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1.
Artigo em Russo | MEDLINE | ID: mdl-32105268

RESUMO

AIM: To assess the formation of positive personality phenomena in patients with mild cognitive impairment and asthenic syndrome during the treatment with recognan (citicoline). MATERIAL AND METHODS: Thirty-eight patients (17 men and 21 women), aged 18 to 45 years (mean age 27.8±12.1 years), with asthenic syndrome with mild cognitive impairment (ICD-10 F06.7) were examined. Patients were divided into two groups: 20 people in the main group and 18 people in the comparison group. The main group received recognan (orally, in solution, 100 mg in 1 ml) for 30 days, the daily dosage of the drug was 0.5 g (5 ml solution). The comparison group did not receive any medications. Adapted methods of positive personality psychology were used: the Fordyce Emotions Questionnaire, the Subjective Happiness Scale (SHS), the Adult Hope Scale (AHS), the Satisfaction with Life Scale (SWLS), M. Atkinson's Scale of Emotional Maturity, the projective technique 'Map of experiences'. The follow-up period was 30 days. All subjects were examined three times (at baseline, 15 and 30 days after treatment). RESULTS AND CONCLUSION: After a month of treatment with recognan, there was an improvement of positive personality traits and a significant decrease in negative experiences, indicating the positive impact of the drug on the formation of positive personality manifestations and compensation for emotional disorders in patients with mild cognitive impairment and asthenic syndrome.


Assuntos
Astenia/complicações , Astenia/tratamento farmacológico , Disfunção Cognitiva/complicações , Disfunção Cognitiva/tratamento farmacológico , Citidina Difosfato Colina/uso terapêutico , Transtornos da Personalidade/complicações , Transtornos da Personalidade/tratamento farmacológico , Personalidade/efeitos dos fármacos , Adolescente , Adulto , Astenia/psicologia , Disfunção Cognitiva/psicologia , Citidina Difosfato Colina/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/psicologia , Adulto Jovem
2.
Psychiatr Danub ; 31(3): 290-307, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31596822

RESUMO

Temperament traits of Novelty Seeking, Harm Avoidance, Reward Dependence, and Persistence, are well defined in terms of their neural circuitry, neurochemical modulators, and patterns of associative learning. When heritably excessive, each of these traits may become a mechanistically fundamental biogenetic trait vulnerability for personality disorder. The other main risk factor for personality disorder is environmental, notably abuse, neglect, and psychological trauma. The emerging concept of mechanism-based pharmacotherapy aims to activate the brain's homeostasis as the only available delivery system to re-calibrate complex neurophysiological participants in each of the temperament traits. In a positive feedback, a homeostasis-driven improvement of excessive temperament is expected to facilitate maturation of neocortical networks of cognition, most reliably in expert psychotherapy (Part I of this paper) and, ultimately, thereby improve top-down cortical control of subcortical affect reactivity. As an emerging concept informed by neuroscience and clinical research, mechanism-based pharmacotherapy has the potential to be superior to traditional symptom-based treatments. Such mechanism-based approach illustrates what the pharmacological treatment of Research Domain Criteria (RDoC) might look like.


Assuntos
Modelos Psicológicos , Transtornos da Personalidade/tratamento farmacológico , Temperamento , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Cognição , Humanos , Personalidade , Transtornos da Personalidade/psicologia
3.
BMJ Open ; 9(4): e025145, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31048431

