Adult Personality Disorder Research Articles

Head Injury and Antisocial Personality Features in a Sample of Juvenile Detainees

Previous research has reported high prevalence rates of head injury amongst juvenile justice involved youth and relations between head injury and different forms of offending. However, little is currently known about the extent to which head injury is associated with antisocial personality features – characteristics that are strongly correlated with adult antisocial personality disorder symptomatology. The current study aimed to address this void in the existing body of research by analyzing a longitudinal sample of juvenile detainees ( N = 881) to examine the relationship between head injury during childhood or early adolescence and a wide range of antisocial personality features in late adolescence. Results from a series of logistic regression models reveal that head injury is associated with impulsivity and aggression more than other features of antisocial personality. The implications of these results for juvenile justice intervention programming and avenues for future research are discussed.

Late Onset Personality Disorders in Mid-Life and Older Adults.

There is little research on personality disorder (PD) onset in older age. Many studies have shown that normative personality traits change across the life span, even into later life. This study aimed to investigate the onset of PDs in later adulthood (>age 55), and the possible influence of major life events on predicting this late onset. The current analysis was conducted with data from the St. Louis Personality and Aging Network (SPAN). Structured diagnostic interviews were administered three times over five years. Logistic regressions were conducted predicting late onset PD from baseline to FU5 and from FU5 to FU10 as a function of each major life event. 75 PD onsets occurred from baseline to FU5, and 39 PD onsets occurred from FU5 to FU10. Personal illness predicted the onset of PDs from FU5 to FU10.

Assessment of Personality Disorders in Older Adults. A Practice Guide.

Assessment of personality disorders (PDs) in older adults is a nuanced trade of its own. The aim of this practice guide is to illustrate gerontological assessment challenges using 3 case vignettes. We argue that it is important to pay extra attention to the influence of cognitive and medical (somatic) disorders on personality functioning in older adults during personality assessment. We also note that information provided by informants contributes added value to personality assessment. Personality assessment should be sufficiently age-specific to prevent overdiagnosis or underdiagnosis in older adults. Furthermore, given the reduced psychological or somatic capacity of some older adults, phased or sequential personality assessment is recommended. This should be focused on the assessment questions to be answered, for example starting with short general screening of personality functioning, followed by more in-depth exploration. Personality assessment should be kept as brief and simple as possible in terms of formulation of the items.

Exploring the association between precipitation and hospital admission for mental disorders in Switzerland between 2009 and 2019.

While several studies proved the relationship between increasing temperatures and poor mental health, limited evidence exists on the effect of other weather factors, such as precipitation. This study assessed the impact of precipitation on hospital admissions for mental disorders in Switzerland between 2009-2019. We defined different precipitation events based on the duration (daily precipitation ≥1mm for 2, 3, or 4 days; PP.2/PP.3/PP.4) and intensity (≥90th percentile for 2 consecutive days; PEP90.2). First, we conducted aggregated time-stratified case-crossover analysis in eight main Swiss cities with distributed lag models to assess the association up to 3 days after the exposure. Then, we pooled the estimates in each city using a multivariate random effects meta-analysis for all hospital admissions and by subgroups (sex, age, diagnosis). Evidence of an association between precipitation and hospital admission for mental disorders was not found in Switzerland (PP.2: 1.003[0.978-1.029]; PP.3: 1.005[0.985-1.026]; PP.4: 0.994[0.960-1.030]; PEP90.2: 1.000[0.953-1.050]). Although the results were highly uncertain, we found an indication of increasing risks of hospital admission with increasing intensity of precipitation in warmer seasons (PP.2: 1.001[0.971-1.032] vs PEP90.2: 1.014[0.955-1.078]), while the risks of hospital admission slightly increased by the duration in colder season (PP.2: 1.009[0.981-1.039]; PP.3: 1.008[0.980-1.036]; PP.4: 1.017[0.956-1.081]). Overall, risks tend to be higher in people aged < 65 years. Duration of the events may influence more than intensity in females, while opposite patterns were observed in males. Risks tended to be larger but still uncertain for schizophrenia, mood disorders, and adult personality disorders. An indication of a negative association was found in neurotic disorders and null risks in the remaining groups. Although our findings did not show a clear association between precipitation and mental disorders, further research is required to clarify the role of precipitation and the potential implications of climate change and extreme precipitation events on mental health.

