Gender Identity and Mental Health Symptom Severity Among Adolescents Admitted to an Inpatient Psychiatric Hospital.

Transgender youth are at an increased risk of suicide, substance use, experiencing violent assaults, and reporting major depressive episodes and greater psychological distress compared to their cisgender counterparts. This study examined mental health symptom severity in adolescents admitted to an inpatient psychiatric hospital who wished they were of a different gender compared to those who did not. A group of 180 adolescents admitted to an inpatient psychiatric hospital completed assessments to measure mental health symptom severity at admission. Gender diverse (n = 90) and cisgender (n = 90) groups were established. Analyses of variance (ANOVA) were used to examine between group (gender diverse vs. cisgender) difference on depression, anxiety, suicide risk, nighttime sleep quality, and emotion regulation problems. Results revealed significant differences in emotion regulation difficulties at admission, specifically in nonacceptance and awareness. There were no significant differences on measures of depression, anxiety, suicide risk, and nighttime sleep quality at admission. This study is one of the first to measure mental health symptom severity in gender diverse adolescents while admitted to an inpatient psychiatric setting. Adolescents in the gender diverse group had significantly higher level of difficulty with emotion regulation, which may indicate an increased risk of developing psychiatric symptoms such as depression and anxiety. This paper demonstrates the importance of using targeted interventions to address difficulties with emotion regulation in at-risk adolescents.

Factor Analysis and Validation of the Disturbing Dream and Nightmare Severity Index in an Inpatient Sample.

STUDY OBJECTIVES: The Disturbing Dream and Nightmare Severity Index (DDNSI) has been used widely in research and clinical practice without psychometric evidence supporting its use in clinical samples. The present study aimed to explore and confirm the factor structure of the DDNSI in an inpatient sample. We also sought to test the measure's construct validity. METHODS: Two samples of U.S. inpatients including adult (N = 937) and adolescent (N = 274) participants provided data on nightmares (i.e. DDNSI), sleep quality (i.e. the Pittsburgh Sleep Quality Index) and related psychopathology symptoms (e.g. depression, posttraumatic stress disorder, anxiety). RESULTS: Exploratory and confirmatory factor analyses found the six original items of the DDNSI to load onto a single latent factor. CONCLUSIONS: The DDNSI was found to be a valid measure of nightmare frequency and distress, as it was significantly correlated with the items related to disturbing dreams, and the DDNSI was able to differentiate between nightmares and psychopathology symptoms. Though this research comes nearly two decades after the initial creation and use of the DDNSI, it provides a foundation for the scientific rigor of previous and future studies on nightmares using the DDNSI.

Difficulties in emotion regulation moderates the relationship between mood symptoms and nightmares in an inpatient psychiatric sample.

BACKGROUND: Emotional processing and regulation of affect are often impaired in psychiatric patients. Nightmares could be considered a manifestation of problems with this process. In the present study, we examined how depression, anxiety and suicidal risk related to difficulties in emotion regulation and nightmares over the course of inpatient treatment. We also explored whether emotion regulation problems moderated the relationship between changes in depression, anxiety, and suicide risk to changes in nightmares from admission to discharge. METHODS: The present study included 1215 adults admitted to an inpatient psychiatric hospital ranging from 18 to 87 years of age (M = 37.18, SD = 16.14). Mood symptoms, emotion regulation difficulties, nightmares and suicide risk were assessed at admission and discharge. Moderation analyses were calculated using Model 1 of the PROCESS Macro (Hayes, 2013). RESULTS: Moderation analyses showed the associations between depression and nightmares (b = 0.25, p < .001) and suicide and nightmares (b = 0.34, p < .001) were strongest when patients had high levels of emotion regulation difficulties. Emotion regulation difficulties did not, however, moderate the relationship between anxiety and nightmares. Furthermore, improvement in depression and nightmares was significantly related to improvement in emotion regulation difficulties. LIMITATIONS: The homogeneity of the sample limits the generalizability of the results. Furthermore, the use of self-report measures, especially sleep related assessments, can bias the data more than objective measures. CONCLUSIONS: These findings provide clinical implications when treating psychiatric patients such as a need for emotion regulation skills building.

Resting-State Functional Connectivity of the Anterior Cingulate Cortex Among Persons With Mood Disorders and Suicidal Behaviors.