RESUMO

INTRODUCTION: Remission rates for mood disorders, including depressive and bipolar disorders, remain relatively low despite available treatments, and many patients fail to respond adequately to these interventions. Evidence suggests that personality disorder may play a role in poor outcomes. Although personality disorders are common in patients with mood disorders, it remains unknown whether personality disorder affects treatment outcomes in mood disorders. We aim to review currently available evidence regarding the role of personality disorder on pharmacological interventions in randomised controlled trials for adults with mood disorders. METHODS AND ANALYSIS: A systematic search of Cochrane Central Register of Controlled Clinical Trials (CENTRAL) via cochranelibrary.com, PubMed via PubMed, EMBASE via embase.com, PsycINFO via Ebsco and CINAHL Complete via Ebsco databases will be conducted to identify randomised controlled trials that have investigated pharmacological interventions in participants aged 18 years or older for mood disorders (ie, depressive disorders and bipolar spectrum disorders) and have also included assessment of personality disorder. One reviewer will screen studies against the predetermined eligibility criteria, and a second reviewer will confirm eligible studies. Data will be extracted by two independent reviewers. Methodological quality and risk of bias will be assessed using the Cochrane Risk of Bias tool. A systematic review, and if sufficient evidence is identified, a meta-analysis will be completed. Meta-analysis will be conducted using the standardised mean difference approach and reported with 95% CIs. A random effects model will be employed and statistical heterogeneity will be evaluated using the I2 statistic. Prespecified subgroup analyses will be completed. ETHICS AND DISSEMINATION: As this systematic review will use published data, ethics permission will not be required. The outcomes of this systematic review will be published in a relevant scientific journal and presented at a research conference. TRIAL REGISTRATION NUMBER: CRD42018089279.


Assuntos
Antidepressivos Tricíclicos/uso terapêutico , Metanálise como Assunto , Transtornos do Humor/tratamento farmacológico , Transtornos da Personalidade/tratamento farmacológico , Literatura de Revisão como Assunto , Inibidores de Captação de Serotonina/uso terapêutico , Adulto , Humanos , Transtornos do Humor/classificação , Transtornos da Personalidade/classificação , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
Psychiatr Danub ; 31(1): 2-17, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30948684

RESUMO

This paper presents an integrative model of personality and personality disorder which incorporates psychoanalytic concepts with modern neuroscience. In addition, a dynamic, personalized, and context - and time-sensitive diagnosis of personality disorder is introduced. The authors cogently argue that all clinical variants of personality disorder share the same common deficit: fragmented basic units of experience at the nonconscious core of the mind (aka "partial object relations"). The fragmentation propagates through mental faculties (thought, motivation, emotion), as they self-organize into subsystems of personality, e.g., one's sense of self, identity, character, moral values, rendering them polarized into extreme and thus adaptively suboptimal. The syndrome of personality disorder arises as a nonconscious compensatory maneuver of the fragmented mind to organize itself through a defensive but unrealistic self-image (e.g., narcissistic, schizoid, antisocial, etc.), giving rise to a host of unique symptoms. Symptomatic pharmacotherapy of personality disorder is best organized around four empirically derived domains of symptoms, shared by all variants to a variable degree: i) mood and anxiety dysregulation; ii) impulsivity, aggression, and behavior dyscontrol; iii) emotional disinterest and detachment; and iv) cognitive distortions and brief reactive psychoses. Pharmacotherapy targeting the above domains is nonspecific, as medications affect multiple domains simultaneously. Modest empirical evidence and considerable clinical benefits continue to support the use of medications in the overall symptomatic treatment of personality disorder.


Assuntos
Transtorno da Personalidade Antissocial , Transtornos da Personalidade , Transtorno da Personalidade Antissocial/tratamento farmacológico , Humanos , Comportamento Impulsivo , Modelos Psicológicos , Narcisismo , Transtornos da Personalidade/tratamento farmacológico , Psicoterapia
5.
Eur Neuropsychopharmacol ; 29(1): 122-126, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30497838

RESUMO

Inhaled Loxapine (IL) has demonstrated efficacy in the treatment of agitation in schizophrenic and bipolar patients, although data in patients with Personality Disorder (PD) are scarce. To evaluate the effectiveness and safety of IL in the treatment of agitation in PD, data from 41 patients who presented at our unit with acute agitation and were treated with 9.1 mg of IL were collected retrospectively. The results showed that IL significantly decreased agitation within 10 minutes and its effect was greater at 20 minutes (Positive and Negative Syndrome Scale-excited component: from 22.78 ±â€¯4.39 at baseline to 11.14 ±â€¯4.17 at 20 minutes; p < 0.001; Agitation and Calmness Evaluation Scale: from 1.80 ±â€¯0.49 at baseline to 4.53 ±â€¯1.05 at 20 minutes; p < 0.01) without any severe adverse reactions registered. IL led to fast, safe and well-tolerated control of agitation in patients with PD.


