Questionnaire (SPQ), and Beck Anxiety Inventory (BAI). Results The all types of schizotypal symptoms were significantly correlated with the scores of childhood abuse and neglect, and BAI. The childhood abuse as a mediator significantly predicted the total YBOCS scores (p = 0.02) after when BAI scores were controlled. However, childhood neglect was not multivariately related to current OCD severity, and did not mediate the relationship between schizotypal traits and total YBOCS scores. Discussion We suggested that childhood trauma mediated the schizotypal traits in relationship with current OCD severity independent from anxiety severity.

A230 GAPS IN IDENTIFYING FOOD-RELATED QUALITY OF LIFE AND HYPERVIGILANCE IN AT-RISK INDIVIDUALS WITH IBD: REVIEW OF VALIDATED SCREENING TOOLS

Abstract Background Inflammatory bowel disease (IBD) has a profound impact on psychosocial aspects of food and nutrition, thereby affecting food-related quality of life (QoL). While there is literature on associated prevalence of increased anxiety in individuals with IBD, there is limited data on its contribution to hypervigilance and orthorexia with food intake. Many patients with IBD have strong beliefs about dietary symptom triggers, which can lead to avoidance behaviors and decreased nutrient intake. This can exacerbate malnutrition and disordered eating, as well as increase disease-related stress and negatively impact coping. While there are validated scales evaluating anxiety-related, QoL-related and food-related behaviors in IBD, a combined screening tool to assess this comorbid axis is not well described. Aims To conduct a systematic review of existing literature in order to inform practice and facilitate development of an effective food-related hypervigilance and QoL evaluation in IBD patients Methods The literature was systematically searched through September 2019, using an electronic database querying Embase, PubMed, MEDLINE, Cochrane Library and PsycINFO. We searched original articles describing development, validation and measurement properties for screening tools on anxiety, QoL and food-related behaviors in IBD from 1975 to 2018. The primary outcome of interest was to evaluate the current measurements of the validated tools to identify whether a screening tool highlighting all above parameters exists for patients with IBD. Results Initial database search resulted in 5548 articles. After screening titles and abstracts, 168 were included. After full text review and deduplication, 23 validated scales were identified for use in IBD patients with respect to measuring anxiety, health-related QoL and food-related behaviors. There was substantial heterogeneity in IBD populations using the assessment tools (adult vs. pediatric, CD vs. UC, inpatient vs. outpatient). The breakdown of studies identified: 2 studies (8.6%) evaluated QoL and anxiety, 2 studies (8.6%) evaluated QoL and food-related behaviors. The remainder of studies individually assessed QoL, anxiety and food-related behaviors (47.8%, 26% and 8.6% respectively). None of the tools performed satisfactory to establish all three measurements in individuals with IBD. Conclusions Recent evidence suggests the presence of dietary hypervigilance in individuals with chronic GI conditions potentially leading to food restrictive behaviors impacting QoL. Screening models evaluating multivariable relations of anxiety in food-related behaviors and QoL in IBD is lacking. Efforts should be made to develop and validate a multi-assessment screening tool to aid in early identification of this prevalence in IBD patients to facilitate improved management outcomes. Funding Agencies None

Machine-learning based brain age estimation in major depression showing no evidence of accelerated aging

Molecular biological findings indicate that affective disorders are associated with processes akin to accelerated aging of the brain. The use of the BrainAGE (brain age estimation gap) framework allows machine-learning based detection of a gap between age estimated from high-resolution MRI scans an chronological age, and thus an indicator of systems-level accelerated aging. We analysed 3T high-resolution structural MRI scans in 38 major depression patients (without co-morbid axis I or II disorders) and 40 healthy controls using the BrainAGE method to test the hypothesis of accelerated aging in (non-psychotic) major depression. We found no significant difference (or trend) for elevated BrainAGE in this pilot sample. Unlike previous findings in schizophrenia (and partially bipolar disorder), unipolar depression per se does not seem to be associated with accelerated aging patterns across the brain. However, given the limitations of the sample, further study is needed to test for effects in subgroups with comorbidities, as well as longitudinal designs.