OBJECTIVE: To assess whether anterior cingulate cortex (ACC) abnormalities contribute to suicide risk in major depressive disorder and bipolar disorder, the investigators compared resting-state functional connectivity (rsFC) of ACC subdivisions between individuals with major depressive or bipolar disorder with and without a lifetime history of suicidal behavior. METHODS: Forty-two inpatients with and 26 inpatients without a history of suicidal behavior (SB+ and SB-, respectively) associated with major depressive or bipolar disorder and 40 healthy control (HC) participants underwent rsFC neuroimaging. RsFC of the subgenual, perigenual, rostral, dorsal, and caudal subdivisions of the ACC was calculated. Possible confounders, such as psychosis and severity of depression, were controlled for, seed-to-voxel and post hoc region of interest (ROI)-to-ROI analyses were performed, and the accuracy of rsFC in classifying suicidal behavior was studied. RESULTS: Compared with individuals in the SB- and HC groups, patients in the SB+ group had higher rsFC between the left rostral and right dorsal ACC seeds and visual cortex clusters. Conversely, rsFC between the left rostral and right dorsal ACC seeds and cingulate and frontal clusters was lower in the SB+ group than in the HC group. Left rostral ACC to left Brodmann's area 18 connectivity showed up to 75% discriminative accuracy in distinguishing SB+ from SB- patients. CONCLUSIONS: A history of suicidal behavior among individuals with major depressive disorder or bipolar disorder was associated with altered rsFC of the rostral and caudal ACC, regions involved in conflict detection and error monitoring. Replication of these findings is needed to further explore the involvement of the ACC in the neurobiology of suicidal behavior and suicidal ideation.

miR-124-3p target genes identify globus pallidus role in suicide ideation recovery in borderline personality disorder.

Borderline personality disorder (BPD) is characterized by patterns of unstable affect, unstable interpersonal relationships, and chronic suicidal tendencies. Research on the genetics, epigenetics, and brain function of BPD is lacking. MicroRNA-124-3p (miR-124-3p) was recently identified in a Genome-Wide Association Study as likely associated with BPD. Here, we identified the anatomical brain expression of genes likely modulated by miR-124-3p and compared morphometry in those brain regions in BPD inpatients vs. controls matched for psychiatric comorbidities. We isolated lists of targets likely modulated by miR-124-3p from TargetScan (v 8.0) by their preferentially conserved targeting (Aggregate PCT > 0.99, see Supplementary Table 1). We applied Process Genes List (PGL) to identify regions of interest associated with the co-expression of miR-124-3p target genes. We compared the gray matter volume of the top region of interest co-expressing those genes between BPD inpatients (n = 111, 46% female) and psychiatric controls (n = 111, 54% female) at The Menninger Clinic in Houston, Texas. We then correlated personality measures, suicidal ideation intensity, and recovery from suicidal ideation with volumetrics. Gene targets of miR-124-3p were significantly co-expressed in the left Globus Pallidus (GP), which was smaller in BPD than in psychiatric controls. Smaller GP volume was negatively correlated with agreeableness and with recovery from suicidal ideation post-treatment. In BPD, GP volume may be reduced through miR-124-3p regulation and suppression of its target genes. Importantly, we identified that a reduction of the GP in BPD could serve as a potential biomarker for recovery from suicidal ideation.

Relationship between parental attachment styles and suicide in adolescents and adults admitted to an inpatient psychiatric hospital.

BACKGROUND: Suicide is among one of the leading causes of death in the United States affecting individuals of all ages. METHODS: We examined the relationship between suicide risk and parental attachment among an inpatient psychiatric sample of 690 adolescents and 1000 adults. Participants completed self-report measures of suicide risk and attachment. RESULTS: We found that both adolescents and adults with insecure (i.e., preoccupied, dismissive, fearful) maternal and paternal attachment are at a significantly higher risk of suicide compared to those with secure maternal and paternal attachment. Adolescents who endorsed a previous suicide attempt (27.2 %) were less likely to have a secure maternal attachment, while adults who endorsed a previous suicide attempt (28.9 %) were less likely to have secure paternal attachment. LIMITATIONS: Our sample had limited racial and ethnic diversity which may limit the generalizability of the results to a broader population. CONCLUSIONS: The present study provides evidence of the importance of parental attachment styles as a predictor of suicide-related behaviors across both adolescents and adults who are admitted inpatient. This suggests the importance of utilizing family-based interventions in order to reduce the risk of suicide.

Nighttime sleep quality & daytime sleepiness across inpatient psychiatric treatment is associated with clinical outcomes.

