Treatment-seeking Individuals Research Articles

A specific neural substrate predicting current and future impulsivity in young adults

Impulsivity (rash action with deleterious outcomes) is common to many psychiatric disorders. While some studies indicate altered amygdala and prefrontal cortical (PFC) activity associated with impulsivity, it remains unclear whether these patterns of neural activity are specific to impulsivity or common to a range of affective and anxiety symptoms. To elucidate neural markers specific to impulsivity, we aimed to differentiate patterns of amygdala–PFC activity and functional connectivity associated with impulsivity from those associated with affective and anxiety symptoms, and identify measures of this circuitry predicting future worsening of impulsivity. Using a face emotion processing task that reliably activates amygdala–PFC circuitry, neural activity and connectivity were assessed in a transdiagnostically-recruited sample of young adults, including healthy (N = 47) and treatment-seeking individuals (N = 67). Relationships were examined between neural measures and impulsivity, anhedonia, and affective and anxiety symptoms at baseline (N = 114), and at 6 months post scan (N = 30). Impulsivity, particularly negative urgency and lack of perseverance, was related to greater amygdala activity (beta = 0.82, p = 0.003; beta = 0.68, p = 0.004; respectively) and lower amygdala–medial PFC functional connectivity (voxels = 60, tpeak = 4.45, pFWE = 0.017; voxels = 335, tpeak = 5.26, pFWE = 0.001; respectively) to facial fear. Left vlPFC, but not amygdala, activity to facial anger was inversely associated with mania/hypomania (beta = −2.08, p = 0.018). Impulsivity 6 months later was predicted by amygdala activity to facial sadness (beta = 0.50, p = 0.017). There were no other significant relationships between neural activity and 6-month anhedonia, affective, and anxiety symptoms. Our findings are the first to associate amygdala–PFC activity and functional connectivity with impulsivity in a large, transdiagnostic sample, providing neural targets for future interventions to reduce predisposition to impulsivity and related future mental health problems in young adults.

Race-based differences in drug use prior to onset of opioid use disorder

Rates of opioid use disorder (OUD) have increased dramatically over the past two decades, a rise that has been accompanied by changing demographics of those affected. Early exposure to drugs is a known risk factor for later development of opioid use disorder; but how and whether this risk factor may differ between racial groups is unknown. Our study seeks to identify race differences in self-report of current and past substance use in OUD-diagnosed treatment-seeking individuals. Patients (n = 157) presenting for methadone maintenance treatment at a racially diverse urban opioid treatment program were approached and consented for study involvement. Participants were administered substance use history questionnaires and urine drug screening at intake. Chi-square, t-tests, and rank-sum were used to assess race differences in demographic variables. Logistic and linear regressions assessed the relationship between race and substance use for binary and continuous variables, respectively. 61% of the population identified as Black and 39% as White. Black participants were significantly older; age was thus included as a covariate. Logistic regressions demonstrated that despite similar urine toxicology at intake, White participants were significantly more likely to report having used prescription opioids and psychedelic, stimulant, and sedative substance classes prior to their first use of non-pharmaceutical opioids. Compared to Black participants, White treatment-seeking OUD-diagnosed individuals reported using a wider range of substances ever and prior to first use of non-pharmaceutical opioids. There were no differences, however, in presentation for OUD treatment, suggesting different pathways to OUD, which may carry important clinical implications.

Initial development of a brief assessment of cocaine demand.

Cocaine demand is a behavioral economic measure assessing drug reward value and motivation to use drug. The purpose of the current study was to develop a brief assessment of cocaine demand (BACD). Results from the BACD were compared with self-report measures of cocaine use. Participants consisted of treatment-seeking individuals with cocaine use disorder (N = 22). Results revealed that indices of brief demand were significantly associated with various self-report measures of cocaine use. Overall, these results support the utility of a BACD for assessing cocaine demand.

