Validation of the French version of the McLean screening instrument for borderline personality disorder (MSI-BPD) in an adolescent sample.

BACKGROUND: The study examines the psychometric properties of the French version of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) created by M. Zanarini to screen borderline personality disorder in clinical and non-clinical populations. METHOD: In this multicentric longitudinal study from the European Network on Borderline Personality Disorder, a sample of 84 adolescent patients from five psychiatric centres and 85 matched controls without psychiatric comorbidity completed the MSI-BPD, French version, and were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV), in order to assess the presence or absence of borderline personality disorder. RESULTS: The MSI-BPD showed excellent internal consistency (α = 0.87 [0.84;0.90]). Compared to the semi-structured reference interview (SIDP-IV), the MSI-BPD showed substantial congruent validity (AUC = 0.93, CI 95%: 0.90-0.97). The optimal cut-off point in the present study was 5 or more, as it had relatively high sensitivity (0.87) and specificity (0.85). In our sample, the cut-off point (7 or more) proposed by the original developers of the MSI-BPD showed high specificity (0.95) but low sensitivity (0.63). CONCLUSIONS: The French version of the MSI-BPD is now available, and its psychometric properties are satisfactory. The French version of the MSI-PBD can be used as a screening tool for borderline personality disorder, for clinical purposes or in research studies.

Gait control and executive dysfunction in early schizophrenia.

Dysexecutive functioning, which is described as an enduring core feature of schizophrenia, has been associated with gait disorders. However, few studies have reported gait disorders in schizophrenia patients. The objective of this study was to examine the association between executive dysfunction and gait performance in recent-onset schizophrenia patients using the dual task paradigm. Thirty-two subjects participated to the study: 17 with recent-onset schizophrenia and 15 healthy age-matched controls. Executive functions were evaluated using the Frontal Assessment Battery, Stroop and Trail-Making tests. Mean values and coefficients of variation (CV) of the temporal gait parameters while single tasking (just walking) and while dual tasking (walking and forward counting, walking and backward counting, walking and verbal fluency) were measured using the SMTEC(®)-footswitch system. We focused on the CV of stride time as this measure has been shown to be the most representative parameter of higher gait control. A strong effect of the stride time was found in the group factor for the verbal fluency dual-task when compared to controls (Cohen's d mean = 1.28 and CV = 1.05). The effect was lower in the other dual tasks, and insignificant in the single task of walking. This study shows that patients exhibit higher stride-to-stride variability while dual tasking than controls. It also shows a stronger impact of verbal fluency on gait regularity compared to the other dual tasks revealing a relationship between the executive dysfunction and gait modification. Those results are in line with the idea that schizophrenia implies not only cognitive but also motor functioning and coordination impairment.

Axis II comorbidity of borderline personality disorder in adolescents.

AIMS: The objective of the present study was to explore the comorbidity of borderline personality disorder (BPD) with other personality disorders in adolescents and compare these comorbidities in male and female subjects. METHODS: The sample was drawn from a European research project investigating the phenomenology of BPD in adolescence (EURNET BPD). A total of 85 BPD patients (11 boys and 74 girls) with a mean age of 16.3 years were included in the study. RESULTS: According to the results of the Structured Interview for DSM-IV Disorders of Personality, obsessive-compulsive (35.3%), antisocial (22.4%), avoidant (21.2%), dependent (11.8%) and paranoid (9.4%) personality disorders had significant co-occurrences with BPD. Although none of the gender differences was statistically significant, we observed a trend towards higher rates of antisocial personality disorders in men (45.5%) than in women (19%). CONCLUSION: The study results confirmed the frequency of Axis II comorbidity in adolescents with BPD and, for the first time, evidenced a differential pattern of comorbidity in males and females. This differential pattern must be taken into account when developing treatment strategies for adolescents with BPD.

Factor structure of borderline personality disorder symptomatology in adolescents.

OBJECTIVE: To examine the factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for borderline personality disorder (BPD) in a sample of adolescents with a borderline symptomatology. METHOD: The latent structure of borderline criteria, assessed with the Structured Interview for DSM-IV Personality, was explored with a principal factor analysis in a sample of 107 adolescents with a borderline symptomatology drawn from a European research project on BPDs. RESULTS: The principal component analysis revealed 2 homogeneous factors accounting for 66.8% of the variance. The first factor included internally oriented criteria, such as avoidance of abandonment, identity disturbance, chronic feeling of emptiness, and stress-related paranoid ideation. The second factor included externally oriented criteria, such as unstable relationships, impulsivity, suicidal or self-mutilating behaviours, and inappropriate anger. Affective instability was the only criterion loading on both factors. CONCLUSIONS: The results of our study suggests that an internal or external dichotomy may be an appropriate way to conceptualize the structure of borderline criteria in adolescents with a borderline symptomatology, with affective instability being a core feature of BPD at this age.