Assuntos
Loxapina/uso terapêutico , Transtornos da Personalidade/tratamento farmacológico , Agitação Psicomotora/tratamento farmacológico , Administração por Inalação , Adolescente , Adulto , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Bases de Dados Factuais , Feminino , Humanos , Loxapina/administração & dosagem , Loxapina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/complicações , Agitação Psicomotora/complicações , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Sci Rep ; 8(1): 17889, 2018 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-30559408

RESUMO

The personality trait neuroticism is associated with increased vulnerability to anxiety and mood disorders, conditions linked with abnormal serotonin neurotransmission and emotional processing. The interaction between neuroticism and serotonin during emotional processing is however not understood. Here we investigate how individual neuroticism scores influence the neural response to negative emotional faces and their sensitivity to serotonergic tone. Twenty healthy participants performed an emotional face task under functional MRI on three occasions: increased serotonin tone following infusion of a selective serotonin reuptake inhibitor (SSRI), decreased serotonin tone following acute tryptophan depletion (ATD) protocol, and no serotonin challenge (control). During the task, participants performed a gender-discrimination task of neutral, fearful or angry facial expressions. Individual variations in neuroticism scores were associated with neural response of subgenual anterior cingulate cortex to fearful facial expressions. The association was however opposite under the two serotoninergic challenges. The fear-related response in this region and individual neuroticism scores correlated negatively during citalopram challenge and positively during ATD. Thus, neuroticism scores were associated with the relative impact of serotonin challenges on fear processing in subgenual anterior cingulate cortex. This finding may link to a neural mechanism for the variable therapeutic effect of SSRI treatment observed in clinical populations.


Assuntos
Medo/efeitos dos fármacos , Neuroticismo/efeitos dos fármacos , Córtex Pré-Frontal/efeitos dos fármacos , Serotonina/administração & dosagem , Adulto , Ira/efeitos dos fármacos , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/metabolismo , Citalopram/administração & dosagem , Emoções/efeitos dos fármacos , Expressão Facial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Personalidade/efeitos dos fármacos , Transtornos da Personalidade/tratamento farmacológico , Transtornos da Personalidade/metabolismo , Estimulação Luminosa/métodos , Córtex Pré-Frontal/metabolismo , Inibidores de Captação de Serotonina/administração & dosagem , Triptofano/metabolismo
7.
Rev Med Chil ; 146(5): 665-669, 2018 May.
Artigo em Espanhol | MEDLINE | ID: mdl-30148931

RESUMO

Upgaze or sustained elevation of the eyes, is an alteration of ocular motility initially described in hypoxic coma. We report a 65-year-old woman admitted with hypotension and alteration of sensorium due to the ingestion of 9.5 g of Bupropion. She presented two seizures of short duration, without epileptic activity on the EEG. She had a persistent asynchronous myoclonus in extremities, tachycardia and prolonged Q-t. She suffered a cardiac arrest caused by asystole, which recovered quickly in five minutes. At that moment, upgaze appeared, associated with a persistent ocular opening, which persisted for days, but finally disappeared, without remission of coma. A magnetic resonance imaging done at the eighth day, showed hyperintensity of the oval center and corpus callosum which disappeared in a new imaging study done 30 days later, where images of hypoxia in the basal nuclei and cortex appeared. The patient died forty seven days after admission. Up-gaze is an ominous oculomotor alteration linked to an important but incomplete damage in the cerebral cortex, a condition that perverts some sequences of the ocular opening, reversing the Bell phenomenon and producing eyelid retraction.