Safety and efficacy of a prescription digital therapeutic as an adjunct to buprenorphine for treatment of opioid use disorder

Objectives To evaluate the safety and efficacy of a digital therapeutic in treatment-seeking individuals with opioid use disorder (OUD) in an analysis of randomized clinical trial (RCT) data (ClinicalTrials.gov identifier: NCT00929253). Methods Secondary analysis of an RCT including 170 adults meeting DSM-IV criteria for OUD. Participants were randomized to 12-weeks of treatment-as-usual (TAU) or TAU plus a digital therapeutic providing 67 digital, interactive educational modules based on the Community Reinforcement Approach. TAU consisted of buprenorphine maintenance therapy, 30 min biweekly clinician interaction, and abstinence-based contingency management. Primary endpoints were treatment retention and abstinence (negative urine drug screen) during weeks 9–12 of treatment. Safety was assessed by evaluating adverse events. Results Participants randomized to TAU plus a digital therapeutic had significantly greater odds of opioid abstinence during weeks 9–12 compared to TAU: 77.3 versus 62.1%, respectively (p=.02), OR 2.08, 95% CI 1.10–3.95. The risk of patients leaving treatment was significantly lower in the digital therapeutic group (HR 0.49, 95% CI 0.26–0.92). No significant difference was observed in the rate of adverse events between groups (p=.42). Conclusions A prescription digital therapeutic (PDT) in combination with buprenorphine therapy improves clinically significant patient outcomes including abstinence from illicit opioids and retention in treatment compared with treatment as usual.

Factors associated with the absence of cocaine craving in treatment-seeking individuals during inpatient cocaine detoxification

ABSTRACT Background Anecdotal evidence suggests a substantial proportion of individuals with cocaine use disorder do not report craving during inpatient detoxification. Objective To examine prevalence and clinical correlates of consistent absence of cocaine craving among inpatients during detoxification. We hypothesized that craving absence would be associated with less severity of cocaine use, depression, and anxiety. Alternative explanations were also explored. Methods Craving absence (i.e., non-cravers) was defined as a daily score of zero across two separate craving visual analogue scales in each of the inpatient days. Participants scoring ≥1 on ≥1 day were considered cravers. Severity of cocaine use disorder as well as in-treatment depression and anxiety were assessed. Alternative contributors included presence of cocaine and other substances in urine at admission, in-treatment prescription of psychotropic medications, treatment motivation, executive function, interoception, and social desirability. Results Eighty-seven participants (78.2% males) met criteria as either non-cravers (n = 29; 33.3%) or cravers (n = 58; 66.7%). Mean length of admission in non-cravers and cravers was, respectively, 10.83 and 13.16 days. Binary logistic regression model showed that non-cravers scored significantly lower than cravers on cocaine use during last month before treatment (OR, 95% CI; 0.902, 0.839–0.970), in-treatment depression (OR, 95% CI; 0.794, 0.659–0.956), and in-treatment prescribing of antipsychotics (OR, 95% CI; 0.109, 0.014–0.823). Model prediction accuracy was 88.9%. Conclusions One in three patients undergoing inpatient detoxification experienced absence of craving, linked to less pretreatment cocaine use, better mood, and decreased administration of antipsychotics. Findings may inform pretreatment strategies and improve treatment cost-effectiveness.

Threat appraisal and negative affect under ambiguity in generalised anxiety disorder

Generalised anxiety disorder (GAD) is one of the most common anxiety disorders, yet its mechanisms remain poorly understood. In the current study, we assessed threat processing and negative affect under conditions of uncertainty and ambiguity in a sample of treatment-seeking individuals with GAD (n = 34) and in community controls (n = 34). Participants completed a laboratory aversive learning task based on that used by Grupe and Nitschke (2011). A bias in threat expectancy was observed in GAD participants relative to controls for an ambiguous cue that had not been mentioned in the instructions. GAD participants also overestimated the number of times this ambiguous cue had been followed by an aversive outcome, relative to an instructed uncertain cue (50 %). This covariation bias was not observed in controls. GAD participants also reported significantly stronger negative affect towards the ambiguous cue than the uncertain cue, a pattern that was not observed in controls, although the group interaction did not reach significance. These results provide preliminary evidence that ambiguity – rather than uncertainty per se – may be a particularly powerful trigger for biased threat appraisal and negative affect in GAD.