Studying the predictive factors of suicide attempts in patients with type 1 bipolar disorder

Bipolar disorder has the highest suicide attempt rate among psychiatric disorders. Many factors are associated with the risk of suicide attempt in patients with type 1 bipolar disorder, but the relation between them has still not been explicitly stated. This study aimed to examine the predictability of suicide attempt risk in BID patients based on quality of life, stressful life events, comorbidity of axis I disorders and medication compliance. We selected 140 inpatients with type 1 bipolar disorder by convenient sampling. Then they completed the WHOQOL-BREF questionnaire, Paykel's stressful life events scale and the medication adherence report scale (MARS). Logistic regression analysis showed that bipolar patients with axis I comorbidity are 40 times more likely to attempt suicide than those without axis I comorbidity. The higher the patients’ quality of life, the lower the chance of attempt of suicide. Higher medication compliance reduces the likelihood of suicidal attempt in these patients. And, the increase of stressful life events would raise the risk of suicide attempts, but the relationship wasn't significant. So it can be concluded that quality of life, stressful life events and axis I comorbidity can predict the risk of suicide attempts in patients with type 1 bipolar disorder.

Indexing the 'dark side of addiction': substance-induced affective symptoms and alcohol use disorders.

The emergence of negative affective symptoms during the course of alcohol use disorders (AUDs) (e.g. 'dark side' symptoms) has been suggested theoretically; however, the description of their occurrence is limited. This study operationalized two negative affect symptoms and tested the strength of association between these phenotypes and (1) indicators of the clinical course of the severity of AUD, (2) comorbid Axis I psychiatric disorders, suicidal behaviors and trait neuroticism and (3) whether participants reported drinking to relieve the negative affective symptoms. A retrospective cross-sectional study was used to evaluate associations, using logistic regression, between the two negative affective symptoms and clinical measures of AUD severity and progression as well as comorbidity with other psychiatric disorders and conditions, adjusted for demographic characteristics. US community-based studies. A total of 2568 individuals with AUDs obtained from larger population studies that targeted individuals of European American (n=1663), Mexican American and American Indian (n=905) ancestry. Semi-Structured Assessment for the Genetics of Alcoholism was used to ascertain the two 'dark side' phenotypes, clinical diagnoses, the clinical course of AUD and associated symptoms. The two phenotypes were: (1) being anxious or depressed when trying to cut down or stop drinking and (2) experiencing disabling depression for more than 24hours while drinking. Both phenotypes were found to be rare in mild and moderate use disorder and highly prevalent in severe AUDs. Having an independent anxiety or affective disorder and elevated scores on trait neuroticism were also associated significantly with the occurrence of both symptoms, as was alcohol 'craving', elevated treatment-seeking, suicidal behaviors and drinking to relieve the symptoms. Affective symptoms are common in severe alcohol use disorders are associated with a history of independent affective/anxiety disorders, neuroticism and suicidal behaviors; and may promote further heavy drinking.

Men and women with borderline personality disorder resident in Dutch special psychiatric units in prisons: A descriptive and comparative study.

The overall prevalence of borderline personality disorder is well known, but characteristics of offender patients with the condition are less clear, especially among men. Describe characteristics of men and women with borderline personality disorder in special psychiatric units in Dutch prisons on three domains: prevalence of child abuse, comorbidity of borderline personality disorder with other disorders, and clinical symptoms. One hundred and sixty-seven people were assigned to this study based on a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnoses retrieved from records. Other DSM-5 diagnoses were also recorded. Two scales, the Dutch Historisch, Klinisch, Toekomst-Revisie and the international Brief Psychiatric Rating Scale-Expanded (BPRS-E) were used to record child abuse and clinical symptoms, respectively. Prevalence rates of child abuse were high, but the men and women did not differ in this respect. The male offender patients were more likely than the women to have a comorbid substance use disorder, whereas the women were more likely to have a comorbid anxiety disorder. Intellectual disability was the most common comorbid Axis II disorder. The women were more likely than the men to have committed a fatal/nearly fatal index offence and showed higher rates of distress or behavioural disturbance on all five BPRS-E factors. This study provides evidence of the importance of in-depth knowledge of presentations with borderline personality disorder specific to setting. Although we were unable to make direct comparisons with other samples, our figures suggest clinically relevant differences among offender patients from the more widely reported general samples. We also shed light on a sometimes underexposed group of men with borderline personality disorder and their clinical needs. More population-specific intervention and follow-up studies are now indicated.

Are studies of psychotherapies for depression more or less generalizable than studies of antidepressants?

