Subtyping patients with heroin addiction at treatment entry: factor derived from the Self-Report Symptom Inventory (SCL-90)

<p>Abstract</p> <p>Background</p> <p>Addiction is a relapsing chronic condition in which psychiatric phenomena play a crucial role. Psychopathological symptoms in patients with heroin addiction are generally considered to be part of the drug addict's personality, or else to be related to the presence of psychiatric comorbidity, raising doubts about whether patients with long-term abuse of opioids actually possess specific psychopathological dimensions.</p> <p>Methods</p> <p>Using the Self-Report Symptom Inventory (SCL-90), we studied the psychopathological dimensions of 1,055 patients with heroin addiction (884 males and 171 females) aged between 16 and 59 years at the beginning of treatment, and their relationship to age, sex and duration of dependence.</p> <p>Results</p> <p>A total of 150 (14.2%) patients with heroin addiction showed depressive symptomatology characterised by feelings of worthlessness and being trapped or caught; 257 (24.4%) had somatisation symptoms, 205 (19.4%) interpersonal sensitivity and psychotic symptoms, 235 (22.3%) panic symptomatology, 208 (19.7%) violence and self-aggression. These dimensions were not correlated with sex or duration of dependence. Younger patients with heroin addiction were characterised by higher scores for violence-suicide, sensitivity and panic anxiety symptomatology. Older patients with heroin addiction showed higher scores for somatisation and worthlessness-being trapped symptomatology.</p> <p>Conclusions</p> <p>This study supports the hypothesis that mood, anxiety and impulse-control dysregulation are the core of the clinical phenomenology of addiction and should be incorporated into its nosology.</p

Progress in achieving quantitative classification of psychopathology

Résumé: Les lacunes des classifications de la psychopathologie fondées sur des consensus d’experts ont conduit à de nombreuses tentatives actuelles pour classer la psychopathologie de manière quantitative. Dans cet article, nous passons en revue les progrès accomplis dans la réalisation d’une classification quantitative et empirique de la psychopathologie. Une littérature empirique substantielle montre que la psychopathologie est généralement plus dimensionnelle que catégorielle. Et lorsque la distinction entre une psychopathologie discrète et une psychopathologie continue est traitée comme une question de recherche, par opposition à une distinction basée sur un argument d’autorité, alors les preuves scientifiques soutiennent clairement l’hypothèse d’une psychopathologie continue. En outre, un corpus de littérature connexe montre comment les dimensions de la psychopathologie peuvent être organisées selon une hiérarchie qui va de dimensions très larges d’un niveau de type « spectre » à des groupes spécifiques et étroits de symptômes. De cette manière, une approche quantitative résout le « problème de la comorbidité » en modélisant explicitement la cooccurrence entre les signes et les symptômes au sein d’une hiérarchie détaillée et variée, maniant des concepts dimensionnels qui ont une utilité clinique directe. De nombreuses preuves concernant la structure dimensionnelle et hiérarchique de la psychopathologie ont conduit à la formation du consortium Hierarchical Taxonomy of Psychopathology (HiTOP, taxonomie hiérarchique de la psychopathologie). Il s’agit d’un groupe de 70 chercheurs travaillant ensemble pour étudier la classification empirique de la psychopathologie. Dans cet article, nous décrivons les objectifs et les axes de recherches actuels du consortium HiTOP. Ces objectifs concernent la poursuite des recherches sur l’organisation empirique de la psychopathologie ; le lien entre la personnalité et la psychopathologie ; l’utilité des construits empiriques de la psychopathologie, à la fois pour la recherche et pour la clinique ; et enfin, le développement de nouveaux modèles exhaustifs et d’instruments d’évaluation correspondant aux construits psychopathologiques dérivés d’une approche empirique. / Abstract: Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad “spectrum level” dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the “problem of comorbidity” by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach

Les progrès dans la réalisation de la classification quantitative de la psychopathologie

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level'' dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity'' by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach. (C) 2020 Published by Elsevier Masson SAS

Understanding the Relative Contributions of Direct Environmental Effects and Passive Genotype-Environment Correlations in the Association between Familial Risk Factors and Child Disruptive Behavior Disorders

BACKGROUND: Previous work reports an association between familial risk factors stemming from parental characteristics and offspring disruptive behavior disorders (DBDs). This association may reflect (a) the direct effects of familial environment and (b) a passive gene-environment correlation (rGE), wherein the parents provide both the genes and the environment. The current study examined the contributions of direct environmental influences and passive rGE by comparing the effects of familial risk factors on child DBDs in genetically related (biological) and non-related (adoptive) families. METHOD: Participants were 402 adoptive and 204 biological families. Familial environment was defined as maternal and paternal maladaptive parenting and antisociality, marital conflict and divorce; offspring DBDs included attention deficit hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD). Mixed-level regressions estimated the main effects of familial environment, adoption status and the familial environment by adoption status interaction term, which tested for the presence of passive rGE. RESULTS: There was a main effect of maternal and paternal maladaptive parenting and marital discord on child DBDs, indicating a direct environmental effect. There was no direct environmental effect of maternal or paternal antisociality, but maternal and paternal antisociality had stronger associations with child DBDs in biological families than adoptive families, indicating the presence of a passive rGE. CONCLUSIONS: Many familial risk factors affected children equally across genetically related and non-related families, providing evidence for direct environmental effects. The relationship of parental antisociality and offspring DBDs was best explained by a passive rGE, where a general vulnerability toward externalizing psychopathology is passed down by the parents to the children

Substance Use Disorders

Given the high cost and prevalence of substance use disorders, researchers have examined potential mechanisms that may serve as targets for assessment and intervention. The goal of this chapter is to examine distress tolerance as a potential mechanism. Distress tolerance has received considerable attention recently and appears to be an important variable for understanding substance use development and relapse. We begin with background information and theoretical rationale for examining distress tolerance in substance use. Next, we review the empirical literature on distress tolerance among substance users, discuss theoretical implications of extant findings, review clinical interventions that have been developed to treat substance users with low distress tolerance, and provide a case example to illustrate the application of specific clinical strategies to increase distress tolerance among substance users

Tests of a Direct Effect of Childhood Abuse on Adult Borderline Personality Disorder Traits: A Longitudinal Discordant Twin Design

We used a longitudinal twin design to examine the causal association between sexual, emotional, and physical abuse in childhood (before age 18) and borderline personality disorder (BPD) traits at age 24 using a discordant twin design and biometric modeling. Additionally, we examined the mediating and moderating effects of symptoms of childhood externalizing and internalizing disorders on the link between childhood abuse and BPD traits. Although childhood abuse, BPD traits, and internalizing and externalizing symptoms were all correlated, the discordant twin analyses and biometric modeling showed little to no evidence that was consistent with a causal effect of childhood abuse on BPD traits. Instead, our results indicate that the association between childhood abuse and BPD traits stems from common genetic influences that, in some cases, also overlap with internalizing and externalizing disorders. These findings are inconsistent with the widely held assumption that childhood abuse causes BPD, and they suggest that BPD traits in adulthood are better accounted for by heritable vulnerabilities to internalizing and externalizing disorders