Anhedonia is central for the association between quality of life, metacognition, sleep, and affective symptoms in generalized anxiety disorder: A complex network analysis

BackgroundPoor quality of life, sleep problems, anhedonia, and negative metacognitions are common in anxiety and depression. To examine the nature of the relationship between these features and the role of metacognitions, anhedonia, and quality of life in anxiety and depression, we conducted a complex network analysis with items of self-report measures assessing quality of life, sleep, negative thinking styles, anxiety, and depression. MethodsParticipants were 226 treatment seeking individuals with a primary DSM-5 diagnosis of generalized anxiety disorder. Node centrality, strength, expected influence, community, and bridge estimation were calculated using partial correlation coefficients and glasso regularization. ResultsResults revealed that anhedonia was the most central node followed by quality of life nodes. Moreover, anhedonia exhibited the highest strength and expected influence, which were both stable, reliable metrics within the network. Metacognitions were not central nodes in the network, but were strong bridge symptoms between communities. LimitationsThe results are limited by the cross-sectional nature of the data and the administration of self-report scales at one time-point, despite different rating anchors. ConclusionThese findings suggest that anhedonia is a crucial element for the association between quality of life, sleep problems, and negative cognitions.

Neurocognitive performance in alcohol use disorder using the NIH toolbox: Role of severity and sex differences

AimsSustained heavy alcohol consumption is associated with a range of neurocognitive deficits. Yet, past research centers on a severe profile of alcohol use disorder (AUD), with persons recruited from in-patient settings. The current project aims to compare neurocognitive performance between individuals seeking AUD outpatient treatment with healthy comparisons while considering the association between performance, disorder severity, and sex. MethodsEnrollment included two matched groups (N = 125; 34 % female): 77 treatment-seeking individuals with AUD; 48 healthy comparison individuals with low drinking patterns. Neurocognitive performance on NIH Toolbox subtests measuring attention, inhibition, episodic memory, working memory, language, and processing speed were compared across groups. Within the AUD group, analyses examined the relationship between performance, disorder severity, recent alcohol consumption, and sex. ResultsAUD group did not perform significantly lower than healthy comparisons on neurocognition subtests assessed. Within AUD group, females displayed significantly higher processing speeds than males (p = .007). Disorder severity and alcohol consumption were not significantly related to performance. However, a significant interaction between disorder severity and sex emerged (p = .010), with higher severity associated with poorer performance in males but not females, on a subtest measuring attention and inhibition. ConclusionsEffect of heavy alcohol use on neurocognitive performance was not detected in this outpatient AUD sample. Weaknesses in domains of attention and inhibition may be correlated with AUD severity among males, but not females. Further research on AUD severity and sex in understanding individual differences in neurocognition is warranted, particularly using novel tools for large scale phenotyping, such as the NIH Toolbox.

Illness perceptions and health beliefs in persons with common mental disorders.

Help seeking is crucial in the context of illness management and care. Various psychological factors impact this process of help-seeking. In this background, the present study explored illness perceptions, attitudes to help-seeking, work and social adjustment in addition to clinical correlates, in a sample of 63 treatment seeking individuals. The study adopted a cross-sectional single group design. Participants were assessed on the Brief Illness Perception Questionnaire, Attitudes Toward Seeking Professional Psychological Help Scale, General Self-efficacy Scale, Internalized Stigma and Work and Social Adjustment Scale. Majority had illness duration of about 6 years and had delayed seeking treatment for about one and half years. Participants reported higher emotional reactions to illness, concerns regarding effectiveness of treatment and understanding and meaning about illness on the BIPQ. Illness perceptions were significantly correlated with work and social adjustment and attitudes toward seeking professional psychological help. General self- efficacy and internalized stigma emerged as predictors of overall work and social adjustment. The study has implications for interventions that need to target beliefs about illness in order to maximize help-seeking and reduce treatment gap.