Psychiatric Morbidity: A Retrospective Study From a Tertiary Care Center.

Background It is crucial to monitor the psychiatric morbidity patterns of patients to comprehend the burden and trends of mental illness, as well as to create targeted prevention and intervention strategies. Due to the significant regional differences in mental illness, the current study assessed the psychiatric morbidity pattern from a tertiary care center in Central India. Methods We conducted this retrospective record-based study using data from the outpatient department register of the Psychiatry Department of Government Bundelkhand Medical College, Sagar, Madhya Pradesh, India. All records from January to December 2022 were included, while duplicate and incomplete records were excluded. Data from 2005 cases were finalized for analysis after considering inclusion and exclusion criteria. Data abstraction was done for age, gender, marital status, family history of any psychiatric disorder, and diagnosis (according to ICD-10) from the records. Data analysis was conducted using SPSS Version 26.0 (IBM Corp., Armonk, NY). Quantitative data were presented as means ± standard deviation (SD), whereas qualitative data were presented as frequency and percentages. The chi-square test was applied to determine the association, and p-values <0.05 were considered significant. Results The mean age of the patients was 37.2±16.9 years, where the youngest patient was of four years of age and the eldest was 85 years of age. Most patients were males (50.6%), married (61.1%), and from rural areas (71.8%). Mood (affective) disorder (32.4%) was the most common, followed by schizophrenia, schizotypal and delusional disorders (20.0%), and neurotic, stress-related, and somatoform disorders (17.4%). Organic mental disorders and substance use disorders were more common in unmarried individuals and males. Females had higher rates of mood disorders and somatoform disorders, with varying age distributions. Adult personality disorder and mental retardation had equal frequencies among males and females, with different age distributions. Hyperkinetic disorder was more common in males, while headache syndrome was more common in females. Psychiatric disorders were more prevalent in the urban population, except for substance abuse and hyperkinetic disorder. Conclusion Our study highlights the types of psychiatric disorders among patients at a tertiary care center, aiding clinicians in improving care and emphasizing early detection and treatment of mental illnesses.

Assessment and Treatment of Childhood-Onset Conduct Disorder: A Literature Review

Introduction: Conduct disorder (CD) is among the most highly represented diagnostic issues in child psychiatry. Current research suggests that early-onset CD is predictive of a worse prognosis and trajectory than other CD subtypes if not subsequently met with appropriate psychological assessment and symptom management. This paper aims to provide an overview of the literature from 2014 to 2021 in assessment and intervention protocols that target childhood-onset type specific CD, and appraise associated barriers implicated by the findings. Methods: This review involved a thorough literature search in electronic databases to extract empirical studies directly related to childhood-onset CD. The review was performed on PsycINFO and PubMed using the following search words: “conduct disorder(s)” OR “CD” OR “conduct disordered”, AND “child(hood)-onset” OR “elementary-onset” OR “early-onset”, AND “assessment” OR “evaluation” OR “examination”, AND “intervention” OR “treatment” OR “symptom management”. Results: Based on trends, articles were sorted into three common topics: assessment, treatment, and barriers to psychological services. The studies demonstrated the importance of sensitive and specific assessment tools, neural measures, behavioural markers, and the limited prosocial emotions (LPE) specifier. The results indicated that comorbidities, tailored school- and family-based intervention, parent-child conflict, and the LPE specifier in addition to the age-of-onset subtype is an area of research for clinicians. Discussion: Research has shown that childhood-onset CD, compared to other age-of-onset subtypes, is associated with individual risk factors such as neurological and cognitive deficits, poor emotion regulation, familial maladaptive parenting styles, and evocative family instability. While research has focused on dispositional risk factors for this heterogenous disorder, it is important to shift the focus to evidence-based clinical assessment and treatment strategies tailored to the poor prognosis of this subtype. Future research should examine current assessment sensitivity and appraise key stakeholders in early identification and treatment. Conclusion: Early detection and intervention will increase the chances of a positive outcome for all parties, which includes reducing emotional strain and internalizing thoughts of caregivers and teachers and preventing antisocial personality disorder in adulthood. Normative treatment options for childhood-onset CD coincides with individual risk factors, further research will have implications in identifying and providing early care to at-risk children.