Why do people with eating disorders drop out from inpatient treatment?: the role of personality factors.

Dropout rates from inpatient treatment for eating disorders are very high and have a negative impact on outcome. The purpose of this study was to identify personality factors predictive of dropout from hospitalization. A total of 64 adult patients with anorexia nervosa consecutively hospitalized in a specialized unit were included; 19 patients dropped out. The dropout group and the completer group were compared for demographic variables, clinical features, personality dimensions, and personality disorders. There was no link between clinical features and dropout, and among demographic variables, only age was associated with dropout. Personality factors, comorbidity with a personality disorder and Self-transcendence dimension, were statistically predictive of premature termination of hospitalization. In a multivariate model, these two factors remain significant. Personality traits (Temperament and Character Inventory personality dimension and comorbid personality disorder) are significantly associated with dropout from inpatient treatment for anorexia nervosa. Implications for clinical practice, to diminish the dropout rate, will be discussed.

Dependent personality disorder and physical abuse.

The aim of this study was to test the hypothesis that the likelihood of physical spousal abuse is increased in dependent personality disorder (DPD) compared to other personality disorders. The sample consisted of 305 subjects consecutively admitted to an outpatient department of legal medicine for physical abuse. Using the Structured Clinical Interview for Disorders, screen questionnaire (SCID-II-SQ), the subjects were divided into three groups: without personality disorders (WPD, N=108), with non-dependent personality disorders (NDPD, N=179) and with DPDs (DPD, N=18). First,, the three groups were compared to the rate of spouses among the perpetrators. The rate of spouses among the perpetrators was significantly different between the three groups: 44.4% of the perpetrators were the spouse for DPD subjects versus 11.2% for WPD and 20.1% for NDPD. Second, logistic regressions using the status of perpetrators (spouse or others) as dependent variable and socio-demographical variables as well as the rates of DPD, avoidant, obsessive-compulsive and borderline personality disorders as independent variables reported that these four disorders of personality were significant predictors. Moreover, the co-morbidities of DPD with avoidant, obsessive-compulsive or borderline personality disorders were higher than 50%. These results suggest first that DPD subjects are at high risk of physical abuse by their spouses and second that this relationship was found also for the two other cluster C personality disorders as well as for borderline personality disorder.

Anhedonia as predictor of clinical events after acute coronary syndromes: a 3-year prospective study.

BACKGROUND: Depression after acute coronary syndromes (ACS) is an important risk factor for further coronary events; but the influence of anhedonia, the decreased capacity to experience pleasure, has received little attention. The aim of the study was to investigate the effects of anhedonia on prognosis at 3-year follow-up in patients hospitalized for ACS. METHOD: Consecutively admitted ACS patients (n = 291) completed the Chapman Physical Anhedonia Scale (PAS) and the Hospital Anxiety and Depression Scale depression subscale (HAD-D) at baseline (1-4 days after their admission). Two definitions of anhedonia were taken into account: dimensional definition using PAS score as well as categorical definition using several cutoff scores (hedonics: PAS less than 23 or 29; anhedonics: PAS equal to or greater than 23 or 29). Patients were followed during 3 years for adverse clinical events divided into severe cardiac events (mortality or myocardial infarction [MI]) and clinical events (mortality, MI, recurrence of ACS, hospital readmission, and onset or deterioration of heart failure). RESULTS: At follow-up, there were 176 clinical events (36 deaths, 8 MIs, 58 ACS, 55 hospital readmissions, 19 heart failures). Dimensional anhedonia and depression were associated with poor prognosis, but anhedonia was the only predictor of severe cardiac events and clinical events after adjusting for demographic and clinical variables. Contrary to depression, categorical anhedonia (PAS >23) was an independent and significant predictor of severe cardiac events after adjusting for clinical variables. The incidence of death/MI in hedonics vs anhedonics was 11.1% vs 22.1% (hazard ratio = 2.18; 95% confidence interval, 1.11-4.26). CONCLUSIONS: Dimensional and categorical anhedonias predicted independently severe cardiac events and clinical events after ACS.

