The cumulative load of depressive illness is associated with cognitive function in the remitted state of unipolar depressive disorder

ObjectiveTo investigate whether the cumulative number, duration and subtypes (severity and presence of psychotic features) of previous episodes of depression in patients with unipolar depressive disorder in a remitted state are associated with decreased global cognitive function.MethodsVia the Danish registers individuals between 40 and 80 years of age were identified: (1) patients with a diagnosis of unipolar disorder at their first discharge from a psychiatric hospital in the period 1994 to 2002, and (2) gender and age matched control individuals. The participants were assessed with the Cambridge Cognitive Examination (CAMCOG), which provides a composite measure of global cognitive function.ResultsA total of 88 patients and 50 controls accepted our invitation to participate, fulfilled the selection criteria and were included in the study. The cumulative duration of depressive episodes was associated with a decreased CAMCOG score adjusted for age, gender, education, premorbid IQ and residual depressive symptoms (B = ?0.14, 95% C.I. (?0.26, ?0.02), R²_adj = 0.31, P = .02). Significant associations were also found between CAMCOG score and the cumulative duration and total number of depressive episodes with psychotic features, respectively.ConclusionOur findings suggest that cognitive dysfunction is associated with the cumulative duration of depressive episodes, and that, in particular, depressive episodes with psychotic features in the course of illness may be a significant predictor of future impairment of cognitive function.     

Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder

ObjectiveIn this study, we aimed to compare the clinical features and response patterns to the long-term prophylaxis of bipolar patients with or without psychotic features.MethodThe life charts of patients with bipolar I disorder were evaluated. Two hundred and eighty-one patients who suffer with bipolar disorder for at least 4 years and who had at least three mood episodes were included to the study. The patients whose all episodes are psychotic (psychotic group) and the patients who never experienced psychotic episode (non-psychotic group) were assigned as comparison groups. The clinical features and the response to long-term prophylaxis were compared across the groups.ResultsThe psychotic group consists of 43 patients; non-psychotic group consists of 54 patients. The history of bipolar disorder among the first-degree relatives was remarkably more prevalent in non-psychotic group (p = 0.032). The predominance of manic/hypomanic episodes was significantly higher in psychotic group than non-psychotic group; and the rate of depressive episodes were higher in non-psychotic group than psychotic group (p = 0.013). Episodes were more severe (p < 0.001) and hospitalization rates were higher (p = 0.023) in psychotic group. The response to lithium monotherapy was better in non-psychotic group (p < 0.001).ConclusionThe well identified psychotic subtype of bipolar patients may give important predictions about long term course and prophylaxis of bipolar disorder.     

DSM-IV criteria for childhood separation anxiety disorder: Informant,age, and sex differences

BackgroundThe present study examines frequency of DSM-IV symptom and diagnostic criteria for separation anxiety disorder (SAD) by informant, age, and sex.MethodsChildren aged 4–15 years with a primary DSM-IV diagnosis of SAD (N = 106) were assessed using structured diagnostic interviews (Kinder-DIPS; DSM-IV-TR Version). Frequency of DSM-IV symptom and diagnostic criteria were examined as a function of informant and child characteristics, along with impairment and distress ratings.ResultsThe most frequently reported symptoms were separation-related distress, avoidance of being alone/without an adult and sleeping away from caregivers or from home, with nightmares the least frequently endorsed criterion. Child report did not yield any significant sex or age differences. However, parent report revealed greater reluctance or avoidance of school attendance for girls than boys, and for younger children (<8 years). Parent report indicated greater symptom-related impairment than child report, and the number of symptoms was correlated with impairment based on parent report, and with distress based on child report.ConclusionsThe primary indicators of SAD appear to be separation distress, avoidance of being alone, and sleeping away from caregivers. Findings suggest that parents may be best placed to determine impairment, while children may be the most accurate reporters of more covert internal distress. Implications for clinicians are that reports from multiple informants should be used to gain the most comprehensive information about childhood SAD.     