The unique contribution of perfectionistic cognitions to anxiety disorder symptoms in a treatment-seeking sample

ABSTRACT Perfectionistic cognitions are thinking patterns that reflect excessive striving and are associated with emotional disorders in nonclinical samples. Despite literature connecting trait perfectionism with psychological disorders, much remains unknown about how perfectionistic cognitions relate to anxiety disorder symptoms in clinical populations. This is the first study to our knowledge that investigates how symptoms of anxiety and related symptoms are influenced by the frequency of perfectionistic cognitions when controlling for well documented correlates of anxiety. Perfectionistic cognitions, depressive symptoms, emotion regulation, anxiety sensitivity, and anxiety symptom severity were assessed prior to starting treatment in 356 treatment-seeking patients diagnosed with an anxiety or anxiety-related disorder at a specialty anxiety clinic. Perfectionistic cognitions were significantly correlated with all anxiety symptom measures as well as measures of depression, emotion regulation and anxiety sensitivity (range of rs =.22-.68). Hierarchical regression analyses revealed that when controlling for depressive symptoms, anxiety sensitivity, and emotion regulation, perfectionistic cognitions significantly and uniquely contribute to the variance of GAD (p <.01) and PTSD (p <.05) symptoms but not other anxiety-related symptoms (all ps >.05). Regardless of specific diagnoses, treatment-seeking individuals reporting frequent perfectionistic thoughts are more likely to report more severe symptoms of PTSD and GAD.

Imprecise action selection in substance use disorder: Evidence for active learning impairments when solving the explore-exploit dilemma

BackgroundSubstance use disorders (SUDs) are a major public health risk. However, mechanisms accounting for continued patterns of poor choices in the face of negative life consequences remain poorly understood. MethodsWe use a computational (active inference) modeling approach, combined with multiple regression and hierarchical Bayesian group analyses, to examine how treatment-seeking individuals with one or more SUDs (alcohol, cannabis, sedatives, stimulants, hallucinogens, and/or opioids; N = 147) and healthy controls (HCs; N = 54) make choices to resolve uncertainty within a gambling task. A subset of SUDs (N = 49) and HCs (N = 51) propensity-matched on age, sex, and verbal IQ were also compared to replicate larger group findings. ResultsResults indicate that: (a) SUDs show poorer task performance than HCs (p = 0.03, Cohen’s d = 0.33), with model estimates revealing less precise action selection mechanisms (p = 0.004, d = 0.43), a lower learning rate from losses (p = 0.02, d = 0.36), and a greater learning rate from gains (p = 0.04, d = 0.31); and (b) groups do not differ significantly in goal-directed information seeking. ConclusionsFindings suggest a pattern of inconsistent behavior in response to positive outcomes in SUDs combined with a tendency to attribute negative outcomes to chance. Specifically, individuals with SUDs fail to settle on a behavior strategy despite sufficient evidence of its success. These learning impairments could help account for difficulties in adjusting behavior and maintaining optimal decision-making during and after treatment.

Subtypes of obsessive-compulsive disorder and their relationship to death anxiety

Recent theoretical and empirical research has demonstrated a relationship between death anxiety and obsessive-compulsive disorder (OCD), with a focus on compulsive washing. However, no study has examined whether death anxiety plays an important role across various symptom domains of OCD. The present studies explored the relationship between death anxiety and OCD subtypes across two independent samples of treatment-seeking individuals with this disorder. In Study 1, results from 79 participants demonstrated significant correlations between the Multidimensional Fear of Death Scale and each Vancouver Obsessive Compulsive Inventory (VOCI) subscale. In Study 2, these results were largely replicated using the Collett-Lester Fear of Death Scale in a larger sample of 132 participants. Lastly, results from integrating the samples indicated that the strength of these relationships, although substantial for all types, varied slightly across the subtypes of OCD. Taken together, the findings demonstrate a strong relationship between death anxiety and the differing forms of OCD. Clinical implications include the possibility that fears of death may need to be directly addressed in order to produce long-term symptom amelioration. However, further research is needed to establish the potential causal role of death anxiety across different OCD subtypes.

Measuring health related quality of life for dengue patients in Iquitos, Peru.