Prevalence of Personality Disorders in Adults With Attention Deficit Hyperactivity Disorder (ADHD)

Objective: To estimate the prevalence of PDs according to Millon’s evolution-based model among adult ADHD outpatients. Method: Cross-sectional study of consecutive patients referred to an adult ADHD clinic. PDs were evaluated with Millon Clinical Multiaxial Inventory–III (MCMI-III). Results: One-hundred-eighty-one participants had valid MCMI-III, of whom147 were diagnosed with ADHD. Mean age: 32.97, SD:11.56, females: 74 (50.3%). Among the 147 participants with ADHD, 29 (19.7%) did not meet criteria for any PD, 43 (29.3%) met the criteria for one PD, 34 (23.1%) for two PDs and the rest three or more. Most common PD was Dependent (n = 58) followed by Depressive (n = 45). Inattentive sub-type was associated with dependent PD, while combined type with antisocial, negativistic (passive/aggressive) and sadistic PD. Conclusion: Particular personality profiles were more common with different ADHD subtypes. Given the developmental origins of PD, further research may help identify possible links with childhood difficulties.

Clinical improvement of teens participating in a dbt skills training

IntroductionDialectical behavioural therapy (DBT) developed by Linehan has been shown to be widely effective in improving emotional regulation capacity in patients diagnosed with borderline personality disorder in adults and adolescents, but also for other profiles of emotional dysregulation, even in the general non-clinical population through emotional regulation skills training programs in schools.ObjectivesThe objective was to describe psychopathological characteristics and to evaluate clinical outcome variables (self-harm, suicide attempts, admissions and emotional regulation difficulties) in young patients who participated in the DBT skills training group carried out by the child and adolescent psychiatry team of Hospital del Mar (Barcelona) between February 2020 and April 2022.MethodsProspective longitudinal study with two evaluations (before starting the group and after finishing it). The clinical variables were evaluated by reviewing the medical records, and the improvement in emotional regulation difficulties was evaluated through the Difficulties in Emotion Regulation Scale (DERS) adaptation to adolescents before and after the intervention.ResultsA total of 36 participants have been referred and assessed to participate in the previously mentioned emotional regulation program. The mean age was 15.6 years (14-17 years old). 100% of the participants were female. All of them met criteria for BPD according to the SCID-II questionnaire; but only 23 patients (63.9%) had BPD as their main diagnosis. 63.9% (n=23) presented psychiatric comorbidities, being 27.8% (n= 10) ADHD, 30.6% (n= 11) substance use disorder and 47.2% (n= 17) eating disorders,77.8% (n=28) had presented self-injurious behaviour, 52% (n=18) had committed a suicide attempt, requiring hospital admission in 36.2% (n=13) at some point in their lives before the therapy group. In the three months after the end of the group, admissions were reduced to 17% (n=6), suicide attempts to 14.8% (n=5) and non-suicidal self-injurious behaviours to 27.8% (n=10).The mean score of all participants on the DERS scale was 129.91 points before participating in the DBT skills group and 105 points right after the group finished. Higher scores translate into greater emotional regulation difficulties.ConclusionsThe reduction in DERS scores, self-injurious behaviours, suicide attempts, and admissions was notable for all participants. It remains to add the results of the groups currently in operation and perform the statistical analysis of all the results. It is necessary to continue studying and testing the benefits of DBT both in the clinical adolescent population and in the general child and adolescent population in order to generalize the promising results observed in our sample. At Hospital del Mar, we will continue to expand the DBT program so that more children and adolescents with emotional dysregulation can benefit.Disclosure of InterestNone Declared

Developmental predictors of young adult borderline personality disorder: a prospective, longitudinal study of females with and without childhood ADHD