A meta-analysis of cortical inhibition and excitability using transcranial magnetic stimulation in psychiatric disorders

ObjectiveTo evaluate transcranial magnetic stimulation (TMS) measures of inhibition and excitation in obsessive–compulsive disorder (OCD), major depressive disorder (MDD) and schizophrenia (SCZ).MethodsParadigms included: short-interval cortical inhibition (SICI), cortical silent period (CSP), resting motor threshold, intracortical facilitation, and motor evoked potential amplitude. A literature search was performed using PubMed, Ovid Medline, Embase Psychiatry and PsycINFO 1990 through April 2012.ResultsA significant Hedge’s g was found for decreased SICI (g = 0.572, 95% confidence interval [0.179, 0.966], p = 0.004), enhanced intracortical facilitation (g = 0.446, 95% confidence interval [0.042, 0.849], p = 0.030) and decreased CSP (g = ?0.466, 95% confidence interval [?0.881, ?0.052], p = 0.027) within the OCD population. For MDD, significant effect sizes were demonstrated for decreased SICI (g = 0.641, 95% confidence interval [0.384, 0.898], p = 0.000) and shortened CSP (g = ?1.232, 95% confidence interval [?1.530, ?0.933], p = 0.000). In SCZ, a significant Hedge’s g was shown for decreased SICI (g = 0.476, 95% confidence interval [0.331, 0.620], p = 0.000).ConclusionInhibitory deficits are a ubiquitous finding across OCD, MDD, SCZ and enhancement of intracortical facilitation is specific to OCD.SignificanceProvides a clear platform from which diagnostic procedures can be developed.     

Avoidance in hypochondriasis

The DSM-5 diagnosis of illness anxiety disorder adds avoidance as a component of a behavioral response to illness fears – one that was not present in prior DSM criteria of hypochondriasis. However, maladaptive avoidance as a necessary or useful criterion has yet to be empirically supported.Methods195 individuals meeting DSM-IV criteria for hypochondriasis based on structured interview completed a variety of self-report and clinician-administered assessments. Data on maladaptive avoidance were obtained using the six-item subscale of the clinician-administered Hypochondriasis - Yale Brown Obsessive Compulsive Scale – Modified.To determine if avoidance emerged as a useful indicator in hypochondriasis, we compared the relative fit of continuous latent trait, categorical latent class, and hybrid factor mixture models.ResultsA two-class factor mixture model fit the data best, with Class 1 (n = 147) exhibiting a greater level of severity of avoidance than Class 2 (n = 48). The more severely avoidant group was found to have higher levels of hypochondriacal symptom severity, functional impairment, and anxiety, as well as lower quality of life.ConclusionThese results suggest that avoidance may be a valid behavioral construct and a useful component of the new diagnostic criteria of illness anxiety in the DSM-5, with implications for somatic symptom disorder.     

Development of a screening instrument to assess premenstrual dysphoric disorder as conceptualized in DSM-5

ObjectiveThis study aimed at developing and validating a screening instrument to assess premenstrual dysphoric disorder (PMDD) based on DSM-5 criteria, which is not yet available.MethodsThe Premenstrual Dysphoric Disorder Questionnaire for DSM-5 (Cuestionario del Trastorno Disfórico Premenstrual – DSM-5), a 25-item questionnaire to assess PMDD was developed and completed in Spanish by 2820 women (Age M = 23.43; SD = 7.87). Exploratory factor analysis (N = 1410) and confirmatory factor analysis (N = 1410) were performed in randomly selected subsamples. Empirical evidence of construct validity was obtained via a multitrait-multimethod approach (N = 118). Additional validity evidence was provided by associating PMDD with Neuroticism. Internal consistency and test–retest reliability were checked.ResultsExploratory and confirmatory factor analyses yielded a bi-dimensional structure. The first dimension, called Dysphoria, included dysphoric symptoms and weight gain; the second dimension, Apathy, referred to apathetic and physical symptoms. Both dimensions displayed good internal consistency coefficients (Dysphoria's ordinal alpha = 0.88; Apathy's ordinal alpha = 0.84), and moderate temporal stability. The multitrait-multimethod analysis showed that convergent coefficients were higher than discriminant coefficients. Furthermore, a positive relationship between Neuroticism and PMDD was observed.ConclusionThese findings suggest that the instrument is valid and reliable to assess PMDD.     