Previous studies measuring the health-related quality of life (HRQoL) of individuals with dengue focused on treatment seeking populations. However, the vast majority of global dengue cases are unlikely to be detected by health systems. Representative measurements of HRQoL should therefore include patients with disease not likely to trigger treatment-seeking behavior. This study based in Iquitos, Peru used the Quality of Wellbeing Scale-Self Administered, a survey that enquires about not only physical health, but also psychological health, self-care, mobility, and usual social activities, and rates HRQoL between 0 (death) and 1 (optimum function), to evaluate the impact of dengue on HRQoL. In order to enroll treatment and non treatment-seeking participants, three modalities of participant recruitment were used. In addition to clinic and community-based febrile surveillance, a contact-cluster methodology was also employed to identify infected individuals less likely to seek treatment. We measured changes in HRQoL and identified common areas of health impairment in 73 virologically confirmed dengue cases at 3 time points during the participant’s illness; the early-acute (days 0–6 post symptom onset), late-acute (days 7–20), and convalescent illness phases (days 21 +). Participants reported HRQoL related impairments at significantly higher frequency during the early-acute versus convalescent illness phase (Fisher’s exact: P<0.01). There was substantial heterogeneity in scores during each illness phase with median scores in the early-acute, late-acute and convalescent phases of 0.56 (IQR: 0.41–0.64), 0.70 (IQR: 0.57–0.94), and 1 (IQR: 0.80–1.00), respectively. In all illness phases participants recruited in clinics had on average the lowest HRQoL scores where as those recruited in the contact clusters had the highest. Only 1 individual who was recruited in the contact-clusters had no reduction in HRQoL score during their illness. These data illustrate that dengue should be considered as a disease that may have significant implications for not only physical health but also psychological health and social functioning. The impact of dengue on the HRQoL of non-treatment-seeking individuals, although lower than the impact among treatment-seeking individuals, is not necessarily trivial.

The relationship between insomnia and the intensity of drinking in treatment-seeking individuals with alcohol dependence

BackgroundAlthough insomnia is highly prevalent in alcohol use disorders(AUD), its associations with the severity of alcohol use, pre-existing psychiatric comorbidities and psychosocial problems are understudied. The present study evaluates the interplay between these factors using a structural equation model (SEM). MethodsWe assessed baseline cross-sectional data on patients with AUD (N = 123) recruited to a placebo-controlled medication trial. Severity of alcohol use was measured by the Brief Michigan Alcoholism Screening Test (B-MAST). Insomnia Severity Index was used to assess insomnia symptoms. The Hamilton scales for Depression and Anxiety, Short Index of Problems and Timeline Follow Back evaluated psychiatric symptoms, psychosocial consequences of drinking and level of alcohol consumption respectively. We used logistic regression to evaluate the association between insomnia and severity of alcohol use while controlling for covariates. We constructed a SEM with observed variables to delineate the effect of psychiatric symptoms, psychosocial factors and current alcohol use on the pathway between alcohol use severity and insomnia. ResultsThe sample was predominately male(83.9 %), Black(54.6 %) and employed(60.0 %). About 45 % of the participants reported moderate-severe insomnia.The association between insomnia and B-MAST attenuated after adjustment for demographics, psychiatric symptoms and psychosocial problems(OR[95 % CI] = 1.17(0.99–1.47). SEM findings demonstrated that B-MAST and insomnia were linked to psychiatric symptoms (95 % Asymptotic-Confidence Interval (ACI): 0.015−0.159, p < 0.05) but not to psychosocial problems or current alcohol use. ConclusionAmong treatment-seeking patients with AUD, psychiatric burden mediated the relationship between severity of alcohol use and insomnia. Clinicians should screen for underlying psychiatric disorders among treatment-seeking patients with AUD complaining of insomnia.