Risk factors for addictive disorders: a discriminant analysis on 374 addicted and 513 nonpsychiatric participants.

Many common risk factors have been described in addictive disorders. Little is known about factors' respective contributions to discrimination of addicted and nonaddicted participants. Two large samples were compared including 513 nonpsychiatric participants and 374 addicted participants meeting the DSM-IV criteria for eating disorders, alcohol, or substance dependence. Twenty-six risk factors were assessed by interview or self-rating scales. A discriminant analysis determined the respective weight of each risk factor. One discriminant function emerged and characterized a depressive dimension. The results suggest that the different risk factors described in addiction could be related to a depressive dimension.

Spontaneous appetence for wheel-running: a model of dependency on physical activity in rat.

According to human observations of a syndrome of physical activity dependence and its consequences, we tried to examine if running activity in a free activity paradigm, where rats had a free access to activity wheel, may present a valuable animal model for physical activity dependence and most generally to behavioral dependence. The pertinence of reactivity to novelty, a well-known pharmacological dependence predictor was also tested. Given the close linkage observed in human between physical activity and drugs use and abuse, the influence of free activity in activity wheels on reactivity to amphetamine injection and reactivity to novelty were also assessed. It appeared that (1) free access to wheel may be used as a valuable model for physical activity addiction, (2) two populations differing in activity amount also differed in dependence to wheel-running. (3) Reactivity to novelty did not appeared as a predictive factor for physical activity dependence (4) activity modified novelty reactivity and (5) subjects who exhibited a high appetence to wheel-running, presented a strong reactivity to amphetamine. These results propose a model of dependency on physical activity without any pharmacological intervention, and demonstrate the existence of individual differences in the development of this addiction. In addition, these data highlight the development of a likely vulnerability to pharmacological addiction after intense and sustained physical activity, as also described in man. This model could therefore prove pertinent for studying behavioral dependencies and the underlying neurobiological mechanisms. These results may influence the way psychiatrists view behavioral dependencies and phenomena such as doping in sport or addiction to sport itself.

Individual cognitive training of reading disability improves word identification and sentence comprehension in adults with mild mental retardation.

Reading therapy has been shown to be effective in treating reading disabilities (RD) in dyslexic children, but little is known of its use in subjects with mild mental retardation (MR). Twenty adult volunteers, with both RD and mild MR, underwent 60 consecutive weeks in a cognitive remediation program, and were compared with 32 untreated control subjects. The experimental group showed a significant improvement in word identification, as measured by oral production (p=0.0004) or silent reading (p=0.023), and sentence comprehension (p=0.0002). Adults with MR appear to benefit from new approaches in the field of RD.

Prepartum chronic ultramild stress increases corticosterone and estradiol levels in gestating mice: implications for postpartum depressive disorders.

Fluctuations in steroid hormones (glucocorticoids and estradiol) levels during pregnancy and after delivery are thought to contribute to the etiology of postpartum depression. Such changes may be exacerbated by stressful events, which constitute a predisposing factor for postpartum mood disorders. In the present study, blood hormonal variations associated with prepartum Chronic Ultramild Stress (CUMS) exposure were assessed at two times (15th day of pregnancy and 3rd day postpartum) in mice stressed from day 1 of pregnancy to termination of pregnancy. Litter weight and litter size were determined in both groups whereas the duration of pregnancy was determined in the 3-day postpartum group. CUMS increased estradiol and corticosterone levels during pregnancy, but such effects were no longer observed in the postpartum period, where cortisol levels were decreased in control and stressed mice and estradiol levels were reduced in previously stressed mothers. No effects of the CUMS procedure were observed on gestational parameters. Given the link between hormonal variations during pregnancy and subsequent postpartum depression, these results suggest that CUMS applied to gestating female may provide a useful model for the study of the mechanisms of stress, which may lead to postpartum mood disorders.

Depressive personality dimensions and alexithymia in eating disorders.