Involuntary emotional expression disorder (IEED) in Parkinson's disease

ObjectiveTo estimate the frequency and correlates of involuntary emotional expression disorder (IEED) in Parkinson's disease (PD) using the Center for Neurologic Study-Lability Scale (CNS-LS) and recently-proposed diagnostic criteria for IEED.BackgroundIEED is characterized by uncontrollable emotional episodes, typically unrelated to or in excess of the underlying mood, and occurring with minimal or no stimulus. IEED has been reported to occur in many neurological disorders and neurodegenerative diseases, but its prevalence and correlates in PD have not been well studied. Additionally, there is no published research using recently-proposed IEED diagnostic criteria in any population.Methods193 patients with idiopathic PD were assessed with a neuropsychiatric battery, including the CNS-LS and the 15-item Geriatric Depression Scale (GDS-15). A subset (N = 100) was also administered a diagnostic interview by a blinded rater that applied criteria for both IEED and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) depressive disorders.ResultsApplying formal diagnostic criteria, 7.0% of patients were diagnosed with IEED, and an additional 7.0% had subsyndromal IEED symptoms. Applying recommended CNS-LS cutoff scores from other populations, either 42.5% (cutoff ≥13) or 16.6% (cutoff ≥17) screened positive for IEED. Depressive symptoms were associated with higher CNS-LS scores (B[SE] = 0.27[.08], P = .001) but not with a diagnosis of IEED (odds ratio = 1.1, [95% CI = 1.0–1.3], P = .16). The CNS-LS had poor discriminant validity for an IEED diagnosis (AUC = .79, no cutoff value with sensitivity and specificity both >60%).ConclusionsIEED and depression are overlapping but distinct disorders in PD. IEED symptoms may occur in up to 15% of PD patients, but a disorder occurs in only half of those, suggesting that often IEED symptoms are not clinically significant in this population. The CNS-LS does not appear to be a good screening instrument for IEED in PD, in part due to its high correlation with depressive symptoms.     

Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders on probation in Sweden

IntroductionBorderline personality disorder (BPD) is a severely disabling condition, associated with substantially increased risk of deliberate self-harm and, particularly in men, also with interpersonal violence and other criminal behavior. Although BPD might be common among prison inmates, little is known about prevalence and psychiatric comorbidity in probationers and parolees.MethodIn 2013, a consecutive sample of 109 newly admitted adult male offenders on probation or parole in all three probation offices of Stockholm, Sweden, completed self-report screening questionnaires for BPD and other psychiatric morbidity. Participants scoring over BPD cut-off participated in a psychiatric diagnostic interview.ResultsWe ascertained a final DSM-5 BPD prevalence rate of 19.8% (95% CI: 12.3–27.3%). The most common current comorbid disorders among subjects with BPD were antisocial personality disorder (91%), major depressive disorder (82%), substance dependence (73%), attention deficit hyperactivity disorder (ADHD) (70%), and alcohol dependence (64%). Individuals diagnosed with BPD had significantly more current psychiatric comorbidity (M = 6.2 disorders) than interviewed participants not fulfilling BPD criteria (M = 3.6). Participants with BPD also reported substantially more symptoms of ADHD, anxiety and depression compared to all subjects without BPD.ConclusionsBPD affected one fifth of probationers and was related to serious mental ill-health known to affect recidivism risk. The findings suggest further study of possible benefits of improved identification and treatment of BPD in offender populations.     

Tempéraments affectifs prébipolaires dans les dépressions récurrentes : vers un dépistage de « fausse unipolarité »

