January 2015 article abstracts
1. ANNUAL ACKNOWLEDGMENT.
John Talbott, MD, Kathy McKnight, M.Ed.
List of manuscript reviewers for JNMD from September 1, 2013 through August 31, 2014.
2. BORDERLINE PERSONALITY DISORDER AND BIPOLAR DISORDER—WHAT IS THE DIFFERENCE AND WHY DOES IT MATTER?
Joel Paris, MD, Donald W. Black, MD.
Borderline personality disorder (BPD) and bipolar disorder (types I and II) are frequently confused because of their symptomatic overlap. While affective instability is a prominent feature of each, BPD is characterized by transient mood shifts that occur in response to interpersonal stressors, while bipolar disorder is associated with sustained mood changes. These disorders can be further distinguished by comparing their phenomenology, etiology, family history, biological studies, outcome, and response to medication. Based on a comprehensive literature review, guidelines for differential diagnosis are suggested.
3. COMMENTARY. BORDERLINE PERSONALITY DISORDER: A DISORDER IN SEARCH OF ADVOCACY.
Mark Zimmerman, MD.
Compared to bipolar disorder, borderline personality disorder (BPD) is as frequent, impairing and lethal; yet, BPD has received less than one-tenth the funding from the National Institute of Health. Paris and Black emphasize the clinical importance of correctly diagnosing BPD and not overdiagnosing bipolar disorder, with a focus on the clinical feature of affective instability and how the failure to recognize the distinction between sustained and transient mood perturbations can result in misdiagnosing patients with BPD as having bipolar disorder. I will illustrate how the bipolar disorder research community has done a superior job of advocating for and “marketing” their disorder compared to researchers of BPD.
4. COMMENTARY. Borderline Personality Disorder and Bipolar Disorder: Commentary on Paris and Black.
Gordon Parker, PhD, MD, DSc, FRANZCP.
I share the model argued by Drs. Paris and Black -- that borderline personality disorder and the bipolar disorders (I and II) are separate conditions and that their clinical distinction is of key importance for two principal reasons. Firstly, the benefits from an accurate diagnosis are both intrinsic and ongoing. Secondly, the conditions under review are likely to show quite differing responses to specific and non-specific therapies. For the bipolar disorders, the prioritized specific management modality is medication to provide mood stabilization while, for a borderline personality disorder, the prioritized management modality is psychotherapy.
5. ANGER IN THE UK ARMED FORCES: STRONG ASSOCIATION WITH MENTAL HEALTH, CHILDHOOD ANTISOCIAL BEHAVIOR AND COMBAT ROLE.
Roberto J. Rona, FFPH, Margaret Jones, BA, Lisa Hull, MSc, Deirdre MacManus, MRCPsych, Nicola T. Fear, DPhil (Oxon), Simon Wessely, FMedSci.
We assessed the strength of the association of several mental health problems, childhood difficulties and combat role with anger, and the contribution of these factors to explain anger assessed by population attributable fraction (PAF). 9,885 UK service personnel, some of them deployed to Iraq and Afghanistan, participated in the study. There was a strong or intermediate association between cases and subthreshold cases of symptoms of PTSD, psychological distress, multiple physical symptoms, and alcohol misuse. Anger is a frequent component of mental disorders; health care professionals need to be aware of the interference of anger in the management of mental illness, and that anger infrequently presents as an isolated phenomenon.
6. ASSOCIATIONS BETWEEN METABOLIC AND AEROBIC FITNESS PARAMETERS IN PATIENTS WITH SCHIZOPHRENIA .
Davy Vancampfort, PhD, Hannes Guelinkcx, Msc, Michel Probsta, PhD, Brendon Stubbs, PhD, Simon Rosenbaumd, PhD, Philip B. Ward, PhD, Marc De Hert, PhD.
