Comorbidity, outcome and treatment of DSM-IV major depressive disorder in psychiatric care

Vantaa depression study

Processing of Self-concept and Identity in Individuals with Borderline Personality Disorder: Findings from a Content-Analytic Follow-up Study

Peer reviewe

Sopiiko potilaalleni psykoterapia?

Vain va­jaa kol­mannes suoma­lai­sista psy­ko­te­ra­peu­teista ar­vioi asiak­kai­densa saa­neen riit­tävää oh­jausta psy­ko­te­rapiaan. Psy­ko­te­rapiaa edel­tävä ar­viointi ja oh­jaus edis­tävät hoi­toon sitou­tu­mista ja te­rapian tulok­sel­li­suutta. Po­tilaan muutos­valmius, ky­ky tarkas­tella it­seä ja omia tun­teita se­kä jous­tavuus vuoro­vai­ku­tuk­sessa ­ennus­tavat toden­nä­köi­sempää ky­kyä tera­peut­tiseen työsken­telyyn ja lyhyes­täkin psy­ko­te­ra­piasta ­hyö­ty­miseen. Po­tilaan ja psy­ko­te­ra­peutin hy­vä yhteis­työ­suhde en­nustaa hoito­tu­losta merkit­tä­västi. Poti­lasta on syy­tä val­mentaa ar­vioimaan, minkä­laisen psy­ko­te­ra­peutin kans­sa hän ko­kee voi­vansa muo­dostaa hy­vän yhteis­työ­suhteen. Po­tilaan val­miuksien ja psy­ko­te­rapian tavoit­teiden ol­lessa epä­selviä on syy­tä konsul­toida psy­kiat­rista ­eri­kois­sai­raan­hoitoa.Peer reviewe

Relationships between self-reported childhood traumatic experiences, attachment style, neuroticism and features of borderline personality disorders in patients with mood disorders

Background: Co-occurring borderline personality disorder (BPD) features have a marked impact on treatment of patients with mood disorders. Overall, high neuroticism, childhood traumatic experiences (TEs) and insecure attachment are plausible aetiological factors for BPD. However, their relationship with BPD features specifically among patients with mood disorders remains unclear. We investigated these relationships among unipolar and bipolar mood disorder patients. Methods: As part of the Helsinki University Psychiatric Consortium study, the McLean Screening Instrument (MSI), the Experiences in Close Relationships-Revised (ECR-R), the Short Five (S5) and the Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n=282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, and multivariate regression (MRA) and mediation analyses were conducted. Results: Spearman's correlations were strong (rho=0.58; p <0.001) between total scores of MSI and S5 Neuroticism and moderate (rho=0.42; p <0.001) between MSI and TADS as well as between MSI and ECR-R Attachment Anxiety. In MRA, young age, S5 Neuroticism and TADS predicted scores of MSI (p <0.001). ECR-R Attachment Anxiety mediated 33% (CI=17-53%) of the relationships between TADS and MSI. Limitations: Cross-sectional questionnaire study. Conclusions: We found moderately strong correlations between self-reported BPD features and concurrent high neuroticism, reported childhood traumatic experiences and Attachment Anxiety also among patients with mood disorders. Independent predictors for BPD features include young age, frequency of childhood traumatic experiences and high neuroticism. Insecure attachment may partially mediate the relationship between childhood traumatic experiences and borderline features among mood disorder patients.Peer reviewe

Personality disorders and suicide attempts in unipolar and bipolar mood disorders