IntroductionThe current categorical split of mood disorders into bipolar disorders and depressive disorders has recently been questioned after the widening of the bipolar spectrum. Recent studies have suggested that clinicians may under-diagnose bipolarity in a substantial proportion of depressed patients, and have proposed the existence of a “pseudo-unipolar” depression. On the other hand, many studies were made to identify factors correlated to bipolarity in depressive disorders. They have shown that the main clinical factors correlated to bipolarity are: pharmacological hypomania, puerperal depression, early age of onset, psychotic features, hypersomnia and psychomotor inhibition. In this context, it should be interesting to study temperaments as predictive factors of bipolarity in depression and to explore their correlation with those clinical predictors.ObjectivesThe aims of this study were to assess affective temperaments in patients with recurrent depressive disorders, and to explore the correlations between these temperaments and clinical features of depressive disorders.MethodsThe study was a cross-sectional one bearing on 91 recurrent depressive patients (40 men and 51 women, mean age: 46.8 ± 10.1 years), who were interviewed using the DSM-IV Structured Clinical Interview during the partial or total recovery period. Data was collected using available medical records. The evaluation of affective temperaments consisted in filling in the Akiskal and Mallya semi-structured questionnaire.ResultsThe depressive temperament obtained the higher mean score (12.3 ± 4.74), followed by the hyperthymic temperament (7.8 ± 4.5), the cyclothymic temperament (5.9 ± 5.8) and the irritable temperament (4.9 ± 3.3). A significant association was found between the onset of the first depressive episode during the postpartum period and the cyclothymic temperament score (7.4 ± 6.9 versus 3.3 ± 3.6, p = 0.04). The psychotic features in the last depressive episode were significantly associated with the hyperthymic (p = 0,001), the cyclothymic (p < 10^?3) and the irritable temperament scores (p < 10^?3). A significant link was found between suicide attempts during the last depressive episode and the cyclothymic temperament on the one hand (p < 10^?3) and the irritable temperament on the other hand (p = 0.01).ConclusionsThe recurrent depressive disorders with hyperthymic, cyclothymic and the irritable temperaments seem to have clinical features similar to those of bipolar disorders. These results point to the importance of evaluating these temperaments in depressed patients, considering the risk of polarity change and of misdiagnoses of unipolar depression.     

Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients

ObjectiveTo identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition.MethodsOne thousand and ninety manic patients (FE = 81, multiple-episodes [ME] = 1009) were assessed for clinical and temperamental characteristics.ResultsCompared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year.ConclusionIn FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.     

Psychological and interactional characteristics of patients with somatoform disorders: Validation of the Somatic Symptoms Experiences Questionnaire (SSEQ) in a clinical psychosomatic population

ObjectiveThe new DSM-5 Somatic Symptom Disorder (SSD) emphasizes the importance of psychological processes related to somatic symptoms in patients with somatoform disorders. To address this, the Somatic Symptoms Experiences Questionnaire (SSEQ), the first self-report scale that assesses a broad range of psychological and interactional characteristics relevant to patients with a somatoform disorder or SSD, was developed. This prospective study was conducted to validate the SSEQ.MethodsThe 15-item SSEQ was administered along with a battery of self-report questionnaires to psychosomatic inpatients. Patients were assessed with the Structured Clinical Interview for DSM-IV to confirm a somatoform, depressive, or anxiety disorder. Confirmatory factor analyses, tests of internal consistency and tests of validity were performed.ResultsPatients (n = 262) with a mean age of 43.4 years, 60.3% women, were included in the analyses. The previously observed four-factor model was replicated and internal consistency was good (Cronbach's α = .90). Patients with a somatoform disorder had significantly higher scores on the SSEQ (t = 4.24, p < .001) than patients with a depressive/anxiety disorder. Construct validity was shown by high correlations with other instruments measuring related constructs. Hierarchical multiple regression analyses showed that the questionnaire predicted health-related quality of life. Sensitivity to change was shown by significantly higher effect sizes of the SSEQ change scores for improved patients than for patients without improvement.ConclusionThe SSEQ appears to be a reliable, valid, and efficient instrument to assess a broad range of psychological and interactional features related to the experience of somatic symptoms.     

The impact of social skills training for social anxiety disorder: A randomized controlled trial

ObjectiveSocial anxiety disorder (SAD) impacts social, occupational and academic functioning. Although many interventions report change in social distress, improvement in social behavior remains under-addressed. This investigation examined the additive impact of social skills training (SST) for the treatment of SAD.MethodUsing a sample of 106 adults who endorsed SAD across numerous social settings, participants were randomized to exposure therapy (imaginal and in vivo) alone, a combination of SST and exposure therapy known as Social Effectiveness Therapy (SET), or a wait list control. The assessment strategy included self-report measures, blinded clinical ratings and blinded assessment of social behavior.ResultsBoth interventions significantly reduced distress in comparison to the wait list control and at post-treatment, 67% of patients treated with SET and 54% of patients treated with exposure therapy alone no longer met diagnostic criteria for SAD, a difference that was not statistically significant. When compared to exposure therapy alone, SET produced superior outcomes (p < .05) on measures of social skill and general clinical status. In addition to statistical significance, participants treated with SET or exposure reported clinically significant decreases on two measures of self-reported social anxiety and several measures of observed social behavior (all ps < .05).ConclusionsBoth interventions produced efficacious treatment outcome, although SET may provide additional benefit on measures of social distress and social behavior.     