BackgroundResearch on the precursors of borderline personality disorder (BPD) reveals numerous child and adolescent risk factors, with impulsivity and trauma among the most salient. Yet few prospective longitudinal studies have examined pathways to BPD, particularly with inclusion of multiple risk domains.MethodsWe examined theory-informed predictors of young-adult BPD (a) diagnosis and (b) dimensional features from childhood and late adolescence via a diverse (47% non-white) sample of females with (n = 140) and without (n = 88) carefully diagnosed childhood attention-deficit hyperactivity disorder (ADHD).ResultsAfter adjustment for key covariates, low levels of objectively measured executive functioning in childhood predicted young adult BPD diagnostic status, as did a cumulative history of childhood adverse experiences/trauma. Additionally, both childhood hyperactivity/impulsivity and childhood adverse experiences/trauma predicted young adult BPD dimensional features. Regarding late-adolescent predictors, no significant predictors emerged regarding BPD diagnosis, but internalizing and externalizing symptoms were each significant predictors of BPD dimensional features. Exploratory moderator analyses revealed that predictions to BPD dimensional features from low executive functioning were heightened in the presence of low socioeconomic status.ConclusionsGiven our sample size, caution is needed when drawing implications. Possible future directions include focus on preventive interventions in populations with enhanced risk for BPD, particularly those focused on improving executive functioning skills and reducing risk for trauma (and its manifestations). Replication is required, as are sensitive measures of early emotional invalidation and extensions to male samples.

Association of Pain Disorder and Psychiatric Disease With Surgical Management of Obstructive Sleep Apnea.

Patients undergoing surgical management for obstructive sleep apnea (OSA) are likely medically distinct from their counterparts not treated surgically. This study examined the associations between psychiatric and pain comorbidities and the likelihood of undergoing sleep surgery. A retrospective cohort study of adults with OSA. Large integrated healthcare system. The primary outcome was nonnasal, nonbariatric sleep surgery. The associations of baseline demographic and comorbid conditions with surgery to treat underlying OSA were examined using bivariable and multivariable analyses. Among 172,854 adults with OSA, 2456 received sleep surgery. Comorbid pain disorder and/or pain medication treatment was associated with 41% higher odds of surgery (95% confidence interval: 1.29-1.54). In bivariable analyses, those with a history of headache (p = .004), particularly migraine (p = .003), disorders of adult personality or behavior (p = .025), or behavioral/emotional disorder (p < .001) were more likely to undergo surgery. Younger adults were also more likely to undergo surgery (mean age at diagnosis 39.8 ± 12.6vs 54.7 ± 14 years), as were men, Asian/Pacific Islander or Hispanic adults, those with lower body mass index (32 ± 7vs34.3 ± 8.1 kg/m2 ), or those with Charlson Comorbidity Index of zero (p < .001). Our study suggests a history of pain disorder (including receipt of pain medication), migraine, or certain behavioral and personality disorders are associated with an increased likelihood of undergoing sleep surgery. The findings may better characterize comorbid predictors of sleep surgery and potentially help clinicians tailor expectations, postoperative pain management, and overall sleep outcomes.

An Integrated Developmental Approach to Personality Disorders in Adolescence: Expanding Kernberg's Object Relations Theory.

This article is a tribute to Dr. Otto F. Kernberg and his contribution to the theoretical understanding of personality pathology in adolescence. In his object relations theory of the structure of personality, an integrated identity is considered central to healthy personality functioning and is contrasted with identity diffusion, which is posited to underlie the maladaptive interpersonal functioning of patients with severe personality disorders. His work provided an early theoretical foundation for the understanding and treatment of personality disorders in adults, but a need remained for a deeper understanding of the development and treatment of personality disorders during adolescence. During the past 10 years, Kernberg has led a group of clinicians and developmental researchers focusing on childhood and adolescence to elaborate an understanding of the development, assessment, and treatment of personality disorders among adolescents. He proposed that in the context of typical development, adolescence is important to the expansion of identity, because it represents the period when sexual and aggressive impulses are integrated and earlier representations of the self and others are revised and become more realistic and nuanced. Furthermore, adolescence entails a reorganization of the moral system and enrichment of the ego ideal. This article presents two methods for assessing personality disorders in adolescence that are based on Kernberg's theory and demonstrates the use of transference-focused psychotherapy for adolescents with personality disorders.