Assuntos
Antidepressivos de Segunda Geração/efeitos adversos , Bupropiona/efeitos adversos , Coma/induzido quimicamente , Overdose de Drogas/complicações , Hipóxia Encefálica/induzido quimicamente , Transtornos da Motilidade Ocular/induzido quimicamente , Idoso , Evolução Fatal , Feminino , Humanos , Imagem por Ressonância Magnética , Transtornos da Personalidade/tratamento farmacológico , Suicídio
8.
Rinsho Shinkeigaku ; 58(8): 499-504, 2018 Aug 31.
Artigo em Japonês | MEDLINE | ID: mdl-30068812

RESUMO

A 51-year-old man with a cerebral lacunar infarction of the midbrain that had occurred two years before, was transferred from a regional psychiatric hospital with chronic progressive psychiatric symptoms including cognitive decline, irritability and hallucinations. Neurological examinations upon admission revealed cerebellar ataxia including dysarthria, ataxic gait and bilateral intention tremor. Brain FLAIR MRI on day 2 revealed abnormal hyperintense lesions in the bilateral insular cortex and temporal pole. Treponemal and non-treponemal specific antibodies were positive in both serum and cerebrospinal fluid (CSF), indicating a diagnosis of neurosyphilis. Treatment with intravenous penicillin (24 × 106 units/day × 28 days) improved his psychiatric symptoms, ataxia, imaging abnormalities and inflammatory CSF findings. Cerebellar ataxia is a rare symptom of neurosyphilis. Nonetheless, the possibility of neurosyphilis should be considered if a young adult ataxia accompanied by psychiatric symptoms.


Assuntos
Ataxia Cerebelar/etiologia , Infarto Cerebral/etiologia , Disfunção Cognitiva/etiologia , Neurossífilis/complicações , Neurossífilis/diagnóstico , Transtornos da Personalidade/etiologia , Ataxia Cerebelar/tratamento farmacológico , Córtex Cerebral/diagnóstico por imagem , Doença Crônica , Disfunção Cognitiva/tratamento farmacológico , Diagnóstico Diferencial , Progressão da Doença , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurossífilis/tratamento farmacológico , Penicilina G/administração & dosagem , Transtornos da Personalidade/tratamento farmacológico , Testes Sorológicos , Fatores de Tempo , Resultado do Tratamento
9.
Tijdschr Psychiatr ; 60(5): 306-314, 2018.
Artigo em Holandês | MEDLINE | ID: mdl-29766478

RESUMO

BACKGROUND: Compared to cluster B personality disorders, the assessment and treatment of people with obsessive-compulsive, dependent, and avoidant personality disorders (cluster C) is given little attention in the field of research and clinical practice. AIM: Presenting the current state of affairs in regard to cluster C personality disorders. METHOD: A systematic literature search was conducted using the main data bases. RESULTS: Cluster C personality disorders are present in approximately 3-9% of the general population. In about half of the cases of mood, anxiety, and eating disorders, there is co-morbid cluster C pathology. This has a major influence on the progression of symptoms, treatment effectiveness and potential relapse. There are barely any well conducted randomized studies on the treatment of cluster-C in existence. Open cohort studies, however, show strong, lasting treatment effects. CONCLUSION: Given the frequent occurrence of cluster C personality disorders, the burden of disease, associated societal costs and the prognostic implications in case of a co-morbid cluster C personality disorder, early detection and treatment of these disorders is warranted.


Assuntos
Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/tratamento farmacológico , Comorbidade , Humanos , Transtornos da Personalidade/epidemiologia , Resultado do Tratamento
10.
J Psychosom Res ; 108: 93-101, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29602331