Prior research has demonstrated the strong link between sleep disturbance and mental health outcomes, including the importance of examining nighttime sleep quality and daytime sleepiness as separate constructs in relation to mental health outcomes. As such, the current study examined patients' self-reported nighttime sleep quality and daytime sleepiness trajectories over the course of inpatient treatment and how these trajectories related to treatment outcomes. Participants were 1,500 adults who voluntarily admitted to an inpatient psychiatric hospital. Mental health outcomes measured were emotion regulation problems, anxiety severity, depression severity, nightmare severity, and suicide risk. Group-based trajectory modeling was used to determine nighttime sleep quality and daytime sleepiness trajectory groups. Multivariate analyses of covariance (MANCOVA) were used to determine between group differences on mental health outcomes. Patients fit into distinct groups based on their trajectories of nighttime sleep quality and daytime sleepiness across inpatient psychiatric treatment: Low, Moderate, and High. Individuals with greater nighttime sleep disturbance and greater daytime sleepiness throughout treatment (High group) demonstrated significantly increased suicide risk, higher nightmare severity, more anxiety, more depression, and more emotion regulation difficulties at discharge. Results suggest an important connection exists between nighttime sleep quality and excessive daytime sleepiness and mental health outcomes for inpatient psychiatry.

Technology Implementation for Mental Health End Users: A Model to Guide Digital Transformation for Inpatient Mental Health Professionals.

Digital transformation is the adoption of digital technologies by an entity in an effort to increase operational efficiency. In mental health care, digital transformation entails technology implementation to improve the quality of care and mental health outcomes. Most psychiatric hospitals rely heavily on "high-touch" interventions or those that require in-person, face-to-face interaction with the patient. Those that are exploring digital mental health care interventions, particularly for outpatient care, often copiously commit to the "high-tech" model, losing the crucial human element. The process of digital transformation, especially within acute psychiatric treatment settings, is in its infancy. Existing implementation models outline the development of patient-facing treatment interventions within the primary care system; however, to our knowledge, there is no proposed or established model for implementing a new provider-facing ministration tool within an acute inpatient psychiatric setting. Solving the complex challenges within mental health care demands that new mental health technology is developed in concert with a use protocol by and for the inpatient mental health professional (IMHP; the end user), allowing the "high-touch" to inform the "high-tech" and vice versa. Therefore, in this viewpoint article, we propose the Technology Implementation for Mental-Health End-Users framework, which outlines the process for developing a prototype of an IMHP-facing digital intervention tool in parallel with a protocol for the IMHP end user to deliver the intervention. By balancing the design of the digital mental health care intervention tool with IMHP end user resource development, we can significantly improve mental health outcomes and pioneer digital transformation nationwide.

Nighttime Sleep Quality and Daytime Sleepiness Predicts Suicide Risk in Adults Admitted to an Inpatient Psychiatric Hospital.

As sleep problems have been identified as an important, yet understudied, predictor of suicide risk, the present study analyzed the relationship between daytime sleepiness and nighttime sleep disturbance in a high-risk population of adults admitted to an inpatient psychiatric hospital. Objectives were to (1) examine the time course of subjective daytime sleepiness, nighttime sleep disturbance, and suicide risk throughout inpatient psychiatric treatment, (2) examine pre- to post-treatment changes in sleep disturbance with treatment as usual in an inpatient psychiatric setting, and (3) investigate whether daytime sleepiness and nighttime sleep disturbance predicted suicide risk above and beyond anxiety and depression. Participants were 500 consecutively admitted adults admitted to an intermediate length of stay (4-6 weeks) inpatient psychiatric hospital (47% female; 18-87 years of age). Measures of sleep, suicide risk, depression, and anxiety were completed at admission, weeks 1 through 4, and at discharge. Latent growth curve modeling (LGM) and hierarchal linear modeling (HLM) were conducted. The LGM analysis demonstrated that daytime sleepiness, nighttime sleep disturbance, and suicide risk all improved throughout inpatient treatment. Further, HLM showed that daytime sleepiness predicted suicide risk above and beyond symptoms of anxiety, depression, major sleep medications, and prior suicidal ideation and attempts, while nighttime sleep disturbance predicted suicide risk above and beyond symptoms of anxiety, major sleep medications, and prior suicidal ideation and attempts. Findings indicate the need to reevaluate safety protocols that may impact sleep, particularly that may increase daytime sleepiness, and to develop evidence-based sleep interventions for individuals admitted to inpatient psychiatric hospitals.

Reward Processing in Psychiatric Inpatients With Depression.