Borderline personality disorder in young adults: features of psychopathology and patterns of course

To identify the psychopathological features of borderline personality disorder (BPD) in adolescence, determine the trajectory of its further course, and develop criteria for differential diagnosis. Clinical/psychopathological and psychometric methods were used to study 143 patients. The patients were divided into two groups: a clinical group - 73 patients, who were inpatients or outpatients in the clinical departments of the Mental Health Research Center (MHRC) in 2019-2022, and a follow-up group - 70 patients who were inpatients or outpatients in the MHRC clinic in 2006-2010. The structure of BPD in adolescence was clinically heterogeneous, which allowed distinguishing three typological varieties: with phenomena of «affective storm», which was characterized by the dominance of affective disorders, including after completion of adolescence, with some stabilization of personality structure (type I); with the dominance of addictive patterns of the type of «adrenalinomania», in which one of the key positions was occupied by craving impairments, with a constant need to search for new extreme hobbies, the use of psychoactive substances, which persisted after the end of adolescence (type II); with the predominance of «cognitive dissociation», which was characterized by the most polymorphic picture of disorders, with the predominance of self-identification disorders with dissociative disorders that retain their severity after the end of adolescence (type III). An integrative assessment of outcomes showed that rather favorable results (47.37%) (χ2=23.37, p=0.001) prevailed at type I, type II was characterized by rather unfavorable (59.26%) and unfavorable results (22.22%) (χ2=12.75, p=0.013) and type III by rather unfavorable (79.17%) and unfavorable (8.33%) outcomes (χ2=16.75, p=0.002). In the nosological evaluation of the follow-up group, 80.0% of patients were diagnosed with BPD, in the rest of the patients there was a change in diagnosis: in 14.3% for schizotypal disorder, in 5.7% for an attack-like form of schizophrenia (χ2=13.8, p=0.008; χ2=14.5, p=0.006). BPD in adolescence was confirmed in the majority of cases in adulthood. The results confirm that the typological variants of BPD are of prognostic value and can serve to further develop therapeutic and socio-rehabilitation measures.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Schema therapy for personality disorders in autistic adults: Results of a multiple case series study.

To our knowledge, treatment of personality disorder (PD) comorbidity in autistic adults is understudied and is still in its infancy. We investigated the effectiveness of schema therapy (ST) for autistic adults with PD. A multiple case series design with 12 adults (aged 19-62 years) was used with baseline, exploration, ST (with cognitive behavioural and experiential techniques) and follow-up conditions. Participants rated dysfunctional core beliefs (primary outcome) weekly during baseline and treatment and monthly during follow-up. Schema modes, general mental health symptoms, social responsiveness, PD traits and common Axis-I mental disorders were assessed. Mixed model analyses indicated significant effects of ST with medium to large effect sizes for dysfunctional core beliefs, functional schema modes, PD traits, general mental health symptoms and social responsiveness. Results remained stable during follow-up. The results of this study indicate that ST might be effective in decreasing dysfunctional core beliefs, PD traits and general mental health symptoms and in increasing functional schema modes and social responsiveness. Improvements persisted over time. ST seems effective in treating PD in autistic individuals.

Validation of the Recovering Quality of Life (ReQoL) questionnaires for patients with anxiety, obsessive-compulsive, stress-related, somatoform and personality disorders in Germany

The health-related quality of life (HrQoL) and the recovery process of persons with mental health conditions can be assessed with the Recovering Quality of Life questionnaires (ReQoL-20 and ReQoL-10). The aim of this study was to assess the psychometric properties of the German version of the ReQoL measures in patients with anxiety, obsessive-compulsive, stress-related, and somatoform disorders and in patients with disorders of adult personality and behavior. This study was based on a sub-sample of patients that were included in a randomized controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER). The internal consistency was assessed using Cronbach's Alpha and the test-retest reliability was assessed by the intra-class correlation coefficient (ICC). Concurrent validity was assessed by Pearson's Correlation Coefficient and the known-group validity was assessed using the Cohen's d. The internal consistency of the ReQoL-20 and ReQoL-10 was excellent and good with Cronbach's alpha of α = 0.91 and α = 0.83 for all items. The test-retest reliability of the ReQoL measures was moderate with ICC of r = 0.72 to 0.74. The concurrent validity of the ReQoL measures with the Global Severity Index was overall high with a correlation coefficient of r = −0.70. In conclusion, for patients with anxiety, obsessive-compulsive, stress-related, somatoform and personality disorders, the German version of the ReQoL measures is valid and reliable for the assessment of HrQoL and the recovery process.