Neurocognitive dysfunction in problem gamblers with co-occurring antisocial personality disorder

ObjectivesProblem gamblers with symptoms of antisocial personality disorder (ASPD) may represent a distinct problem gambling subtype, but the neurocognitive profile of individuals affected by both disorders is poorly characterized.MethodNon-treatment-seeking young adults (18–29 years) who gambled ≥5 times in the preceding year were recruited from the general community. Problem gamblers (defined as those meeting ≥1 DSM-5 diagnostic criteria for gambling disorder) with a lifetime history of ASPD (N = 26) were identified using the Mini International Neuropsychiatric Interview (MINI) and compared with controls (N = 266) using questionnaire-based impulsivity scales and objective computerized neuropsychological tasks. Findings were uncorrected for multiple comparisons. Effect sizes were calculated using Cohen's d.ResultsProblem gambling with ASPD was associated with significantly elevated gambling disorder symptoms, lower quality of life, greater psychiatric comorbidity, higher impulsivity questionnaire scores on the Barratt Impulsiveness Scale (d = 0.4) and Eysenck Impulsivity Questionnaire (d = 0.5), and impaired cognitive flexibility (d = 0.4), executive planning (d = 0.4), and an aspect of decision-making (d = 0.6). Performance on measures of response inhibition, risk adjustment, and quality of decision making did not differ significantly between groups.ConclusionsThese preliminary findings, though in need of replication, support the characterization of problem gambling with ASPD as a subtype of problem gambling associated with higher rates of impulsivity and executive function deficits. Taken together, these results may have treatment implications.     

Risk profiles for poor treatment response to internet-delivered CBT in people with social anxiety disorder

In social anxiety disorder (SAD) co-morbid depressive symptoms as well as avoidance behaviors have been shown to predict insufficient treatment response. It is likely that subgroups of individuals with different profiles of risk factors for poor treatment response exist. This study aimed to identify subgroups of social avoidance and depressive symptoms in a clinical sample (N = 167) with SAD before and after guided internet-delivered CBT, and to compare these groups on diagnostic status and social anxiety. We further examined individual movement between subgroups over time. Using cluster analysis we identified four subgroups, including a high-problem cluster at both time-points. Individuals in this cluster showed less remission after treatment, exhibited higher levels of social anxiety at both assessments, and typically remained in the high-problem cluster after treatment. Thus, in individuals with SAD, high levels of social avoidance and depressive symptoms constitute a risk profile for poor treatment response.     

A longitudinal study of neurocognitive function in individuals at-risk for psychosis

IntroductionClinically defined prodromal diagnostic criteria identify at-risk individuals with a 35–40% likelihood of developing a psychotic disorder within a year. The time course and predictive value of cognitive deficits in the development of psychosis has not been established.MethodsA comprehensive neurocognitive battery and clinical assessments were administered to 37 subjects meeting Criteria of Prodromal States (COPS) criteria for being at risk for psychosis, and two comparison groups: 59 first episode and 47 healthy subjects. Subjects were also evaluated at 6-month and 1-year follow-up periods. Primary analyses used a neurocognitive composite score derived from individual neurocognitive measures, including measures of vigilance, verbal memory, working memory, and processing speed.ResultsAt-risk subjects performed more poorly than healthy subjects (t = 2.93, P = 0.01), but better than first episode subjects (t = 4.72, p < 0.0001). At-risk subjects were particularly impaired on measures of vigilance and processing speed. Cognitive composite scores were significantly lower in at-risk subjects who progressed to psychosis (N = 11; z = − 1.2), while those at-risk subjects who did not progress to psychosis (N = 17) performed better (z = − 0.5), and not significantly different from controls. Poor CPT performance combined with better WAIS-R digit symbol performance predicted progression to psychosis. Severity of neurocognitive deficits was not related to duration of prodrome or to time to development of psychosis and neurocognitive function improved in all subjects except those who progressed to psychosis.ConclusionNeurocognitive impairment emerges early in the course of psychotic illness. Performance on tests of neurocognition may prove to be an early risk predictor for subsequent development of psychotic disorders.     

Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder: Prospective 1-year follow-up study

ObjectiveTo compare the predictive validity and clinical utility of DSM-IV somatoform disorders and DSM-5 Somatic Symptom Disorder (SSD) at 12-month follow-up.MethodsIn a sample of psychosomatic inpatients (n = 322, mean age = 45.6 years (SD 10.0), 60.6% females) we prospectively investigated DSM-IV somatoform disorders and the DSM-5 diagnosis of SSD plus a variety of psychological characteristics, somatic symptom severity, and health-related quality of life at admission, discharge, and follow-up.ResultsDSM-IV diagnoses and DSM-5 SSD similarly predicted physical functioning at follow-up; SSD also predicted mental functioning at follow-up. Bodily weakness, intolerance of bodily complaints, health habits, and somatic attribution at admission were significant predictors of physical functioning at follow-up. The change in physical functioning during inpatient therapy was a significant predictor for the course of physical functioning until follow-up.ConclusionsPsychological symptoms appear to be predictively valid diagnostic criteria for the 12-month functional outcome in patients with SSD. Mental functioning can be better predicted by the DSM-5 diagnosis than by DSM-IV diagnoses. Not the change in single psychological features but in physical functioning during the treatment interval predicted the change in physical functioning until follow-up.     

Association between childhood psychiatric disorders and psychotic experiences in adolescence: A population-based longitudinal study

BackgroundAdolescent psychotic experiences (PEs) are common, and are associated with both psychotic and non-psychotic illnesses. In order to examine psychopathological and cognitive antecedents of adolescent PEs, we have conducted a longitudinal study of common childhood psychiatric disorders and subsequent adolescent PEs in the population-based prospective ALSPAC birth cohort.MethodDepression, anxiety, attention deficit hyperactivity disorder, oppositional defiant or conduct disorder, and pervasive developmental disorder were diagnosed according to DSM-IV criteria in 8253 participants at age 8 years. IQ was assessed by WISC-III also at 8 years. PEs, depressive and anxiety symptoms were assessed at 13 years. Logistic regression calculated odds ratio (OR) for PEs at 13 years associated with psychiatric disorders at 8 years. Linear regression calculated mean difference in IQ between groups with and without psychiatric disorder. Mediating effects of IQ, mood and anxiety symptoms on the psychiatric disorder-PEs relationship were examined.ResultsIn total, 599 children were assessed to have a DSM-IV psychiatric disorder at 8 years (7.2%). These children compared with those without any psychiatric disorder performed worse on all measures of IQ; adjusted mean difference in total IQ − 6.17 (95% CI, − 7.86, − 4.48). Childhood psychiatric disorders were associated with PEs subsequently in adolescence; adjusted OR 1.96 (95% CI, 1.47–2.68). The association between psychiatric disorder and subsequent PEs was partly mediated by, independently, IQ deficit at 8 years and depressive and anxiety symptoms at 13 years.ConclusionsThe findings indicate that adolescent PEs are associated with general cognitive ability and past and present psychopathological factors.     

Dimensional anxiety scales for DSM-5: Sensitivity to clinical severity

PurposePsychometric properties and clinical sensitivity of brief self-rated dimensional scales to supplement categorical diagnoses of anxiety disorders in the DSM-5 were recently demonstrated in a German treatment seeking sample of adults. The present study aims to demonstrate sensitivity of these scales to clinical severity levels.MethodsThe dimensional scales were administered to 102 adults at a university outpatient clinic for psychotherapy. Diagnostic status was assessed using the Munich-Composite International Diagnostic Interview. To establish a wide range of clinical severity, we considered subthreshold (n = 83) and threshold anxiety disorders (n = 49, including Social Phobia, Specific Phobia, Agoraphobia, Panic Disorder, and Generalized Anxiety Disorder).ResultsIndividuals with either subthreshold or threshold anxiety disorder scored higher on all dimensional scales relative to individuals without anxiety. In addition, individuals with a threshold anxiety disorder scored higher on the dimensional scales than individuals with a subthreshold anxiety disorder (except for specific phobia). Disorder-related impairment ratings, global functioning assessments and number of panic attacks were associated with higher scores on dimensional scales. Findings were largely unaffected by the number of anxiety disorders and comorbid depressive disorders.ConclusionThe self-rated dimensional anxiety scales demonstrated sensitivity to clinical severity, and a cut-off based on additional assessment of impairment and distress may assist in the discrimination between subthreshold and threshold anxiety disorders. Findings suggest further research in various populations to test the utility of the scales for use in DSM-5.     