BACKGROUND: Previous neuroimaging studies have investigated reward-processing dysfunction in major depressive disorder and have led to the common finding that major depressive disorder is associated with reduced reward responses within the reward circuit. Yet it is unclear whether such reward-processing dysfunction is specifically associated with the severity of depressive symptoms in major depressive disorder or is associated with common comorbidities. METHODS: We investigated reward-processing differences using a classic juice-delivery functional magnetic resonance imaging experiment to compare psychiatric patients with severe depressive symptoms (DEPs) to both psychiatric control subjects (PCs) and healthy control subjects. In this study, the DEPs (n = 108) were matched to healthy control subjects (n = 62) for demographic characteristics and to the PCs (n = 108) for demographics and comorbid psychiatric diagnoses. An a priori region of interest, the left putamen, was selected using previous studies. An exploratory whole-brain analysis was performed to explore for nonhypothesized regions. RESULTS: Relative to the PCs and healthy control subjects, the DEP group showed smaller responses to reward stimulus in the left putamen. Whole-brain exploratory analysis revealed that DEPs had significantly lower responses to reward stimulus in the bilateral dorsal striatum (putamen and caudate), middle frontal gyrus, left precentral gyrus, and middle cingulate cortex than PCs. CONCLUSIONS: Our findings suggest that DEPs may have a lesser ability to modulate behavior as a function of reward, especially in those individuals who experience the most severe depressive symptoms. In both DEPs and PCs, the severity of depressive symptoms was related to reduced reward responses in the left putamen.

Impact of personality dysfunction on interdisciplinary treatment team working alliance in an inpatient psychiatric population.

Cluster B personality disorders (PDs) share specific traits that can result in interpersonal conflict. As therapeutic working alliance has a strong relationship with improved outcomes, there is interest in understanding the relationship between PDs, working alliance, and clinical outcomes. This is especially compelling in inpatient populations, where symptoms are severe, and patients are working with a treatment team. The aims of this study were to (a) assess whether higher team working alliance is associated with lower depressive symptoms, (b) assess whether patients with Cluster B PD traits have worse working alliance with their team than patients without those Cluster B PD traits, and (c) assess whether higher team working alliance is associated with lower depressive symptoms when Cluster B PD traits are present. Team working alliance was measured at baseline and at discharge for 3,406 inpatients at a psychiatric hospital. Improved team working alliance was associated with lower depression scores at discharge. Patients with borderline personality disorder traits had worse team working alliance, whereas patients with narcissistic personality disorder and antisocial personality disorder traits had similar working alliance scores as other patients. Borderline personality disorder and antisocial personality disorder traits moderated the association between team working alliance and depressive symptoms differently. Findings suggest that team working alliance works similarly to therapist working alliance. Of clinical importance is the finding that team working alliance and its relationship with depression symptoms differ based on Cluster B PD traits, and the importance of strong working alliance regardless of interpersonal challenges due to personality pathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An Examination of the Treatment Utility of the MMPI-2-RF: Prediction of Post-Treatment Depressive Symptoms and Increased Understanding of the Therapeutic Alliance in an Inpatient Mood Disorder Treatment.

The study examined the ability of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) substantive scales to predict depressive symptoms in a psychiatric inpatient setting. The indirect effect of patient-rated alliance with their treatment team on these relationships was also investigated. Participants included 678 (52.5% female, 97.1% White) inpatients diagnosed with a mood disorder. MMPI-2-RF scales, Patient Health Questionnaire (PHQ-9) at intake and discharge, and Working Alliance Inventory-Short at discharge were used to test study hypotheses regarding MMPI-2-RF predictive utility and the influence of alliance. Jacobson and Truax's (1991) reliable change index (RCI) was calculated to identify those who did (74% of the sample) and did not (24%) make reliable and clinically significant depressive symptom change, and the predictive utility of MMPI-2-RF scores in distinguishing these groups was examined. MMPI-2-RF scales assessing internalizing and somatic dysfunction accounted for an additional 2% to 8% of the variance in depressive symptoms reported at discharge, above and beyond depressive symptoms reported at intake. Somatic scales were also able to differentiate groups based on clinically significant change on the PHQ-9 (small-sized effect). The relationship between MMPI-2-RF scales and depressive symptoms at discharge was indirect through alliance in 64% of models. Clinical implications are discussed.

Emotion Regulation Mediates the Relationship Between Therapeutic Alliance and Anxiety in Emerging Adults During Inpatient Psychiatric Treatment.