RESUMO

OBJECTIVE: Low omega (n)-3 polyunsaturated fatty acid (PUFA) levels have been found in patients with various major psychiatric disorders. This study aims to identify whether psychological vulnerabilities (personality and cognitive reactivity) underlying these psychiatric conditions are also associated with n-3 PUFA blood levels. METHODS: Data was used from 2912 subjects (mean age 41.9 years, 66.4% female) from the Netherlands Study of Depression and Anxiety (NESDA). Five personality dimensions (NEO Five Factor Inventory) and cognitive reactivity measures (Leiden Index of Depression Sensitivity-Revised and Anxiety Sensitivity Index) were assessed. Plasma n-3 PUFA and docosahexaenoic acid (DHA) levels (as ratios against total fatty acids; mmol%) were assessed using a nuclear magnetic resonance platform. RESULTS: Low n-3 PUFA and DHA levels were associated with high neuroticism (Standardized beta (Beta) = -0.045, 95% Confidence Interval (CI) = -0.079 to -0.010, p = 0.011; Beta = -0.058, 95%CI = -0.093 to -0.022, p = 0.001), low extraversion (Beta = 0.065, 95%CI = 0.031 to 0.099, p < 0.001; Beta = 0.074, 95%CI = 0.039 to 0.109, p < 0.001) and low conscientiousness (Beta = 0.060, 95%CI = 0.027 to 0.093, p < 0.001; Beta = 0.074, 95%CI = 0.039 to 0.108, p < 0.001). Low n-3 PUFA and DHA levels were related to high hopelessness/suicidality (Beta = -0.059, 95%CI = -0.096 to -0.023, p = 0.001; Beta = -0.078, 95%CI = -0.116 to -0.041, p < 0.001), but not with other cognitive reactivity measures. Directions of associations were generally consistent in subjects with and without a current depressive disorder. CONCLUSION: Low n-3 PUFA and DHA levels are associated with personality (high neuroticism, low extraversion and low conscientiousness) and cognitive reactivity (high hopelessness/suicidality). Effect sizes were rather small, but in line with previous research on personality and chronic diseases. Future research should examine which lifestyle and/or biological pathways underlie these associations.


Assuntos
Cognição/efeitos dos fármacos , Ácidos Graxos Ômega-3/uso terapêutico , Transtornos da Personalidade/tratamento farmacológico , Adulto , Ácidos Graxos Ômega-3/farmacologia , Feminino , Humanos , Masculino
11.
Artigo em Inglês | MEDLINE | ID: mdl-29483349

RESUMO

This paper presents a discussion of principles and problems of neurotransmitter challenge tests using examples of experiments, most of which were performed in the author's laboratory. Drugs targeting synthesis, release, receptors or reuptake of dopamine, serotonin and noradrenergic transmitter (TM) systems were used for characterizing or discriminating certain temperament or personality traits and their sub-factors. Any personality or temperament trait is characterized by multiple TM responses, thus constellations of hormone responses to drugs acting on different TM systems or on different sources of TM activity were investigated within individuals in crossover designs. The major conclusions are: (i) intra-individual patterns of hormone responses to different TM-related drugs, or to agonists and antagonists, can help to discriminate subtypes of temperament dimensions, and (ii) the latency and shape of response curves may help specify processes of biological responses related to psychological dimensions and reveal common TM sensitivities in clusters of traits. TM sensitivity, defined by hormone responses, does not always correspond to accompanying behavioural indicators, but may provide more specific information on underlying mechanisms. Additional consideration of drug doses and experimental induction of stressors may serve to identify temperament-related susceptibilities to certain drugs. Limitations of the challenge approach and recommendations for future research are discussed.This article is part of the theme issue 'Diverse perspectives on diversity: multi-disciplinary approaches to taxonomies of individual differences'.


Assuntos
Neuroticismo/efeitos dos fármacos , Inibidores da Captação de Neurotransmissores/farmacologia , Transtornos da Personalidade/tratamento farmacológico , Psicotrópicos/farmacologia , Temperamento/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Encéfalo/fisiopatologia , Análise por Conglomerados , Dopamina/metabolismo , Relação Dose-Resposta a Droga , Comportamento Exploratório/efeitos dos fármacos , Feminino , Humanos , Comportamento Impulsivo/efeitos dos fármacos , Individualidade , Masculino , Norepinefrina/metabolismo , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/fisiopatologia , Transtornos da Personalidade/psicologia , Serotonina/metabolismo , Temperamento/fisiologia
12.
Aging Ment Health ; 22(3): 371-378, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-27960533