Precuneus-related regional and network functional deficits in social anxiety disorder: A resting-state functional MRI study

BackgroundNeuroimaging findings suggest that social anxiety disorder (SAD) may be correlated with changes in regional- or network-level brain function. However, few studies have explored alterations in intrinsic resting cerebral function in patients with SAD at both the regional and network levels, particularly focusing on the theory of mind (ToM)-related regions. This study was performed to investigate changes in neural activity and functional connectivity (FC) in ToM-related regions during the resting state in SAD patients and to determine how these alterations are correlated with the clinical symptoms of SAD.MethodsForty-three SAD patients and 43 matched healthy controls underwent resting-state functional magnetic resonance imaging (rsfMRI) scans. First, the amplitude of low-frequency fluctuation (ALFF) approach was used to explore regional activity. Then, the ToM-related region, i.e., the left precuneus, which showed altered ALFF values, was adopted as a seed for further FC analyses to assess network-level alterations in SAD. Between-group differences were compared using voxel-based two-sample t-tests (P < 0.05, with Gaussian random field correction). Pearson's correlation analyses were performed to examine relationships between alterations in ALFF and FC and clinical symptoms.ResultsCompared with the healthy controls, SAD patients showed decreased ALFF in the bilateral putamen (PUT) and left supplementary motor area (SMA) and increased ALFF in the right inferior parietal lobule (IPL), left precuneus and right cerebellar posterior lobe. Moreover, SAD patients exhibited lower connectivity between the left precuneus and the cerebellar posterior lobe, right inferior temporal gyrus (ITG), right parahippocampal gyrus (PHG) and left medial prefrontal cortex (mPFC). The altered ALFF values in the left precuneus and the hypoconnectivity between the left precuneus and left cerebellar posterior lobe were correlated with the patients' clinical symptoms (P < 0.05).ConclusionThe precuneus, a ToM-related region, was altered at both the regional and network level in patients with SAD. Pathological fear and avoidance in SAD were correlated with abnormal regional function in the precuneus, whereas depression and anxiety were primarily correlated with functional deficits in the precuneus-related network. The altered FC within the precuneus-cerebellar region may reflect an imbalance in the neuromodulation of anxiety and depressive symptoms in SAD. These findings may facilitate a greater understanding of potential SAD neural substrates and could be used to identify potential targets for further treatment.     

Borderline Personality Disorder and Personality Inventory for DSM-5 (PID-5): Dimensional personality assessment with DSM-5

IntroductionBorderline personality disorder (BPD) diagnosis has been considered highly controversial. The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) proposes an alternative hybrid diagnostic model for personality disorders (PD), and the Personality Inventory for DSM-5 (PID-5) has adequate psychometric properties and has been widely used for the assessment of the dimensional component.MethodsOur aim was to analyze the utility of the personality traits presented in Section III of the DSM-5 for BPD diagnosis in an outpatient clinical sample, using the Spanish version of the PID-5. Two clinical samples were studied: BPD sample (n = 84) and non-BPD sample (n = 45). Between-sample differences in PID-5 scores were analyzed.ResultsThe BPD sample obtained significantly higher scores in most PID-5 trait facets and domains. Specifically and after regression logistic analyses, in BPD patients, the domains of Negative Affectivity and Disinhibition, and the trait facets of emotional lability, [lack of] restricted affectivity, and impulsivity were more significantly associated with BPD.ConclusionsAlthough our findings are only partially consistent with the algorithm proposed by DSM-5, we consider that the combination of the PID-5 trait domains and facets could be useful for BPD dimensional diagnosis, and could further our understanding of BPD diagnosis complexity.