The primary aim was to determine if the presence of metabolic syndrome (MetS) limits aerobic fitness in patients with schizophrenia. A secondary aim was to investigate the associations between aerobic fitness and MetS parameters. Those with MetS (n=19) were similar in age, gender, antipsychotic medication use, symptomatology and smoking behavior than those without (n=31). Estimated maximal oxygen uptake was 21.4% lower (P=0.001) in patients with MetS than in patients without MetS. The estimated maximal oxygen uptake of the entire sample was correlated with waist circumference, the level of high-density lipoproteins and fasting glucose. The current study demonstrates that the additive burden of MetS might place people with schizophrenia at increased risk for functional limitations in daily life activities.
7. MENTAL DISORDERS IN ASYLUM SEEKERS: THE ROLE OF THE REFUGEE DETERMINATION PROCESS AND EMPLOYMENT.
Debbie C. Hocking, DPsych, Suresh Sundram, MBBS, MMed, FRANZCP, PhD.
The refugee determination process (RDP) and social factors putatively impact on the psychiatric morbidity of adult asylum seekers (AS). Clinical and socio-demographic data, relevant to AS experience in the RDP, were collected using self-report measures to assess post-traumatic stress (HTQ-R), depressive and anxiety symptoms (HSCL-25), and the MINI psychiatric interview used to establish a cut-off for caseness. Prevalence of major depression (MDD) and post-traumatic stress disorder (PTSD) was 61% and 52%, respectively. Unemployment and greater numbers of both potentially traumatic events (PTE) and RDP rejections were predictors of symptom severity. Unemployed AS were more than twice as likely to have MDD, and AS with at least one RDP rejection were 1.35 times more likely to develop PTSD for each additional rejection. Reducing the asylum claim rejection rate and granting work rights is likely to reduce the rate of PTSD and MDD in community-based AS.
8. HOSPITAL LENGTH OF STAY IN INDIVIDUALS WITH SCHIZOPHRENIA WITH AND WITHOUT COCAINE POSITIVE URINE DRUG SCREENS AT HOSPITAL ADMISSION.
Hanjing Emily Wu, MD, PhD, Satyajit Mohite, MBChB, Ikenna Ngana, MD, Wilma Burns, MSc, Nurun Shah, MD, Laurie Schneider, MD, Joy M. Schmitz, PhD, Scott D. Lane, PhD, Olaoluwa O. Okusaga, MD, MScPHR.
Despite the high prevalence of cocaine use disorder (CUD) in individuals with schizophrenia, current understanding of the effect of cocaine on psychiatric hospital length of stay (LOS) in individuals with schizophrenia is limited. We therefore retrospectively examined the medical records of 5106 hospital admissions due to exacerbation of schizophrenia. T-test and linear regression were used to compare LOS between individuals with schizophrenia with cocaine positive urine drug test results and those with negative test results. Individuals with schizophrenia who were also positive for cocaine had shorter LOS from both unadjusted and adjusted analyses. Our results suggest that individuals with schizophrenia who also have comorbid CUD may require shorter inpatient treatment during periods of exacerbation of symptoms.
9. SOCIAL FUNCTIONING AND AGE ACROSS AFFECTIVE AND NON-AFFECTIVE PSYCHOSES.
Elizabeth A. Martin, PhD, Dost Öngür, MD, PhD, Bruce M. Cohen, MD, PhD, Kathryn E. Lewandowski, PhD.
The current study examined the relationship between social functioning and age in schizophrenia (SZ), schizoaffective disorder (SZA), and psychotic bipolar disorder (PBD). We found that individuals with PBD had the highest functioning while individuals with SZ had the poorest. The functioning of individuals with SZA fell in between the other groups. We also found that older ages were associated with poorer functioning. These results indicate that a decline in social functioning with may be an important area of unmet need in treatment across psychotic disorders.
10. LEVELS OF SYMPTOM SEVERITY AND FUNCTIONING IN 4 DIFFERENT DEFINITIONS OF SUBTHRESHOLD POSTTRAUMATIC STRESS DISORDER IN PRIMARY CARE VETERANS.