Understanding the Overlap Between Cannabis Use and Gambling Behaviour: A Systematic Review of Empirical Findings and Consideration of Policy Implications

Given recent changes in cannabis legalization across North America, understanding cannabis-gambling relationships is of increasing interest. This review examines the current state of the research literature on the co-occurrence of cannabis and gambling. Specifically, the relationship between cannabis and gambling is examined in youth, adults, treatment-seeking individuals, as well as in specific populations. Literature search findings show that the majority of studies to date examining gambling and cannabis are epidemiological investigations conducted in youth. Overall, studies suggest a link between cannabis and gambling, whereby engaging in any form of gambling is linked with cannabis use; moreover, increasing problem gambling severity is associated with cannabis use. The literature search revealed no studies that systematically investigate simultaneous cannabis use during gambling in gambling populations. Findings from the current review demonstrate high rates of co-occurrence between cannabis use and gambling, albeit less information on simultaneous use exists. An important research priority for informing policy, therefore, is a better understanding of cannabis’ effects on decision-making and risky behaviours. Findings from the current review highlight that these behaviours begin in youth even before reaching high school. Longitudinal studies are needed to clarify the epidemiology of gambling-cannabis relationships, nevertheless, initial findings suggest that early gambling behaviour may serve as an important behavioural marker. Altogether, the findings demonstrate that regulatory frameworks should not only consider cannabis co-use with other substances but also a need to include other addictive behaviours, such as gambling.

Partner Abuse Among Treatment-Seeking Individuals with Chronic Pain: Prevalence, Characteristics, and Association with Pain-Related Outcomes.

This study assessed the prevalence of abusive partner relationships among individuals presenting for chronic pain treatment. In addition, this study examined the association between partner abuse histories and pain-relevant outcome variables. Cross-sectional. This study took place at a specialty pain rehabilitation treatment center in the Midwestern United States. Participants in this study (N = 108) included adults (Mage = 45.73 [15.95] years) presenting for chronic pain treatment who consented to participate in a research study on stress, relationships, and chronic pain. Participants completed self-report measures about relationship and abuse histories, physical and mental health, and demographic information. Participants were categorized into the following groups: no intimate partner violence (IPV), past IPV (>12 months ago), or current/recent IPV (≤12 months ago). Results indicated that over half (56%) of the sample endorsed a history of partner abuse and around one-third (29%) of the sample had experienced abuse within the past year. Psychological/emotional abuse was the most common form of abuse reported. Those with current/recent abuse histories reported greater impairment in pain interference, post-traumatic stress symptoms, mental health functioning, and pain self-efficacy compared with those who had not experienced abuse in the past year. Partner abuse appears common among individuals with chronic pain and is associated with pain-relevant outcomes, warranting additional clinical attention and research in this area.

Age-related differences in borderline personality disorder symptom networks in a transdiagnostic sample

BackgroundNaturalistic longitudinal studies of Borderline Personality Disorder (BPD) indicate that symptoms improve over time. In the present study, we applied network theory to the question of how BPD symptom networks may differ as a function of age. MethodsIn a transdiagnostic sample of 5,212 patients presenting for acute psychiatric treatment, we administered a measure of BPD symptoms and then used a novel machine learning technique to test the hypothesis that symptom networks would significantly differ across the age of participants. ResultsResults supported two significant differences in the BPD symptom network that emerged at age 46. In older participants, the relationships among symptoms of non-suicidal self-injury/suicide and emptiness was weaker, yet the relationship between anger and relationship problems was stronger. No differences emerged for relationships between all other symptoms. LimitationsGiven the cross-sectional nature of this study, the potential influence of cohort effects cannot be ruled out. ConclusionsThese findings support the utility of network theory for elucidating potential pathways by which the relationships between symptoms of BPD may differ as a function of age in treatment-seeking individuals. In parallel, results of this study support the highly central role of strong emotions in BPD regardless of age.

Medical Conditions Linked to Atherosclerosis Are Associated With Magnified Cortical Thinning in Individuals With Alcohol Use Disorders.