The Well-informed Patient: a Survey on Patients' Initiative in Seeking Disease-related Information

Internet and print media are frequently used by laypersons to learn about health issues. The objective of this study was to find out whether people with mental disorders showed a special pattern of usage. Where and why do they seek for information about their disorder? How do they experience their search? In semi-standardized interviews, we surveyed 200 psychiatric inpatients. Only patients of the following diagnostic groups were included: 1. Schizophrenia, schizotypal and delusional disorders (F20-F29), 2. Affective disorders (F30-F39) and 3. Disorders of adult personality and behavior (F60-F69). We focused on the sources the patients had used and the experiences they had in the course of their internet search. The vast majority had already searched for information about psychiatry, psychology or medication via internet or in print media. Most participants described positive emotions while reading. More than two-thirds rated the information as useful. Only 10 participants discontinued or rejected therapeutic measures due to information they had gained. Patients with personality disorders were significantly more likely than other patients to attribute their symptoms to a wrong diagnosis after seeking for information. Overall, psychiatric patients mostly experience helpful effects of reading medical information. In rare cases there are negative effects, e. g. negative emotions, discontinuation of therapy or an incorrect assessment of one's own illness. Further research is required in order to find out how the use of internet by people with mental disorders, which is already successful in many cases, can be improved even further.

Reciprocal relationships between personality disorders and eating disorders in a prospective 17-year follow-up study.

This study aimed to report the presence of categorical and dimensional personality disorders (PD) in adults with longstanding eating disorders (ED) over a period of 17 years and to investigate whether changes in PD predict changes in ED symptoms or vice versa. In total, 62 of the 80 living patients (78% response rate) with anorexia nervosa (n=23), bulimia nervosa (n=25), or other specified feeding or ED (n=14) at baseline were evaluated during hospital treatment and at 1-year, 2-year, 5-year, and 17-year follow-up. PD were assessed using the Structured Clinical Interview for DSM-IV Axis II disorders, and the eating disorder examination (EDE) interview was used to assess ED. Data were analyzed using multilevel modeling. From baseline to the 17-year follow-up, the number of patients with any PD decreased significantly from 74.2% to 24.2%, and the total number of PD diagnoses declined from 80 to 22. Mean EDE score was significantly reduced from 4.2 (SD: 1.1) to 2.0 (SD: 1.6). There was a positive association between ED and PD where the initial level of either disorder was followed by similar levels of the other disorder throughout the entire follow-up period. High baseline levels of borderline PD predicted less decrease in ED symptoms. No significant within-person effects were found. Both ED and PD significantly declined over time. As the severity of either disorder seems to be associated with the other, thorough assessment and treatment that incorporates both the ED psychopathology and the personality disturbances are advisable. While personality disorders were highly prevalent in the sample of patients with longstanding eating disorders, both disorders were significantly reduced at the 17-year follow-up. The disorders are related in the sense that an initial high level of either disorder is associated with a high level of the other over time. A thorough assessment and attention to both illnesses are advisable in therapy. NCT03968705.

Exploring the association between precipitation and mental health hospitalizations in Switzerland

Background and aim: While several studies proved the relationship between temperature and mental health, limited evidence exists on the effect of other weather factors, such as precipitation. The aim of this study was to assess the impact of precipitation on mental disorders in Switzerland between 2009–2019. Methods: Daily hospitalizations between 2009–2019 were obtained from Switzerland’s Federal Office of Statistics. Daily precipitation was taken from 2km gridded maps developed by MeteoSwiss. We conducted aggregated case-crossover analysis with a conditional quasi-Poisson regression to assess the association up to 7 days after the exposure. We considered daily precipitation in millimeters (mm), and persistent extreme precipitation events (PEP90.2) when daily precipitation exceeded the 90th percentile for more than 2 days. The analysis was conducted separately in eight Swiss main cities (Basel, Bern, Geneva, Lausanne, Lugano, Luzern, St. Gallen, and Zurich) and stratified by sex, age (&amp;#x3c;65years, &amp;#x2265;65years), and group of diagnosis (ICD-10). Models were adjusted by daily mean temperature. Results: The total number of hospital admissions included in the study was 147,768. On average, the risk of hospitalization increased by 38% (95%CI:1.30-1.46) for every 10mm increase in daily precipitation and by 52% (95%CI:1.33-1.74) for PEP90.2 events. Larger risks were found in males (1.67;95%CI:1.42-1.96, vs 1.38; 95%CI:1.17-1.63 in females) and under 65 years old (1.53;95CI:1.33-1.77 vs 1.45;95%CI:1.17-1.80 in &amp;#x2265;65years) for PEP90.2 events. By sub-diagnosis categories, larger risks were found for adult personality disorders (F60-F69) in daily precipitation (1.61;95%CI:1.42-1.83) and PEP90.2 (1.94;95%CI:1.34-2.80), while no evidence was found for developmental disorders (F80-F98) and similar risks to the average in the remaining groups. We observed a positive association in all cities with higher risks in Luzern for daily precipitation (1.68; 95%CI:1.43-1.97) and PEP90.2 (2.22; 95%CI:1.33-3.69). Conclusions: Our findings suggest that extreme precipitation events could have adverse impacts on mental health in Switzerland. Keywords: Precipitation; Climate change; Mental health