An association has been reported between high levels of alexithymia and depression in patients with eating disorders. This study has examined alexithymic features and depressive experiences in patients with DSM-IV eating disorder (restricting anorexia, n=105; purging anorexia, n=49; bulimia, n=98) and matched controls (n=279). The subjects were assessed with the Toronto Alexithymia Scale (TAS-20); the Beck Depression Inventory; and the Depressive Experiences Questionnaire, which defines two types of depressive personality style (dependent and self-critical). The patients had high levels of alexithymic features and depressive symptoms. Comparisons of alexithymic features between patients and controls after adjustment for depression showed a significant difference between bulimic patients and controls for the TAS Difficulty Identifying Feelings factor, and between restricting anorexic patients and controls for the TAS Difficulty Describing Feelings factor. With regard to depressive personality styles, only scores on the self-critical dimension were significantly higher in bulimic patients than in restricting anorexic patients and controls. In the entire group of eating disorders, dependency was associated with the TAS Difficulty Identifying Feelings factor only in anorexic patients. Self-criticism, on the other hand, was associated with the TAS Difficulty Identifying Feelings factor in all subtypes of eating disorders, although the relationship was significantly stronger in restricting anorexic than in bulimic patients. The results of this study suggest that people with restricting anorexia and bulimia show specific clinical profiles associating alexithymic features and depressive dimensions.

Dependency and suicidality in addictive disorders.

Excessive interpersonal dependency has been described in depression and addictive disorders. Moreover, excessive dependency and suicidality are linked in psychiatric subjects, but their relationships have not been studied in specific addictions. Separate samples of female anorectic patients (n=150), female bulimic patients (n=95), male (n=150) or female (n=68) alcoholics, male (n=94) or female (n=54) drug abusers and non-psychiatric control subjects (n=683) were included in the study. On the basis of a structured interview, suicidal ideations, number of previous suicide attempts and diagnoses of dependent personality disorder (DSM-IV) were collected, and the subjects completed the Interpersonal Dependency Inventory and the Beck Depression Inventory. Logistic regression analysis revealed that excessive dependency and notably dependent personality disorder increased the likelihood of suicidal ideation or suicide attempts with a range of 2.65 to 9.42 in bulimic patients, female alcoholics and male drug abusers. Excessive dependency in specific addictive disorders as well as in male non-psychiatric subjects could constitute a risk factor for suicide. This hypothesis must be confirmed using prospective studies.

Chronic ultra-mild stress improves locomotor performance of B6D2F1 mice in a motor risk situation.

Chronic low grade stress predispose to psychopathological disorders. We consistently showed that chronic ultra-mild stress (CUMS) applied to B6D2F1 female mice induced behavioral disinhibition in several conflict exploration models. Insufficient reactivity to conflicts may be maladaptive and lead to inappropriate appreciation of potential risks and impaired ability to cope with those. Therefore, the purpose of the study was to assess the effect of a CUMS procedure on the behavior of mice in a motor risk situation based on multisensory conflict. Following three weeks exposure to various mild stressors, stressed and control B6D2F1 mice were tested on the rotating beam to determine how CUMS exposure affected balance control, posture stability and locomotor performance in response to a sensory-motor challenge. Detailed behavioral analysis included several parameters, both postural (height of the trunk, tail angle, number of imbalances, falls and head movements) and kinetic (mean velocity on the beam, distance covered with large and small movements, plus time spent in no-motion episodes). Comparisons between control and stressed mice showed that CUMS exposure increased mean velocity and improved locomotor performance in the learning task. In addition, sensitivity to sensory conflict seemed to be reduced in stressed mice, which displayed fewer behavioral adjustments to the increasing difficulty of the test compared to control mice. The results are discussed in terms of the possible influence of disturbances in behavioral and attentional inhibitory processes following CUMS exposure. Whether longer periods of CUMS exposure would shift the performance on the RTB from improvement to deterioration remain to be established.

Posture and balance responses to a sensory challenge are related to anxiety in mice.

Anxiety disorders and balance disorders share common clinical features related to perception such as spatial disorientation or dizziness. The search for the mechanism underlying this core of symptoms led us to investigate impairments in multisensory integration. In mice, the 'rotating beam test' allows analysis of changes in balance control and posture in response to a multisensory challenge. We used the BALB/c and C57BL/6 inbred strains of mice, known for their contrasted anxiety-related behavior. The level of anxiety was also manipulated using anxiolytic and anxiogenic pharmacological compounds. Despite equal sensori-motor abilities, anxious mice were more prone to fall off the rotating beam and showed more imbalance than non-anxious mice. Striking inter-strain differences in posture were also observed. Diazepam and beta-CCM reversed these strain-specific responses in opposite directions. We demonstrated that balance and postural strategies developed in response to a multisensory challenge vary as a function of the level of anxiety in mice.