Background: Comorbid personality disorders may predispose patients with mood disorders to suicide attempts (SAs), but factors mediating this effect are not well known. Methods: Altogether 597 patients from three prospective cohort studies (Vantaa Depression Study, Jorvi Bipolar Study, and Vantaa Primary Care Depression Study) were interviewed at baseline, at 18 months, and in VDS and PC-VDS at 5 years. Personality disorders (PDs) at baseline, number of previous SAs, life-charted time spent in major depressive episodes (MDEs), and precise timing of SAs during follow-up were determined and investigated. Results: Overall, 219 (36.7%) patients had a total of 718 lifetime SAs; 88 (14.7%) patients had 242 SAs during the prospective follow-up. Having any PD diagnosis increased the SA rate, both lifetime and prospectively evaluated, by 90% and 102%, respectively. All PD clusters increased the rate of new SAs, although cluster C PDs more than the others. After adjusting for time spent in MDEs, only cluster C further increased the SA rate (by 52%). Mediation analyses of PD effects on prospectively ascertained SAs indicated significant mediated effects through time at risk in MDEs, but also some direct effects. Limitations: Findings generalizable only to patients with mood disorders. Conclusions: Among mood disorder patients, comorbid PDs increase the risk of SAs to approximately two-fold. The excess risk is mostly due to patients with comorbid PDs spending more time in depressive episodes than those without. Consequently, risk appears highest for PDs that most predispose to chronicity and recurrences. However, also direct risk-modifying effects of PDs exist. (C) 2015 Elsevier B.V. All rights reserved.Peer reviewe

Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders

Background: Substantial literature exists on risk factors for suicidal behaviour. However, their comparative strength, independence and specificity for either suicidal ideation or suicide attempt(s) remain unclear. Methods: The Helsinki University Psychiatric Consortium (HUPC) Study surveyed 287 psychiatric care patients with ICD-10-DCR depressive or bipolar disorders about lifetime suicidal behaviour, developmental history and attachment style, personality and psychological traits, current and lifetime symptom profiles, and life events. Psychiatric records were used to confirm diagnosis and complement information on suicide attempts. Multinomial regression models predicting lifetime suicidal ideation and single or repeated suicide attempts were generated. Results: Overall, 21.6% patients had no lifetime suicidal behaviour, 33.8% had lifetime suicide ideation without attempts, and 17.1% had a single and 27.5% repeated suicide attempts. In univariate analyses, lifetime suicidal behaviour was associated with numerous factors. In multivariate models, suicidal ideation was independently predicted by younger age, severe depressive disorder, bipolar disorder type II/nos, hopelessness, and childhood physical abuse. Repeated suicide attempts were independently predicted by younger age, female sex, severe depressive disorder with or without psychotic symptoms, bipolar disorder type II/nos, alcohol use disorder, borderline personality disorder traits, and childhood physical abuse. Limitations: Cross-sectional and retrospective study design, utilization of clinical diagnoses, and relatively low response rate. Conclusions: Risk factors for suicidal ideation and attempts may diverge both qualitatively and in terms of dose response. When effects of risk factors from multiple domains are concurrently examined, proximal clinical characteristics remain the most robust. All risk factors cluster into the group of repeated attempters. (C) 2015 Elsevier B.V. All rights reserved.Peer reviewe

A single dose of mirtazapine attenuates neural responses to self-referential processing

Increased self-focus is a core factor in the psychopathology of depression. Cortical midline structures (CMS) are implicated in the neurobiology of self, depression and antidepressant treatment response. Mirtazapine, an antidepressant that increases serotonin and norepinephrine release, enhances processing of positive and attenuates processing of negative emotional information in healthy volunteers after a single dose. These early changes, which are opposite to the negative information bias in depression, may be important for the therapeutic effect of mirtazapine. It nevertheless remains unresolved whether/how mirtazapine specifically influences processing of self-referential emotional information. Half of the healthy volunteers (n=15/30) received a single dose of mirtazapine, in an open-label design, two hours before functional magnetic resonance imaging (fMRI), and the other half was scanned as a control group without medication. During fMRI the participants categorized positive and negative self-referential adjectives. Mirtazapine attenuated responses to self-referential processing in the medial prefrontal cortex and the anterior cingulate cortex. Mirtazapine further decreased responses to positive self-referential processing in the posterior cingulate cortex and parietal cortex. These decreased responses of the CMS suggest that mirtazapine may rapidly improve the ability of the CMS to down-regulate self-referential processing. In depressed patients, this could lead to decreased self-focus and rumination, contributing to the antidepressant effect.Peer reviewe

The Effect of Personality on Daily Life Emotional Processes

Peer reviewe

Psykoterapeuttikoulutuksia tutkimalla vaikuttavampaa opetusta ja hoitoa?

English summar