Magnetic resonance imaging (MRI) studies report widespread cortical thinning in individuals with alcohol use disorder (AUD), but did not consider potential effects of pro-atherogenic conditions such as hypertension, type 2 diabetes mellitus, hepatitis C seropositivity and hyperlipidemia on cortical thickness. The conditions are associated with regional cortical thinning in those without AUD. We predicted that individuals with concurrent AUD and pro-atherogenic conditions demonstrate the greatest regional cortical thinning in areas most vulnerable to decreased perfusion. Treatment-seeking individuals with AUD (n=126) and healthy controls (CON; n=49) completed a 1.5T MRI study. Regional cortical thickness was quantitated via FreeSurfer. Individuals with AUD and pro-atherogenic conditions (Atherogenic+), AUD without pro-atherogenic conditions (Atherogenic-) and CON were compared on regional cortical thickness. Individuals with AUD showed significant bilateral cortical thinning compared to CON, but Atherogenic+ demonstrated the most widespread and greatest magnitude of regional thinning, while Atherogenic- had reduced thickness primarily in anterior frontal and posterior parietal lobes. Atherogenic+ also showed a thinner cortex than Atherogenic- in lateral orbitofrontal and dorso/dorsolateral frontal cortex, mesial and lateral temporal and inferior parietal regions. Our results demonstrate significant bilateral cortical thinning in individuals with AUD relative to CON, but the distribution and magnitude were influenced by comorbid pro-atherogenic conditions. The magnitude of cortical thinning in Atherogenic+ strongly corresponded to cortical watershed areas susceptible to decreased perfusion, which may result in morphometric abnormalities. The findings indicate that pro-atherogenic conditions may contribute to cortical thinning in those seeking treatment for AUD.

Mnemonic discrimination in treatment-seeking adults with and without PTSD

Posttraumatic stress disorder (PTSD) is characterized by overgeneralized emotional reactivity following a trauma. Similarities between current, safe contexts and past, threatening events trigger recurrent, distressing responses and can contribute to a host of symptoms, including reexperiencing and hypervigilance. Mnemonic discrimination, a component process of episodic memory, could promote overgeneralization when impaired. Mnemonic discrimination reflects the integration of old and new experiences and one's ability to differentiate them despite their similarities. To date, little research has been conducted in clinical populations and none with individuals with PTSD. In this study, we examined mnemonic discrimination performance among treatment-seeking adults with and without PTSD and healthy comparison participants (n = 190). There were significant group differences in mnemonic discrimination performance, but not in general recognition memory. Individuals without psychopathology outperformed individuals with PTSD and treatment-seeking individuals without PTSD. However, there were no differences in mnemonic discrimination performance among individuals with PTSD and any other diagnoses. Finally, clinical groups with or without trauma exposure also did not differ in mnemonic discrimination performance. Results held when we adjusted for general recognition memory. Findings suggest that poor mnemonic discrimination is transdiagnostically associated with emotional disorders. Future work is merited to explore this as a measurable and potentially malleable, though non-specific, risk factor.

DSM-5 Maladaptive Personality Domains among Treatment-Seeking Individuals with Alcohol Use Disorder: The Role of Disinhibition and Negative Affectivity

Background: Dimensional models of personality and personality disorders (PDs) have been widely investigated among individuals with alcohol use disorders (AUD). Nevertheless, DSM-5 maladaptive personality domains showed mixed associations with AUD. Furthermore, no studies have explored the role of DSM-5 maladaptive personality domains on the comorbidity between AUD and different PDs. Objective(s): This study aims at investigating whether DSM-5 maladaptive personality dimensions could differentiate individuals with AUD from normative and healthy controls (HCs) subjects. The study also investigated relationships between these personality dimensions and AUD clinical features (i.e. onset, severity of concurrent substance use disorders), as well as their role in accounting for the comorbidity between AUD and PDs. Methods: This study administered the personality inventory for DSM-5 (PID-5) to 99 treatment-seeking individuals (male 68.8%; female 31.2%; age: 48.12 (14.32)) with AUD (41 AUD only; 58 AUD with PDs), comparing the participants’ levels of PID-5 domains with normative data and the data from a HC sample (N = 40; male 50%; female 50%; age: 48.12 (14.32)). Results: Disinhibition and negative affectivity were relevant maladaptive personality dimensions of AUD, even when controlling for the impact of PD diagnoses. Disinhibition and negative affectivity were associated to the onset of AUD and the severity of concurrent substance use disorders. The co-occurrence of AUD and PDs is related to other two domains, namely antagonism and detachment. Conclusions: AUD is a complex psychopathological disorder in which both externalizing and internalizing aspects determine relevant clinical features.