RESUMO

INTRODUCTION: The Delphi method is a consensus-building technique using expert opinion to formulate a shared framework for understanding a topic with limited empirical support. This cross-validation study replicates one completed in the Netherlands and Belgium, and explores US experts' views on the diagnosis and treatment of older adults with personality disorders (PD). METHODS: Twenty-one geriatric PD experts participated in a Delphi survey addressing diagnosis and treatment of older adults with PD. The European survey was translated and administered electronically. RESULTS: First-round consensus was reached for 16 out of 18 items relevant to diagnosis and specific mental health programs for personality disorders in older adults. Experts agreed on the usefulness of establishing criteria for specific types of treatments. The majority of psychologists did not initially agree on the usefulness of pharmacotherapy. Expert consensus was reached following two subsequent rounds after clarification addressing medication use. CONCLUSIONS: Study results suggest consensus among regarding psychosocial treatments. Limited acceptance amongst US psychologists about the suitability of pharmacotherapy for late-life PDs contrasted with the views expressed by experts surveyed in Netherlands and Belgium studies.


Assuntos
Consenso , Técnica Delfos , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/tratamento farmacológico , Fatores Etários , Idoso , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino
13.
Turk Psikiyatri Derg ; 28(2): 132-134, 2017.
Artigo em Turco | MEDLINE | ID: mdl-29192946

RESUMO

Many drugs including anti-depressants and anti-psychotics are known to cause excessive sweating (hyperhidrosis). Hyperhidrosis may be caused by drugs acting at the hypothalamus, spinal thermoregulatory centres, and sympathetic ganglia or at the eccrine-neuroeffector junction. Hyperhidrosis can be distressing and embarrassing symptom, which if not addressed properly, may lead to non-concordance to medication. Two female patients are reported here who developed hyperhidrosis with aripiprazole. Both the patients stopped experiencing hyperhidrosis after their aripiprazole was discontinued. To the best of the knowledge of the author, no case of aripiprazole induced hyperhidrosis has been published in the literature.


Assuntos
Antidepressivos Tricíclicos/efeitos adversos , Aripiprazol/efeitos adversos , Hiperidrose/diagnóstico , Transtornos da Personalidade/tratamento farmacológico , Transtornos Psicóticos/tratamento farmacológico , Administração Oral , Adulto , Antidepressivos Tricíclicos/administração & dosagem , Aripiprazol/administração & dosagem , Diagnóstico Diferencial , Feminino , Humanos , Hiperidrose/induzido quimicamente
14.
Nord J Psychiatry ; 71(6): 433-440, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28472591

RESUMO

BACKGROUND: There is strong evidence to suggest that personality factors may interact with the development and clinical expression of panic disorder (PD). A greater understanding of these relationships may have important implications for clinical practice and implications for searching reliable predictors of treatment outcome. AIMS: The study aimed to examine the effect of escitalopram treatment on personality traits in PD patients, and to identify whether the treatment outcome could be predicted by any personality trait. METHOD: A study sample consisting of 110 outpatients with PD treated with 10-20 mg/day of escitalopram for 12 weeks. The personality traits were evaluated before and after 12 weeks of medication by using the Swedish universities Scales of Personality (SSP). RESULTS: Although almost all personality traits on the SSP measurement were improved after 12 weeks of medication in comparison with the baseline scores, none of these changes reached a statistically significant level. Only higher impulsivity at baseline SSP predicted non-remission to 12-weeks treatment with escitalopram; however, this association did not withstand the Bonferroni correction in multiple comparisons. LIMITATIONS: All patients were treated in a naturalistic way using an open-label drug, so placebo responses cannot be excluded. The sample size can still be considered not large enough to reveal statistically significant findings. CONCLUSIONS: Maladaptive personality disposition in patients with PD seems to have a trait character and shows little trend toward normalization after 12-weeks treatment with the antidepressant, while the association between impulsivity and treatment response needs further investigation.