BackgroundThe generalizability of findings from studies exploring the efficacy of psychotherapy and antidepressants has been called into question in part because studies exclude many patients. Despite this, the frequency with which psychotherapy and antidepressant studies use specific inclusion and exclusion criteria has never been compared. We explored the exclusion criteria used in psychotherapy and pharmacotherapy studies from 1995 to 2014. MethodSystematic literature searches were conducted in PubMed, Medline, PsycINFO, and Embase of published randomized controlled trials (RCTs) of the treatment of major depressive disorder (MDD) in adults with either antidepressants (vs. placebos) or psychotherapy (vs. placebos, treatments as usual, or other controls). ResultsMost psychotherapy (81%) and antidepressant (100%) trials excluded patients with milder symptoms as well as patients with elevated suicidal risk (56–75%), psychotic symptoms (84–88%), or substance misuse (75–81%). Psychotherapy studies were less likely to exclude patients on the basis of brief episode duration (0% vs. 48%) and co-morbid Axis I disorders (6% vs. 27%). However, psychotherapy studies excluded patients with more severe symptoms more frequently (38%) than antidepressant studies (8%). ConclusionsOverall, psychotherapy studies appear somewhat more inclusive than antidepressant studies. On average, antidepressant studies appear to target patients with more chronic and severe, as well as more purely depressive presentations.

Comorbidities and correlates of conduct disorder among male juvenile detainees in South Korea

BackgroundThe purpose of this study was to examine the rate and distribution of comorbidities, severity of childhood maltreatment, and clinical characteristics of adolescents with conduct disorder detained in a juvenile detention center in South Korea.MethodsIn total, 173 juvenile detainees were recruited. We analyzed the distribution of psychiatric disorders among the sample and compared the rate of comorbidities between groups with and without conduct disorder. We compared the two groups in terms of demographic and clinical characteristics, as well as severity of childhood maltreatment and psychiatric problems, using the Young Self Report (YSR) scale.ResultsA total of 95 (55%) of the detainees were diagnosed with conduct disorder, and 93 (96.9%) of them had at least one comorbid axis I psychiatric disorder. Detainees with conduct disorder had a higher number of comorbid psychiatric disorders; a higher rate of violent crime perpetration; had suffered more physical, emotional, and sexual abuse; and showed higher total YSR scores and externalizing behavior, somatic complaints, rule-breaking behavior, and aggressive behavior YSR subscale scores.ConclusionsConduct disorder is a common psychiatric disorder among juvenile detainees in South Korea, who tend to commit more violent crimes and show more psychopathology than detainees who do not have conduct disorder. These findings highlight the importance of diagnosing and intervening in conduct disorder within the juvenile detention system.

Clinical psychopathology in youth at familial high risk for psychosis.

While the course of psychopathology has been explored from an index mental health diagnosis onwards, there are few detailed, prospective studies of the occurrence of clinical psychopathology in youth with familial risk for severe mental illnesses such as psychosis. We sought to describe the appearance of Axis I psychopathology in a unique sample of adolescents with a family history of schizophrenia (FHR). One hundred and sixty two first- and second-degree relatives (mean age 15.7 ± 3.6; range 8-25) of probands with schizophrenia or schizoaffective disorder were assessed at baseline and annual intervals for up to 3 years, focusing on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) Axis I psychopathology. Fourteen individuals (8.6%) developed a psychotic disorder. One hundred and five subjects (65%) met criteria for an Axis I disorder over the course of the study, the most common of which was a depressive episode (40 subjects; 25%). Of the 148 individuals who did not develop psychosis, 91 (61%) had one or more Axis I disorders compared with 10/14 converters who had a comorbid Axis I disorder (71%). Ordered by increasing age of onset, diagnoses included cognitive and externalizing disorders, anxiety disorders, affective disorders, substance use disorders and psychotic disorders. In addition to an elevated risk of psychosis, young FHR relatives manifest a broad range of non-psychotic Axis I psychopathology in childhood and adolescence. This breadth of diagnoses has implications for the structure and function of mental health services for young people.

The comorbidity of Axis I disorders in depressed pregnant women.

Depression during pregnancy is highly prevalent and is associated with increased risk of a variety of negative psychological and medical outcomes in both mothers and offspring. Antenatal depression often co-occurs with significant anxiety, potentially exacerbating morbidities for women and their children. However, screening during the antenatal period is frequently limited to assessment of depression so that other significant comorbid disorders may be missed. Follow-up assessment by clinicians has similarly focused primarily on detection of depressive symptoms. Anxiety, obsessive compulsive disorder, and post-traumatic stress disorder, among others, often go undetected in perinatal care settings, even when depression is identified. Failing to recognize these comorbid diagnoses may lead to inadequate treatment or only partial alleviation of distress. Consequently, screening for and assessment of comorbid disorders is warranted. In this study, 382 pregnant women (M age=25.8 [SD=5.3] years, 85.0% Caucasian) receiving care at a university hospital clinic and Maternal Mental Health Care centers in eastern Iowa and who screened positive for depression on the Beck Depression Inventory completed the Structured Clinical Interview for DSM-IV to assess comorbid mental health symptoms and diagnoses. Overall, findings demonstrate high rates of anxiety disorders among women both with and without current major depression, although depressed women reported higher rates of generalized anxiety disorder and post-traumatic stress disorder. Notably, however, incidence-specific symptoms were comparable across groups. Routine screening of both anxiety and depression during pregnancy should be conducted.