The Role of Mental Health and Behavioral Disorders in the Development of Temporomandibular Disorder: A SWEREG-TMD Nationwide Case-Control Study

PurposeThere is a well-known association between mental and behavioral disorders (MBD) and temporomandibular disorder (TMD), although the association has not been established in population-based samples. This study aimed to investigate this relationship using national population-based registry data.Patients and MethodsThis case–control study used prospectively collected data from Swedish national registries to investigate exposure to MBD and the probability of developing TMD in all Swedish citizens with hospital-diagnosed or surgically treated TMD between 1998 and 2016. Odds ratios were calculated using conditional logistic regression adjusted for educational level, living area, country of birth, musculoskeletal comorbidity, and history of orofacial/neck trauma.ResultsA statistically significant association between MBD and TMD was found for mood affective disorders (OR 1.4), neurotic, stress-related and somatoform disorders (OR 1.7), behavioral syndromes associated with psychological disturbances and physical factors (OR 1.4), disorders of adult personality and behavior (OR 1.4), disorders of psychological development (OR 1.3), behavioral and emotional disorders with onset usually occurring in childhood and adolescence (OR 1.4), and unspecified mental disorder (OR 1.3). The association was stronger for TMD requiring surgery, with the strongest association in patients with disorders of psychological development (OR 2.9). No significant association was found with schizophrenia, schizotypal and delusional disorders, or mental retardation.ConclusionThe findings indicate an increased probability of TMD among patients with a history of certain MBD diagnoses, and a stronger association with TMD requiring surgery, specifically repeated surgery. This highlights the need for improved preoperative understanding of the impact of MBD on TMD, as TMD and chronic pain itself may have a negative impact on mental health.

Childhood symptoms of attention-deficit/hyperactivity disorder and borderline personality disorder.

Childhood attention-deficit /hyperactivity disorder (ADHD) is known to be associated with adult Borderline Personality Disorder (BPD). We investigated if any of the subdimensions of childhood ADHD, that is, impulsivity, inattention, or hyperactivity was more prominent in this association. In a nation-wide cohort (N= 13,330), we utilized parent reported symptoms of childhood ADHD and clinically ascertained adult BPD diagnoses. The summed total scores of ADHD symptoms and its three subdimensions were used and standardized for effect size comparison. Associations were analyzed using Cox regression with sex and birth-year adjustments. Secondary outcomes were BPD-associated traits (i.e., self-harm and substance use) analyzed using logistic- and linear regression respectively. ADHD symptom severity was positively associated with BPD with a hazard ratio (HR) of 1.47 (95% confidence interval [CI]: 1.22-1.79) per standard deviation increase in total ADHD symptoms. Impulsivity was the most prominent subdimension with the only statistically significant association when analyzed in a model mutually adjusted for all ADHD subdimensions-HR for inattention: 1.15 (95% CI: 0.85-1.55), hyperactivity: 0.94 (95% CI: 0.69-1.26), impulsivity: 1.46 (95% CI: 1.12-1.91). In secondary analyses, weak positive associations were seen between total ADHD symptom score and self-harm and substance use. In analyses by subdimensions of ADHD, associations were weak and most prominent for inattention in the model with self-harm. Childhood ADHD symptoms were associated with subsequent development of BPD diagnosis and appeared to be driven primarily by impulsivity. Our findings are important for understanding the association between childhood symptoms of ADHD and subsequent BPD.