Assuntos
Antidepressivos/uso terapêutico , Citalopram/uso terapêutico , Transtorno de Pânico/tratamento farmacológico , Transtorno de Pânico/psicologia , Transtornos da Personalidade/tratamento farmacológico , Transtornos da Personalidade/psicologia , Adulto , Antidepressivos/farmacologia , Citalopram/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/epidemiologia , Personalidade/efeitos dos fármacos , Transtornos da Personalidade/epidemiologia , Inventário de Personalidade , Suécia/epidemiologia , Resultado do Tratamento
15.
J Affect Disord ; 217: 8-15, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28364620

RESUMO

BACKGROUND: While major depressive disorder (MDD) is considered to be a heterogeneous disorder, the nature of the heterogeneity remains unclear. Studies have attempted to classify patients with MDD using latent variable techniques, yet the empirical approaches to symptom-based subtyping of MDD have not provided conclusive evidence. Here we aimed to identify homogeneous classes of MDD based on personality traits, using a latent profile analysis. METHODS: We studied 238 outpatients with DSM-IV MDD recruited from our specialized depression outpatient clinic and assessed their dimensional personality traits with the Temperament and Character Inventory. Latent profile analysis was conducted with 7 dimensions of the Temperament and Character Inventory as indicators. Relationships of the identified classes with symptomatology, prescription pattern, and social function were then examined. RESULTS: The latent profile analysis indicated that a 3-class solution best fit the data. Of the sample, 46.2% was classified into a "neurotic" group characterized by high harm avoidance and low self-directedness; 30.3% into an "adaptive" group characterized by high self-directedness and cooperativeness; and 23.5% into a "socially-detached" group characterized by low reward dependence and cooperativeness and high self-transcendence. The 2 maladaptive groups, namely neurotic and socially-detached groups, demonstrated unique patterns of symptom expression, different classes of psychotropic medication use, and lower social functioning. LIMITATIONS: Generalizability of the findings was limited since our patients were recruited from the specialized depression outpatient clinic. CONCLUSIONS: Our personality-based latent profile analysis identified clinically meaningful 3 MDD groups that were markedly different in their personality profiles associated with distinct symptomatology and functioning.


Assuntos
Transtorno Depressivo Maior/psicologia , Transtornos da Personalidade/diagnóstico , Adulto , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Redução do Dano , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Transtornos da Personalidade/complicações , Transtornos da Personalidade/tratamento farmacológico , Inventário de Personalidade , Psicotrópicos/uso terapêutico , Comportamento Social
16.
Artigo em Inglês | MEDLINE | ID: mdl-28407461

RESUMO

Objective: To provide understanding into the biological basis of thinking and behavior in people with personality disorders, explain anatomic findings, and appraise therapeutic options. Data Sources: PubMed was searched with no date restrictions using the terms personality disorders DSM-5, cluster B personality disorders, biological psychiatry of personality disorders, neurobiology of personality disorders, and neurobiology of cluster B personality disorders. Study Selection/Data Extraction: We identified 2,790 English-language articles and utilized 18 in this report. Results: There are anatomic features typical to the brains of individuals with cluster B personality disorders, for example, abnormalities in the superior frontal cortex and amygdala and enlarged striatal volumes. Emotional dysregulation and impulsiveness are 2 prominent symptoms. Hereditary factors may contribute to the development of such conditions. Conclusion: Understanding the neurobiology of cluster B personality disorders expands knowledge that hopefully results in better clinical management and development of improved treatments. Psychotherapy is currently the most effective intervention for borderline personality disorders. Symptomatic pharmacotherapies may be prescribed adjunctively on an individualized basis if clinically indicated (eg, with a coexistant depression).


Assuntos
Encéfalo/patologia , Encéfalo/fisiopatologia , Transtornos da Personalidade , Encéfalo/efeitos dos fármacos , Humanos , Transtornos da Personalidade/tratamento farmacológico , Transtornos da Personalidade/patologia , Transtornos da Personalidade/fisiopatologia , Psicoterapia
17.
Psychiatr Q ; 88(1): 129-140, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27167133