Emerging adulthood is a critical developmental period characterized by emotional growth and unstructured living. To date, there is little research on emerging adults-defined as those 18 to 25 years old-with serious mental illnesses and even less on emerging adults in psychiatric hospitals. This study analyzed therapeutic alliance with the clinical team and change in anxiety symptoms in emerging adult psychiatric inpatients with the goal of establishing whether emotion regulation could serve as a mediator between these 2 constructs. Participants were 913 emerging adults (46.7% female; 18 to 25 y of age) who were voluntarily admitted to an intermediate length-of-stay (6 to 8 wk) inpatient psychiatric hospital. Each patient completed measures assessing anxiety symptoms, emotion regulation strategies, and working alliance as an assessment of therapeutic alliance. The results indicated that working alliance had significant indirect effects on change in anxiety symptoms through emotion dysregulation and lack of awareness, limited access to emotion regulation strategies, and lack of emotional clarity. This study emphasizes the need to understand emerging adults and the difficulties characteristic of this developmental period, and that clinicians should be aware that cognitive factors involved in emotion regulation may impact anxiety symptoms in emerging adult populations.

Increased symptom severity in adults and adolescents admitting to an inpatient psychiatric hospital during the COVID-19 pandemic.

While the negative effects of Coronavirus Disease-2019 (COVID-19) on general mental health are well-established, less is known about the impact on those with severe mental illness. Thus, this study examined symptom severity among psychiatric inpatients admitted prior to versus during the COVID pandemic. Self-reported anxiety (GAD-7), depression (PHQ-9), emotional dysregulation (DERS-SF), sleep quality (PSQI), nightmares (DDNSI), and suicidal ideation (SBQ-R) were examined in 470 adults (n = 235 admitted pre-pandemic) and 142 children and adolescents (n = 65 admitted pre-pandemic) at admission. Adults also completed measures of disability (WHODAS) and substance use (WHOASSIST). Adults admitted during the COVID pandemic reported significantly higher levels of anxiety [p < .001, partial η2=0.18], depression [p < .001, partial η2=0.06], emotion dysregulation [p < .001, partial η2=0.05], nightmares [p = .013, partial η2=0.01], and disability [p < .001, partial η2=0.04] compared to adults admitted pre-COVID. Levels of anxiety [p = .005, partial η2=0.05], depression [p = .005, partial η2=0.06], and sleep quality [p = .011, partial η2=0.05] were significantly higher among adolescents admitted during COVID compared to pre-COVID. The findings help identify areas of prioritization for future mental health prevention/intervention efforts for future disease outbreaks.

A false sense of security: Rapid improvement as a red flag for death by suicide.

OBJECTIVE: Postdischarge from inpatient psychiatry is the highest risk period for suicide, thus better understanding the predictors of death by suicide during this time is critical for improving mortality rates after inpatient psychiatric treatment. As such, we sought to determine whether there were predictable patterns in suicide ideation in hospitalized psychiatric patients. METHOD: We examined a sample of 2,970 adult's ages 18-87 admitted to an extended length of stay (LOS) inpatient psychiatric hospital. We used group-based trajectory modeling via the SAS macro PROC TRAJ to quantitatively determine four suicide ideation groups: nonresponders (i.e., high suicide ideation throughout treatment), responders (i.e., steady improvement in suicide ideation across treatment), resolvers (i.e., rapid improvement in suicide ideation across treatment), and no-suicide ideation (i.e., never significant suicide ideation in treatment). Next, we compared groups to clinical and suicide-specific outcomes, including death by suicide. RESULTS: Resolvers were the most likely to die by suicide postdischarge relative to all other suicide ideation groups. Resolvers also demonstrated significant improvement in all clinical outcomes from admission to discharge. CONCLUSION: There are essential inpatient psychiatry clinical implications from this work, including that clinical providers should not be lulled into a false sense of security when hospitalized adults rapidly improve in terms of suicide ideation. Instead, inpatient psychiatric treatment teams should increase caution regarding the patient's risk level and postdischarge treatment planning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Crisis Preparedness in Acute and Intensive Treatment Settings: Lessons Learned From a Year of COVID-19.