John Kasckow, MD, PhD, Derick Yeager, PhD, Kathryn Magruder, MPH, PhD.
Four definitions of subthreshold Posttraumatic Stress Disorder (PTSD) were compared in 815 primary care veterans. We compared scores between participants meeting criteria for one of the subthreshold PTSD definitions (based on Schnurr, Marshall, Blanchard, or Stein) to those with and without PTSD. Using regression, those meeting subthreshold criteria by any of the 4 definitions had lower mental and physical health functioning and higher PCL scores relative to those without PTSD; they also had higher mental health functioning and lower PCL scores relative to those with PTSD. With SF 36 physical functioning scores, only those meeting the Stein definition differed from the group with PTSD. Thus, these definitions appear to distinguish individuals who are qualitatively different from individuals with no PTSD or with PTSD and are nearly equivalent in their ability to discriminate individuals.
11. ACUTE VERSUS CHRONIC STRESSORS, MULTIPLE SUICIDE ATTEMPTS, AND PERSISTENT SUICIDE IDEATION IN U.S. SOLDIERS.
Craig J. Bryan, Tracy A. Clemans, Bruce Leeson, M. David Rudd.
This study examined recent-onset (i.e., acute) and persistent (i.e., chronic) life stressors among 54 acutely suicidal U.S. Army Soldiers, and examined their relationship persistence of suicidal crises over time. Soldiers with a history of multiple suicide attempts reported the most severe suicide ideation and the greatest number of chronic stressors. Chronic but not acute stressors were correlated with severity of suicide ideation. Participants reporting low to average levels of chronic stress resolved suicide ideation during the 6-month follow-up, but participants reporting high levels of chronic stress did not (Wald χ2 (1) = 4.57, p = .032). Soldiers who are multiple attempters report a greater number of chronic stressors. Chronic, but not acute-onset stressors are associated with more severe and longer-lasting suicidal crises.
12. COMORBID BIPOLAR DISORDER AND BORDERLINE PERSONALITY DISORDER AND SUBSTANCE USE DISORDER.
Diego Hidalgo-Mazzei, MD, Emily Walsh, BA, Lia Rosenstein, BA, Mark Zimmerman, MD.
Bipolar disorder (BD) and borderline personality disorder (BPD) are disabling and life threatening conditions, and both share the risk of having a lifetime substance use disorder (SUD). We tested the hypothesis that patients with both BD type I(BDI) or II(BDII) and BPD would have a higher rate of SUD than patients with either disorder alone. Out of 3,651 psychiatric patients, 63 patients were diagnosed with both BD and BPD, and these patients were significantly more likely to have a SUD compared to BDII patients without BPD. There were no differences when comparing the comorbid group to BPD patients without BD. The present study shows the importance of taking both BPD and BD into consideration insofar as the co-occurrence of the disorders increased the risk of having a substance use disorder especially when compared to BDII alone.
13. ARIPIPRAZOLE ADJUNCT TREATMENT IN BIPOLAR I OR II DISORDER, DEPRESSED STATE – A 2 YEAR CLINICAL STUDY.
Rao N. Malempati, MD, FRCPC.
There is evidence to suggest that aripiprazole is beneficial in major depressive disorder and bipolar disorder with depression (BPD). We therefore investigated 2-year clinical outcomes with aripiprazole adjunct therapy at 5-15 mg once-daily alongside a mood stabilizer in 40 patients with BPD. All patients experienced marked improvements in Montgomery-Åsberg Depression Rating Scale scores by 6 weeks, and substantial reductions in Clinical Global Impressions Scale scores by 6 months. All patients were able to return to optimal or premorbid functioning by 6 months to 1 year. By 1 year, all patients made a complete functional recovery on the Sheehan Disability Scale, and improvements were maintained on all measures up to 2 years.