RESUMO

The aim of this study was to understand which of a number of factors are most associated with psychiatric inpatient length of stay (LoS). We hypothesized that a longer LoS would be predicted by: older age, male gender, unmarried marital status, foreign nationality, more than one hospitalization, being hospitalized involuntarily, psychotic symptoms and behavioral dyscontrol at admission, discharge diagnosis of psychotic and personality disorders, not having a substance use disorder, treatment with more than one class of medications, and being discharged to a community residential facility. All admissions to the Psychiatric Inpatient Unit of Santa Maria della Misericordia, Perugia Hospital, Umbria, Italy, from June 2011 to June 2014, were included in a medical record review. Bivariate analyses were performed and a multiple linear regression model was built using variables that were associated (p < .05) with LoS in bivariate tests. The study sample included 1236 patients. In the final, most parsimonious regression model, five variables independently explained 18 % of variance in LoS: being admitted involuntarily, being admitted for thought disorders, not having a substance-related disorder, having had more than one hospitalization, and being discharged to a community residential facility. LoS on this inpatient psychiatric unit in Umbria was associated with a number of sociodemographic and clinical characteristics. Knowledge of these and other predictors of LoS will be increasingly important to, when possible, reduce the length of restrictive, costly hospitalizations and embrace community-based services.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Estado Civil/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Instituições Residenciais/estatística & dados numéricos , Adulto , Fatores Etários , Feminino , Unidades Hospitalares , Hospitalização/estatística & dados numéricos , Hospitais Gerais , Humanos , Itália , Masculino , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Transtornos do Humor/tratamento farmacológico , Transtornos do Humor/epidemiologia , Alta do Paciente , Transtornos da Personalidade/tratamento farmacológico , Transtornos da Personalidade/epidemiologia , Unidade Hospitalar de Psiquiatria , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/epidemiologia , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
19.
Lakartidningen ; 1132016 12 06.
Artigo em Sueco | MEDLINE | ID: mdl-27959459

RESUMO

Compliance and patience is needed when meeting patients with personality disorder To encounter patients with personality disorders in health care settings is often challenging. Most treatment studies published have included only patients with borderline personality disorder. Of evaluated psychological treatments in borderline personality disorder, dialectical behaviour therapy (DBT) has the strongest research support, followed by mentalization based therapy (MBT). Pharmacological treatment in personality disorders should focus on time-limited crisis intervention and treatment of comorbidity. There are few studies on inpatient care of persons with personality disorder. However, there are some interesting projects on brief self-directed inpatient stays as crisis intervention. There is a consensus to avoid long inpatient stays and coercive measures as far as possible.


Assuntos
Transtornos da Personalidade , Psicoterapia/métodos , Terapia Comportamental/métodos , Transtorno da Personalidade Borderline/tratamento farmacológico , Transtorno da Personalidade Borderline/terapia , Intervenção na Crise , Humanos , Assistência Centrada no Paciente , Transtornos da Personalidade/tratamento farmacológico , Transtornos da Personalidade/terapia , Relações Profissional-Paciente
20.
Rev. lab. clín ; 9(4): 173-176, oct.-dic. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-158434

RESUMO

La resistencia a hormonas tiroideas, descrita por Refetoff en 1967, es un desorden genético autosómico dominante. Se caracteriza por una respuesta reducida de los tejidos blandos a la hormona tiroidea con incremento de niveles de tiroxina libre sin inhibición de la hormona tirotropa, como consecuencia de mutaciones presentes en el gen receptor beta de la hormona tiroidea (rTHβ) en el 85% de los casos. Es una entidad poco frecuente y el diagnóstico definitivo se basa en el estudio genético. Presentamos el caso de una probable nueva mutación en el gen rTHβ (AU9


Resistance to thyroid hormone, described by Refetoff in 1967, it is an autosomic dominant genetic disorder. It is characterised by a reduced soft-tissue response to thyroid hormone action, associated with increased free thyroxin (FT4) levels with no thyrotrophic hormone inhibition, as a consequence of mutations present in thyroid hormone receptor beta gen (rTHβ) in 85% of cases. It is a rare disease and the definitive diagnostic is based on a genetic study (AU)


Assuntos
Humanos , Masculino , Adulto , /diagnóstico , /genética , Mutagênese/genética , Tireotropina/análise , Técnicas de Laboratório Clínico/instrumentação , Testes Laboratoriais/análise , Testes Laboratoriais/métodos , Tiroxina/análise , Receptores dos Hormônios Tireóideos/análise , Receptores dos Hormônios Tireóideos/genética , Transtornos da Personalidade/complicações , Transtornos da Personalidade/tratamento farmacológico , Risperidona/uso terapêutico
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