The impact of COVID-19 changed the use and delivery of health care services, requiring an abrupt shift in treatment and staffing models 1,2. This is particularly salient in youth acute and intensive treatment services (AITS), including inpatient psychiatric hospitals (IPH), intensive outpatient programs (IOP), and partial hospitalization programs (PHP), because of challenging issues of maintaining high-quality care and a safe therapeutic milieu during increased demand for acute services,3 all while limiting transmission of COVID-19 on locked units, in close quarters, and for youths traveling back and forth to day-programs. Over the past year, AITS adapted and evolved without the ability to pause services and plan, increase staffing, or allocate additional resources. This article discusses themes of changes made based on more than 20 facilities across the United States through the American Psychological Association Child and Adolescent Psychology Division's Acute, Intensive, and Residential Service Special Interest Group.4 These facilities include psychiatric inpatient units and day-treatment programs. We discuss lessons learned from these changes, the need for evaluating these changes, and application of these lessons in future crises.

Sleep disturbance in patients in an inpatient hospital mediates relationship between PTSD and suicidal ideation.

A common reason for admission to inpatient psychiatric units is suicidal ideation. Growing evidence of the link between sleep disturbance and suicidal ideation brings an interest in greater clarity of the pathways; this paper focused on post-traumatic stress disorder (PTSD), which carries increased risk for both sleep disturbance and suicidal ideation, as well as sex differences in those pathways. Patients were 2822 inpatients studied at admission to an inpatient psychiatric hospital and mediation analyses were used to examine pathways of interest. There was an indirect effect of PTSD on suicidal ideation through sleep disturbances for the entire sample and for men and women separately. The effect for men was larger than that for women, suggesting a stronger effect for sleep disturbance in the relationship for men. For women only, the direct effect between PTSD and suicidal ideation remained significant after mediation. Sleep disturbance plays an important role in the relationship between PTSD and suicidal ideation. Early identification of sleep disturbance in inpatients and targeted focus of sleep in conjunction with resolving trauma-related symptoms may help reduce suicidal ideation. This may be especially true of men; the indirect effect was smaller for women, suggesting that sleep disturbance should be addressed in conjunction with other PTSD symptoms likely leading to suicidal ideation.

Time in treatment: Examining mental illness trajectories across inpatient psychiatric treatment.

Early discharge or reduced length of stay for inpatient psychiatric patients is related to increased readmission rates and worse clinical outcomes including increased risk for suicide. Trajectories of mental illness outcomes have been identified as an important method for predicting the optimal length of stay but the distinguishing factors that separate trajectories remain unclear. We sought to identify the distinct classes of patients who demonstrated similar trajectories of mental illness over the course of inpatient treatment, and we explore the patient characteristics associated with these mental illness trajectories. We used data (N = 3406) from an inpatient psychiatric hospital with intermediate lengths of stay. Using growth mixture modeling, latent mental illness scores were derived from six mental illness indicators: psychological flexibility, emotion regulation problems, anxiety, depression, suicidal ideation, and disability. The patients were grouped into three distinct trajectory classes: (1) High-Risk, Rapid Improvement (HR-RI); (2) Low-Risk, Gradual Improvement (LR-GI); and (3) High-Risk, Gradual Improvement (HR-GI). The HR-GI was significantly younger than the other two classes. The HR-GI had significantly more female patients than males, while the LR-GI had more male patients than females. Our findings indicated that younger females had more severe mental illness at admission and only gradual improvement during the inpatient treatment period, and they remained in treatment for longer lengths of stay, than older males.

Subcortical brain morphometry of avoidant personality disorder.

BACKGROUND: Avoidant personality disorder (AvPD) is a condition typified by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. AvPD has a high comorbidity rate with other personality disorders and other psychological diagnostic categories. There is very little research investigating subcortical volumetry in AvPD. We studied subcortical brain morphometry in AvPD as compared to both healthy controls and comorbidity-matched psychiatric controls (patients in the same clinic matched for age, sex and all psychiatric diagnoses except for AvPD). METHODS: We compared volumetric measures of 9 bilateral subcortical brain regions between AvPD patients, healthy controls, and psychiatric controls (n = 100 each group). The Bonferroni correction was used to control for multiple comparisons across regions (p < 0.0028). RESULTS: Compared to healthy controls, AvPD patients had lower volume of the left accumbens and left thalamus. However, no significant results were found when comparing AvPD patients and psychiatric controls. An exploratory study of cortical regions showed similar results: statistically significant differences between HC and AvPD (left lateral occipital, left and right pericalcarine smaller in AvPD) but no differences between AvPD and PC. LIMITATIONS: MRI and neuroimaging provides correlational information, and no causal claims can be made. CONCLUSIONS: These results suggest there may be no overt subcortical volumetric differences specific to AvPD, and provide strong cautionary advice when comparing patients to healthy controls, a common practice in psychiatry biomarker research.