Executive dysfunctions as potential markers of familial vulnerability to bipolar disorder and schizophrenia.

Attentional and executive impairments have been found both in patients with schizophrenia and in their unaffected first-degree relatives, suggesting that they might be considered as familial vulnerability markers. Several studies have shown that the performance of bipolar patients does not significantly differ from that of schizophrenic patients, so that executive and attentional deficits might not be specific to schizophrenia. In the present study, we aimed to identify executive dysfunctions in schizophrenia and bipolar disorder that might be vulnerability trait markers specific to one or common to both of these diseases. We assessed cognitive performance of euthymic bipolar and schizophrenic patients, their unaffected first-degree relatives and a healthy control group, using neuropsychological tasks to test different components of executive function: the Verbal Fluency Test, the Stroop Word Colour Test, the Wisconsin Card Sorting Test and the Trail Making Test. The two groups of patients and their unaffected relatives demonstrated disproportionately increased slowness on the Stroop test in comparison to the normal healthy group. Patients with schizophrenia performed poorly on all the tests in comparison to the normal healthy subjects, while no other impairment was observed in the bipolar patients and in the relatives of schizophrenic and bipolar patients. Enhanced susceptibility to interference and reduced inhibition could be transnosographical markers for a shared familial vulnerability common to schizophrenia and bipolar disorders.

Criterion validity of the interpersonal dependency inventory: a preliminary study on 621 addictive subjects.

The interpersonal dependency inventory comprised three subscales called Emotional reliance of another person (ER), lack of social self confidence (LSS) and Assertion of autonomy (AUT). Several formula have been developed for deriving whole-scale scores. The aim of the study on 621 addictive subjects was to determine the best formula using the DSM-IV dependent personality disorder as gold standard. The formula 3 ER + LSS - AUT yielded the best values of sensitivity and specificity.

Depressive psychopathology and adverse childhood experiences in eating disorders.

PURPOSE: The aim of this paper was to investigate the diagnostic specificity of the self-critical and dependent depressive experiences in a clinical sample of eating disorder patients and to explore the impact of adverse childhood experiences on these dimensions of personality. METHOD: A sample of 94 anorexic and 61 bulimic patients meeting DSM-IV criteria and 236 matched controls were assessed with the Depressive Experience Questionnaire (DEQ), the abridged version of the Beck Depression Inventory (BDI) and the AMDP Life Events Inventory. Subjects presenting a major depression or a comorbid addictive disorder were excluded from the sample using the Mini International Neuropsychiatric Interview (MINI). RESULTS: Anorexic and bulimic patients showed higher scores than controls on both self-criticism and dependency sub-scales of the DEQ. Bulimic patients scored significantly higher than anorexic patients on self-criticism and reported more adverse childhood experiences. Finally, negative life events correlated only with self-criticism in the whole sample. DISCUSSION: Differences in the DEQ Self-Criticism between anorexics and bulimics could not be accounted for by depression since bulimic patients did not show higher BDI levels compared to anorexic patients and depressive symptoms measured with the BDI were not found to be significant predictors of diagnostic grouping in a logistic multiple regression. CONCLUSION: This study supports the diagnostic specificity of the dependent and self-critical depressive dimensions in eating disorders and strengthens previous research on the role of early experiences in the development of these disorders.

Innovative technology-based interventions for autism spectrum disorders: a meta-analysis.

This article reports the results of a meta-analysis of technology-based intervention studies for children with autism spectrum disorders. We conducted a systematic review of research that used a pre-post design to assess innovative technology interventions, including computer programs, virtual reality, and robotics. The selected studies provided interventions via a desktop computer, interactive DVD, shared active surface, and virtual reality. None employed robotics. The results provide evidence for the overall effectiveness of technology-based training. The overall mean effect size for posttests of controlled studies of children with autism spectrum disorders who received technology-based interventions was significantly different from zero and approached the medium magnitude, d = 0.47 (confidence interval: 0.08-0.86). The influence of age and IQ was not significant. Differences in training procedures are discussed in the light of the negative correlation that was found between the intervention durations and the studies' effect sizes. The results of this meta-analysis provide support for the continuing development, evaluation, and clinical usage of technology-based intervention for individuals with autism spectrum disorders.