The Rate of Improvement in Long-Term Dynamic Psychotherapy For Borderline Personality Disorder.

Controlled trials of psychotherapy and follow-up studies of borderline personality disorder (BPD) have shown significant, but usually limited, improvement. We examined the hypothesis that BPD changes more slowly than nonborderline disorders. In a study of long-term dynamic psychotherapy, 16 subjects with BPD and 35 with non-BPD disorders were treated for a median of 3 years with a follow-up of 5 years. From periodic assessments, we calculated the rate of change for each subject over the course of the study on each measure of symptoms and functioning. At intake, borderline psychopathology was associated with higher levels on 76% of 17 measures of comorbid axis I disorders, symptoms, and functioning. BPD psychopathology was associated with faster (not slower) rates of improvement on three measures, but after controlling for the initial level of each measure, there were no significant associations. These findings counsel both optimism and patience in the long-term treatment of patients with BPD.

Suicidal ideation and its risk factors in borderline personality disorder

Objective To investigate suicidal ideation and its risk factors in patients with borderline personality disorder (BPD), and raise awareness of suicidal risk in BPD. Methods Patients with BPD were selected from in-patient and out-patient departments as case group(n=84), while 84 subjects were selected as control group, 1∶1 matched by gender and age. Barratt impulsiveness scale, Buss-Perry aggression questionnaire, childhood trauma questionnaire, Beck depression inventory, Beck hopelessness scale and Beck scale for suicide ideation were used to measure the two groups. Results (1)In case group, the number of incidence of suicidal occurred was 84 .The scores of suicidal ideation in the recent week(4.94±4.57 vs 0.50±0.51), suicidal ideation in the worst situation(20.43±6.58 vs 1.26±2.60) and the total score(25.37±9.78 vs 1.76±3.65) were statistically higher than those in control group (t=8.499, 24.972, 20.847, all P<0.01). (2) Multiple regression analysis showed that motor impulsivity, physical neglect in childhood, impulsivity, co-morbidity of axis I disorders, physical abuse in childhood, unemployment and unmarried status were risk factors of suicidal ideation in patients with BPD (β=0.876, 0.640, 0.428, 0.350, 0.236, 0.165, -0.205, all P<0.05). Conclusion The suicide ideation of patients with BPD are prevalent and intense. Awareness of risk factors for patients with BPD, thereby reducing the risk of suicide. Key words: Borderline personality disorder; Suicidal ideation; Risk factor

ADHD, comorbid disorders and psychosocial functioning: How representative is a child cohort study? Findings from a national patient registry

BackgroundCohort studies often report findings on children with Attention Deficit Hyperactivity Disorder (ADHD) but may be biased by self-selection. The representativeness of cohort studies needs to be investigated to determine whether their findings can be generalised to the general child population. The aim of the present study was to examine the representativeness of child ADHD in the Norwegian Mother and Child Cohort Study (MoBa).MethodsThe study population was children born between January 1, 2000 and December 31, 2008 registered with hyperkinetic disorders (hereafter ADHD) in the Norwegian Patient Registry during the years 2008–2013, and two groups of children with ADHD were identified in: 1. MoBa and 2. The general child population. We used the multiaxial International Classification of Diseases (ICD-10) and compared the proportions of comorbid disorders (axes I–III), abnormal psychosocial situations (axis V) and child global functioning (axis VI) between these two groups. We also compared the relative differences in the multiaxial classifications for boys and girls and for children with/without axis I comorbidity, respectively in these two groups of children with ADHD.ResultsA total of 11 119 children were registered with ADHD, with significantly fewer in MoBa (1.45%) than the general child population (2.11%), p < 0.0001. The proportions of comorbid axis I, II, and III disorders were low, with no significant group differences. Compared with the general child population with ADHD, children with ADHD in MoBa were registered with fewer abnormal psychosocial situations (axis V: t = 7.63, p < .0001; d = -.18) and better child global functioning (axis VI: t = 7.93, p < 0.0001; d = .17). When analysing relative differences in the two groups, essentially the same patterns were found for boys and girls and for children with/without axis I comorbidity.ConclusionsSelf-selection was found to affect the proportions of ADHD, psychosocial adversity and child global functioning in the cohort. However, the differences from the general population were small. This indicates that studies on ADHD and multiaxial classifications in MoBa, as well as other cohort studies with similar self-selection biases, may have reasonable generalisability to the general child population.